Sunday, April 10, 2011

Inferior Pubic Ramus Pelvic STRESS FRACTURE! This HIP just ain't right.

This is the continuation of my earlier post about the Marathon Training Team.

Early August 2010, I was in the midst of training for the Richmond Marathon.  I was maybe doing 40-50 miles per week at this point.  I had been smart about not increasing the mileage too quickly (10% rule).
I was cruising along when suddenly, things didn't feel right.  Earlier in the day, I had done a long hill workout and in the evening, I was doing a 6 mile slow cruise jog with my boyfriend.
Not my hill.  My hill was an URBAN ASSAULT
in downtown Richmond VA.
When I struck the ground with my left leg, I remembered feeling a strange sensation.  After that, it hurt to run and we ended up walking the remaining 1 mile to get home.

Next day, I made an appointment with an sports medicine/orthopedic MD that someone at work had recommended to me.  When I saw him, he didn't know what was wrong.  He had thought it was maybe a hamstring insertion site strain.

He told me to call him in a week if it still hurt and we'd do an MRI.

I flagged down a physical therapist at work and he spent less than 5 minutes with me and he decided that I had a stress fracture in my L hip, based on my symptoms.  My hip hurt when I landed on my left leg but didn't hurt when I bent into all sorts of crazy stretching positions.

I returned to the MD and had an MRI, which did indeed show a stress fracture in my inferior pubic ramus.

The physical therapist had been working with runners (and non-runners) for over 30 years and it turns out that his experience is super valuable (figured it out before my MD).

Basically it's a stress fracture in the bottom of your pelvis.
best photo I could find at www.over40runner.com
Apparently, this is a very uncommon injury, but it does sometimes happen with female distance runners.

I ended up taking off 4 to 5 months of running.  Injury was on August 11th and I did not run outside again until December 25th.

This was my time for cross training and I did some stuff that my MD told me would be OK.  This included SPINNING/BIKING, SWIMMING, CROSS COUNTRY SKIING.  None of which were as great as running, but I would take what I could get.
getting ready to go out and cross country ski
Did some biking, but mostly spinning
And I did a lot of OBSERVING Tappan run.  Here he is:


I have been conservative about upping the miles since January and THANKFULLY have not had any issues since restarting running.

Has anyone else had stress fractures from running?  Any reoccurrences after resting and letting it heal?

If you have a stress fracture in your pelvis, please feel free to leave a comment and I'll e-mail you back with any advice or any answers to your questions!

46 comments:

  1. oh my gosh! That must have been so painful!! Fortunately I have not had any bone issues so far...how were you able to take off for that long?!

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  2. That is so scary! I'm so glad you aren't having any issues anymore! You are a little speed demon in your races! I love bright colors too!

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  3. Hey. I just found your blog this morning and finally was able to read this post this afternoon. I too fractured the top and bottom right side of my pelvis in October training for the Richmond Marathon. During an 18 mile run I felt a horrible pain around mile 9. I ran through it literally limping the last 5 miles which ended me up on crutches for 3.5 months :(

    It is refreshing to know someone else has experienced something like this because let me tell you it sucked and still does!

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  4. I am finding a lot about this injury and have yet to be formally diagnosed...that being said I have researched the hell out of this injury and feel it is what I am dealing with, it's refreshing to know that you will heal and run again...I will be getting an MRI but in the mean time I'm staying off of my feet as much as I can, as it hurts to put weight on my right leg...thanks for giving me hope sweetie!

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  5. I was diagnosed with this as well and it's truly horrible! After the MRI I was told complete rest for 6 weeks (no swimming, cross training etc. due to the stress fracture and muscle damage) Last week, I was told the stress fracture is healed and I am able to slowly start working out and running again. Unfortunatley, my first 2 mile run was very painful and I'm scared it's not healed although the MRI shows it is. I have done the elliptical and some biking and I'm still in some pain. Any suggestions or have you experienced this as well? I'd love to hear your feedback!

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    1. My stress fracture hurt for a LONG time...I waited 5 months before I started running again. But when I started back up, I was good to go and didn't have ANY additional discomfort. VERY IMPORTANT: I waited until it felt totally better while walking and while doing all other stuff and then I waited another couple weeks and then I ran, I didn't rush into it at all. Best of luck to you!! -Katherine

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  6. I am in the military and i just found out I got two pubic ramus stress fracturs and one in the same place in my left. my right has been hurting but my left hasn't. I can't march or do pt at all and now i am set back in my training. I will not make it home for thanksgiving but hope for christmas. they put me on cruhes for a month and hope that is as long as I will be on them. what exersises could u do with a stress fracture bc on pt days there going to send me to the gym but what could i do there?

