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Proximal right femur stress fracture
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Hello,

Anyone have experience in getting through a stress fracture of the hip? Mine is just below the femoral neck. Exact MRI result: an incomplete fracture is present at the proximal right femur deep to the lesser trochanter.

I had been training for my first full Ironman starting back in Dec 2014 after recovering from a strained hip flexor (left hip). So at the end of May when my right hip/groin started to have pain while running I thought it was just another strain. I thought I could train through it but that was the worst decision. On June 21 I tried to finish the Mont Tremblant 70.3 (half ironman). I had a good swim and bike but had to drop out after a mile of the run. I was limping after 5 minutes into the run and ended up not being able to even walk for a few hours. I had an MRI a little over a week after the 70.3. I'm now on crutches for probably at least 6 weeks.

I've run 4 marathons in the past with higher mileage and never a stress fracture. I even won a half marathon at the end of this April. We are getting professional coaching but I made an error is moving a hill workout right before a club bike TT. But I didn't think it would lead to an injury. I have a cycling background as well. I do lots of core work and some prehab work. I take calcium supplements, Vit D and Iron as well as other vitamins. I thought I was doing all the right things. But I am a 45 yr old woman. Maybe my age is catching up to me :-(

It is very painful to try and walk right now which is frightening, so the crutches seem like the smart option. I'd like to try open water swimming with a pull buoy but not sure if that will slow down the recovery process.

Has anyone had a similar experience? How long did it take you to get back to your training? Did you have pain in the surrounding area when trying to sleep?

Thanks,
Joyce in Vermont

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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I'm sorry to hear about your injury.

Yes, I had a similar injury. The pain at night was intense as was the pain when getting in and out of the car - that seemed like such a silly thing to admit too, but after reading a lot of information I learned that was an important symptom. I was on crutches, bearing no weight, for about 4 weeks. The pain was better but was still there so a follow up with a specialist diagnosed a labral tear and FAI as well. That seemed to be more of what lead to the injury. There is a lot of discussion on this forum regarding how to treat tears. I did have surgery.

My dr suggested no swimming, but I BEGGED to swim with a pull buoy. After 2 weeks on crutches I did swim but did use the crutches to get to the pool entry. If I had any pain during swimming I was told to stop.

Best of luck. Rest now will speed up the recovery.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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My experience is a little different.

I had a comminuted intertrochanteric fracture. So basically a full break, and there were some small pieces as well rather than just 2 full pieces.

I had 2 titanium rods inserted to hold things together, took 7 months to be cleared to put more than 50% weight on it. Bone growth was slow in the area, but they recommended getting in the water, easy biking etc. as I rehabbed it in the meantime.

Worst part was, because the femoral neck has low blood-flow, there was a chance of avascular necrosis, basically that the blood flow was interrupted, and running on it could result in essentially wearing down the bone faster than my body could repair it simple due to the low blood flow. Hopefully for you this isn't the case as it's not a complete fracture. Those 2 years SUCKED.

After the 7 months I felt like I could run, and the odd time I was chasing my kids it felt ok, it was just the chance of avascular necrosis that stopped me.

Running better now than I ever did before the accident though!
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Hi MI Salted and Dfquigley,

Thank you for your posts. I'm sorry you also suffered through these frustrating injuries! It sounds like the hardest part is being patient and letting the body rest and heal.

I'm lucky I was able to get an MRI soon after the 70.3 and know for sure I had a stress fracture. I cringe at thinking about all the limping around I did before I got the results. I didn't think I had a stress fracture or maybe I was in denial. But when your doctor tells you that you have a high risk stress fracture, it's very sobering.

Thanks again for your posts,

Joyce

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Sorry to hear about your injury.
You might ask to have your bone density tested.
Do you take the Ca and Fe at the same time? (they bind... take them separately if you're not already).

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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Re: Proximal right femur stress fracture [tigerchik] [ In reply to ]
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tigerchik wrote:
Sorry to hear about your injury.
You might ask to have your bone density tested.
Do you take the Ca and Fe at the same time? (they bind... take them separately if you're not already).


Hi Tigerchik, thanks for your post. I do take the Ca and Fe together.I'll take them separately tomorrow. I have another doc apt on July 16 and I'm hoping he will order me a bone density test along with some blood work. I've always run on the low side of Iron levels, but never had a stress fracture from running higher mileage for marathon training. Maybe it's an absorption issue.


Joyce

Death is easy....peaceful. Life is harder.
Last edited by: JoyceVT: Jul 5, 15 13:30
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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How did it go Joyce?

