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Stress Fractures in Female Runners

Patient Presents

Initial Visit

Ellen Foster is an 18-year-old female competing on the cross country team at a Division I University. She presents to a physical therapist with a doctor's script to evaluate and months ago which has become progressively worse. She reports experiencing pain on her ® proximal tibia 3 months ago which has become progressively worse. She reports experiencing pain at the end of her runs, which has gradually come on earlier and earlier in her runs. She now reports the pain is constant during any weight bearing (both running and walking), and is intermittent at rest.

After a short history and brief objective evaluation the physical therapist quickly realizes the athlete has many issues outside the spectrum of physical therapy. For the patient to recover and heal properly the patient must be referred to other medical professionals as well as continue physical therapy.

Further Questions to Ask

1. How many miles a week does the patient run?
   Was there an increase in total mileage or intensity?
    
2. Does the patient exhibit structural abnormalities seen in a physical therapy examination (foot pronation / supination, knee varus / valgus, hip rotation and malalignment)?
    
3. In what condition are the patient's current running shoes?
   What do the wear patterns on the sole of the shoe indicate?
   Are the shoes appropriate for running?
   How long has the patient been running in her current shoes?
    
4. Has the patient lost a substantial amount of weight?
   Does she have amenorrhea?
    
5. What type of surface does the patient run on?
    
6. What is the patient's daily calcium intake?
    
7. What is the patient's nutrition and calorie intake?
    
8. What does the patient's past medical history indicate?
   Has she experienced a stress fracture prior to this diagnosis?
   What has helped decrease/increase her symptoms in the past?
    
9. By what percentage can a person safely increase their total weekly mileage?

   A. 4 to 5%
   B. 10 to 15%
   C. 30 to 35%