Stress fractures and overuse injuries of the hip develop when repetitive loading exceeds the body’s ability to recover and adapt. Unlike an acute injury that occurs suddenly, these conditions tend to develop gradually over time and are commonly seen in runners, endurance athletes, dancers, military personnel, and individuals who have recently increased their activity levels.

Hip overuse injuries can be particularly frustrating because symptoms often start subtly and are easy to dismiss. Continuing to exercise through pain, however, can lead to worsening symptoms and a longer recovery period.

At London Bridge Orthopaedics (LBO), our specialist hip team has extensive experience in diagnosing and managing both straightforward and complex hip overuse injuries. Through our one-stop service, patients have access to expert orthopaedic assessment, advanced imaging, and on-site physiotherapy, allowing for rapid diagnosis and the development of a personalised treatment plan.

Anatomy

The hip is a ball-and-socket joint, where the femoral head (the ball) sits within the acetabulum (the socket) of the pelvis. The joint is surrounded by a complex network of muscles, tendons, ligaments, cartilage, and bone, all of which can become overloaded.

The hip must absorb substantial forces during everyday activities and even greater forces during running and jumping. Repetitive loading without sufficient recovery can lead to injury in various structures around the hip and pelvis.

Types of Hip Stress Fractures and Overuse Injuries

Femoral Neck Stress Fractures

Stress fractures of the femoral neck are among the most important overuse injuries to recognise early. They occur when repetitive loading causes microscopic damage within the bone that outpaces its ability to repair itself.

These injuries are most commonly seen in:

• Distance runners
• Military recruits
• Dancers
• Endurance athletes
• Women with low bone density or menstrual irregularities

Certain femoral neck stress fractures are considered high risk because they can progress to complete fractures if left untreated.

Pelvic Stress Fractures

Stress fractures can also occur in the:

• Pubic ramus
• Sacrum
• Acetabulum

These injuries typically cause groin, buttock, or lower back pain and may be mistaken for muscle strains or other soft tissue injuries.

Gluteal Tendinopathy

Overuse of the gluteal tendons can lead to pain over the outside of the hip, often referred to as greater trochanteric pain syndrome. It is particularly common in runners and middle-aged women.

Hip Flexor Tendinopathy

Repetitive kicking, sprinting, or uphill running can overload the hip flexor tendons, causing pain at the front of the hip and groin.

Proximal Hamstring Tendinopathy

This condition causes pain deep within the buttock and is commonly aggravated by running, prolonged sitting, and activities involving repetitive hip flexion.

Bone Stress Reactions

Before a stress fracture develops, the bone may become inflamed and painful. These early-stage injuries, known as bone stress reactions, are important to identify because prompt treatment can prevent progression to a complete fracture.

Causes and Risk Factors

Several factors can contribute to hip stress fractures and overuse injuries, including:

• Sudden increases in training volume or intensity
• Inadequate recovery between exercise sessions
• Poor biomechanics and movement patterns
• Muscle weakness, particularly around the hip and pelvis
• Running technique issues
• Poor nutrition or low energy availability
• Vitamin D deficiency
• Osteopenia or osteoporosis
• Hormonal changes and menstrual irregularities
• Previous stress fractures or injuries
• Inappropriate footwear or training surfaces

Often, several factors combine to increase the risk of injury.

Symptoms

Symptoms often develop gradually and may include:

• Deep groin pain during running or exercise
• Pain that initially settles with rest but gradually becomes more persistent
• Pain when hopping or weight-bearing
• Buttock pain or pain over the outside of the hip
• Stiffness and reduced performance
• Limping
• Pain that eventually occurs during walking or everyday activities

A key warning sign is pain that progressively worsens despite continuing exercise.

Diagnosis

Because hip overuse injuries can mimic many other conditions, accurate diagnosis is essential.

At London Bridge Orthopaedics, our one-stop diagnostic service includes:

Specialist Clinical Assessment

Your consultant will take a detailed history, examine your hip and assess movement patterns, muscle strength, and gait.

Imaging

Investigations may include:

• X-rays to assess bone and joint health
• MRI scans, which are highly sensitive for identifying bone stress reactions and stress fractures
• CT scans when further detail is required
• Bone density investigations where appropriate

Having access to advanced imaging on-site allows us to make an accurate diagnosis quickly and initiate treatment without unnecessary delays.

Treatment Options

Non-Surgical Treatment

Most hip stress fractures and overuse injuries can be successfully managed without surgery.

Treatment may include:

• Temporary reduction or modification of activity
• Protected weight-bearing using crutches if necessary
• Physiotherapy and rehabilitation
• Progressive strengthening exercises
• Biomechanical assessment and gait retraining
• Addressing nutritional deficiencies and bone health
• Optimising training loads and recovery strategies
• A carefully planned return-to-running programme

Our physiotherapy team works closely with our orthopaedic specialists to address not only the injury itself but also the underlying factors that contributed to its development.

Surgical Treatment

Surgery is occasionally required, particularly for high-risk femoral neck stress fractures or fractures that fail to heal appropriately.

Procedures may involve:

Internal Fixation

Screws are inserted to stabilise the fracture and reduce the risk of displacement.

Surgery for Associated Conditions

In certain cases, surgery may also be recommended to address underlying structural issues, such as femoroacetabular impingement (FAI), which may contribute to recurrent overuse injuries.

Outcomes and Recovery

Most patients recover extremely well with early diagnosis and appropriate management.

Recovery times vary depending on the injury and severity:

• Bone stress reactions: approximately 6-8 weeks
• Low-risk stress fractures: approximately 8-12 weeks
• High-risk stress fractures: often several months

Most patients are able to return to their previous level of activity, although rehabilitation must be carefully progressed to minimise the risk of recurrence.

How London Bridge Orthopaedics Can Help

At London Bridge Orthopaedics, we provide comprehensive care for patients with hip stress fractures and overuse injuries through our multidisciplinary approach.

Our one-stop service includes:

• Rapid access to specialist hip surgeons
• On-site X-rays and MRI scans
• Expert physiotherapy and rehabilitation
• Biomechanical and movement assessments
• Bone health evaluation where appropriate
• Individualised return-to-sport programmes

By bringing together diagnostics, specialist expertise, and rehabilitation under one roof, we can accurately identify the cause of your symptoms and guide you safely back to the activities you enjoy.

Frequently Asked Questions

Can I run through hip pain?

No. Persistent or worsening groin, buttock, or hip pain during running should be assessed, as continuing to exercise through a bone stress injury can lead to a more serious fracture.

Are stress fractures common in runners?

Yes. Stress fractures of the hip and pelvis are relatively common in endurance athletes and runners, particularly after sudden increases in training.

Do stress fractures always show on X-rays?

No. Early stress fractures frequently appear normal on X-rays. MRI scans are often much more sensitive and can detect bone stress reactions before a fracture becomes visible.

Why do some people develop stress fractures repeatedly?

Recurrent stress fractures often occur because underlying factors such as low bone density, nutritional deficiencies, biomechanical problems, or training errors have not been identified and addressed.

Will I need surgery?

Most hip stress fractures heal successfully without surgery. However, certain high-risk femoral neck stress fractures require surgical stabilisation to prevent complications and protect the long-term health of the hip joint.