Proximal femoral stress reaction in a professional football player

There have been no previous case reports of femoral stress fractures in professional football players. We present a professional defensive back who presented 1 week after noting mild soreness in the right proximal thigh during practices, prior to a regular season game. Early diagnosis of a stress reaction was made with magnetic resonance imaging (MRI). Magnetic resonance imaging is an excellent imaging modality for stress reactions/fractures given its high sensitivity, specificity, and ability to image surrounding soft tissues. Short tau inversion recovery and fat-suppressed images are best for seeing early osseous edema. Early detection of this injury allowed us to hasten the recovery and prevent further injury. The patient was treated successfully with early nonweight bearing, a gradual increase in activity via cross training, and a structured functional progression to return to play. Normalization of MRI lagged behind the player's healing and was not necessary to determine advancement of rehabilitation or return to play. Three main issues are important to review in this case of a proximal femoral stress injury: early diagnosis is the key to treatment and early return to play; imaging studies lag behind clinical symptoms; and the treatment regimen should consist of a period of rest and be tailored to the individual.