Sacral stress fracture in a professional hockey player: a case report

Lumbosacral pain is common in the general population and among athletes. Many athletes are diagnosed with low back strain and treated with nonsteroidal anti-inflammatories, rest, and muscle relaxers. However, the differential for low back pain in athletes is broad and includes many potential etiologies such as: lumbar disk disease, facet arthropathy, spondylolysis, sacroiliitis, tendinopathies, ligament sprains, hip pathology, bursitis, intraabdominal processes, and neoplasm. Sacral stress fractures are included among the many possibilities. Stress fractures are rare in the general population, with a <1% incidence over a lifetime, but up to 20% of runners may experience a stress fracture while participating in their sport. Athletes are unique as they engage in prolonged strenuous activities, both in practice and competition. Sports activities have the potential of placing extreme amounts of repetitive loading on bones, articular surfaces, and soft tissues throughout the body, including the sacrum. Hockey players place considerable demands on their pelvis during training and competition given the physical demands of the sport. This article presents a case of a delayed diagnosis of a sacral stress fracture in a professional hockey player. This is the first known report of a hockey-related sacral stress fracture.