Patient compliance for successful stress fracture rehabilitation

The views and findings contained in this report are those of the authors and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other official documentation. An avid 39-year-old female runner experiencing left groin pain was initially assessed as having a muscle strain but treated conservatively with crutch ambulation since the possibility of a left femoral neck stress fracture was not ruled out. A subsequent bone scan revealed a left medial femoral neck stress fracture. In the ensuing 18 months, evidence of stress fractures at multiple sites differing from the original fracture surfaced due to her noncompliance to the rehabilitation program and restrictions. Counseling for lifestyle modification were rejected by the patient. Resultant healing of her stress fracture was poor. Alerting clinicians to the importance of referral to behavior modification specialists from the onset of treatment for avid runners appears to be critical. In addition, a review of two other contributory factors possibly predisposing one to stress fractures was examined for consideration for future research.J Orthop Sports Phys Ther 1990;11(7):321-325.