hip flexor strain vs. femoral neck stress fracture

Hello I am currently in the army and have had some consistent discomfort in my left groin. Not sure if there are any vets in here but I’ve already been to sick call for it once and am deathly afraid of getting med boarded as I’ve only recently graduated OSUT. Never needed to limp or woken up in the middle of the night with pain, no specific thing causes an increase not even the jump test. However occasionally I will have pain in my testicle on that side and the outer part of my butt. Can anyone offer any insight as to what the problem might be. I’m in the infantry so my lower body needs to work I’ve had the discomfort for a few months with no real increase despite running and rucking with the injury.

I have had pain in my Groin, Hip and Glute for 2 weeks after a long run. A hour or so after the run it was tight pain feeling. I don’t have pain all the time, I can do the elliptical without any pain unless I’m doing threshold type workouts on it where I’m pushing real hard.

I notice pain after I place the leg hip under load. As soon as I take off the weight I feel a radiating sprain feeling. I can’t seem to find any pain when digging into the bones. It seems to be the muscles that are all painful. It’s like I strained one then the others tried to make up for it and they are strained. The muscles in that area all seem to be unstable including the knee now. I can hop on two legs and feel slight muscle pain I can’t hop on one without pain(pain comes during the attempt to stabilize the landing) been to chiropractor/Doctor 3 times and he believes it’s muscles strains. He had XRay completed with no fracture showing.

I had a stress fracture 5 years ago from a biking incident. The pain was a hell of a lot worse and rehabilitating. Also I was back to riding and training in 4 weeks. This doesn’t feel as bad. I can sit without pain. When I initially get up the muscles pop and are in pain till I do some mobility rotations then I’m good. No pain dangling leg either. Will see another doctor Tuesday that specializes in HIPs. Been knocking out 8-10 hours on the elliptical for the last 2 weeks because I don’t want to lose fitness or gain weight.

Guess no one has an opinion

What did the new doctor say? What you are describing is very similar to what I’ve been dealing with for the last 8 weeks. Your description of pain radiating when you take the weight off the sore leg is exactly what I have and I can’t figure it out. It is like something squeezing the inside of my leg and then releasing it. I can’t hop on my sore leg at all.

My doctor said it was inflammation and sent me to the PT who diagnosed a strained hip flexor resulting in a lopsided pelvis. She fixed the pelvis issue in one visit (when standing on my sore leg I was having to lean over to keep balance and that was resolved immediately). She said since I could walk normally that I could try running again so I did (I hadn’t run for 4 weeks by this time) but the pain came back as well as the weakness. I took 2 more weeks off with no cross training or anything and again running results in more pain for days. I am able to run without a lot of pain but afterwards it is just as painful as it was weeks ago. I had to postpone any more PT because of coronavirus and not being able to run is driving me crazy.

Anyway I am very curious what your hip specialist said!

I had a stress reaction at the top of my femur a few years ago. I went to two PT's and a doctor, that all thought it was muscular, caused by my SI joint being "out", causing my hip to be uneven. It turned out to be a stress reaction. The one PT worked on me, and got me "even" again. This actually made my symptoms much better. Luckily I still got the MRI. I recommend getting an MRI if you can. My symptoms were sharp pain on impact and slight tightness in the muscle. I never had any radiating pain, however, I caught my stress reaction before it got bad. No massage or stretching had any impact on the discomfort. Good luck and let us know how it turns out.

I am a very consistent 65-85mpw 2:52 female marathon runner and few injuries in the past. Mostly foot hiccups but one stress fx 5 years ago. I recently started experiencing very similar symptoms. Haven't been doing anything very fast or voluminous and was focusing on ~5k-10k efficiency work. This came on in my left leg last week after a very light ladder on the track/double that evening. Started as a dull throb on backside around high hamstring/adductor, but has kind of orbited around my leg since then. Most of the tenderness/soreness is in the hip flexor/groin/adductor area. I took Mon and Tues off, tried to run 30' on Wednesday which was probably a 6/10, took Thurs, Fri, and Sat off. Tried to go for a test run this morning and turned around after 2 minutes because the same issues popped up again in that inner thigh/groin area. (Had done about 30 minutes of pre-run exercises/rehab before to make sure I was warmed up). Just knew that it didn't feel right. I've been pool running this week without pain.

I can do anything on two legs w/o pain or discomfort, but balancing/stabilizing with my left leg is difficult. Trying to do mini hops on that leg is also not easy. I've had it looked at by a couple of PTs/trainers/sports chiro. They did basic range of motion/pressure tests and I passed easily for almost all except the adductor-focused ones. They weren't painful or excruciating, but range of motion definitely less. Had shockwave, dry needling, and ART-like treatment. Pool running is fine and pain free. Mostly just annoyed, confused, and frustrated. So many muscles/attachments/things going on in that area that it could be a number of issues. Do I have the chiro needle me again this week and just take another week off? I feel like I'm too asymptomatic to have any bone issues but also know that marathon runners have a whacky pain tolerance. As if COVID quarantine/shutdowns weren't bad enough...

Interested to read and consider these other scenarios.

How long were you out with the reaction? I feel like my symptoms are similar to yours despite never having had any hip issues before. Ugh!

My recommendation is to be very careful. I never had a history of injuries, ran about 45 miles a week at the time. I had no warning what so ever that something was brewing. One day I'm running fine, the next day I have a sharp, but not excruciating, pain in the groin. I ran on it for three days. Each run I could feel it for the first two miles and then the pain went away. On the third day, I decided to get it looked at. At this time I could only feel the sharp pain when I ran, hopped or stood on one leg. The PT's I went to did all the tests you were given, and I passed all of them. I actually went on a few very slow runs after these visits, before getting the MRI. I caught it early, which is why I didn't have a lot of pain and could only feel it when running, hopping, or standing on one leg. Because I caught it early I think I was able to be more aggressive with my cross training and had a quicker recovery.