I was diagnosed with a stress fracture in the medial right femur on July 10th. The doctor originally told me 4 weeks on crutches and 4 months before full activity. I'm hoping that gets revised down though because I already feel like I'm close to walking without support (12 days on), and after looking at additional scans she thinks we caught it early.

My story: had a slight pain in my right quad after a heavy bike workout on a Wednesday (Sunday was long run, monday was swim, Tues was bike/run). Didn't think much of it. On the Thursday morning I went to jog to work and it hurt like hell for the first few steps so I stopped. I spent about 7 days doing low activity and then it started coming back. The only time the pain exhibited itself was: trying to put my shoe on in the morning while standing on the bad leg (hurt like hell) and the first few steps while running. I put it down to a stabiliser muscle, saw the PT and they thought the same. It was getting better so did a 4 day training camp on it. By the time I got back it was painful to walk in the morning but normally 'loosened' up by evening. I saw a doctor and they immediately figured out it was a stress fracture, and the MRIs/XRays confirmed it. I still don't know what caused it, but figure it was a gradual issue.

Right now I'm able to swim without any pain using a pull buoy, so trying to swim A LOT! Yesterday I also tried doing 50 yards of aquajogging and it didn't hurt. Also did 50 yards without the pull buoy (minimal kicking) and it was okay. I am currently pushing off the wall pretty gently. I got on the bike and rode extremely easy to work this morning: my rationale - which my girlfriend disagrees with - is spinning very gently to work puts very little stress on the femur and is less risk compared to standing on the train and being thrown around, even when I have a crutch/cane. That might be me reaching. I'll know tomorrow!

Here's a useful article on a possible route to rehabiliation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465093. I think I'm coming towards the symptomatic phase (haven't had any pain for a few days, nor the courage to fully put any weight on it).



I currently have an entry for Ironman Louisville (Oct 11) and am guessing I'm probably reaching thinking there is any chance I can compete by then. I've also got NYC marathon on the cards (first weekend of November) and can roll IM Lou over to Austin 70.3. I'm trying to ignore races though as it'll cloud judgement.

Anyone have any stories they can share? From reading other forums around the interweave the general consensus is to be more cautious than you think you should be. I'd be particularly interested in knowing of cases of what people have been able to do after the symptoms dissipate and what recovery strategy was successful?

My approach is going to be (if approved by my doctor):
Gate 1: Swim with pull buoy
Gate 2 (no symptoms): Swim with kicking, gradually reintroducing the kickboard. Resume easy spinning in the granny ring, no climbing. (Basically going on very flat rides with the weakest riders I can find!). Start aquajogging at easy level.
Gate 3 (3 weeks after no symptoms): Lots of swimming still (gradually introduce fins to test the leg). Walk treadmill, gradually increasing incline. Introduce 'sprinting' efforts while aqua jogging. Basic Z2 cycling (i.e. staying <75% FTP) on flats.
Gate 4 (3 weeks after gate 3): Lots of swimming still. Reintroduce jogging (via Antigravity treadmill). Some Z3 intervals on the bike.
Gate 5 (3 weeks after gate 4): Lots of swimming still. Reintroduce normal jogging. Intervals allowed around FTP on the bike.
Gate 6 (3 weeks after gate 5): Lots of swimming still. Reintroduce longer running at Z2. Intervals allowed around FTP on the bike.
Gate 7 (6 weeks after gate 6): Gradually reintroduce full intensity.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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I just read another thread about correct stomach acidity to absorb Ca and Fe.
Antacids and acid reducers can impact absorption of those...
KS

Karen ST Concierge
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Re: Proximal right femur stress fracture [STConcierge] [ In reply to ]
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Hi dado0583, Thanks for your post and sharing your story. Iím so sorry to learn you are also going through the frustrations of a stress fracture. It sounds like you are healing much quicker than most people who suffer femur stress fractures. That is great news you might be off the crutches sooner than the 4 weeks. Your symptoms are interesting where it only hurt in the beginning of the run. For me it hurt throughout the run and each run it would get worse. But mine is closer to the femoral neck in the hip. I did also have pain when putting all weight on my right leg.

My update: Iíve been on crutches for 3.5 weeks now. Iím seeing progress and know Iím healing, but I am not sure when Iíll be off the crutches. The ortho specialist said that when I can walk pain-free I can ditch the crutches. Iím allowed to swim with a pull buoy and spin easily on the computrainer. And I have some PT exercises. I can do activities that wonít cause pain.

