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Hip Stress Fracture
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FML

Just got my MRA results (MRI with contrast) and they don't look too peachy. I need to find a surgeon in NYC who specializes in this kind of situation, go for a chat, figure out what I need to do + what I can and can't do in terms of exercise. Anyone have any suggestions?

The crazy part is that the groin pain I'd been having since mid-December was mostly gone. I've decreased my mileage a lot but was still getting 3-4 runs in per week at 5-8 miles at a decent clip, and a managed a 14 miler last weekend without any real pain (1 on a scale of 1-10 basically). Thought I was getting better. I only got the MRI to really know what I was dealing with and see if it was indeed a labrum tear, and if so, how bad. Looks like it is a tear, and a fracture, and some other stuff. Lovely.

For those curious:


FINDINGS: There is fusiform cortical thickening along the medial cortex of the femoral
neck, just above the lesser trochanter, in the typical location for hip stress fracture. A
subtle transverse linear focus is present in the cortex at the site, consistent with
cortical stress fracture. There is a small amount of periosteal edema at the site. In
addition, there is a small amount of marrow edema lining the adjacent endosteal cortical
surface, seen on both the T1 and T2-weighted scans. The appearance is thus consistent with
cortical stress fracture. There is no fracture line extending into the marrow cavity of
the bone, however. The remaining included osseous structures demonstrate normal marrow
signal characteristics. There is no avascular necrosis within the femoral head. There is
mild retroversion of the upper acetabulum, predisposing to "pincer -type" femoroacetabular
impingement. There is also a small cam lesion on the superior surface of the subcapital
femur. The bony articular cortices of the hip are smooth. There appears to be slight
thinning and subtle irregularity of articular cartilage in the superior joint space,
especially anteriorly. There appears to be a moderate-sized os acetabula versus prominent
spur embedded within the superior to posterior acetabular labrum. This causes overall
enlargement of this labral segment. Also, there appears to be some subtle tearing of the
anterior acetabular labrum. The corrected right femoral angle of anteversion is 0 degrees.
There is no inflammatory change or fluid in the greater trochanteric bursa. The gluteus
minimus and medius tendons are well attached onto the femoral greater trochanter, without
sign of tendinosis or partial tear. The proximal right hamstring attachment onto the
ischium tuberosity appears normal. The remaining soft tissues surrounding the hip are
unremarkable.

IMPRESSION:

1. Cortical stress fracture along the medial surface of the right femoral neck. There is
no extension of the fracture line into the marrow cavity at this time.
2. Subtle developing chondromalacia in the superior joint space, especially anteriorly.
3. Tear of the anterior labrum. There also appears to be a prominent spur or os acetabula
embedded within the labrum at the junction of its superior and posterior segments.
4. Possible underlying mild "mixed" femoroacetabular impingement.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Easy answer. Nothing for at least 3 months.



Sponsored By Jack and Adams Bicycles
Austin, TX
http://www.jackandadams.com
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Re: Hip Stress Fracture [Blazier] [ In reply to ]
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Blazier wrote:
Easy answer. Nothing for at least 3 months.


