Hip Pain After A Fall In Your 60s

Most falls at home are low energy and leave nothing worse than a bruise. In your 60s and beyond, though, hip pain after a fall deserves a closer look, because the same tumble can produce three quite different hip injuries. At MTP Health we see all three, and sorting out which one you have is the first step towards getting back on your feet with confidence.

Key Takeaways

• After a fall at 60 or older, hip pain usually comes from a fracture, a bone bruise, or an injury to the gluteal tendons on the side of the hip.
• Being able to walk does not rule out a fracture. Some femoral neck and pelvic fractures allow partial weight bearing at first.
• A normal X-ray with persistent groin or thigh pain is a reason for further imaging, not reassurance.
• Fractures are managed by an orthopaedic surgeon and almost always need surgery; bruises and tendon injuries are led by the MTP physiotherapy and exercise physiology team.
• A leg that looks shorter or turned outward, an inability to lift your heel off the bed, or pain worsening over 48 hours all need same-day review.

Fracture, Bruise Or Tendon

A hip fracture is a broken bone in the upper femur, or thigh bone, either through the neck just below the ball of the hip joint or slightly lower through the intertrochanteric region.

Bone that has lost some density can break under a simple sideways fall, and the result is usually deep groin or front-of-thigh pain, an unwillingness to put weight through the leg, severe pain, and sometimes a visible deformity where the leg looks shorter and rolled into external rotation when you lie flat.

A serious injury like this is the first we set out to exclude at our orthopaedic and physiotherapy clinic on Sydney’s North Shore, because it is the most serious of the common injuries after hip trauma.

A bone bruise, sometimes called a hip pointer after a direct impact to the hip bone, is bleeding and swelling inside the bone without a crack running through it. Landing on the point of the hip can bruise the greater trochanter, the bony prominence on the outside of the hip. The skin often turns purple within a day or two, yet the bone remains sound, walking is possible, and the pain in the affected area usually eases over two to six weeks.

The third possibility is an injury to the gluteus medius and minimus tendons where they attach to the greater trochanter. Over 60, these tendons are often already worn, and a fall can partially or fully tear them from the bone.

The clue is pain on the side of the hip rather than the groin, tenderness over the bony point, muscle spasms in the surrounding muscles, and weakness when you stand on the injured hip alone. Muscle strains and a hip flexor strain in the hip flexor muscles at the front can produce similar discomfort with a smaller injury.

Why Some Fractures Still Walk

Walking does not mean nothing is broken. An impacted fracture of the femoral neck, where the broken ends are wedged together, can let you hobble around the house for days. Fractures of the pubic ramus, the thin bones at the front of the pelvis, are also common in this age group and often present as groin pain with a limp rather than collapse.

The risk is that an undisplaced fracture can shift with continued walking, causing further damage and turning a break that might have been fixed with screws into one that needs a hip replacement.

Persistent groin or thigh pain that is worse when you rotate the leg or lift it straight off the bed, or a painful hip with a limited range of motion, should be treated as a fracture until proven otherwise.

An X-ray is the starting point, but undisplaced fractures can be invisible on early films and pelvic fractures are easy to miss. If the X-ray is clear but the pain and limp persist beyond a few days, a CT or MRI scans are usually the next step.

Post-Fall Red Flags

If your leg looks shorter than the other or rests turned outward, if you cannot lift your heel off the bed while lying flat, or if you cannot put any weight through the leg, you need urgent medical attention at an emergency department the same day. Pain worsening over the first 48 hours, a new limp, or numbness in the leg are other symptoms that warrant prompt review.

Australian guidance on hip pain, and the Arthritis Foundation, likewise treat pain after a fall as a reason to see a doctor if you notice these following symptoms.

What A Fracture Means

A confirmed hip fracture is managed by an orthopaedic surgeon and almost always involves hip surgery within a day or two. Dr Donald Cawthorne assesses the fracture pattern, your bone quality and your overall health to recommend the right operation.