To add insult to injury Iíve been dealing with flu symptoms and a low grade fever since this past Saturday that wax and wane. I hate doing it but Tylenol is the only thing that provides me some relief. And Iíve not been able to eat properly and have lost all appetite. This is not good for the healing of a stress fracture. I hardly ever get sick and canít remember the last time I had a flu.

The doc thought it was realistic to consider an early spring 70.3......just not sure which one. Any recommendations?

Iím still trying to determine how I got this stress fracture. The doc thought it was over training. I still have a little trouble buying completely into that. Iíve run marathons with much higher mileage and intensity and never got a stress fracture. I am getting my blood drawn this Monday and waiting back to hear about when Iíll get a bone density scan. My primary care provider had to order both. I might have some muscle imbalances that need to be addressed and luckily I now have an excellent PT who does Ironmans and understands where Iím coming from.

So thatís the story for now.

Joyce

Death is easy....peaceful. Life is harder.
Last edited by: JoyceVT: Jul 22, 15 13:54
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Glad you updated. Sorry to hear you're sick though... but it's awesome that you can swim with a pull buoy and do some easy spinning. If you get bored with just the buoy, try a band only (hard!), and paddles.
Glad you're getting a DEXA scan, too.

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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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 - Did your doctor help you determine the root cause of your stress fracture? What do you think caused it?

I keep hearing that the good news with stress fractures is that bones heal. But I keep reading we are then prone to future stress fractures. I want to make sure I do everything possible to prevent a second one from happening.

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [tigerchik] [ In reply to ]
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tigerchik wrote:
Glad you updated. Sorry to hear you're sick though... but it's awesome that you can swim with a pull buoy and do some easy spinning. If you get bored with just the buoy, try a band only (hard!), and paddles.
Glad you're getting a DEXA scan, too.

Thanks tigerchik! Yes, we have the bands too. My PT has me wrapping it around my legs with the pull buoy in the open water to keep it from moving. I will also use it in the pool by itself. It's definitely a good upper body workout using the swim bands. And I love my paddles.

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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JoyceVT wrote:
The doc thought it was realistic to consider an early spring 70.3......just not sure which one. Any recommendations?

Where do you live?


JoyceVT wrote:
Iím still trying to determine how I got this stress fracture. The doc thought it was over training. I still have a little trouble buying completely into that. Iíve run marathons with much higher mileage and intensity and never got a stress fracture.

That's the exact same for me. My weekly hours have been stable, my Training Stress Score (TSS) has been stable, and the high-end intensity have gradually been coming down too. I was wondering whether it might be osteoperosis or diet but it's been pretty good (lots of greens, etc). I'm tempted to put it down to one-of-those-things if tests don't raise any health issues.

I'll be monitoring your progress and exchanging notes with you I'm sure! Get well soon.
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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We live in Vermont so we would have to fly somewhere warm enough. New Orleans, Galveston and Puerto Rico are considerations. I just posted a separate thread on spring 70.3 events. It will be interesting to see any feedback :-)

I would get bloodwork and a bone density scan ordered to rule out anything. I'll be following your progress too. It does really sound like you will be back on track quickly. Please keep in touch!

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Hope your recovery is going well.

I saw the doctor Friday and can walk without crutches/walking stick now! Bone density looks good generally and apparently my hip joints are top notch! Saw the stress fracture of the femur in the X-ray but it's on its way to healing. Got a prescription to run on the Altra-G treadmill at the PT for ~ 6 weeks which is great. She wasn't massively keen on me cycling though, but I figure if I can do Altra-G I can do really gentle cycling (< 65% of FTP). Still need to be careful pushing off the wall in the pool and will gradually be introducing kicking (no kicking drills for a couple weeks though).

Was supposed to be doing ITU worlds in September but the doctor thought IM Louisville in Oct is more realistic. The rationale being that the intensity required to prepared for an Olympic in 7-8 weeks time would just be too much.
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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Hi dado0583, thanks for you update. So glad you are having such a speedy recovery. That is wonderful news. The Alter G is a great recovery tool. I've used it several times. It does seem strange that you can do the Alter G and yet the doc isn't keen on riding your bike. Maybe just easy spinning on the indoor trainer?

My recovery is slow but steady. I am still on the crutches after 4 weeks but I do feel improvement. If things keep improving I could be off them in a few weeks. I was very sick all last week and have not been sleeping much at night due to a non-stop violent cough (when it rains it pours!). So this crazy sickness could be slowing down my healing progress as sleep is very important. One day at a time for me. I'll never forget this hellish experience but I know things can only improve from here :-)

Hoping once I get through this cough and sickness I can swim again and get on my bike in the basement to spin easily. This sickness/flu/cough has kept me mostly inactive the last 9 days. I did try one open water swim last Monday night but due to my fever I had trouble warming up afterward and had to soak in a hot bath just to stop shaking. So I'm waiting until I'm better and have the energy to swim outside.