I'm considering weight lifting, since I don't want to get fat. Obviously I won't be doing leg work, but I wonder if there are other support muscle things I can do for the legs, light or no weight bearing. I also assume I can swim. I want to know how long before I can bike and also if I can use one of those silly ellipticals.

~~~~~~~~~
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Last edited by: Mendeldave: Mar 6, 14 7:42
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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This is a quality , complete report on your MR arthrogram.
The issues seem relatively minor.
1. Cortical stress #. This is undisplaced,small, healing, with no current marrow edema ( who knows what it looked like in December- almost certainly worse).
2. Subtle chondromalacia= minimal softening of cartilage. Common in a high % of athletes.
3. Labral tear. The report says " possible, subtle"- maybe yes, maybe no.
4. Possible mixed FAI. Again "possible"...This is minor , and not uncommon.
No running for a month. Swimming, water running, and Z2 biking should be fine.
Treat the patient, not the imaging study. Let honest self-assessment/pain be your guide.
By all means , get an ortho opinion.
That's what I would do- radiologist for 30 years, triathlon for 10. All the best.
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Re: Hip Stress Fracture [rosegarden] [ In reply to ]
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rosegarden wrote:
This is a quality , complete report on your MR arthrogram.
The issues seem relatively minor.
1. Cortical stress #. This is undisplaced,small, healing, with no current marrow edema ( who knows what it looked like in December- almost certainly worse).
2. Subtle chondromalacia= minimal softening of cartilage. Common in a high % of athletes.
3. Labral tear. The report says " possible, subtle"- maybe yes, maybe no.
4. Possible mixed FAI. Again "possible"...This is minor , and not uncommon.
No running for a month. Swimming, water running, and Z2 biking should be fine.
Treat the patient, not the imaging study. Let honest self-assessment/pain be your guide.
By all means , get an ortho opinion.
That's what I would do- radiologist for 30 years, triathlon for 10. All the best.

Thanks for that. ST is always a wealth of info! I am scheduling an appt with a dr who specializes in this specific injury (a recco from ST actually, that I passed on to my chiro and he said that's the guy he'd recommend too). So, I'll keep people posted if they're interested. Hopefully I'll be back up and running after some rest. In the meantime, I'm gonna do crossfit.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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have not read the thread.
Find a hip specialist. This place is in Maine
http://www.orthoassociates.com/...cialists/huffard.php
they treated my hip issues - maybe they could give you some names of someone closer.

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD
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Post deleted by DrTriKat [ In reply to ]
Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Mendeldave wrote:
I need to find a surgeon in NYC who specializes in this kind of situation, go for a chat, figure out what I need to do

As noted the absolute last thing you want is surgery - specifically you don't want hardware in your hip if you can avoid it. Maybe you're talking about surgery for the possible soft tissue (labrum) issue, but that seems premature.

As to weights and not wanting to get fat...let me repeat, the last thing you want is surgery with hardware in your hip, which is what you'll end up with if you break it all the way through. You need time off. Off. If you don't want to get fat, eat less. You should be able to swim of course, but even hard pushes and breaststroke kick could continue stressing the area more than you want to.

Your body is telling you "keep pushing me and I'm going to break your leg". Listen. Take the long view. Be patient.
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Re: Hip Stress Fracture [skip] [ In reply to ]
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I'm not planning on surgery (want to avoid it at all costs) but I'm getting the advice of a guy who specializes in hip and specifically labrum tears to get an idea of what, if anything, I need to do. For now I'm resting. Just walking but no running and no bike. The lifting is upperbody only and not heavy weights. Also doing some easy ab work.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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See Marci Goolsby, MD at HSS on the Upper East Side. She's an expert in stress fractures.

http://www.hss.edu/physicians_goolsby-marci.asp
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Re: Hip Stress Fracture [teamfrankel] [ In reply to ]
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I'm seeing dr Kelly at hss (he's the labrum guy) but he will review my MRI and decide if I need to see him, or someone else at hss.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Dr. Kelly is a top hip arthroscopist, but it is unlikely you'll be heading to surgery if the stress fracture is your pain generator, as non-operative treatment is the proper course of action. In addition, even with a labral tear/femoroacetabular impingement, many patients get better with PT and don't require surgery. Good luck.
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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I fractured my acetabulum in September and saw Christopher Michelson at Columbia Presbyterian whom I found to be excellent. If you want his info, feel free to PM me.
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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How did you injure yourself? I have hip injury as well... Did 3 marathons(in a 3 month period) on it regardless. Ton of pain... Groin, buttocks, and then ball and socket a couple more miles down the road. I was evaluated by pt but things appear stable to him. Would pt have caught yours?
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Re: Hip Stress Fracture [woof] [ In reply to ]
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How did I do it? I suspect it was just the really high mileage I had with little to no rest last Aug Sept Oct Nov and most of Dec. according to my running log it started to hurt mid Dec (70+ mile weeks, feeling good and motivated!). I ran a few very successful races on it, then a snowy trail marathon and then some half marathons. All with discomfort. Eventually I was limping when simply walking.

PT failed to help and thought I had a mild groin pull. Went to PT probably 2 months with no positive returns. Switched to my chiro and he said it was more than a groin pull an probably labrum tear and impingement. He did get me feeling 95% better after just a few sessions attacking all the leg muscles that had basically locked up.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [woof] [ In reply to ]
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woof wrote:
How did you injure yourself? I have hip injury as well... Did 3 marathons(in a 3 month period) on it regardless. Ton of pain... Groin, buttocks, and then ball and socket a couple more miles down the road. I was evaluated by pt but things appear stable to him. Would pt have caught yours?

Do you know what your injury is? If not, you might want an MRI with contrast. The first MRI I had (without contrast) showed nothing and they told me I was 100% fine. Clearly not the case. My Chiro did a muuuuuuuuuch better job that my PT, but that could be an experience thing. He's been doing it a lot longer than she has. If you're getting good results from the PT, might be that's all you need. Personally, even when I was getting "better" I wanted to know more definitively what was causing the pain, and just an educated guess by those working on me. I really was not expecting a fracture!

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Ya the marathons have been getting less painful. But my run volume is super low. For the pt, no clicking or impingement. But deep in my buttocks, basically the sitting part of my hip bone, hurts quite often. Running always hurts it. Uphill running is even worse. The groin gets tight but not like is used to. The tightness over the ball and socket begin take hold after running for awhile. And all this started in early November. IMAZ went okey for me though. 3 weeks after that I did a marathon and pulled out at mile 17 due to the pain.

I have IMAZ again this year and don't want to be out for it. So I am thinking about calling my doctor to see about getting that MRA. I have another marathon in 1.5 months that I want to do, but if the MRA shows a tear or something else, I'll call it off. Plus I have a Grand Canyon(R2R2R) coming up in mid June.
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Re: Hip Stress Fracture [woof] [ In reply to ]
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woof wrote:
Ya the marathons have been getting less painful. But my run volume is super low. For the pt, no clicking or impingement. But deep in my buttocks, basically the sitting part of my hip bone, hurts quite often. Running always hurts it. Uphill running is even worse. The groin gets tight but not like is used to. The tightness over the ball and socket begin take hold after running for awhile. And all this started in early November. IMAZ went okey for me though. 3 weeks after that I did a marathon and pulled out at mile 17 due to the pain.

I have IMAZ again this year and don't want to be out for it. So I am thinking about calling my doctor to see about getting that MRA. I have another marathon in 1.5 months that I want to do, but if the MRA shows a tear or something else, I'll call it off. Plus I have a Grand Canyon(R2R2R) coming up in mid June.

I didn't have any clicking either and was sore after sitting for a while, when I'd get up to go get water or go wherever, I'd limp a few minutes until it "warmed up." Now I have none of that. For a while I kept expecting pain when I'd get up, since I'd gotten used to it. But now it's gone. I could feel a very minor ache coming and going a bit last night when I was in bed. It was super mild and I actually had to concentrate to feel it. I really think my chiro did wonders loosening up the area.

I have two 70.3s this season I don't want to miss. Plus, I'd planned on two, maybe 3 marathons (want to re-qual for Boston, and just race them because I like to) and a lot of podium spots I wanted to defend at shorter stuff. We'll see how all of that goes depending on what my doc ends up saying.

Hopefully you'll be ok too, and won't have to miss anything!

Right now I'm off to the gym to do arms. Sad how little I can lift lol.

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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This may be a bit of a tanget, but I'm experiencing something similar and am wondering if it could be the same thing. I'm a fairly regular runner and have been for the last 3 years (2 marathons, multiple halfs, regular mileage between 30 and 45/week depending on if I'm training). 4 weeks ago I began having a tightness in my left hip that I felt when running. One or two days after I first noticed it (it came on very quickly), I was walking with a limp all day long, and going up stairs (or simply walking) was a nightmare. I've stretch and foam rolled like crazy. I've taken ample rest time for a muscular injury just now started back to running. The pain is still there, though not nearly as bad as it was. Some days I can get past 4 or 5 miles and it seemingly "goes numb". It is no longer excrutiating to run, but I do still feel it. When I stop running, it's difficult to take a step and get going again. Has anyone experienced anything like this? When it's at it's worst, I can feel it in my groin, glutes and even lower back. During the day when I'm not running, it's more of a dull ache. Any advice would be helpful! I've made an appointment with my orthopaedic doc and skipped right over my family doc, but it's not for 2 weeks and the anticipation is the hardest part. I don't want to waste his time if this is nothing, but for a girl who was trying to qualify for boston this year, I can't stand more weeks off or the thought of being passed from doc to pt to chiropractor, etc.
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Re: Hip Stress Fracture [jgoodb] [ In reply to ]
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Good call on seeing the doc. Is there a chiro near you who does ART? That might be all you need but what you describe is close to my experience too.

My chiro told me my biggest running problem is I wait too long when I get injured. He says if it's sore and 2 or 3 days doesn't cure it, see someone. I will follow this advice in the future, given my current circumstance.

If your doc orders an MRI for you, be sure to speak to him/her about the difference between an MRI and an MRA (MRI with contrast). My first MRI showed nothing. It was the contrast one that showed the issues.

Hopefully you'll be ok and on your way to Boston!

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Thanks for the feedback. And I just read my original post and it seems so all over the place. It's so hard to describe.

No one close to me does ART, and the closest place is a little over an hour drive. It's worth a shot though if you think it could help. I'm also going to go into my appt armed with questions because the last thing I want to do is try one thing after another and have a 3 week wait for an appointment each time.

So frustrating! Thanks again.
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Re: Hip Stress Fracture [jgoodb] [ In reply to ]
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jgoodb wrote:
It's worth a shot though if you think it could help.

I can only speak from personal experience but my chiro is the only person who has ever fixed a running issue I've had. ITB syndrome, PF, shin splints, to name a few. Like I said earlier, my recent bit with the PT did nothing, I was feeling 50% better after the first chiro visit, and now I'd say 95%-99% better feeling (though I'm still damaged... clearly he can't heal bones lol).

