Pelvic stress injuries in the athlete: management and prevention

Stress-related injuries of the pelvis are an important consideration in sports medicine. Diagnosis of stress injuries may be difficult and requires a high index of suspicion. Plain radiographs are the first step in imaging but magnetic resonance imaging is the imaging modality of choice for definitive diagnosis. Repetitive forces transferred to the bone, either through muscle fatigue or from the tensile forces generated by the contracting muscles, are thought to be the causative mechanism of stress injuries. Interestingly, the reparative and reorganisational process of bone result in a temporary weakening before ultimately producing a reinforced structure better adept at supporting repetitive stress. This temporary weakness occurs for several weeks after the initiation of a training programme. Knowledge of the mechanism and aetiology of stress injuries provides the foundation for treatment and prevention. Resting the involved bone through modifying the training programme is the mainstay of treatment. Every effort to prevent stress injuries should be made when initiating a training programme. A cyclical training programme, one that does not place continued and undue stress on any one bone, but provides adequate rest for bone recovery, is recommended. Attention to proper nutrition is emphasised for both treatment and prevention. Maintenance of a normal hormonal balance is additionally important in the female athlete. The bone-maintaining properties of estrogen from a normal eumenorrhoeic menstrual cycle should be preserved. Rarely, women may develop an inter-related problem of disordered eating, amenorrhoea and osteoporosis, the female athlete triad. The female athlete triad is a serious problem that may result in a permanent loss of bone mass. This article more fully explains the mechanism of stress injuries to bone, and provides a more detailed discussion of diagnosis, treatment and prevention.