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Yeah. The doctor feels comfortable with Altra-G because it's a controlled environment. I figure the bike is a controlled environment if I limit the power I am allowed to generate.

That's good news you're feeling an improvement on your leg even though you're sick as a dog. Good luck and get well soon!
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Update: Rode last week and hit a couple hills harder than I had been previously. It was mostly planned. No pain/aches/etc the day after. I'm on the Altra-G treadmill 2 times per week running for 20 minutes at 65% body weight with no issues. Planning to get back into bike racing next weekend!

No ETA on running yet. I also found out a lady from my tri club had the exact same injury about a month ahead of me, and experienced similar recovery times to me (although she's been more conservative with regards to riding). She got signed off to normal activity a week ago.

I've been keeping meticulous notes on my day-to-day progress if useful.
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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Hi dado0583, you are making great progress with your recovery! Thanks for posting an update! 65% of body weight on the Alter G is fantastic! You should be running outside soon!

I've been on crutches for 7 weeks and may have a couple more weeks to go but I am healing. I can walk around in my kitchen with little pain but have to limp. Using one crutch works well too. I am getting over pnuemonia so that put a dent into the stress fracture healing process. But things are looking up for me. Done with some very strong antibiotics. I did a 1 mile open water swim yesterday morning. It was slow and I'm so out of shape. But it felt great to swim! Been also riding on the computrainer this week for a little bit. 30-45 minutes choosing an easy course riding 11-14 mph. Each day gets a little better. May try an easy ride outside on my cross bike later today.

Turns out my bone density test came back normal. The tech who did my DXA scan said I was just starting to get Osteopenia. But the official results from an MD were that my bone density was normal for someone my age (45 yr old female). While my results are normal, it still looks like I am on the low end of normal. So I'm still going to work on building back up my bone density with supplements and lower body strength and weight training. If I had a high bone density, I don't think I'd be having stress fractures.

Seriously considering signing up for the Puerto Rico 70.3 next March. It's been a nightmare of a summer and it would be nice to look forward to a "race-cation" around my birthday :-)

So that's my story at the moment.

Joyce

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [JoyceVT] [ In reply to ]
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Wow, you've had it rough. That sucks you had the perfect storm to slow down the recovery too. I didn't get on the bike until I was off the crutches. I waited until I could do a one-legged partial squat without pain and then started commuted to work by bike. sounds like your approach to rebuild bone density is a good one (I am currently drinking a coffee and looking at my Calcium/Vit D supplements I haven't taken for a few days :S)
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 wrote:
Wow, you've had it rough. That sucks you had the perfect storm to slow down the recovery too. I didn't get on the bike until I was off the crutches. I waited until I could do a one-legged partial squat without pain and then started commuted to work by bike. sounds like your approach to rebuild bone density is a good one (I am currently drinking a coffee and looking at my Calcium/Vit D supplements I haven't taken for a few days :S)

Yeah it's been crazy with the pneumonia added to the mix. On the bright side, being that sick did keep me on the sofa for a few weeks and forced me off my feet. I might have been tempted to push things a bit if I was healthy (getting on the computrainer too soon). Femoral neck stress fractures take a little longer to heal but things seem to be moving along better now that I'm on the mend from the pneumonia. Walking around more in my kitchen with my "monster walk" :-)

Since the doctor said I could do anything that didn't cause pain or soreness, I decided to ride one of my bikes outside over the weekend. We live on a dirt road which is very hilly. My fat bike has the best option for granny gears so that was the bike of choice this weekend. Rode both days this past weekend for a little over an hour each ride. My hip seemed fine and no pain. I probably looked like a fool riding my fat bike in the summer, but it did feel great to get outside and feel the sun! Been 8 weeks since I've ridden outside!

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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Progress update. I'm back running! I got in a couple 20 minute runs and then did a longer run. The ankle on my 'good' leg started complaining a little so I backed off again and ran for 40 minutes yesterday. I'm just going to run twice a week for a few months and then have a run focus early next year, I think. Leg very occasionally throbs but seems unrelated to whatever I'm doing or have been doing.

How's your progress?
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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Curious if my symptoms sound similar at all to anyones. Did you go right to a specialist or just see standard doc first?