~~~~~~~~~
Empire Tri Coach
Team Gatorade Endurance
USATF Coach | NYRR Distance Pacer
Dad of twins
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Re: Hip Stress Fracture [jgoodb] [ In reply to ]
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If you are talking "tingling"... that is a nerve issue most likely stemming from your lower back. Somebody will probably end up ordering an MRI. Not sure a chiropractor is a good choice until after diagnosis, for fear of a bad disc rupturing. I may be in a similar predicament as I have another marathon(up hill) coming up that I want to train for and then would like to qualify for Boston on the next one.
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Mendeldave wrote:
woof wrote:
Ya the marathons have been getting less painful. But my run volume is super low. For the pt, no clicking or impingement. But deep in my buttocks, basically the sitting part of my hip bone, hurts quite often. Running always hurts it. Uphill running is even worse. The groin gets tight but not like is used to. The tightness over the ball and socket begin take hold after running for awhile. And all this started in early November. IMAZ went okey for me though. 3 weeks after that I did a marathon and pulled out at mile 17 due to the pain.

I have IMAZ again this year and don't want to be out for it. So I am thinking about calling my doctor to see about getting that MRA. I have another marathon in 1.5 months that I want to do, but if the MRA shows a tear or something else, I'll call it off. Plus I have a Grand Canyon(R2R2R) coming up in mid June.


I didn't have any clicking either and was sore after sitting for a while, when I'd get up to go get water or go wherever, I'd limp a few minutes until it "warmed up." Now I have none of that. For a while I kept expecting pain when I'd get up, since I'd gotten used to it. But now it's gone. I could feel a very minor ache coming and going a bit last night when I was in bed. It was super mild and I actually had to concentrate to feel it. I really think my chiro did wonders loosening up the area.

I have two 70.3s this season I don't want to miss. Plus, I'd planned on two, maybe 3 marathons (want to re-qual for Boston, and just race them because I like to) and a lot of podium spots I wanted to defend at shorter stuff. We'll see how all of that goes depending on what my doc ends up saying.

Hopefully you'll be ok too, and won't have to miss anything!

Right now I'm off to the gym to do arms. Sad how little I can lift lol.



Went to my doc and he said the pain area combination doesn't fit to the hip. He thinks its coming from my lower back as I have degenerative issues there. But I don't get it, it was very tender around the hip. The hip is very stiff and bit of trouble to walk on. But there is no shooting or tingling pain like that from a compressed nerve. My back doesn't really hurt much either. But he ordered Xrays of the lower back and hip, waiting to get results to see if more advanced imaging needs to be done. Maybe running 8 full marathons and an Ironman within a year wasn't such a good idea.
-----------------------
Got the results... no progression in lumbar. So the back is not the issue. Hip showed negative, but he doesn't want to do the MRA. Ok... then I am not stopping. What is the worst that can happen if there is a labrum tear?
Last edited by: woof: Mar 11, 14 7:46
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Re: Hip Stress Fracture [Mendeldave] [ In reply to ]
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Just curious how your recovery went. Had an MRI last week which revealed a femoral neck stress fracture.
Similar scenario.. lots of run miles.. went on til the stiffness turned into pain. 3 physio visits for opinions - only the last suggested a stress fracture.
Not run at all for 3 weeks now and waiting to see a fracture specialist next week.
Bought myself some crutches to take the weight off it in the mean time
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