Femoral Stress Fractures

What is a stress fracture?

A stress fracture is a type of overuse injury that affects the bone and causes tiny, hairline cracks to develop. It occurs when muscles become fatigued and are unable to absorb the forces being applied to them. Eventually, the fatigued muscle transfers the overload of stress to the bone.

Essentially, the bone is weaker than is required for the activity demands or exercise intensity.

Stress fractures can also develop from normal use of a bone that’s weakened by a medical condition such as osteoporosis.

Pain usually develops gradually as a dull ache, which intensifies with any weight bearing activity.

Physiotherapy is an excellent line of treatment for a stress fracture of the shaft of the femur.

What Causes a Femoral Stress Fracture?

Femoral stress fractures are often the result of increasing the amount or intensity of an activity too quickly.

Bone is able to adapt, remodel, and rebuild in response to the normal stresses and loads applied to it. This process is sped up if the demand is gradually increased; however if this force and demand outweighs the speed of recovery, the bone is not able to regenerate fast enough, causing stress fractures to develop.

Risk factors for developing a femoral stress fracture

Certain sports/activities – Stress fractures are more common in people who engage in high-impact sports, such as long distance running, basketball, dance, gymnastics, or track and field athletics.

Sex – Women, especially those who have abnormal or absent menstrual periods, are at higher risk of developing stress fractures.
Training schedule – Stress fractures often occur in people who suddenly shift from a sedentary lifestyle to an active training regimen or who rapidly increase the intensity, duration or frequency of training sessions.
Weakened bones – Conditions such as osteoporosis cause bones to weaken which makes it easier for stress fractures to occur.
Previous injury: Having had one or more stress fractures puts you at higher risk of having more.
Nutrition – Low BMI and lack of vitamin D and calcium can make bones more likely to develop stress fractures.

What are the Symptoms of a Femoral Stress Fracture?

A stress fracture of the shaft of the femur is characterised by a dull ache that is usually felt in the front of the thigh, although sometimes it can be hard to localise and may even be felt as far down as the knee. The pain develops over a period of a few weeks, and many people can’t remember hurting themselves. The pain is frequently made worse by exercise and gets better with rest; however, it may also be felt during walking, rest and even at night.

If you suspect you may have a stress fracture, or have ongoing pain without an obvious cause, you should contact a specialist healthcare professional for advice and an assessment.

Main symptoms may include:

Dull ache in the general area of the thigh
Increased pain with activity
Pain subsides with rest
Pain felt in the groin
Joint stiffness in the hip
Symptoms may also be referred to the knee
Gait (walking) problems

If you are suffering from any of the symptoms described, or are concerned that you have a femoral stress fracture, and would like to see one of our expert physiotherapists, please call 0207 482 3875 or email info@complete-physio.co.uk.

How do we Diagnose a Femoral Stress Fracture?

Physiotherapy Assessment

Your Physiotherapist will carry out a subjective evaluation to assess your risk factors for stress fracture. They will then carry out a full physical examination with will likely include:

Hip range of movement tests.
Gait analysis – assessing how you walk and any asymmetry or abnormal patterns
Palpation – gently, but skilfully, feeling around your thigh, groin to locate the exact source of your pain.
Functional tests – if your pain is present during a specific activity or task, you may be asked to perform these, so the physiotherapist can assess exactly what is aggravating your pain.
Fulcrum (or hang) test – the patient allows their thigh to hang over the edge of a bench or chair. A weight is then applied downwards onto the thigh. If pain is reproduced then the test is positive and it may be a femur stress fracture.

There are other conditions of the hip and lower limb that may cause similar symptoms, so it is vital that you see a specialist clinician who can correctly diagnose your condition and allow for a rapid and effective treatment approach.

Imaging for stress fractures

X-rays

Stress fractures often can’t be seen on regular X-rays taken shortly after your pain begins. It can take several weeks, and sometimes longer than a month for evidence of stress fractures to show on X-rays.

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Magnetic resonance imaging (MRI)

An MRI uses radio waves to create detailed images of your bones and soft tissues. An MRI is considered the best way to diagnose stress fractures. It can visualise lower grade stress injuries (stress reactions) before an X-ray shows changes. This type of test is also better able to distinguish between stress fractures and soft tissue injuries.

At Complete Physiotherapy we are able to refer you directly for an MRI scan without a GP referral, making the process very cost effective and efficient.

Bone scan

A bone scan will identify “hot spots”, which may indicate an area of bone damage, however, many types of bone problems look alike on bone scans, so the test isn’t specific for stress fractures.

Be aware there are other conditions that can mimic the pain associated with stress fracture of the femur the most common are:

“Referred pain” from the lower back and/or sacroiliac joints (SIJ).
Femoral acetabular impingement (FAI)
Hip osteoarthritis
Proximal hamstring tendinopathy
Greater trochanteric pain syndrome or trochanteric bursitis

It is therefore vital that you seek professional advice and assessment to ensure that you get a quick and accurate diagnosis and can be started on the most effective treatment plan.

If you would like to see one of our expert physiotherapists, please call 0207 482 3875 or email info@complete-physio.co.uk.

We have clinics all across London and can often offer same or next day appointments for urgent referrals.

How do we Treat a Femoral Stress Fracture?

If you have or suspect you have a femoral stress fracture, you shouldn’t continue to exercise or participate in sport; the most important treatment is rest.

A stress fracture represents an area of breakdown within the bone. If you continue to exercise or compete, it will weaken the area further and potentially cause further breakdown. In severe cases this can result in a complete bone fracture.

Individuals need to rest, and only engage in completely pain free, non or very limited weightbearing activities for at least six to eight weeks. It is vital that your rehabilitation is closely managed and monitored by an expert physiotherapist.

Treatment Includes:

Limited or Non weight-bearing with crutches until you are completely free of pain – normally 6-8 weeks but can be as long as 14 weeks.
Gradually increase weight bearing as pain allows – this will be guided by your orthopaedic specialist
Core and pelvic girdle stability exercises
Gradual return to minimal-impact activities such as cycling, pool walking/running, antigravity treadmill running, cycling, and swimming.
Balance and proprioception exercises
Muscle strength and endurance training
A progressive running plan to safely return to running
Sports and activity specific rehabilitation exercises

Treating stress fractures often requires a multidisciplinary approach. At complete physiotherapy we have a highly experienced team of healthcare professionals including:

Physiotherapists – for whole lower limb strengthening, core muscle and joint function, and sports specific rehabilitation.

Pilates instructors – for initial non weight bearing core strength training.

Podiatrists – or foot biomechanics and running assessments.

We also work very closely with some of London’s leading orthopaedic and sports medicine specialists so if an onward referral is required we will make sure that you receive the best possible care.