I'm a bit over weight, so definitely more impact on the bones than a standard endurance sports athlete. Pain started on the outside of my left hip, bursa sac inflammation was an easy diagnosis. Started recently (last month) to move into the inside, hip flexor region. Sore at the start of runs, would loosen up after the first mile. Can still handle long runs fairly easily. Now the pain is in the thigh, seemingly below the muscle. Had a long run on Tuesday and after the hip loosened up in the first mile it went well. Yesterday went for a slow recovery jog and could barely move. Definitely not muscular, quad was firing fine and pain free. Pain was deeper. Felt like where I would imagine the bone is, hence my immediate fear of stress fracture. I also had read that weak supporting hip muscles, which cause both hip flexor and bursitis can lead to femoral stress fractures. My glutes I thought were plenty strong from all of the cycling. None the less, walking is a challenge. Not excruciating pain, but it's definitely there. Running was near impossible. The pain wasn't debilitating, but felt almost like a weakness. Like my leg might buckle.

I guess I'm due for a trip to the doc. Curious as to what others initial symptoms were like.
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Re: Proximal right femur stress fracture [cmd111183] [ In reply to ]
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cmd111183 wrote:
Started recently (last month) to move into the inside, hip flexor region. Sore at the start of runs, would loosen up after the first mile. Can still handle long runs fairly easily. Now the pain is in the thigh, seemingly below the muscle. Had a long run on Tuesday and after the hip loosened up in the first mile it went well. Yesterday went for a slow recovery jog and could barely move. Definitely not muscular, quad was firing fine and pain free. Pain was deeper. None the less, walking is a challenge. Not excruciating pain, but it's definitely there.

I had these exact symptoms (I've removed part of your quote which were things I did not experience). I thought it was a stabiliser muscle because once I got going I was able to crank out a run without any pain except maybe on a couple steps on the run.

For me the realisation that it was a real issue was when I couldn't stand on the bad leg to put on my shoe without pain. The pain doing that was greater than everything else. I went to a regular sports doc and she suspected stress fracture almost immediately, and put me onto crutches immediately. Went for an MRI the next day to confirm.
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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Hi dado0583, looks like you are making good progress. Great news that you are running!

I got my second MRI results last Friday when meeting with my ortho doctor. I was extremely disappointed to learn that my FNSF wasn't healed. But it is healing and there is progress. It does feel better to walk around. The other bad news is that the doctor doesn't think I'll be running for another 3 months! Yikes. I really hope it doesn't take that long. Originally he thought I might be running by now. My FNSF is more in the trochanter which takes even longer to heal sometimes. These types of SFs can take 4-6 months to heal. I had started running on the Alter G at 25-33% of my body weight and that seemed to be working well. But the doctor had me cut down on the Alter G and only bike once a week. I can still swim. Some good news is that I'm swimming stronger at our master swims. I had a great swim this morning and have progressed so much from a year ago when I started swimming with the group. So at least I can continue to focus on swimming which is my weakest sport. I also have to do some deep water running at least one a week. Boring but it is better than nothing.

My new coach still thinks Puerto Rico 70.3 in March is feasible. As long as I can start running by the end of December I should be OK. I will probably do the run conservatively (even though it's a tough run).

I am supposed to have another MRI at the end of December.

Death is easy....peaceful. Life is harder.
Last edited by: Herding Cats: Oct 8, 15 6:48
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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Your swim will be awesome my March! Good luck
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 wrote:
Your swim will be awesome my March! Good luck

Thanks, I'm looking forward to the swim in Puerto Rico.

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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I'm signed up to Austin 70.3. Strangely I'm not looking forward to the run which used to be my favourite part!
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 wrote:
I'm signed up to Austin 70.3. Strangely I'm not looking forward to the run which used to be my favourite part!

I don't blame you after recovering from a SF. You could focus on a fast swim and bike and treat the 13.1 as a nice moderate "sunday long run". I think that's what I'll be doing in Puerto Rico. Austin is such a cool city. Make sure you hit Barton Springs for a lovely outdoor swim!

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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I'll be racing against a couple of friends for the first time so I'll be going all out :)
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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Herding Cats,

Are you back running yet?

I'm now just over 4 months out from my proximal shaft femur stress fracture and I ran twice this week. Both times I experienced what I would describe as "quad fatigue" on the affected leg during running. It makes me super nervous, but this odd feeling in my quad is down towards my knee (away from the fracture). No pain with hop test or fulcrum test. No pain in my groin or thigh where the fracture was. But it feels like my distal quad won't relax for a day after I ran. I'm having a tough time deciding if this is normal muscle stuff after having a stress fracture and not doing anything for a long time, or its just not ready. I work in an ortho practice, and all the docs say it's gonna hurt some, but then they caution me to be careful.... So helpful...

