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GROIN PAIN, HIP PAIN AND THE RARE STRESS FRACTURE

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Tid Bits of Info

  • FNSF are uncommon, and it has been reported that less than 10% of all hip injuries.
  • Some healthcare professionals suggest that as many as 75% of all FNSF are initially undiagnosed or misdiagnosed.
  • Tensile stress fractures are more involved and often require surgery to stabilize the bone.
  • Women are more prone to FNSF, and their diets might be a component that impedes bone remodeling.
  • If you injure your hip, seek the advice and treatment of a Physical Therapist.

Athletes commonly suffer from hip pain, complaining of pain on the outside of the hip.  Less commonly, some athletes complain of groin pain or inner hip pain. If there is no identifiable incident where the muscles in that region might have been pulled, the examiner must consider a more serious condition such as a femoral neck stress fracture (FNSF).

A FNSF is rare and comprises roughly less than7% of all hip pathologies that are recorded yearly.  Unfortunately, they can lead to a prolonged period of “down” time if they are not diagnosed and treated appropriately.  These fractures are difficult to diagnose and the standard X-ray usually does not assess the site accurately.  Most people suffering from this condition will need an MRI to fully diagnose the condition.

MRI Stress Fracture

Bones tissue is constantly renewed and being reconstructed and remodeled throughout life. Unfortunately, when there is significant force applied to the bone, it can break down and not be replaced with new bone cells.  When remodeling process does not occur there is a weakened area of the bone and the stress fracture can occur.

Like all stress fractures, a FNSF occurs due to too much training or not enough preparation for a particular activity.   If there is too much force applied to the bone, it will eventually not be able to handle the amount of force that is placed through it and the bone “gives” and a fracture occurs.  If someone has not trained properly and proceeds to participate in an activity that requires a great deal force be applied to the femoral neck, the bone will not be able to handle the stress that is present and a fracture occurs.

There are two basic types of FNSF, tensile and compressive.  The femoral neck connects the shaft of the femur to the head and is responsible for transmitting the force from the leg to pelvis which enables movement.  Unfortunately, too much force can lead to one of the different types of fractures.  The tensile type fracture occurs on the top of the bone and the compressive fractures are present on the inferior aspect of the neck.  Of the two types of fractures, the compressive fracture is less debilitating and can often times be treated conservatively. Many tensile type FNSF require surgery to stabilize the bone.

Women tend to be more susceptible to FNSF than men and women who participate in distance running, endurance sports and military recruits are the most prone to this condition. There might be a dietary aspect to this increased susceptibility.  If these women are found to have an eating disorder, consume a low daily caloric intake or eat entirely a low fat diet there might not be enough nutritional value in their diet to supply the necessary ingredients for the body to replace the bone as it is “broken” down during impact exercises.

As mentioned earlier, diagnosing these stress fractures is not easy or clear cut.  Most athletes will complain of groin pain that is most intense during weight bearing activity and there is significantly less pain when they are not weight bearing.  Many of these stress fractures go undiagnosed or misdiagnosed initially.  Once the diagnosis is clear, there has to be a determination as to the proper treatment approach by the doctor.  The worst case scenario requires surgery to fix the stress fracture and the best situation enables the injured individual to completely experience resolution of their symptoms.

Regardless of the selected treatment protocol, the patient will be required to see a Physical Therapist for some type of rehabilitation.  These healthcare professionals are licensed and they will assess your status and design a rehabilitation program for you based on their findings and the doctor’s protocols. Initially the goal is to reduce the symptoms and restore normal ADL activity.  The final phase might take several months (up to 12 months is not abnormal) to achieve and it is totally geared towards restoring the normal pre-injury status for the involved individual.

Femoral neck stress fractures are uncommon but the can occur and do occur more frequently in women.  In many instances these women participate in distance running, endurance activities and military recruits and depending on the severity of the stress fracture they might require surgery to fix the problem.  The rehabilitation process is extensive and the athlete will not be able to participate in their events for a long time.