Femoral Stress Fracture: How to Treat It

What is a femoral stress fracture?

The femur is the long bone in the thigh that runs from your hip down to your knee. It’s the longest and strongest bone in the body. It’s also one of the most frequently broken bones.

If you repeatedly put too much pressure or weight on the bone, it can break at the hip (the femoral neck) and cause a stress fracture.

A femoral stress fracture is different from a broken hip after a fall. (That is more likely to happen to an elderly person.) Femoral stress fractures occur from overuse, like from long distance running or doing other endurance sports.

It is most common in young, active people. These fractures can heal on their own if you avoid moderate-to-high impact activities.

Symptoms of a femoral stress fracture

Femoral stress fractures can be hard to diagnose. Symptoms may be mild at first, like a muscle pull. It’s easy to ignore, but can get worse if you don’t stop the activity that caused it.

If your pain is severe, you can't put weight on the leg, or you have pain even when you’re resting, go to urgent care or the ER. Or go if the pain gets worse.

In rare instances, a stress fracture can go from a hairline crack to a complete break in the bone.

Main symptoms

• Dull, gnawing pain in the groin or thigh
• Pain when putting weight on the leg
• Pain when lifting the leg or with movement

Other symptoms

• Pain also affects the knee
• Pain gets better with rest

Femoral stress fracture treatment

Your doctor will probably X-ray your leg. If they suspect a stress fracture, they will also do an MRI (magnetic resonance imaging). Most stress fractures can only be seen on an MRI.

Most likely, your doctor will tell you to keep weight off the leg, and use crutches. It may take 6 to 8 weeks before you start to feel better. And it may take another several months for the symptoms to completely get better.

If your pain doesn’t begin to improve in 4 to 6 weeks, you may need surgery. It may be a sign that the fracture is not healing. Surgery may also be needed if the MRI shows that the stress fracture is likely to worsen or become a complete break.

Surgery

If you need surgery, the doctor will make a small incision on the outside of the hip. They will put titanium screws across the injured area to keep the bone in place.

How active you can be after surgery depends on how bad the break is. Most people are on crutches for 2 to 6 weeks. Then they can begin to move more, but it’s important not to do anything that causes pain. It can take 3 to 6 months before you are back to your pre-injury level of activity and exercise.

Next steps

If you don’t have surgery, follow up with your doctor every 2 to 4 weeks to make sure the fracture is healing. You will know it’s healing when you have less pain, especially during and after exercising.

If you had surgery, follow up 2 weeks after to make sure your incision is healing and that your symptoms are improving. After that, check in with your doctor every 3 to 6 weeks, depending on symptoms.

Prevention

The best ways to prevent stress fractures:

• Do not exercise to the point of pain. And never push through the pain.
• If you begin to feel pain in your groin or thigh, choose non-impact exercise over impact exercise. And rest for a few days.
• Gradually add mileage and intensity to your workout rather than ramping up quickly.
• Add rest days if you’re training for a marathon or doing high-intensity workouts daily.
• Consider taking vitamin D supplements.

Risk factors for femoral stress fractures

Several factors can increase your likelihood of developing a femoral stress fracture. Women, especially those with low body fat, are at higher risk. This is because fat cells produce estrogen, a hormone that helps build strong bones. Young female endurance athletes are particularly vulnerable due to their typically low body fat.

Suddenly increasing the intensity or duration of your physical activity can also lead to stress fractures. This is why it's crucial to gradually build up your training regimen, especially if you're new to exercise or returning after a break. Poor overall physical fitness at the start of a new exercise program is another risk factor.

Certain sports and activities carry a higher risk of femoral stress fractures. Long-distance running, marathon running, and military training are among the most common causes. These activities involve repetitive impact on the legs, which can overload the femur if proper rest and recovery aren't allowed.

Some anatomical factors may also increase your risk. These include having high arches in your feet, a supinated foot type (where the foot rolls outward), or certain hip conditions like coxa vara (where the angle of the hip joint is decreased). However, more research is needed to fully understand the relationship between these factors and femoral stress fractures.

Remember, having one or more of these risk factors doesn't mean you'll definitely develop a stress fracture. But being aware of them can help you take steps to protect your bone health during physical activity.

Femoral stress fracture causes

Femoral stress fractures are caused by repeated pressure being put on the bone. Eventually, the bone can no longer handle being overworked and a tiny crack forms.

Distance runners and military recruits often train themselves to “push through the pain.” Exercising beyond the body’s normal limits makes you more likely to develop these fractures.

It can also happen to people who haven’t worked out in a while and jump into exercising before their body is ready. Or people who quickly ramp up the intensity of their training. For instance, by not following guidelines for preparing for a marathon.

Young, female endurance athletes are at particular risk of a stress fracture because they don’t usually have a lot of body fat. Fat cells produce the female hormone estrogen, which helps build strong bones. So having a low body fat can lead to weaker bones.

Risk factors

• You are a dancer or a distance runner.
• You are actively training in the military.
• You suddenly increase physical activity.
• You have or had an eating disorder (anorexia). It can affect bone formation.
• You miss your period (interrupted menstrual cycle) because of overexercising and low body fat.

What does a femoral stress fracture feel like?

A femoral stress fracture often starts with a deep, dull gnawing or aching in the groin (inside of the leg) or front of the hip. Sometimes, the pain is felt in the thigh. It may even travel down into the knee.

The pain is more noticeable when you walk or put weight on the leg. And it becomes stronger or sharper with more strenuous movement—like when running, walking up stairs, or lifting your leg to get in and out of a car.

How long does it take for a femoral stress fracture to heal?

Femoral stress fractures take several months to fully heal. If the pain is manageable and you can walk without too much discomfort, start with at-home treatment. Stop any moderate activity and repetitive, stressful exercises (running, squatting, cycling). Take an over-the-counter nonsteroidal anti-inflammatory (NSAID), like ibuprofen, if needed for the pain.

If pain does not go away after 2 to 4 weeks of rest, make an appointment with your doctor.