Stress Fractures are common in runners, especially young female runners.
Recently a 15 year old competitive cross country runner presented to our clinic complaining of pain that started in her hip and would sometimes radiate down towards her knee. She expressed that it hurt when she first started to run, would warm up but that after running would be painful and cause her to limp. Limping after running is always an ominous sign and often indicates that a stress fracture is present.
I asked her to do 10 squats in order to activate her glutes, hamstrings and quad muscles. If a muscle injury was present it should hurt if the muscle is activated and stressed. The squats did not illicit any pain. Next I had her do 10 forward lunges onto the painful leg in order to further stress the muscles. Lunges opposed to squats require all the weight to be stressed on one side at a time. This requires the muscle to exert more effort and if muscle injury was present should illicit pain. It did not. Next I had her jump up and down on both legs and asked if she felt any pain or discomfort. She stated it hurt her right hip a little and pointed to the front of her hip. For the last test I had her jump up and down only on the involved leg. I noticed her face when I asked her to do it…….she looked afraid and concerned. I’ve seen that face before. In fact I have seen it hundreds if not thousands of times before. I call it the “apprehension sign”. She reluctantly started jumping and immediately stopped due to the pain. Apprehension sign positive, single leg hop test positive and diagnosis of stress fracture confirmed.
She did not understand why if it was fractured it did not hurt while running and why the pain felt like it was in the Quadriceps. “That is called muscle splinting” I explained. The muscle spasms and guards in an attempt to force you to recognize the injury and stop aggravating by running on it. Muscle splinting is common and causes some confusion to patients as they try to interpret their injury. Unfortunately it also causes confusion among most doctors, chiropractors and physical therapists. In their world everything is either tight or weak and needs to be stretched or strengthened. Because of their basic belief in this falsehood they lead runners down a bad path and their stress fractures worsen. Of course you could always get an MRI to confirm the diagnosis as stress fractures are not seen on X-ray but bear in mind that the MRI result will not alter your pain nor speed your recovery. I have seen many a patient get an MRI that showed “nothing” and be told it was OK to run. When they did and the pain got worse they had to stop running anyway. MRI technology is not infallible and neither are the people (radiologists) that read them. It is not uncommon for injuries, including stress fractures, to be missed or overlooked with MRI.
I outlined a solid rehabilitation plan for the runner which included running sessions on the Altered Gravity Treadmill which is an amazing rehabilitation tool for runners. This latest technology allows runners with stress fractures to maintain their running muscles and cardiovascular fitness while their bones are healing and is probably the single best rehabilitation tool invented during my lifetime. Unfortunately, due to the companies (AlterG) lack of effective marketing it is also one of the best kept secrets!