Any of you guys experience this with a femur stress fracture?
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Re: Proximal right femur stress fracture [dawnawanna] [ In reply to ]
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dawnawanna wrote:
Herding Cats,

Are you back running yet?

I'm now just over 4 months out from my proximal shaft femur stress fracture and I ran twice this week. Both times I experienced what I would describe as "quad fatigue" on the affected leg during running. It makes me super nervous, but this odd feeling in my quad is down towards my knee (away from the fracture). No pain with hop test or fulcrum test. No pain in my groin or thigh where the fracture was. But it feels like my distal quad won't relax for a day after I ran. I'm having a tough time deciding if this is normal muscle stuff after having a stress fracture and not doing anything for a long time, or its just not ready. I work in an ortho practice, and all the docs say it's gonna hurt some, but then they caution me to be careful.... So helpful...

Any of you guys experience this with a femur stress fracture?

I'm not quite better yet but will have my third MRI on Dec 30th. I am running at 75-80% of my body weight on the AlterG (Anti-gravity treadmill) so I am making progress. Hope to be at 90% in a couple weeks. And outside by January doing the run/walk thing. Hopefully I get a clean MRI so I can start officially training sometime in January.

I haven't experienced the quad fatigue. Here's my current situation: I get other sensations and twinges around the SF area and also on the outside of my hip at random times even sitting. I'm hoping these random twinges are just the bone healing or bone re-mineralization. My SF area feels OK when walking and running on the AlterG so that's important. Another odd thing I get is soreness on the outside of my hip from time to time. The doctor said it's not referring pain from my SF but I feel like it's connected. The soreness on the outside of my hip started when I had the initial hip pain running before my femur fractured (the soreness would move from groin to outside of my hip and back and forth while running). These things are frustrating as no medical professionals seem to know what sensations are OK and what ones are not when I explain mine. Even online I can find nothing. My gut feeling is that there is going to be some soreness getting back into running so I keep doing the Alter G and try to move forward.

You are lucky to be back running after 4 months. I'd take it slowly and carefully. Do you have access to an Alter G to supplement your running? (I'm not an Alter G rep :-)...I just really love them and can't imagine getting through this nightmarish injury w/o it).

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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Thanks for the response. No access to Alter G. Just lots of pool and biking.

The bonus for me is that I caught it really early, so it was really just a stress response. Regardless, I don't want to be back where I was 4 months ago.

I talked to my sister (she had a stress fracture in the same spot as me years ago). She said she recalls nagging pains when she got the ok to run, and she would just back off again and try a short run again in a week.

It's so tough to know what's ok and what isn't. I expect some soreness, but any unusual sensation in that leg makes me nervous. I'm thinking I'll just back off again. Sigh.
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Re: Proximal right femur stress fracture [dawnawanna] [ In reply to ]
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dawnawanna wrote:
Thanks for the response. No access to Alter G. Just lots of pool and biking.

The bonus for me is that I caught it really early, so it was really just a stress response. Regardless, I don't want to be back where I was 4 months ago.

I talked to my sister (she had a stress fracture in the same spot as me years ago). She said she recalls nagging pains when she got the ok to run, and she would just back off again and try a short run again in a week.

It's so tough to know what's ok and what isn't. I expect some soreness, but any unusual sensation in that leg makes me nervous. I'm thinking I'll just back off again. Sigh.

I would let things settle down and try again. I had more soreness than normal a couple weeks ago after standing at a social gathering for 4 hours. But I had also increased my weight on the Alter G the previous day. After the party, I gave my legs a rest for a few days and got on the Alter G the following week and things were back to normal. Maybe just a rest is all you need for a few days (or a week).

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [dawnawanna] [ In reply to ]
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dawnawanna wrote:
I experienced what I would describe as "quad fatigue" on the affected leg during running. It makes me super nervous, but this odd feeling in my quad is down towards my knee (away from the fracture). No pain with hop test or fulcrum test. No pain in my groin or thigh where the fracture was. But it feels like my distal quad won't relax for a day after I ran. I'm having a tough time deciding if this is normal muscle stuff after having a stress fracture and not doing anything for a long time, or its just not ready.

Any of you guys experience this with a femur stress fracture?

