Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8323-8329
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8323
Femoral neck stress fracture and medial tibial stress syndrome following high intensity interval training: A case report and review of literature
Tin Lung Alan Cheung, Dekai Ng, Fiona Millicent Cheung, Dawn Suwanie Tan
Dawn Suwanie Tan, Fiona Millicent Cheung, Dekai Ng, Tin Lung Alan Cheung, Department of Orthopaedic Surgery, International Orthopaedic Clinic, Singapore, 329563, Singapore
Author contributions: Cheung FM and Cheung TLA designed the research; Tan DS and Ng D performed the research; Ng D and Cheung FM analysed the data; Tan DS and Cheung FM wrote the paper; Cheung TLA contributed to the revision process and wrote the revised manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest involved.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tin Lung Alan Cheung, MBBS, Director, Department of Orthopaedic Surgery, International Orthopaedic Clinic, 38 Irrawaddy Road, 05-24 Mount Elizabeth Novena Specialist Centre, Singapore 329563, Singapore. drcheung@ioc-ortho.com
Received: February 27, 2022
Peer-review started: February 27, 2022
First decision: April 8, 2022
Revised: May 25, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 16, 2022
Processing time: 155 Days and 4 Hours
Abstract
BACKGROUND

Femoral and tibial stress injuries are commonly found in long distance running athletes. Stress fractures have rarely been reported in athletes performing high intensity interval training (HIIT) exercise. The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.

CASE SUMMARY

A 26 year old female presented with bilateral medial tibial pain. She had been performing HIIT exercise for 45 min, five times weekly, for a seven month period. Her tibial pain was gradual in onset, and was now severe and worse on exercise, despite six weeks of rest. Magnetic resonance imaging (MRI) revealed bilateral medial tibial stress syndrome. As she was taking norethisterone for birth control, a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck. She was managed conservatively with analgesia and physiotherapy, but continued to exercise against medical advice. She presented again six months later with severe right hip pain. MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region. Her symptoms resolved with strict rest and physiotherapy.

CONCLUSION

HIIT may cause stress injury of the tibia and femur in young individuals.

Keywords: High intensity interval training; Medial tibial stress syndrome; Femoral neck stress fracture; Exercise; Fracture; Case report

Core Tip: Stress injuries of the femur and tibia commonly occur in long distance runners, but have rarely been reported in individuals performing high intensity interval training (HIIT). An index of suspicion for stress injury, and proper investigation is required for patients presenting with hip or tibial pain following HIIT.