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Wednesday, May 15, 2013

Femoral stress fracture versus hamstring tear

If you remember way, way back in November, I was convinced that I had a hamstring tear. It wasn't until May that I was diagnosed with, instead, a distal femoral stress fracture! Why the confusion?

1. I was confused:
- The pain began as very diffuse pain and even numbness. I couldn't even point to where it hurt. From my hip to my knee was numb, mostly at the back of the leg.
- I had bruising in striations on the back of my thigh. I still can't explain this. It was definitely there. Did I have two injuries at once? Did a hamstring strain lead to a fracture?
This is someone else's hamstring. But my bruising looked almost exactly like this. 
- Graston - a soft-tissue treatment - brought relief. After my first session of Graston I could finally walk down stairs.

2. Medical professionals were confused:
- By the time I saw a chiropractor, pain had localized to a pretty small area on the back of my thigh (and the front if my thigh was unsupported, like dangling off a chair). I asked the chiropractor if he thought it could be a stress fracture, but he immediately wrote it off due to the location. The injury was still new, so I pressured him, and he did the "tuning fork test", which was negative - however, my thighs are muscular and fat, and I seriously doubt that fork got anywhere near my bone (plus the test is just 50% accurate!)
- When I saw a PT, he was already biased by my previous diagnosis. I brought up stress fracture again, because by now I could probe under the muscle and tendon and touch a spot the size of a quarter on the bone that hurt to pressure. But my PT very firmly told me there was "zero chance" of a stress fracture at that location.

3. I did not follow traditional treatment:
- I didn't completely rest.
- For some reason I decided to see a chiropractor first, hoping to discover an imbalance that caused the "hamstring tear". I did rest on my own, but the chiropractor actually urged me to return to running sooner than I had planned. He told me that it was the best way to get blood flow to an injured tendon, which he thought was the cause of the lingering pain.
- My PT also encouraged continued sport, as he does not advocate complete rest for any soft tissue injury.
- I didn't get any imaging done until five months from injury.

So there you have it. A lot of confusion contributing to a misdiagnosis. I learned two things from this injury:
1. See a doctor first. When my doctor walked into the exam room in May, 5 months after injury, he was reading my chief complaint. Before I finished my first sentence he was saying, "Stress fracture. Go get in that x-ray machine." I don't usually like doctor's jumping to conclusions, but he was right. What can I say? Go to the professional with the most experience and the ability to order imaging!
2. REST. Runners love to hear, "Oh, you can run through it" or "You need to use the muscle to get blood flow to the area" etc. But I think I learned my lesson here. Most injuries need rest and rehab and honestly a little rest never, ever hurts you! From now on, I rest my injuries! And then I rebuild.


  1. You know, I love the thought that these alternative treatments are great, and chiropractors can help with running injuries... but the two times I have seen chiropractors for running injuries, they have failed to help me. Conversely the two times I have seen two separate sports doctors, they have diagnosed and prescribed treatment that has fixed my problem. Its anecdotal evidence, but like you - Im always going to the doctor first now!

  2. Yea, I learned my lesson in 2011 - always go to the sports doc first so they can diagnose what you have. Chiropractors and PT people can be good about some treatment and helping with symptoms, but some of them aren't qualified to fully diagnose you to discover what you are dealing with. Also, isn't it their job to have you come back as often as possible? I realize that most chiros would be truthful about what you are dealing with, but if you go to a sports doc and get fully healed, you are lost to them as a patient.

  3. Frustrating to have lost all that time, I'm sure, especially when you suggested the actual problem early on. I'm glad you've got the answers now, anyway.

  4. Rest is HARD. Hope you are feeling better!

  5. And sometimes we like to live a bit in denial city, hoping for the best. It's so tricky. I will say that years ago when I had a tibial stress fracture, my calf hurt like a beast too, so maybe the opposing muscle hurting is part and parcel to the injury?

  6. I agree Doc is the first step
    The second maybe another doc
    Then rehab
    Rest...I did the same as you never really rested
    This week is the first week I have not taken one step on my treadmill
    This is not easy but now I have a new plan and I will follow it and try to avoid surgery hopefully...
    I hope you are starting to feel better

  7. those weird bruise stripe things in that stranger's photo and on your leg are so crazy....I wonder what causes that.

    At least a stress fracture will heal up and you'll be done with it, that's how mine in my hip was at least.

    1. I know - so distinctive! I think muscle striations cause the pattern.

  8. I believe my chiropractor worsened my stress fracture. I have a tibial stress fracture...causing pain I thought was my knee. The chiropractor said my leg was out of alignment, pulled my leg and whacked the sides of my knee to put things back. I told him this was hurting...but he didn't stop. The pain got worse, and I had an MRI from the sports doctor and found a severe stress fracture. No more chiropractor for me.

  9. “Go to the professional with the most experience...” - I agree with you. When our health is on the line, it's always best to look for the most experienced specialist to assure that we will be healed immediately. This may not be a good experience for you, but what matters most is you're getting better. I hope you're now doing great! => Tanisha @ US Health Works (Lynnwood Center)