This sounds similar to what I experienced when I got back to running. It wasn't down next to the knee but sometimes I'd get a throbbing pain very occasionally during a run, and often in the evening or the morning after a run. I'd do a partial single leg squat to test and then to the hop test and both were fine. Physio and doctor were fine with me running despite these 'pains/aches' as long as they were mild/intermittent/etc. Although they couldn't tell me what was the cause of these sensations they said that it could be when the blood flow gets back into the bone, the muscles adjusting to the new bone shape (i.e. the bit that fractured would be a bit more dense and the muscle has to 'get used to it').

I can post my diary of the SF which is very verbose if you want? It's a day-by-day account of what I did and I wrote down when I was feeling issues
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 wrote:
I can post my diary of the SF which is very verbose if you want? It's a day-by-day account of what I did and I wrote down when I was feeling issues

If you don't mind posting, I think it might be helpful for dawnawanna and myself. Thanks for the offer. I trust you are doing well?

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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Yeah, I'm great. After the stress fracture I had a bike crash but it didn't keep me immobile for long. The stress fracture/reaction is a distant memory now.

Note are below. I pulled them from my email so they're not quite in chronological order, but go to the bottom first. I probably have X-rays/MRI images available somewhere I can post for reference although not sure when I can get round to doing that.

============

My notes trailed off after early September. After the date below I think I started doing 30 minute sessions. Eventually I got to the point where I would do 2 30 minute sessions in one day, then started building back up to normal training. Did Austin 70.3 in November with no issues.

====

9/5 - Did 110km on the bike. For the most part very chilled although I did a few hard sprints up some of the hills. Leg felt good and my bike fitness is starting to come back.
9/6 - Did 160km today in a group and it was a hammerfest (very hard session!). Exhausted by the end of it. No pain during or after. Haven't run since 9/3. Trying to keep it to 2 days a week until we lengthen the session. I figure the bike sessions are great for overall fitness and the run will come back gradually. No point in pushing it.
====

Notes below. First run was fine although brief. do we need to do another MRI or checkup before starting to figure out how to reengage in normal activities?
8/27 - did the rehab exercises as well as my normal injury prevention routine. Lots of stretching. Did a very easy 20 minute swim focusing on technique followed by hot tub.
8/28 - physio in a.m. swam for an hour then cycled 150km. Cycle was very chilled over 6 hours.
8/29 - cycled 110km. Did a few pickups and legs felt good. Starting to feel at one with the bike again. No pain from previous day and legs felt strong.
8/30 rest. no pain at all. Did lots of stretching foam rolling and rolling on a lacrosse ball.
8/31 swam. Felt good.
9/1 jogged for 9 minutes with 1 minute walking break in the middle. No issues. Figured best to keep it short. I felt really heavy when running. Think I got used to the reduced weight on the altra-G. Swam for an hour and then did an easy hour cycling with the team practise. No issues so far. Taking a rest day tomorrow and then PT on Thursday.
9/2. Chilled all day. No issues. Stretched in the evening.
9/3 - Swam in the evening. Then did a 20 minute jog on the treadmill. Walked to warm up, then 9 min jogging, 1 min walk then 9 min jog. Ran at 7.5mph @ 1%.
9/4 - No issues from run yesterday! Swam in the evening.

====================

8/14. Swam. No problems with leg. Kicked during the entire main set.
8/15. Cycled for 90 minutes with 5-6 hard hill repeats. No pain/ache/etc. Swam in the evening with the pull buoy (didn't use legs for the swim)
8/16. Took a rest day. The legs were fatigued from the previous day. Not sure if there was any damage done from going hard. Difficult to distinguish muscle fatigue versus the aches I was feeling a couple weeks ago so figured I should play it safe.
8/17. Leg throbbed a couple times while sitting at the desk. Did some one leg pistol squats to see if there was anything wrong. After the pistol squats there was no pain or throbbing. I can't seem to correlate the throbbing back to any causal event. The only thing I can think of is that the Saturday bike ride was way too hard and caused damage. Will scale back on the cycling again for a few days and see what happens.
Swam with buoy before PT, no issues. Ran for 20 Mins at 70% body weight.
8/18 - leg feels great today. Muscle a little sore where it was worked from the massage but no throbbing or anything all day.
8/19 - rode in the a.m. for 2 hours. Did a few efforts sightly harder than the previous week. Swam easy in the evening with pull buoy. [EDIT: I think this was a 2hr team ride where I made the silly mistake of going way too hard]
8/20 - leg feels terrible today, it aches a lot more than normal. I attributed it to yesterdays bike ride. Not sure if I've done damage to the bone. No pain when doing single leg squats or moving around. Occasionally complains throughout the day and commuting home on my bike it complained multiple times. Did an easy swim with pull buoy.
8/21- PT. No treadmill today. 'Good' leg was tighter than bad leg. Did normatec booties. Leg feeling better afterwards although I've lost confidence in it. Swam in the p.m. and no problems pushing off the wall. Will reduce the bike for a few more days to see if that makes a difference.
8/22 - easy 30 min swim. Did stretches and rehab exercises. Leg still not feeling great. Walked a lot today.
8/23 - leg feeling okay. Did an easy swim and relaxed a lot.
8/24 - did altra-G in the p.m. ran 10mins at 75% then 10 @ 80%. Leg felt great. No issues. Swam in the a.m. sometimes swimming with kicking.
8/25 - still commuting easy to work. No pain at all. Lots of swimming in the p.m. no pain. Was kicking while swimming for about 30% of session.
8/26 - slept 10hrs. Guess I needed it!? Leg feels good although maybe a little tight at hip on 'bad' leg. Will take it easy today and tomorrow.

