Hip Health for Active Women in Sydney CBD

Understanding and Managing Stress Fractures – What role does a good sports physio have to play? Evoker Physio, Hayley O’Brien dives in deep to the diagnosis and management of stress fractures. At Evoker, we are here to help you get better faster, and to help you keep this pain away such that your running performance can again shine.

In our fast-paced society, Sydney women are required to juggle demanding roles (particularly in the CBD), and this often leads to time constraints on our personal well-being. As the pursuit of a ‘balanced’ life becomes increasingly challenging, running emerges as a popular and accessible exercise choice for both men and women. It’s appeal lies in the ease of application (very little equipment is required to make a start), the efficiency of a run (the minimal time commitment required for max gains), and the potential for community building through platforms like Strava.

At Evoker Physio Sydney, we’ve recently observed a growing number of women embracing running, transforming into fitter, stronger, and faster athletes. However, this dedication to pushing physical boundaries with running can sometimes come at a cost to our bone health. Bone pathology initially presents as a deep, dull pain, often in the front of your hip (that is hard to actually put your finger on), and it will often increase during or after running (including the morning after a run). It’s not uncommon for women to walk through our doors with sometimes subtle, yet persistent, discomfort in their anterior hip.

These women share snapshots of their experiences:

  • “I feel a deep, dull pain inside my hip.”
  • “I think it’s my hip flexor, but I can’t quite pinpoint it.”
  • “The pain surfaces during activities like running and HIIT classes.”
  • “I’ve intensified my training.”
  • “I’m gearing up for a marathon.”
  • “I manage only one long run per week due to work and kids.”
  • “I just had a baby and want to regain fitness through running.”
  • “It hurts when I stand on one leg, putting on my shoes/pants.”
  • “I’ve had this pain before, but it went away.”

These stories often point to a building stress response, or stress fracture, of the hip. Each person will have a different story, but there will always be a consistent theme. The first step in addressing this issue is determining the presence, and then grade, of such a stress reaction. An MRI is the gold standard in medical imaging here, and your Evoker physio will refer you for an MRI immediately – should they be at all concerned by a potential stress fracture at the hip. Once the MRI has indeed ruled in a stress fracture, your Evoker physio will tailor your physiotherapy treatment plan to your individual and specific needs.

  • Can you still run (generally speaking, this is a no)?
  • Could you low load run on the Alter G, or are we cross training another way?
  • Is your low back moving as it should?
  • How strong is your core?
  • Is the tone of your glutes/TFL/ITB/hammy/quad all appropriate?
  • Is the strength of your posterior running chain (glute, hammy & calf) where it should be?
  • Has your hip joint got adequate power and protection when it is given the clearance to return to sport?
    • Your elite sports physio at Evoker Sydney CBD will guide you on all of the answers to these very important questions
    • Importantly, your Evoker physio will help you implement the necessary changes to your body, such that once your pathology has settled, you are far less likely to have the same pain return once your running builds up again.   

While a low-grade stress reaction may heal relatively quickly, more severe bone stress injuries require a longer recovery. Hearing about a potential hairline fracture can be confusing and frightening for these dedicated runners. At Evoker Physio Sydney, such conversations are not uncommon and we are here to help you understand what it means for you. Your Evoker physio is here to help you get better faster, and to help you keep this pain away such that your running performance can again shine.

If caught early, stress fractures in the hip are very manageable injuries with a super low likelihood of surgical intervention. Typically, bone recovery takes 6-8 weeks, and this gives us the perfect opportunity to build significant strength of key running muscles. We then follow this rest period (from running, but not the gym) with a careful regime of systematically loading the bone. To prevent recurring “hip pain“, that could definitely escalate into a more serious injury, a safe return to full load running might take 3-6 months – under the guidance of your physiotherapist. If these injuries are missed, and you continue to run through this hip pain until you can no longer walk, the consequences become much greater, and rather urgent surgery can be needed to stabalise your hip joint. Talk to us, and we will help you avoid this situation. 

In addition to load management and strength building, managing stress fractures requires attention to nutritional factors. Reduced intake of calcium and vitamin D can expose the bone to stress fractures (especially when high load running is frequent). Therefore, maintaining a healthy, balanced diet with adequate calorie intake and a stable weight is important. Discussions about nutrition should be conducted under the guidance of a doctor or dietitian.

At Evoker Physio Sydney, we aim to ensure that the joy of running remains sustainable for all, and we are here to keep female runners healthy. We understand the precise management that is required in these sensitive cases (get an MRI early!), and we are very confident in tackling stress fractures of the hip in the running community. We empower women to maintain their active lifestyles, whilst optimising their bone health for the long term.

By Hayley O’Brien | Evoker Physiotherapist


MSc Physiotherapy | BSc (Hons) Sport and Exercise Science

Connect with Hayley O’Brien on LinkedIn

Hayley is a very strong, confident young lady that exercises & trains herself… a lot. Hayley has almost 10 years experience treating sports & spinal injuries, & she most definitely ‘knows her stuff’. Like all great physios, if you have a personal history of pain or injury in your chosen sport & exercise pursuits, then you intimately understand the pain experience & all of the frustrations that accompany such a journey. You simply can not replace this element, & it intuitively empowers physios when they are assigned to helping others return from pain & suffering. Hayley just gets it, and she will very quickly ‘get you’.

Couple this rather natural, organically driven, physio ‘know how’, and underpin it with 2 classy degrees and you now have a highly skilled, always empathetic, very effective physiotherapist. The foundations of Hayley’s Masters in Physiotherapy is the science backbone that allows for some artistic interpretation when it comes to the exercise delivery. Hayley knows when to use the hands (and these hands are strong) to provide the ‘feel good’ hands on relief, and when to jump out into the gym and prescribe just the right exercises to get your movement patterns humming once again.

Hayley holds a both Master’s Degree in Physiotherapy, and a Bachelor’s Degree in Sport Science. Together, this tirade of tuition has equipped her with a comprehensive understanding of human anatomy, movement mechanics, loading patterns and rehabilitation techniques. This educational foundation has provided Hayley with the knowledge necessary to effectively listen and assess, diagnose and educate, and efficiently develop a tailored treatment plan for individuals seeking a rapid recovery from various injuries and conditions.In private clinics like Evoker, things move quickly, and Hayley has learned to work well in a collaborative team, absorb pressure and manage case variations ‘on the run’. Near 10 years of fast paced experiences have allowed Hayley to excel at her job, no matter the case, the body region, or the patient’s likely high sporting demands. Hayley has all aspects of treatment covered. From acute pain (think bruised and swollen) management, to a reintroduction of impact with jump, hop, run… and everything ‘gym & load’ in between.

Some physios have the gift, most do not. Hayley is one that most definitely ‘just gets it’. She will listen to you very carefully, and you will never need to tell her anything twice. Be prepared to move fast with Hayley, she is not here to mess around. Hayley is known for her diligent work ethic, friendly demeanour, and collaborative approach to problem-solving. She builds strong relationships with patients, quite simply – because she cares, and she nurtures trust as she begins to get your pain down and relief up. Expect Hayley to encourage your active involvement in your personalised path to a pain free recovery. Hayley genuinely cares about your result on the day that you walk out of the halls of Evoker. Hayley wants to see you at 110% with both prevention and performance high – such that she never sees you for the same problem again.

Hayley is here to help YOU!