hip flexor strain vs. femoral neck stress fracture

Get on crutches and use them until you can walk with little or no pain (probably about 4 weeks). Don't excercise at all. Take calcium pills and don't even think about running for 3-4 months from when you started on crutches. At the 1.5 month mark start out with the excercise bike, at 2 months some elliptical and then at 3 months evaluate how you feel and start planning to get back into running. When you do start back do so with 3-5 minute runs twice a week one grass and gradually increase time and frequency. It took me 3 months to get back to 40mpw but I did it in a smart way. Push the recovery too hard and you will hit the reset button and be right back to day one on the crutches.

Also pain is to be expected for the first 3-4 weeks. You might not feel like you are making much progress but one day you will realize that you are finally feeling a bit better and it will improve day by day.

I was diagnosed with a FNSF in September 2008 after about a month of thinking it was a muscle issue. I was training for the Chicago marathon at the time. I was on crutches fully for 6 weeks and partially for the next several weeks. After I was off crutches I started biking, increased walking activity over time and then started the elliptical....based on what my PT recommended. I also was in physical therapy for two months. Throughout my recovery, I felt like I would take 10 steps forward and 5 steps back over the last 4 months since getting off crutches. The beginning of February I started to feel like I turned the corner, but the last couple weeks I've taken a total turn for the worse. I just went to the Dr and he thinks I shouldn't be having these issues 5 months since diagnosis/going on crutches and that I should have been back running some time ago. He put me back on crutches until we figure out what's going on :(. I have another MRI next week.

I periodically would get sharp pains in my groin like I did in the beginning and I also would get heaviness in my leg and some numbness and tingling all through my leg and foot. I would feel good for some time but never 100%. I feel like a took it easy in increasing my activity and if I felt any issue I rested. Has anyone else experienced that with their FNSF or taken this long to recover?

My doc basically recommended strict non weightbearing for 8 weeks, and he wouldn't even let me do upper body lifting. Swimming is non weightbearing, but if your stroke involves contraction of the hip flexor, then you're still creating force across the healing bone. He didn't want me doing lifting at all because you still brace yourself to some degree with your legs. It was a pain, and frustrating, but at the same time, i came back with no ill effects.

After the 8 weeks was up, i started with 5 minutes of brisk walking, and then just slowly worked my way back into running. Again, it was a pain in the arse, but i have no limitations at all 5 years later. Better to be patient at your age.

I was diagnosed with a FNSF in September 2008 after about a month of thinking it was a muscle issue. I was training for the Chicago marathon at the time. I was on crutches fully for 6 weeks and partially for the next several weeks. After I was off crutches I started biking, increased walking activity over time and then started the elliptical....based on what my PT recommended. I also was in physical therapy for two months. Throughout my recovery, I felt like I would take 10 steps forward and 5 steps back over the last 4 months since getting off crutches. The beginning of February I started to feel like I turned the corner, but the last couple weeks I've taken a total turn for the worse. I just went to the Dr and he thinks I shouldn't be having these issues 5 months since diagnosis/going on crutches and that I should have been back running some time ago. He put me back on crutches until we figure out what's going on :(. I have another MRI next week.

I periodically would get sharp pains in my groin like I did in the beginning and I also would get heaviness in my leg and some numbness and tingling all through my leg and foot. I would feel good for some time but never 100%. I feel like a took it easy in increasing my activity and if I felt any issue I rested. Has anyone else experienced that with their FNSF or taken this long to recover?

Pam

The MRI is a good bet...I thought I had a hip flexor strain, turned out to be the start of osteoarthritis (bone on bone)which I am dealing with now.

So it's the only way to be definitive with your hip joint, so many things could be going on.

Hope this helps.

I'm sorry to hear that. Were your symptoms similar to that of FNSF? How have you been treating it?

I, too, was diagnosed with a FNSF (compression side) in late September 2008. I first began feeling pain in late August and was told it was a hip flexor strain as well, but eventually insisted on getting an MRI. I was then on crutches for 6 weeks (I think) and was off of running for a total of 8 or 9 weeks. The pain was deep in the groin and it would sometimes radiate down the quad. It was difficult to lift the leg, like when getting out of a car, and it would also hurt when I leaned on that side. I swam during the fall using a pull buoy (it hurt to kick and it hurt to pool-run and bike).

I came back in mid-November and did a few one-mile runs, and then the pain returned. I took another week off and was very concerned. A subsequent MRI revealed the stress fracture had healed, so I started running again and haven't looked back. Although I am currently running about 35 miles per week, I am very close to PR shape again.

Hope this helps.

So I had my second MRI and the FN stress fracture I had in September was completely healed. Unlike the last MRI, this time they injected dye into my hip and they found a small labral tear on the same side that I had the stress fracture that is likely causing me continued issues. Not sure if it's common to have both a FN stress fracture and a labral tear.....does one potentially cause the other?? Anyway, glad to finally know what it is and I'm meeting with a surgeon to talk about next steps. I would appreciate any insight anyone could share about a labral tear, what the surgery entails and recovery. Thanks!!

