Background and objective: Outline the biomechanics and pathophysiology of stress-induced injuries to the femur. Provide various imaging presentations of stress injuries of the femur including radiographs, computed tomography (CT), and Magnetic resonance imaging (MRI). Understand treatment modalities, recognize complications and become proficient in avoiding pitfalls. Methods: This paper will discuss detailed macro and microanatomical features of the femur and associated soft tissues such as muscles, tendons, and cartilage. A review of biomechanics of the femur with consideration to the remodeling process of the femur will be provided. Emphasis will be placed on structural integrity and composure of trabecular bone and its response to stress. Results: Multiple cases of stress response and fractures in the femur using various modalities such as radiographs, CT, and MRI will be used to review presentations of stress related injuries to the femur. Treatment options and imaging follow up for these cases will also be discussed. Conclusion: The learner will be exposed to key concepts of stress related injuries and informed of pitfalls.