A good preventive strategy for stress fractures is to know your athlete’s medical history. Should he or she have an underlying chronic condition, such as vitamin D deficiency or hypothyroidism, be sure that the condition is well controlled. If abnormal menstruation is occurring, try to identify if it is attributable to an energy imbalance. In addition, should your athlete start a new training regimen, it is recommended that he or she starts at a low mileage and gradually increases his or her mileage each week (17). Orthotics may help in athletes with certain disorders of the foot (15). Many practitioners use video-assisted gait analysis in the rehabilitation program to provide secondary prevention in athletes who have had a previous stress fracture that does not have a clearly identifiable cause. In this setting, a runner’s foot strike, vertical motion, foot mechanics/position, stride length, and crossover gait can be analyzed and altered in a training program. The use of calcium and vitamin D also may show some benefit in stress fracture prevention (15).
Patellofemoral pain syndrome is a common disorder, accounting for approximately 25% of the knee pain visits to primary care sports medicine clinics (8). Its cause is a combination of mechanical and overuse factors that ultimately contributes to either patellar misalignment or maltracking. The athlete typically will complain of pain in the anterior knee that is worsened with going up stairs or up a hill. Risk factors for developing this condition include a large Q angle (more common in women), sulcus angle (defined by the intersection of the lines connecting the highest point of the femoral condyles to the deepest point of the trochlear groove) and patellar tilt ankle, decreased hip abduction strength, low knee extension strength, and decreased hip external rotation strength (12).
Because of the mechanical nature of this disorder, preventive strategies primarily should be aimed to core strengthening of the hip abductors and external rotators as well as obtaining a strength balance between the vastus medialis oblique and vastus lateralis (6). Surgery with a release of the lateral retinaculum was a previous treatment option; however, this has fallen out of favor and is now used for cases that don’t respond to simple physical therapy (longer than 12 months) (5).
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