Intertrochanteric fractures are usually fixed with a nail or a plate and screws, which preserves your own joint. Displaced fractures through the femoral neck are more often treated with a partial or total hip replacement, because the blood supply to the ball of the joint that sits in the hip socket may have been damaged.

Surgery carries risks, including infection, blood clots, dislocation and the need for further surgery, and these are weighed against the risks of prolonged bed rest without surgery. Non-operative management is reserved for people too unwell for an anaesthetic.

The operation is one part of a longer journey. Walking within a day or two of surgery, followed by structured rehabilitation and physical therapy to ensure proper healing, turns a fixed fracture into a hip you can rely on and supports a full recovery.

Bruises And Tendon Injuries

Most people who fall and hurt their hip have not broken anything. A bone bruise settles with brief relative rest, an ice pack in the first days to reduce pain and reduce inflammation, a gradual return to walking, and a program to strengthen muscles around the hip.

The MTP physiotherapy and exercise physiology team guides the pace so that you do not lose fitness while the bone heals, and uses strength training to rebuild the balance, range of motion and confidence a fall can shake.

A gluteal tendon injury needs a more deliberate plan. Partial tears often recover with a progressive strengthening program over several months, and lifestyle adjustments help protect the tendon. Hip bursitis, irritation of the cushioning sac on the outside of the hip, and labral tears of the cartilage surrounding the socket can sit alongside a tendon injury and are checked at the same time.

A full tear with a marked limp and weakness may not recover with exercise alone, and Dr Cawthorne may discuss surgical repair once the extent of the tear is clear on MRI. Either way, rehabilitation is led by the MTP team, with the goal of a hip that supports you through everyday tasks and physical activities.

How MTP Health Assesses It

An assessment starts with how the fall happened, where the pain is causing you trouble and what you have managed since. We examine your walking, hip rotation, side-of-hip strength and the bony landmarks, and check for any structural abnormalities in the hip area.

If a fracture has not been excluded, we arrange imaging before any hands-on treatment, and Dr Cawthorne reviews the scans directly, as he does for every hip fracture he manages. Where the diagnosis is a bruise or a tendon injury, your physiotherapist or exercise physiologist builds a plan around your goals.

For milder aches from sports injuries, options such as chiropractic care, assistive devices for a short period, and graded loading all have a place, and the same principles help prevent hip pain from returning.

Frequently Asked Questions (FAQs)

Can you still walk with a fractured hip?

Sometimes. An impacted femoral neck fracture or a pelvic fracture can allow partial weight bearing at first. Walking on it risks the fracture shifting, so persistent groin or thigh pain should be assessed even if you are mobile.

How long should a bruised hip hurt after a fall?

A bone bruise usually improves steadily over two to six weeks, with the worst pain in the first few days. If the pain plateaus or worsens after the first week, or a new limp develops, the diagnosis should be reviewed with further imaging.

What if my X-ray was normal but my hip still hurts?

Early X-rays can miss undisplaced fractures and pelvic fractures. If pain and a limp persist beyond a few days, a CT or MRI is usually recommended, and MRI will also show bone bruising and tendon tears.

Do all hip fractures need surgery?

Almost all do, because surgery allows early walking and reduces the complications of prolonged bed rest. The operation may be fixation with a nail or screws, or a partial or total hip replacement, depending on the fracture pattern.

When should I see a specialist after a fall?

Seek same-day emergency care if you cannot bear weight, cannot lift your heel off the bed, or your leg looks shorter or turned outward. For pain that is manageable but not settling after a few days, book an assessment so the cause can be identified and the right plan put in place.

Conclusion

A fracture, a bone bruise and a gluteal tendon injury can all start with the same tumble, but they follow very different paths. An early, accurate diagnosis protects the joint, and the right plan, surgical or exercise based, gets you moving with confidence again. If you have had a fall and your hip is not settling, book an assessment with MTP Health on (02) 9437 9794.