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