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    1. Interesting that you're in the military and you had this injury...the only literature I was able to find about inferior pubic ramus stress fractures was written about women military recruits!

      I'm not sure what exercises to recommend, you should check with your doctor. My doctor told me (based on where mine was located) just to do whatever felt OK and that I could bike as long as it felt OK. However, the most highly recommended cross training was swimming because it was virtually no impact.

      Best of luck with your injury, I hope you feel better soon!

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  7. I just got the diagnosis of a pubic ramus stress fracture this morning. My doctor was very laid back about it and basically told me to just stop running. I have seen several other people online who were put on crutches. Were you? I am wondering how much my doctor knows about this.

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    1. I stopped running for 5 months when I had mine...I waited until it felt better and then waited another couple weeks and started back up. Since then (January 2011), I've qualified for Boston twice and haven't had any issues with it. Definitely make sure you let it heal and then wait a couple weeks before you start training again.

      I did NOT need to have crutches, but my MD gave them to me just for comfort if I wanted to use them.

      Hope you feel better soon!!

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    2. Thanks for getting back to me. I have had a hard time finding information on this injury and was a bit concerned my doctor might not know what he was doing when he didn't put me on crutches. I am relieved to hear yours did not either. Perhaps our cases are less severe than the others I've read? (Here's hoping!) I have little to no pain while walking on it at this point. Did you ever use the crutches you had?

      I am also glad to hear you made a full recovery and have done so well after it healed. It is heartbreaking news, but I will survive if I can swim and bike. Like you said... you take what you can get!

      Happy holidays.

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    3. I used the crutches only a handful of times...they were more of a nuisance and I'd rather put up with a little discomfort!!

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  8. Did you have to do PT? If you did, did it made a difference? How long did it take f
    Before you were able to walk in your normal gait and pace?

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    1. I never did PT, didn't really have a need to. I never had an altered pace or gait while walking...just with running. Five months before I was running again.

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  9. Finally diagnosed today, definitively, with a pubic ramus stress fx. I'd been prepping for Officer Training (military) by running every night after work (about 5 miles, 5 x a week), and experienced that sudden onset of stabbing aching pain in my inner groin, exactly 30 days ago....right out of nowhere, while jogging. I still feel it, butg it's gotten a little better.

    Worst part? I am on official orders to leave for my training and then Active Duty in 14 days. What now? Any military people out there... can you advise? I'm already a fully Commissioned Officer, but I'm so anxious and frightened they will medically DC me, before I even got a chance to start my military career. Help? Advice? And how long until I can run again?

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    1. BTW, I haven't ran since the initial injury. And also, my MRI confirmed the fx, but it took TWO Radiologists to finally identify it on the imaging. :P How long until I can run? And what to do to expedite healing?

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    2. That's funny that you mention that you're in the military, because the one piece of literature that I found about inferior pubic ramus stress fractures was in female military recruits.

      It took me 5 months before I could run again. 4.5 months until it felt perfect, then I gave it another couple weeks to just be sure.

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    3. Thanks. I'm freaking out a little, that the military will kick me out bc of it. Thanks for all your advice and experience. God bless.

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  10. I have a stress fracture here. I've been told to completely rest but think that swimming is ok? I have been doing some since i've been injured and will go mad not doing anything...it's pretty painful and i'm trying to use my crutches. Very fed up!!!

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    1. I was allowed to swim! In fact, it was encouraged, it's a great non-weightbearing exercise.

      I would have done more swimming if I actually enjoyed it. It took me 5 months before I ran again, so I mostly kept myself busy with spin classes (which my MD said was fine, based on the location of my fracture.)

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    2. How did you get out of the pool without putting weight on your leg. I fell yesterday in the kitchen and swimming sounds like an excellent idea.

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    3. You just have to figure out how to move around without putting pressure on it. Hardest part of my day was putting on my socks and pants in the morning.

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  11. Do you feel any pain now that you are fully recovered? Did you take some time off work??

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    1. I have no pain...I took off 5 months, started running again and had no issues. Less than 1 year after I started back running, I ran a 3:30 marathon (which was really fast for me).

      I didn't take any time off of work. It was uncomfortable, but not bad enough not to work.

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  12. NBR, I'm 12/20/2012 10:06 Anonymous poster, and just wanted to ask a few more questions,if you don't mind. Just found out the military rolled my orders back two months to heal this, before I leave for training. You think that'll do it? Also, did elliptical hurt? Tonight at PT, I did the E for twenty minutes and the insides of BOTH of my upper legs/inner groin HURT. Did you ever experience pain on the opposite side from your fracture (maybe because of overcompensating? Or ANOTHER fx, on the other side?! My worry is that the Radiologist made [another] oversight, and that God forbid, this is a situation of bilateral fxs). Was there pain when you reintegrated into activity, post total exercise abstinence? Elliptical or not, and is this just muscle pain now? I am so anxious. This happened on November 20th, and I am easily into six solid weeks. Can you give me your personal experience with timeframe, expectations, and pain issues? Thank you, in advance. I have no one who understands what hell I'm going through.