Pam

So I'm getting an MRI tomorrow to see if I have a femoral head stress fracture, and I'm really worried. I really would hate to be off for 8 weeks or more, and being that it is such a dangerous injury. I did the leg dangle test and it didnt come back positive. Really there is no horrible pain ever,just very pressure related. I just feel very unbalanced. The pain started on the outside of my quad and then it went into my groin area. I feel like I'm very very unbalanced on my one leg and my trainer says my gluteus medius is not functioning properly. I walk with a slight limp but its not too painful until I run. Im praying that is an overuse injury, and just me compensating which caused general leg pain. So my question is How painful is a FHSF? Does it hurt all the time? I need some advice? Im a college runner and would hate to miss a season.

MRI's are terrible.

At first mine would feel like my hip flexor was occasionally snapping during runs. It would happen, hurt for about 5 seconds, then go away. Soon it was just sore from the first minute on. After that it got to the point that i was walking with a limp.

You know what i remember more than anything though? If i tried to do a straight leg raise lying on my back, it would KILL for the first one, then just kind of hurt for the rest of them. I knew it was healed because i tried it again in the last week i was on crutches and didn't feel a thing.

I can't really offer any advice you haven't gotten but I will emphasize that it takes most people a while to get over this injury. Keep the long term in perspective and find something else to do. If you are fit when you stop running you can get back to where you were in 6 - 12 weeks I would imagine. Make sure not to put on too much weight though!

I had a FNSF last winter that was misdiagnosed as ( of course ) a hip flexor strain and I can sympathize. It does take time but you will be back sooner if you just rest it.

And when you come back rock the ice bath. I use one daily during high intensity or high volume training and it keeps me right..

I definitely agree with Digital. They are very commonly misdiagnosed as a hip flexor strain, and they present just like one, so it makes sense.

From my readings, the most important thing is just getting the proper diagnosis in time. This will keep you out of surgery. Just as an FYI - This is the timeline I was on (helps to keep a running log)

Nov 16 - Stress fracture diagnosed on MRI.

Jan 20 - Follow up MRI showed full healing.

Jan 21 - Started walking program with 5 minutes a day, also finally came off crutches.

Feb 14 - Walked X 60 minutes briskly with no pain at all.

Feb 15 - Started with 3x 5:00 walk / 5:00 run

Feb 20 - Ran x 21 minutes and pain came back.

Feb 21 - Started walking again.

March 31 - Ran 3 minutes

April 13 - Ran 2.5 miles slow, but without pain.

April 24 - Ran 5 miles at 34:30

After that i never looked back. Got into the 70/week range and ran the NYC marathon that fall (not well, but i ran it)

That was almost 4.5 years ago, and i haven't had any issues with it since. You have to be really really patient in the early going. Its tough, but it beats being the person who is still trying to get rid of it a year later you know?

To RIPT:

Did you ever have pain in the top of your hamstring...right under the buttox muscle? I was diagnosed with a FNSF on Jan. 9 2009...I'm almost at 9 weeks (was on crutches for 3 weeks) but still have pain in that area when I lift my leg backward in the air (as if tightening the butt muscle)...did you have that? And if so, when does it go away?

I had that too, it's normal. It should go away as your healing progresses. It takes 3-4 months depending on the person, to fully heal.

I personally didn't have that pain, but i'm not sure if i tried to do hip extension though. You're basically pointing to the origin of the hamstring muscle at the ischial tuberosity. I would imagine that any straight leg motion against gravity would hurt the hip though. You're still putting compression forces through the hip. With the straight leg raise you're pulling right on the hip flexor from the site of the fracture. Regardless, i don't remember that bothering me. I have heard of people getting stress reactions at the ischial tuberosity though, so keep a close eye on it.

Well I was just diagnosed and it turns out I have a stress fracture in my femur, not the neck so thats a lot better. I have been on crutches for 5 days and already feel better. Since I have already taken 3 weeks off the doctor says I should be healed in 5 weeks. So for now Im pool running like crazy, from there I will slowly build up. I already feel better, but I need to take it slow.

The key is to absolutely take it slow. I know from experience though, that we as runners typically dole out advice better than we follow it. Just trust me on this one. You can be done with it in a few months, or still dealing with it a year from now depending upon how conservative you are.

I have a similar situation. I have been running quite a bit this fall and winter, I ran a marathon in October and a 30K March 1st. I have no pain while running only sitting. My main sport is marathon canoe racing (long races 4-8 hours seated). I began training this in the boat this spring and my hip has a dull pain. The pain is deep inside but I would say more toward the front than the rear, one specific spot not down my leg (rules out sciatica). I am getting frustrated as I transisition sports. Mind you this is the first year I have really ran a lot. I always ran for fitness, but know I have been focusing on speed, endurance, and actually racing. Tuesday I ran a 6 mile tempo at about 6:20's and felt like a million bucks. Wednesday I paddled for 2 hours and my hip ached the whole time. Even now as I sit at my desk I can feel it. Any Thoughts?