Femoral Neck Stress Fractures: Early Rehab
I'm an assistant cross country coach at a local high school, and a few weeks ago I went to cross country practice with crutches after being diagnosed with a femoral neck stress fracture.
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After I told the group why I was using crutches, one of the kids walked up to me individually and said, "Coach Steph, why did this happen??"
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I considered diving into the complex web of variables that interact to contribute to injury risk, but instead I just looked at him and said "We believe it's because I wasn't sleeping my required 8+ hours a night" - so you better believe he will be emphasizing sleep the rest of the season ;-)
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But truly, stress fractures are incredibly difficult to predict. We know the primary risk factor is a history of stress fracture - but beyond that, not much else is clear, even in regards to training variables. So it's important to always be considering this as a diagnosis when you see an endurance athlete with pain, even if it stress fracture seems unlikely for this individual.
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Here are a few clinical pearls for diagnosing stress fracture, specifically for femoral neck (which is unfortunately fairly common in runners & a high-risk site - so needs to be addressed & managed ASAP:
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Earliest sign: a feeling of muscle tightness in the anterior hip - not necessarily pain
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Tightness quickly progresses to pain with continued loading
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Night pain
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Difficulty lifting the leg e.g. getting out of the car, straight leg raise
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Positive special tests like FADIR, log roll, i.e. hip internal rotation limited by pain
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Pain with loading (single leg stance, single leg squat) and unloading (shifting weight back onto unaffected leg)
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**I would avoid testing a single leg hop if all of the above are positive**
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When suspected, refer for imaging to confirm - having an ortho MD or DO in your area whom you can trust is key here.
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During the first few weeks of healing, the goals are to:
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Promote healing & minimize pain via:
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Non-weight bearing using crutches until pain-free with daily activities
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Sleeeeeep 8+ hours per night​
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Continue fueling appropriately
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Maintain some muscular strength, if possible​
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Upper body & trunk strength​
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Non-weight bearing & pain-free lower body strength
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Improve mood & avoid going insane​
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Trying to maintain fitness isn't a good idea, but you can try things like battle ropes in a seated or tall kneeling position, arm bike or swimming to burn off some steam & get your heart rate up​
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Check out the videos below for some exercise examples. Keep an eye out for the next phase of rehab, and reach out if you have any questions!
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