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    1. Oops, sorry. Saw your earlier post about the 5 months you took off from running. But if you could shed ANY insight on the other Qs, I'd so appreciate it.

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    2. I have no idea how long it'll take your injury to heal, it took mine over 4.5 months before I could run again.

      I can't really remember but I think the elliptical did not hurt a lot, it was maybe a little uncomfortable at times? I only did it a handful of times because I did not enjoy it. I'd stick to swimming for cross-training if you want to go fully non-weight bearing. I wouldn't do ANYTHING that exacerbates it or doesn't have 0 pain.

      I never had pain on the opposite side of my fx.

      Over 4.5 months of discomfort, then waited a couple weeks to fully heal and then started running again.

      Hope this helps! Heal up soon!

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    3. Thanks, NBR. I appreciate it.

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    4. I'm active duty military with 19 years in service. I believe I suffered a stress fracture during the Army 10 miler. I went to a doctor who told me it was not anything concerning so I ran a marathon two weeks later. The pain went from bad to worse. The marathon was on 4 November. After two weeks of limping I started to try to run again. First I could run only a 10th of a mile. Without a diagnosis I kept at it. As long as I noted improvement I kept increasing my running. I was just diagnoses with a left inferior pubic ramus stress fracture. However, the doctor said that I can run because the x-ray was fuzzy indicating healing. I have been continuing to run with mild discomfort that goes away in a few hours. I think you will be just fine. In the military you almost never run for more than two miles at a time and at a slow pace. Usually you do this three days a week. I suspect you will be able to accomplish this and much more. I feel confident that I can max my PT test and still leave the men in the dust.

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    5. Wow that's pretty amazing! I wasn't able to even take a couple steps of running because it felt so awful...but perhaps if I were tougher, I could have pushed through it, but I didn't have anything like a PT test to pass. Best of luck on your PT test!!

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  13. I'm another "anonymous" poster. So glad I found your blog. I believe I have a stress fracture of the inferior pubic ramus. Have had three hip surgeries in the last four years (two on the left side). Just before the revision I had last July I felt something happen on the left side p.r. and was in extreme pain for the last two weeks before my hip surgery. (I was taking an aerobic class -- "Sh'bam!" -- in order to maintain some fitness when it started.) I could hardly walk. After surgery I was only partially weight-bearing for several weeks, so that side had extended time to heal. I was doing OK until I went back to work in the fall and began ramping up my exercise regimen (elliptical and strength=training machines, along with some warm-water therapeutic exercises). Went to see my family doctor, who thought it was a strained adductor, so he put me back in back in p.t. After a month, it is not better and my physical therapist thinks it is a stress fracture of the inferior p.r., but advises that maybe I should get other things ruled out. He was in the military and saw this injury a lot with the female recruits. It often feels like I am sitting on a rock. Does that sound familiar to you or anyone out there?

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    1. Yes, the only literature I was able to find about the inferior pubic ramus was in female recruits!

      I don't remember feeling like I was sitting on a rock...I usually only felt it when I stood on it or beared weight on it.

      Best of luck to you!

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    2. Anonymous from Jan. 5:
      I went back to my hip surgeon, and what they found was not a stress fracture but a complete fracture of the inferior pubic ramus. Same treatment, though ... rest it and do whatever exercise you can do without pain.
      It is healing ... so I just have to let pain be my guide. They pulled up the previous x-rays and it looks like it was present when I had my hip surgery (back in July). Even though it was visible on the x-rays, they didn't "notice" it because it's part of the pelvis and they were looking at the hip structure (not the pelvis).
      I do floor exercises for strengthening (no resistance yet), some easy aquatic work, and recumbent bike. Like others here, I know it will be slow. But I'm thinking positive and just have to give it the time. The doc will take another look at it in 3 months.

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    3. Anonymous from Jan. 5:
      I went back to my hip surgeon, and what they found was not a stress fracture but a complete fracture of the inferior pubic ramus. Same treatment, though ... rest it and do whatever exercise you can do without pain.
      It is healing ... so I just have to let pain be my guide. They pulled up the previous x-rays and it looks like it was present when I had my hip surgery (back in July). Even though it was visible on the x-rays, they didn't "notice" it because it's part of the pelvis and they were looking at the hip structure (not the pelvis).
      I do floor exercises for strengthening (no resistance yet), some easy aquatic work, and recumbent bike. Like others here, I know it will be slow. But I'm thinking positive and just have to give it the time. The doc will take another look at it in 3 months.

