Stress Fracture - Not all back of the leg pains are hamstring strains

Stress fracture of the Femoral Neck On MRI

Many injuries can occur with athletes and those that take part in routine physical activity. The scariest of those injuries are the ones that present like a lesser version of what they are.

A 13-year old soccer player was recently seen at SSMI for what was initially presumed to be a hamstring strain. The patient reported aggressive gym fitness workup where he heard a pop while performing lunges prior to the onset of symptoms. He experienced enough pain where he needed to use crutches to walk into clinic. This sign is never consistent with simple hamstring strains based on clinical experience.  Preliminary x-ray results of the legs were unrevealing but due to the patient's history and an increased index of suspicion, an MRI was ordered which revealed a stress fracture of the femur (similar to the picture shown).  

One example of this is stress fractures. Stress fractures can occur for many reasons, including overuse, high impact activities, poor diet, osteoporosis, and sudden increase in volume or intensity of activities. Stress fractures of the femur specifically are uncommon, but can occur in several different areas along the bone (Wright, Taylor, Ford, Siska, & Smoliga, 2015). These injuries can mask themselves causing those affected to think that they have an injury of less severity. This may result in improper treatment and further injury. When pain occurs after activity, especially intense activity, it is extremely important to seek medical attention and get proper treatment. Differential diagnosis for stress fractures can include; muscle strain, tendonopathy, osteoid osteoma, ligament strain, nerve entrapment syndrome, external compartment syndrome, or infection. Diagnostic imaging should be used to identify the type of injury and where the pain is coming from. Risk factors that could put one at risk are female gender, age, low BMI, decreased bone density, and consistent exposure to high impact activity (McInnis & Ramey, 2016). That being said stress fractures can occur in anyone. Treatment for stress fractures depends on the area of injury and the degree of fracture. Some fractures require surgical evaluation and treatment while other require only pain management and non-weight bearing. Almost all fractures require some sort of rehabilitation and physical therapy. So if you are experiencing pain post work out or are at risk for fractures and experiencing pain, call and make an appointment today with Dr. Carfagno to receive the best treatment for your injury!


McInnis, K. C., & Ramey, L. N. (2016). High-risk stress fractures: diagnosis and management. PM&R, 8(3), S113-S124.

Wright, A. A., Taylor, J. B., Ford, K. R., Siska, L., & Smoliga, J. M. (2015). Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med, bjsports-2015.

Case courtesy of Dr Andrew Dixon, From the case rID: 34081