What is a Femoral Neck Bone Stress Injury?

The femoral neck is a critical part of the hip joint, connecting the femur (thigh bone) to the hip. A femoral neck bone stress injury is a stress reaction or fracture that occurs due to repetitive loading or overuse of the femoral neck. Although not common, it is most frequent among athletes involved in activities like running, long-distance walking, or dancing, where the hip and thigh experience repetitive impact.

Causes of Femoral Neck Bone Stress Injuries:

A bone stress injury occurs when there is a mismatch between training and recovery. This is because the body doesn’t have the time or energy to relay down the bone after the repetitive movement breaks it down. However, the underlying causes of this type of bone stress injury can vary from the more common bone stress injuries (shins and feet). This is because the area of bone in the femoral neck is trabecular rather than cortical bone. This means that it is more energy dependent. Although, spiking your load, overtraining and decreased bone density can increase your risk of this injury, having a disrupted energy intake due to low caloric intake or disturbed menstrual cycles can also place you at a higher risk.

Symptoms of Femoral Neck Bone Stress Injuries:

Hip and Groin Pain:

Persistent pain in the hip or groin area, especially during weight-bearing activities, is a common symptom.

Limited Range of Motion:

Individuals may experience stiffness and reduced flexibility in the hip joint.

Pain During Activities:

Pain that worsens during activities and improves with rest can be a sign of stress injuries.

Discomfort at Night:

Some individuals may experience pain or discomfort while lying down or attempting to sleep.

Diagnosis and Treatment:

Medical Evaluation:

A healthcare professional will conduct a physical examination, review medical history, and may order imaging tests such as an MRI, or bone scans (to diagnose femoral neck stress injuries) in combination with blood tests (to review hormonal and vitamin levels that may indicate caloric deficit). 

Rest and Activity Modification:

Rest is crucial for the healing process. Activity modification and avoiding high-impact exercises are recommended.

Physiotherapy:

Physiotherapy can design rehabilitation programs to improve strength, flexibility, and correct biomechanical issues, whilst slowly integrating you back into activity. Prevention classes are a great way to have closely monitored and guided rehab following a bone stress injury.

Nutritional Support:

Adequate calcium and vitamin D intake are essential for bone health and recovery.

Possible Surgical Intervention:

In severe cases, surgical intervention may be necessary, such as internal fixation or hip arthroscopy.

Prevention:

Gradual Training Progression:

Incremental increases in exercise intensity and duration help the body adapt to stress.

Proper Technique:

Ensuring proper running or walking technique can reduce the impact on the femoral neck.

Cross-Training:

Incorporating low-impact activities and strength training into the routine can enhance overall fitness and reduce the risk of stress injuries.

Regular Monitoring:

Athletes should pay attention to their bodies, promptly addressing any signs of pain or discomfort

Nutritional Uptake

Athletes should ensure they are meeting all their nutritional and caloric needs to undertake their training loads. Collaborating with a dietician may be recommended to assist athletes with this. 

Femoral neck bone stress injuries can pose challenges for individuals pursuing physically demanding activities. Early detection, appropriate medical intervention, and a commitment to rest and rehabilitation are essential for a successful recovery. Athletes and healthcare professionals must work together to understand, prevent, and effectively manage femoral neck stress injuries, ensuring the longevity of an active and healthy lifestyle.

Robertson GA, Wood AM. Femoral Neck Stress Fractures in Sport: A Current Concepts Review. Sports Med Int Open. 2017 Mar 15;1(2):E58-E68. doi: 10.1055/s-0043-103946. PMID: 30539087; PMCID: PMC6226070.
Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. Acta Biomed. 2017 Oct 18;88(4S):96-106. doi: 10.23750/abm.v88i4-S.6800. PMID: 29083360; PMCID: PMC6357658.

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