Hip Stress Fracture Symptoms, Causes, and Treatment

A hip stress fracture is caused by a small, repetitive injury (micro-trauma) to the hip bone. It often happens from overuse activity. When the body cannot keep up with the forces acting on the bone, a break eventually occurs. This generally occurs in the area near the ball of the ball-and-socket hip joint.

A hip stress fracture differs from a high-energy hip fracture due to a fall or a pathologic fracture due to osteoporosis, tumors, or infections.

You may think of broken hips only in the elderly, but a hip stress fracture can happen at any age. Learn about hip stress fractures, including common symptoms and treatments.

Hip Stress Fracture Symptoms

High-mileage runners, military recruits, or athletes who play significant impact sports activities are the most likely to get hip stress fractures. The injury usually causes aching groin pain with activity that is relieved by rest.

The symptoms are usually noted after a recent increase in the level of activity, such as increasing running mileage.

After a stress fracture, the bones often maintain their proper alignment. In fact, these fractures are sometimes not even visible—especially in the early stages—on a regular X-ray.

However, if the stress fracture is left untreated, and the bone continues to weaken, the fracture can displace, or cause the bones to go out of alignment.

Healthcare providers are usually concerned about stress fractures of the femoral neck in the hip. This is the area that cradles the ball of the femur, or thigh bone. If the injury is suspected, the provider will usually ask the patient to use crutches until the necessary diagnostics tests are complete.

Hip Stress Fractures Causes and Risk Factors

In the situation of a stress fracture, repetitive injury to the bone eventually leads to failure of the bone or fracture.

Normally, bone is constantly undergoing a cycle of turnover during which old bone is reabsorbed, and new bone is created. If the process cannot keep up, eventually the bone can fracture.

Hip stress fractures most often occur just below the ball of the ball-and-socket hip joint. This location of the bone is called the femoral neck.

Stress fractures can occur in other areas of the hip and pelvis, but the femoral neck is the most common and most concerning location for a hip stress fracture.

Risk Factors

Having certain risk factors can make you more likely to get a hip stress fracture. These include:

• Sedentary lifestyle
• Tall height
• Low body weight
• Malnourishment/undernourishment (e.g., vitamin and mineral deficiencies) 
• Heavy caffeine and/or alcohol consumption
• Tobacco use
• Vision problems
• Dementia
• Living in a facility (like assisted living/nursing home)
• Use of medications that cause bone loss
• Low bone mass (osteopenia or osteoporosis) 
• Being disabled 
• Chronic medical conditions like diabetes, stroke, or cancer
• Being at an increased risk for falls and/or having had a fall in the past (e.g., being weak or unsteady on your feet)

How Hip Stress Fractures Are Diagnosed

If a hip stress fracture is suspected, an X-ray will be performed. While some hip stress fractures will be seen on X-ray, some X-rays may appear normal.

If the injury is still suspected, magnetic resonance imaging (MRI) or a bone scan can also be obtained to evaluate for a stress fracture.

Treatment for Hip Stress Fractures

Hip stress fractures require you to immediately stop any activities that place stress on the joint, as well as significantly reduce pain or discomfort.

If you only have pain when running, then the running must be stopped. If the pain occurs while walking, then crutches should be used.

The important concept is to stay under the level of pain. If you avoid activities that aggravate your symptoms, then it is often possible that hip stress fractures will heal without surgery.

Surgery for Hip Stress Fractures

Surgery is needed if there is a concern that the fracture may displace. This is often considered if the break is significant and located on the femoral neck, which is less apt to heal on its own.

The specific location of the fracture can help your healthcare provider to determine the best course of treatment.

Hip stress fractures that lead to compression tend to be more stable than those that occur where the bone is under tension. Your provider can determine if the stress fracture is stable based on the X-ray and MRI results.

Recovery From Hip Surgery

There are a few stages of recovery after hip surgery, but how fast you progress will depend on the type of surgery you had and your overall health.

Some people can move around quite well soon after they have surgery, which can help promote healing and prevent complications. Other people take longer to get back on their feet and may need more support in the hospital in terms of pain control.

Physical therapy (PT) will probably be a big part of your recovery. You might even start before you go home from the hospital. Even though PT can be challenging, it’s very important that you stick with your treatment plan and work toward meeting your goals.

You may need some help around the house while you are recovering, especially if you live in a house that has stairs or you’re not feeling steady enough on your feet to take care of chores and self care tasks.

You’ll also need to care for your incisions while they heal. Your providers will show you how to do this before you go home, but call your surgeon’s office if you have questions. You might be able to have a nurse come to your house to help you with wound care. 

It’s key that you go to your follow-up appointments with your surgeon. They will check to make sure that you are healing well and let you know when you’re ready to go back to your typical activities, like work and exercise. 

How to Prevent Hip Stress Fractures

You may not be able to completely prevent a hip stress fracture from happening, especially if you have several risk factors that make it more likely you'll experience the injury in your lifetime.

That said, there are some general steps you can take to lower your risk of stress fractures while staying active:

• Wear the right footwear and gear for the exercise, sports, and other physical activities you do.
• Go slow when you want to increase the intensity or frequency of your activities.
• Make strength training a part of your fitness routine to support muscle and bone health.
• Support your overall health by staying hydrated, eating a nutritious diet, getting enough sleep, quitting smoking, and managing your weight.
• Stop and rest if you experience pain or any other signs of an injury. Contact your provider if you aren't improving after a few days.

Summary

Hip stress fractures are most common in athletes, especially runners. That said, people who have risk factors for breaking a hip—like low bone mass and certain health conditions—can also get them.

A stress fracture can be difficult to diagnose, but it might show up on an X-ray.Y Once diagnosed, your provider will want you to rest and may give you some medication to help with the pain.

You may need to use supports like crutches for a while. In some cases, surgery is needed. Physical therapy will likely be an important component of the healing process. 

A Word From Verywell

Hip stress fractures can become very serious injuries that require immediate treatment. While not every hip stress fracture will require surgical treatment, immediate modification of activities in order to relieve symptoms and allow the bone to heal is a necessity.

Neglected hip stress fractures can lead to serious problems, most notably the displacement of the fracture that would require surgery, and could lead to serious complications, including hip osteonecrosis.