Physiotherapy Approach to Femoral Stress Fractures: Causes, Symptoms, and Recovery
A femoral stress fracture is a small crack in the femur caused by repetitive stress. These injuries are common among athletes, military personnel, and individuals engaged in high-impact activities. Physiotherapy plays a vital role in recovery by promoting healing, restoring function, and preventing recurrence.
Causes from a Physiotherapy Perspective
Femoral stress fractures occur when repeated mechanical stress exceeds the bone’s ability to repair itself. Contributing factors include:
Overuse and Training Errors: Rapid increases in activity without adequate recovery strain the bone.
Muscle Weakness or Imbalances: Weak hip, glute, or quadriceps muscles can alter biomechanics and increase stress on the femur.
Poor Running Mechanics: Excessive internal rotation, overstriding, or high-impact loading can contribute to injury.
Nutritional Deficiencies: Calcium, vitamin D, and energy availability are crucial for bone remodelling and repair.
Inadequate Footwear and Surface Impact: Worn-out shoes or training on hard surfaces can increase loading forces.
Symptoms and Physiotherapy Assessment
Symptoms develop gradually and can include:
Deep, aching thigh or groin pain that worsens with weight-bearing activity.
Pain that starts during exercise and persists afterwards.
Tenderness over the affected area and possible mild swelling.
Altered gait or limping due to pain avoidance.
A physiotherapist will conduct a thorough assessment, including movement analysis, strength testing, and special tests such as the hop test or fulcrum test, to identify the injury.
Physiotherapy Treatment and Rehabilitation
Initial Phase (Rest and Protection)
Activity Modification: Avoid weight-bearing activities to allow healing.
Crutches or Partial Weight Bearing: Depending on severity, assistive devices may be needed.
Pain Management: Ice and gentle range-of-motion exercises help reduce discomfort.
Rehabilitation Phase (Strength and Mobility Restoration)
Muscle Strengthening: Targeting the hip abductors, core, and lower limb muscles to correct imbalances.
Biomechanical Correction: Gait and running retraining to reduce excessive stress on the femur.
Progressive Loading: Gradual return to weight-bearing exercises, such as aquatic therapy and controlled resistance training.
Return to Activity and Prevention
Gradual Return to Sport: A structured programme ensuring safe reintroduction to high-impact activities.
Optimising Biomechanics: Ongoing monitoring to prevent recurrence.
Education on Load Management: Helping individuals recognise early signs of overuse and adjust training accordingly.
Physiotherapy is essential in managing femoral stress fractures by addressing the root causes, promoting recovery, and ensuring a safe return to activity.
