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. <br>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. <br>After six weeks of modified hip rehab and relative hamstring rest, hamstring flexibility was permitted and a hamstring strengthening program was started. <br>After 4 weeks of full rehab, strength was equal and range of motion was normal bilaterally. <br>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. <br>Knowledge of unusual sites of stress fractures is necessary to avoid late diagnosis, increased morbidity, and increased rehabilitation time. <br>MRI is the most sensitive modality to detect stress fractures. <br>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 <br>2) Hong R, Hughes T. Magnetic Resonance Imaging of the Hip. Journal of Magnetic Resonance Imaging 27: 435-445. 2008 <br>3) Sabo M. Physical Therapy Rehabilitation Strategies for Dancers. A Qualitative Study. Journal of Dance Medicine and Science. 17(1): 11-17. 2013 <br>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 <br>5) Steinberg N. Injury Patterns in Young, Non-Professional Dancers. Journal of Sports Science. 29(1): 47-54. 2011 <br>6) Reid DC. Prevention of Hip and Knee injuries in Dancers. Sports Medicine 6. 295-307. 1988

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