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training post hip fracture: screwed?
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I'm looking for tri geeks out there with a past compression fracture at the neck of the femur. This blog post is a small part in my trying to figure out how much, or how little, is typically appropriate training wise after such injuries. My doctor tells me to go by feel...and I'm feeling great, but I'm still a bit concerned about doing "too much". Yes, I know that everyone is different, but I'm interested in hearing others stories about returning to more competitive training/racing?

For what it's worth, I am 51 y/o (nearly 30 years a triathlete), now 8 months post compression hip fracture at the neck of my femur, resulting from a bike crash. I've got 2 (yes, most of you have 3) screws still in place (planning to just leave there for now). Currently I'm running 3x per week and limiting it to 7 miles max thus far...though I feel I could run forever again. No limp, no pain. I do have a leg length difference now that the angle of my hip is different than previous (corrected with a simple heel lift at the moment). Anyway, my biggest concern is possible avascular necrosis down the road, but I'm not sure if my training volume/intensity/frequency directly effects that or not? I've also got concerns about possible post traumatic arthritis, though nothing indicates such to this point. Anyway, thanks for sharing your experiences with me and others reading along!
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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I had a different hip fracture; I shattered the acetabulum, the socket itself, on my right hip in 2007. I've got a bunch of plates and screws in there and generally I've noticed no big issues with training. I don't run that much (usually max out a run at 6-7 miles, no marathon training but have done a few halfs), but I've experienced no pain that would cause concern. I usually try to run 3 1/2 - 4 hours a week. Swimming gets about 3 - 3 1/2 hours a week. Cycling is on hold right now because I've been trying to get more consistent with the running and swimming. I get normal aches and soreness but nothing that to me says 'uh-oh, we need to stop doing this right now' style pain.

I can't answer the avascular necrosis part since the ball of my femur was fine but for arthritis I've noticed no issues. I do go in yearly for checkups to make sure everything still looks good in there but so far everything has been fine.
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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I broke mine at 30y/o.

If you are truly pain free, then from a training standpoint you're probably doing well. You can slowly increase your training volume and intensity while listening to you body.

My major concern however, would be strength and stability of the hip on that side and the implications down the road on your knees and back etc.

Have you completed physical therapy and are they happy with the muscular strength and stability?
If not, I would keep training where it is and work on hip function more. It's important that the assessment individual is knowledgeable (Think PT, Athletic trainer, etc) and not "the personal trainer at the local gym".
This will protect you from injury and improve performance down the line.

We offer a return to sport evaluation, a clinic near you may offer similar.

https://www.bcsm.org/rehab/acl-injury-prevention-injury-assessment-program/#RTS

I talk a lot - Give it a listen: http://www.fasttalklabs.com/category/fast-talk
I also give Training Advice via http://www.ForeverEndurance.com

The above poster has eschewed traditional employment and is currently undertaking the ill-conceived task of launching his own hardgoods company. Statements are not made on behalf of nor reflective of anything in any manner... unless they're good, then they count.
http://www.AGNCYINNOVATION.com
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Re: training post hip fracture: screwed? [xtrpickels] [ In reply to ]
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Great points and yes, I do have a PT and background in rehab myself. That said, it's good to be reminded and simply seeing someone else right it down is extremely motivational. Yep, too bad I'm on the East Coast vs. in Boulder or I'd check out your clinic for sure.
My next MD visit includes several questions related specifically to the effects that running has on my potential for future AV (avascular necrosis)...which I suppose is my #1 concern. Thanks guys.
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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You'll also be concerned about any angulation or shortening at the fracture site resulting in a limb length inequality which would alter your previous comfort with biking and running. Have your doc/PT measure your leg lengths and comment on hip rotation. If still unsure, a simple, fairly low tech/low dose radiation xray called scanagram can image the hip, knee and ankle in "one" xray giving you the ability to determine to the millimeter the length of your legs. If any type of insert were needed, you could figure all this out before you've taken the first step.

Good luck,

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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I broke mine at 14 yo and had three screws to repair it. At around 22 I had the screws removed and was very active for years without issue. At 38 I started feeling pain after activity that just wouldn't go away. Finally saw a doc and X-ray showed the cartilage was completely gone.

Had a full replacement a few months later and have had pretty good success in running and triathlon since. I do get sore at times but backing off intensity usually resolves it quickly.

My biggest issue has been ignoring the supporting muscles, specifically the glute medius and hip flexors. Caused some bad ITB pain. It's easy for me to forget taking care of those while in big training blocks.

AVN is a good concern but I would think if you routinely see your doc and listen to your body you will be fine.

I've just learned to live with the arthritis.

Good luck with it.

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Loud pawls save lives
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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My history is fairly similar to yours (51 years old and 33 years of triathlons). In 2005 I developed a stress fracture of the femoral neck. I didn't end up with the hardware you did, but did have to work my way back to training.

It sounds like you're already most of the way back. My only real change to training was that I now do more lateral strengthening of the hip to help with stabilization. If I start feeling pain it's an indication that my shoes are getting worn and that I need to up the lateral exercises again.

Good Luck

-- Scott
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Re: training post hip fracture: screwed? [johnpostmd] [ In reply to ]
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Thanks for your thoughts John. I have had a full lower body CT scan where they measured the bone length and angle differences, so hopefully that will help when I get my orthotic made. Also, several folks have mentioned keeping my hip muscles particularly strong to help maintain joint stability. Much appreciated guys! Anyone else out there with a history of this injury, I'm happy to hear more from you. thanks!
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Re: training post hip fracture: screwed? [BionicMan] [ In reply to ]
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So, you still going strong with that Bionic hip? Wow, sounds like you've pushed the envelope. Good for you if that's whats best in your world. You mentioned revisiting your MD consistently. How often are you getting checked up on and when you do, does that mean x-rays and such, or just consultation? Thanks!
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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Still doing very well with it. I have probably pushed it too much but it just hasn't caused me much problem. When it has been problematic I've always taken time off to let it get happy again. Having it broken almost 30 years ago I have a pretty keen feeling for when something is wrong so I just do my best to not ignore the signals.

I'm to the point now where my doc only wants to see me every other year unless I have troubles. The first few checkups went well. He takes X-rays and does some range of motion and gait analysis. So far so good.

I only plan to do one more full IM - Florida next fall. Don't want to press my luck much more. I can handle 70.3 and shorter with little issue but the full IM is stressful and certainly much higher risk.

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Loud pawls save lives
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Re: training post hip fracture: screwed? [1triguy] [ In reply to ]
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Heck just get it replaced. Got mine done in 2009 after Kona and still can manage 30 mpw. Mostly on soft surfaces. Those screws
will come loose at some point, and I would think a full hip replacement would be low maintenance. Did IM Canada last year and
missed my spot by 32 seconds...
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