Episode 17 | Patient Story | Guest: Nick, patient at LBSM
Nick was 31 when he first came to LBSM. Like a lot of runners, he had found the sport during lockdown – a way to get outside, clear his head before a busy shift on the shop floor of a large department store, and compete against himself. And as it turns out, he was genuinely good at it! He went from a 26-minute 5K to just over 18 minutes within months. He got a running coach. He built his weekly mileage to 50–60 kilometres.
And then his hip stopped him.
How a stress fracture develops – and how it felt
There was no dramatic moment. No sudden snap, no fall. Nick ran a threshold test, felt reasonable about his performance, headed into work, and noticed a dull ache deep in his right groin. He assumed a groin strain. He did some stretches, tried a few cautious runs, and found the pain worsening rather than settling. After four weeks of attempting and failing to restart, his physio referred him for a scan.
The MRI confirmed a stress fracture of the femoral neck – the narrow section of bone connecting the ball of the hip joint to the thigh bone. It is one of the more serious sites for a stress fracture, because the femoral neck is under significant compressive and rotational load with every step, and fractures there can fail to heal or, in the worst cases, progress to a complete break.
Dr Ajai Seth, who treated Nick at LBSM, explains that stress fractures are less commonly associated with men than women – hormonal and biomechanical differences mean women are typically at higher risk. But in Nick’s case, the pattern was clear: a rapid escalation in mileage, a body weight that was likely too low for the training load he was carrying, and a vegan diet that he now believes was under-fuelling him in ways he hadn’t appreciated at the time.
Two surgeons, two very different opinions
With a femoral neck stress fracture confirmed, Nick was referred to two orthopaedic surgeons for their opinions on management. What he heard from each could not have been more different.
The first surgeon was upbeat and decisive: fix the fracture surgically with two screws, and Nick could be back walking within two weeks, back running within six to eight. The appeal was immediate – compared with the prospect of 12 weeks on crutches with no weight bearing, the surgical option offered a much faster return. The surgeon acknowledged that the screws might cause discomfort later in life and could require removal, but felt the overall risk-benefit calculation favoured operating.
The second surgeon took the opposite view. He would not consider operating until Nick had given the fracture at least 10 to 12 weeks to heal naturally. In his assessment, the risk of long-term complications from the hardware – and from intervening in a fracture that might well resolve on its own – far outweighed the benefit of a faster timeline.
Dr Seth’s reflection on this illustrates something important about medicine more broadly: neither surgeon was wrong. Both were offering an opinion grounded in genuine expertise and clinical experience, applied to a situation where the evidence does not provide a single clear answer. The right decision depends on the individual patient – their circumstances, their priorities, and how much time they have to give recovery.
Nick, fortunate to have a supportive employer who put no pressure on his return to work, chose to wait. He gave the fracture its 12 weeks. “I could give both options a try in a way,” he reasoned. “I could try the natural first, and if it didn’t work, I could use the screws. Whereas if you jump straight to the screws, you can’t rewind time.”
Twelve weeks on crutches – and what changed
Living alone, the practical reality of 12 weeks non-weight-bearing was challenging. The smallest tasks – making dinner, walking to the bathroom – became hard. “It’s a humbling experience,” Nick says, “when you have something you take for granted taken away from you.”
The period also prompted a significant reassessment of his diet. At the time of his injury, Nick was 59kg at just under 5’ 8” – lean even by runner’s standards – and had been vegan for two years. Blood tests revealed slightly low vitamin D. Looking back, he believes he was simply not eating enough to support the training load he was placing on his body, and that the restricted profile of a vegan diet he was not managing carefully enough contributed to the bone stress that led to the fracture.
He is careful not to condemn plant-based eating – “you can absolutely be a successful high-performing athlete on a plant-based diet” – but is clear that it requires a higher level of dietary discipline than he was applying. He resumed eating meat and dairy during recovery, gained around seven kilos over the 12 weeks, and is candid that the weight gain, while initially unsettling, was part of the process.
Vitamin D supplementation, increased caloric intake, and a focus on protein to support bone and tissue repair formed the nutritional backbone of his recovery alongside the physical rehabilitation.
The return to running
Follow-up MRI scans at two intervals confirmed the fracture was healing well. Once he had the all-clear, Nick’s first run back was a slow, supervised treadmill session with his physio. His gait was unaffected – no hip drop, no compensation pattern – a reassuring sign that the recovery had been complete. From there, a structured return protocol: run two minutes, walk 30 seconds, repeat, and build load incrementally over weeks.
He is now back to around 50km per week, feeling stronger than before, and racing again. His first mass-start race – a 10K in London – produced a time of around 42 minutes off eight weeks of training. He has since run his first half marathon as part of a training block.
Strength training – previously something he had little interest in – is now a regular part of his routine. During lockdown, home-based resistance work had meant improvising with backpacks filled with baked beans and beverages. Gym access has changed that. “Bones like to be loaded heavily,” says Dr Seth. “With compound lifting in a controlled manner, they respond well and bulk out.” For Nick, that understanding came the hard way – but it has stuck.
Nick’s key lessons
- Get more than one opinion. Two experts can reach genuinely different conclusions from the same scan. Take the time to hear both before making any significant medical decision.
- Don’t rush the decision. When you’re injured and desperate to get back, the option that promises the fastest return is enormously appealing. Resist it until you’ve had time to properly consider the alternatives.
- Take nutrition seriously. Nick had never had a serious injury before and assumed his body was resilient enough to handle whatever he threw at it. It wasn’t. Underfuelling a high training load – whatever the reason – has consequences for bone health that may not show up immediately.
- Build load gradually. Going from nothing to 30km a week in a fortnight caused his first injury. Reaching 50–60km too quickly caused the second. The 10% rule exists for a reason.
- Trust the body’s ability to heal. Given the right environment – rest, nutrition, progressive rehabilitation – the body is remarkably capable. Nick’s fracture healed completely without surgery. “That’s a testament to what the body can do if you let it,” says Dr Seth.
Hip stress fractures are a serious but manageable injury. If you’re a runner experiencing groin or hip pain that isn’t settling, early assessment is key – the sooner the cause is identified, the more options are available and the faster the path back.
Book an appointment with the LBSM team at lbsm.co.uk/booking
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