Sacral stress fracture in a distance runner

Sacral stress fractures are uncommon injuries that are associated with repetitive load-bearing activities. The authors describe a 23-year-old male cross-country runner who presented with low back and buttocks pain. Radiographic findings were unremarkable, but a hop test identified a sacral stress fracture. The patient was instructed to stop running and to take calcium and vitamin D supplements. Four months later, his symptoms completely resolved and he began running again. The authors also present a review of the literature, which revealed that patients with sacral stress fractures are likely to have normal neurologic examinations and full active range of motions. However, they will likely describe discomfort with passive hip flexion. The authors recommend the hop test for patients with this type of history and these physical examination findings. If a sacral stress fracture is found, treatment regimens should consist of 4 to 6 weeks of rest with gradual return to activity.