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    4. Oh my goodness, a true fracture?! I hope it heals up quickly!! Best of luck with the rest and non-impact workouts, I know that can be hard :(

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  14. I am the January 3rd poster (mil officer) an i can totally relate with all of what you are saying. Have you gotten a recent MRI to definitively diagnose the problem? Considering you have already had prior hip surgeries, I would think an MRI would probably be the most helpful in elucidating the problem.

    What I am finding to be so intensely frustrating, is that so little is known about how to expeditiously diagnose and treat this condition (which obviously seems to strike the most active, fast-paced individuals). More so, nobody knows what they're doing! Elliptical is NOT helpful for me yet my doc and PT insist it should be fine and the pain I feel is just muscular. Um, NOPE. It's frustrating beyond belief to be out of play, no timeline for a full return (and with active duty orders, this is no bueno), and no suggestions from my medical people. I have received tremendous help from other sufferers (thanks to this page), but that's all. So frustrating. I wish the best for a speedy recovery, for all who are suffering from this misery.

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    1. I know, it is so frustrating.....a lot of MDs don't seem to be super familiar with this type of stress fracture...

      Hope you heal up soon!!

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  15. I posted earlier as well. I am about 8 1/2 weeks into my p.r. stress fracture and am still feeling some discomfort and pain. My doctor did not put me on crutches but did suggest I stop all exercise for 10 weeks. I have done that but still maintained my regular daily activities (which is pretty active with 3 kids). I know you said you waited 5 months to run, were you in some pain and discomfort during most of that time? If yes, did that concern you while cross training? I am excited about swimming soon but am fearful too. I am wondering if the pain means it is not healing or just that it has yet not yet healed completely. I am anxious to put this behind me!

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    1. I would never consider it to be a huge pain (unless I tried to run on it, in which case it was excruciating), it was definitely more of a discomfort when putting weight on it...like when I'd put on my socks and stuff.

      I didn't do any cross training if I was able to feel the stress fracture. Elliptical didn't bother me, but I've heard of a couple people who did have some discomfort with it. Swimming was fine, but I'm not a huge swimming. I think I did do a lot of resting from heavy exercise, which I think is the most helpful thing to do. Swimming does not cause you to bear any weight on the injury, so it should be OK.

      I think it will probably feel comfortable for a long time, that's normal for this type of thing I think.

      Hope you feel better ASAP!

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  16. I'm currently recovering from a hip stress fracture and now able to do the elliptical and bike. Do you have any exercises you do to prevent repeat injuries?
    Thanks

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    1. I actually don't! After taking off 5 months from running, I was completely healed and haven't had the same issue since. I've tried to add in more rest days and more hip/core strengthening exercises. Best of luck to you!!

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  18. I'm so glad I found your blog! There's absolutely no information about this in my language. I've had the very same stress fracture since january but it wasn't diagnosed right until march. It still hurts a lot - sitting is horrible and I have to use a crutch when I walk - but my doctor said I could do some aqua jogging. Did your fracture hurt all the time when you started swimming and did swimming actually help against the pain?
    Thank you :)

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    1. I actually didn't really swim much at all, I never aqua jogged. Took me 4.5 months to not feel the pain in my hip... Best of luck to you!

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  19. So glad I found your blog! Guess who just found out she has SEVERAL stress fractures in her pubis ramus? My story is all on my blog, but sounds similar. I had just finished my peak weeks -- 5 of them -- at 70 miles a week and topped it off with a hilly 10 mile race. Took it easy for a few days after the race, and four days later felt something was not right.

    Unfortunately I went through some misdiagnosis before I finally got confirmation TODAY, as proven by MRI. I haven't run much since then -- I ran 7 miles on March 2 (which was pretty much the shortest distance I'd ever run during marathon training), didn't run for two weeks and then tried 2 (hurt), tried 2.5 a couple days later (hurt), stayed off it for six weeks, then tried a minute on, a minute off a couple of times last week (hurt) -- so that's when I demanded, er firmly requested, an MRI.

    I'm looking forward to reading more of your blog as I start the recovery proccess-- thanks!!!

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    1. Oh yeah it took me an eternity to feel better (4.5 months) and then I gave it additional couple weeks to fully heal before I headed out running.

      I looked around your blog a little, it appears that you're also in Virginia woohoo!!

      Best of luck with your injury, it's a tough one to get over. But when it's done, it's done and you won't have to worry about it after that!

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