Case report
Femoral neck stress fracture in a female athlete: a case report

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Abstract

Objective

The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology.

Clinical Features

A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non–weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale.

Intervention and Outcome

This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non–weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities.

Conclusion

This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries.

Introduction

Stress fractures can be commonly found in various female subgroups. One of the highest proportions of stress fracture incidence rates in women is found in military personnel.1 Another common group of women that have the tendency to develop stress fractures are endurance athletes that perform repetitive weight-bearing sports such as distance running.2 Stress fractures can also frequently occur in adolescent athletes with amenorrhea, eating disorders, and osteopenia, otherwise known as the female athlete triad.3, 4

Several locations in the lower extremity have a predisposition towards developing stress fractures, including the tibia, metatarsals, and fibula.5, 6 Owing to the aforementioned subgroups and frequently reported sites of injury, clinicians will frequently screen athletes in these groups and add a differential diagnosis of stress fracture. However, it is still possible for healthy athletes to sustain stress injuries or fractures that can easily be overlooked.

It is typical for a clinician to manage an athletic patient with conservative therapy before sending them for advanced imaging. Therefore, the misdiagnosis and subsequent mismanagement of an athlete with groin pain may easily occur, compounded by the complexity of the anatomical structures in the hip. Delay in diagnosis and treatment may result in undesired complications and lost time from sport participation. It is important to have imaging evidence in combination with physical examination findings to appropriately manage these problematic patients. The differential diagnosis of femoral neck stress fracture through clinical history and physical examination needs to be confirmed by advanced imaging.

To date, there have been no reports in the scientific literature of chiropractic management or comanagement of a patient with femoral stress fracture. This case report describes chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provides a brief discussion of stress fracture pathology.

Section snippets

Case report

A 41-year-old female personal trainer who competed regularly in mountain biking and cross-country skiing competitions presented to 3 doctors of chiropractic and a physical therapist, on separate occasions, with groin pain during weight-bearing activity. She stated that the pain began as a dull ache only present at the end of a session of physical activity. Over the ensuing season, her symptoms became progressively worse to the point where she experienced constant pain with walking.

On each

Case discussion

This case describes the findings and chiropractic rehabilitation of a clinically suspected proximal femoral stress fracture in a master's-level athlete confirmed by MRI. This patient avoided weight-bearing activity for 8 weeks while cross-training and receiving chiropractic care. The patient was able to return to her sport after this period. Non–weight-bearing cross-training exercises in combination with chiropractic care can help expedite the rehabilitation process and allow athletes to return

Conclusion

This case summarizes the literature on repetitive stress fractures and provides insight into the importance of early detection through clinical history and physical examination, which can be confirmed by MRI. This case demonstrates the importance of the non–weight-bearing rehabilitation therapy process that can be supplemented with chiropractic care. Ascertaining the appropriate diagnosis and providing the necessary management for these patients are crucial to their rehabilitation process and

Funding sources and potential conflicts of interest

No funding sources or conflicts of interest were reported for this study.

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