I ended up being out from running for 9 weeks. At 8 weeks I had a followup MRI. I took the first week completely off, then swam for a week, and then swam and biked the third week. From week 4 -9 I swam a lot, biked and did the alter G a couple times a week. I also did a bit of elliptical. I did not feel comfortable aqua jogging, so I only tried that once. If you decide to cross train, pay close attention to how your leg feels. If you feel any bit of tightness of discomfort, don't do that activity.

I was able to cross train quite a bit, but others with this injury have had to be more conservative. It all depends on how bad the reaction/fracture is and where it is located.

Thank you for sharing. Sounds eerily similar. Will see what I can do. How's your running going now? Any issues in that area?

It's been a couple years since my injury and I have had no issues. Once I was allowed to run, I had a slow buildup of milage, starting at 6 land miles the first week. It took about 10 - 12 weeks to get back to 40. As I ran more, I gradually swam and cross trained less. I continued to AlterG once or twice a week at a lesser body weight while building my milage.

That injury was a huge reality check for me, regarding alignment and muscle imbalance, since I feel that my reaction was caused by this. I now do daily strength exercises and occasional massages. I also do a self check every day to make sure my hips are in line.

My recommendation if you have a stress reaction or fracture:

---Go to a sports orthopedist that specializes in runners and a PT that specializes in runners. This is so important.

---Be careful with the cross training. Don't do anything that you think is aggravating the area. You want to get over this as soon as possible and not slow the healing process. Swimming is by far the safest activity and you can stay in fantastic shape.

---see if you can find an AlterG to use, directed by your PT or Orthopedist. I loved this and found it very helpful.

---Your return to full running needs to be very gradual.

---keep up with exercises and make sure your aligned.

I hope you don't have a stress reaction or fracture. If you do, hopefully you found it in the early stages, since I have heard that this makes a huge difference on how long the recovery is. There's not a lot of information out there and this can be a very scary injury. Let me know if you have any other questions and keep me posted on what happens.

I just reread your first post. You said you first felt it in the back. I never felt anything in the back and from what I read most people feel the pain in the front. However, there are some that feel it in the back also. The problem with this injury is that it is misdiagnosed so much because the strong muscles in that area mask the bone pain. My only red flag that mine was bone was that the sharp pain on impact, felt deep in. The weird thing is, once I was adjusted, the sharp pain turned more similar to a very tight muscle. I was lucky I had an MRI, since I probably would have kept running on it and it most likely would have turned into a stress fracture.

Did you do the fulcrum test? If not, try that. Also, my sports doc said that there is also a backside fulcrum test that a person should perform, incase the reaction/fracture is on the backside.

Thanks so much for your insight. The timing of all of this really sucks with many places closed or having limited hours. I was able to get a virtual visit with my general doctor at Mayo tomorrow (she could send referral for imaging if she thinks we need to go that route) and also got in with a reputable PT clinic here in town that is known for working with runners. Hate to go "overboard" with two appointments tomorrow, but I would rather get an answer than guess. My general doctor has been working with me since 2012 and also specializes in sports med/women's health, so she's got a good understanding of some of my background info. Given my Type A personality, I'll probably continue to do anything that isn't painful but don't want to negate any potential healing with exercises that are too stressful to the area. I'm not sure what kinds of PT exercises you can/cannot do at this stage, assuming the worst. As of now, the rehab/treatment place I go to on a regular basis has an Alter G. They aren't closed...yet.

Never had the fulcrum test, nor have I ever heard of it. No one has used a tuning fork either, but I'm not so sure that those are always accurate. I had a calcaneous stress reaction in 2015 and I don't think the tuning fork caught it.

Anyway, thanks so much for your insight. Hoping it's not the aforementioned, but I guess we'll know more in the next few days.

Supposedly, the fulcrum test is pretty accurate. Look online, there are a lot of videos showing how to do it. It's very easy to perform. Not sure if there's a video on the fulcrum test performed backwards, though. The hop test is used also, but is not recommended because it could be a symptom of other things too. Plus, it would not be good to perform if you had a fracture.

Glad you're going in to the doc. Do as much research tonight, so that you can have as much information before your visits. This is an injury that is not seen much at all, so it's often miss diagnosed. After my injury I was surprised to find that many top female runners have had this injury at one time. Jenny Simpson, Des Linden, Shannon Rowburry, along with a few other top pros.

Just in case others are following and curious....

I knew something wasn't right and proceeded with imaging. MRI confirmed stress fx of interior pubic ramus and stress reaction of superior acetabulum (I guess that's the neighboring socket). Sounds like I nailed it with the complaints/symptoms and not being able to pinpoint too much since it's deep in there. Supposed to let pain be my guide per doctor and PT, both of whom work actively with runners/athletes but can use a crutch if walking is painful. I'm going to try going without and to limit walking too much. Given timeline of ~8 weeks no running for now and will proceed with non-impact/non-weight bearing for next few weeks (deep water running is okay unless any pain or discomfort + core also okayed by doctor), can integrate bike in a few weeks, and can think about Alter G integration at the end of May. PT will continue to do like muscular work. Never a good time to be hurt, but at least races are canceled for a bit and will have time to focus on healing.

Glad I followed through with having it looked at after reading about frequent misdiagnosed strains/tendon issues in the area.

Glad you got that MRI and now you have answers. Thanks for posting what happened, so it will potentially help others dealing with pain in this area.

Will they give you a repeat MRI to see healing or will the doctor just go by lack of symptoms?

Good luck!!