Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones. ![]() He is also a trained MSK Sonographer and uses diagnostic ultrasound regularly, in his clinical practice.Risk factors for developing avascular necrosis include: He is a Master Trainer in Shockwave therapy and is the UK head of education for Venn Health Care. More than 2500 participants from 12 countries have attended his course in the last 8 years. He is passionate about the application of research in clinical practice and is involved in regular teaching on multiple courses, both in the UK and overseas. Clinically, he specializes in the management of difficult musculoskeletal and sports injuries with a particular focus on overuse running injuries and young hip and knee injuries. He qualified as a physiotherapist in 1998 and completed his Masters in London in 2014. 2016 Oct 26 2016:bcr2016216820.īenoy is a highly specialist physiotherapist and works as an advanced practice Physiotherapist for the National Health Service (NHS), London, and also in private practice in Central London, mainly treating runners and complex lower limb injuries. Young man with sudden severe hip pain secondary to femoral neck stress fracture. Diagnosis and management of bone stress injuries of the lower limb in athletes. Lodge CJ, Sha S, Yousef AS, MacEachern C. 16-Detector multislice CT in the detection of stress fractures: a comparison with skeletal scintigraphy. Groves AM, Cheow HK, Balan KK, Housden BA, Bearcroft PW, Dixon AK. Clinical Orthopaedics and Related Research®. Avascular necrosis of the femoral head after femoral neck fracture. To learn more about the management of runners with injuries, including initial rehab, load management, strength training, and running re-training, check our comprehensive online Running Rehab Course with access to all information related to the rehab of running injuries.īachiller FG, Caballer AP, Portal LF. This blog article is taken from our Running Rehab – From Pain to Performance Online Course. Worsening hip pain in a runner and inability to bear weight should raise concern for serious hip pathology and prompt an urgent orthopedic referral.ĭownload our FREE FORM on Screening for Stress Fractures Checklist by Clicking HERE! ![]() Plain film X-rays are insufficient for early diagnosis and MRI imaging is recommended. A positive hop test combined with no specific tenderness raises particular concern for a stress fracture, which must be ruled out with imaging. The insidious onset of a vague, poorly localized pain is particularly concerning. Clinicians should have a high index of suspicion for stress fractures as the cause of hip and groin pain in the long-distance female runner. 2016).įemale runners are at increased risk for stress fractures in and around the hip. In advanced cases, it may progress to night pain and even limping during walking ( Petrin et al. The pain typically worsens with impact activities and worsens over time. Tenderness is rarely elicited, even with severe stress fractures. Typically, the pain is diffuse around the groin, anterior hip and can radiate to the proximal thigh region. Most runners usually present with vague symptoms about the hip and groin region. In female runners, a history comprising of amenorrhea reduced calorie intake, and previous bone stress injuries should raise the suspicion of a stress fracture ( Lodge et al. The key risk factors for stress fractures are highlighted below, as a checklist. There are multiple risk factors for the development of stress fractures within the athletic population. Femoral stress fractures account for around 11% of all stress fractures in the athletic population. Stress fractures in the hip and pelvis region (femoral neck, pubis, sacrum, and ischium) are more common in female runners and should not be missed, as a possible differential diagnosis of hip and groin pain. What is the ONE condition that you don’t want to miss in this runner?Ī stress fracture is caused by repeated sub-optimal loading on a bone over time as opposed to a single severe impact. She has reduced her training schedule to two sessions a week due to her pain and is currently unable to run beyond 15 minutes. ![]() A 28-year-old woman presents to the physiotherapy clinic with a 3-week history of left groin and anterior thigh pain that has progressively worsened while training for her first half-marathon.
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