Working Diagnosis:
Ischial Stress Fracture secondary to overuse.

Treatment:
The patient was put on relative hamstring rest, as she continued her core, lumbar and hip strengthening. She was held from activity for 6 weeks which included withholding her from dancing and gym class, though she was allowed to weight bear.
She also maintained a food journal to assess for the female athlete triad, which was negative.

Outcome:
Patient has been showing improvement in pain and discomfort with each subsequent three-week visit.
After six weeks of modified hip rehab and relative hamstring rest, hamstring flexibility was permitted and a hamstring strengthening program was started.
After 4 weeks of full rehab, strength was equal and range of motion was normal bilaterally.
At 10 weeks post treatment, she was allowed to return to dance.

Author's Comments:
Stress fractures of the lower extremity are very common. However, most involve the long bones of the leg, usually affecting the femoral neck and proximal shaft of the femur.
Knowledge of unusual sites of stress fractures is necessary to avoid late diagnosis, increased morbidity, and increased rehabilitation time.
MRI is the most sensitive modality to detect stress fractures.
There appears to be a lack of research in this population of dancers, in regards to age.

Editor's Comments:
This case demonstrates the importance of close follow-up and further investigation if your patient's symptoms are not improving.

References:
1) Clarke A.W. Conell D.A. Case Report: Bilateral Ischial Stress Fractures in an Elite Tennis Player. Skeletal Radiology 38: 711-714. 2009
2) Hong R, Hughes T. Magnetic Resonance Imaging of the Hip. Journal of Magnetic Resonance Imaging 27: 435-445. 2008
3) Sabo M. Physical Therapy Rehabilitation Strategies for Dancers. A Qualitative Study. Journal of Dance Medicine and Science. 17(1): 11-17. 2013
4) Jacobs C, Hincapie C. Musculoskeletal Injuries and Pain in Dancers. A Systemic Review Update. Journal of Dance Medicine and Science. 16(2): 74-84. 2012
5) Steinberg N. Injury Patterns in Young, Non-Professional Dancers. Journal of Sports Science. 29(1): 47-54. 2011
6) Reid DC. Prevention of Hip and Knee injuries in Dancers. Sports Medicine 6. 295-307. 1988

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