Working Diagnosis:
Compression side femoral neck stress fractures, bilateral much more severe on the right than the left

Treatment:
Recommended non-weight bearing with crutches and acetaminophen as needed for pain

Outcome:
At one month follow up patient was advised wean off the crutches, but to start using them immediately if he developed any pain or discomfort. He was also told to gradually return to work with only one twelve-hour shift per week for the next two weeks and then progress as tolerated. He was instructed it was ok for upper extremity weight training and upper extremity cardiovascular exercise, such as arm bike. Patient was to avoid lower extremity lifting as well as treadmill, elliptical, bike, and swimming. Physical therapy was ordered to work on hip abductor/gluteal strengthening, gradual progression back to activity and lifting, advance home exercise program.
At the two month follow up he was pain free and told he could return to work full duty without restrictions. He could continue to progress activity and exercise as tolerated. The plan was to repeat the MRI at 3 months, but the patient did not return.

Author's Comments:
It is unclear if the labral tear resulted in improper loading resulting in stress fractures, or if fractures occurred due to overuse from weight lifting program alone. Femoral neck stress fractures should be included in the differential diagnosis of strength athletes with changes in their weight lifting programs.

Editor's Comments:
Weight lifting sports includes a number of activities including Olympic weight lifting, power lifting, body building, crossfit, and strong man to name the most popular. While rare, one can see how weight lifters can be susceptible to stress injuries much like endurance athletes because of the chronic repetitive stress by heavy weights and high repetition practice. Compressive loads on the hip while doing deadlift have been measured to 1,047 Nm in powerlifters. Also important to note that body builders and powerlifters may have a restrictive diet that focuses more on protein than adequate caloric intake. Just as in endurance sports, stress fracture management focuses around decreasing the load to the bone and optimizing bone health.

References:
Siewe J et al. Injuries and Overuse Syndromes in Powerlifting. International Journal of Sports Medicine 2011; 32(9): 703-711.
Siewe J et al. Injuries and Overuse Syndromes in Competitive and Elite Bodybuilding. International Journal of Sports Medicine 2014; 35(11): 943-948

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