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.

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??" 

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 ;-)

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.

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: 

  • Earliest sign: a feeling of muscle tightness in the anterior hip - not necessarily pain

  • Tightness quickly progresses to pain with continued loading

  • Night pain

  • Difficulty lifting the leg e.g. getting out of the car, straight leg raise

  • Positive special tests like FADIR, log roll, i.e. hip internal rotation limited by pain

  • Pain with loading (single leg stance, single leg squat) and unloading (shifting weight back onto unaffected leg)

  • **I would avoid testing a single leg hop if all of the above are positive**

When suspected, refer for imaging to confirm - having an ortho MD or DO in your area whom you can trust is key here. 

During the first few weeks of healing, the goals are to:

  • Promote healing & minimize pain via:

    • Non-weight bearing using crutches until pain-free with daily activities

    • Sleeeeeep 8+ hours per night​

    • Continue fueling appropriately

  • Maintain some muscular strength, if possible​

    • Upper body & trunk strength​

    • Non-weight bearing & pain-free lower body strength

  • Improve mood & avoid going insane​

    • 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​

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!