==============

Quick update and question:
8/12 - cycled in the a.m. ended up doing 90 mins with some stints at 170bpm which is harder than I had been doing previously. (My Max on the bike is 182-185).
8/13 - no pain/ache/spasm at all today. Did he altra-G at 65% of body weight for 20 Mins. I feel great so far.
So. Now for the question. What's the thoughts on doing an bike 'race' this weekend? It would be ~100 miles on the bike but my heart rate would be <150bpm and I wouldn't actually be racing, just participating. Is that a crazy thought? I'm already entered and lots of friends are doing it but recovering is my primary concern.
=============
8/2
Another hour easy cycling on the trainer where I can control intensity easily. Riding at 110w which is less than 50% of my Max one hour effort before the fracture. Heart rate at 105bpm.
No pain. Will be swimming this evening with the pull buoy throughout.
8/1
Swam. Used pull buoy for 90% of the session.
Cycled for an hour very gently. Heart rate averaged 110-120. (This is very low for me). This equates to my warm up intensity normally.
I can walk up stairs comfortably with no pain but most of the time I'm still using the handrail as a precaution. Now able to balance on bad leg with no problems. Still afraid to do anything impactful on it.
July 7/26-7/31
No pains. Swam Tuesday, Thursday. Still not pushing off at normal force. Using the pull buoy so as not to use my legs for most of the session. I use my legs in the warm up and cool down now and not kicking with full force.
Cycling to and from work at a very very gentle effort. On my racing bike being passed by citibikes. Not even sweating in this heat with my work clothes on. It's VERY easy!
July 25
Swam in am. Walked without stick - no issues.
Did 200 yards swim without buoy, kicking. No pain. Wasn't kicking very hard though
July 22/23/24
- No issues. Still using the walking stick.
- On evening of 24 I realised I was standing around chatting with people for 10-15 minutes without using it and didn't feel a thing.
- On 24th I got the okay to start walking without it, although keeping it close by.
Tuesday July 21st
- Feeling a lot better. Walking stick feels like a safeguard rather than a necessity now
- Swam in the evening. Push-offs from the wall feel fine and pushing a little harder
Monday July 20th
- Swam in the a.m. used pull buoy. No discomfort or issues. Pushing off the wall with a little more confidence but still holding back a lot.
- Walking with walking stick today, sometimes with the crutches I trip
- No pain/discomfort with the walking stick at all. I know I can't stand on it yet though!
Sunday July 19th
- Supposed to be racing today :(
- Stayed in bed until 4pm.
- Leg feeling stronger compared to Monday which is good. Still using the crutches.
Saturday July 18th
- On two crutches. Leg feels okay but not putting any weight on it
- Occasionally mistime walking with the crutch and put weight on my leg and can feel it's very weak (wouldn't necessarily call it pain, at least compared to a week ago).
- Swam for 20 minutes very easy, followed by hot tub. Plan is to go easy today to do a longer swim tomorrow. Still using the pull buoy.
- Introducing Calcium, Vitamin A,D and K supplements into diet.
- Eating more fish (for magnesium) and cutting out soda/coffee/sugar
- Got MRI done
Friday July 17th
- Confirmed stress fracture/reaction. Crutches for 4 weeks, resume activity ~ 4 months (I presume this means I will be in full training again in ~ 4 months).
- Swim with pull buoy so not using the legs. Total ~3500 yards. Swam at higher intensity with no pain, very careful when pushing off the wall (using mostly my left foot), no pain.
- Walking with crutches. Two is more cumbersome and occasionally trip and have to put a little weight on the bad foot to balance. Doesn't hurt too much but can feel it's very weak.
- Pain in the middle of quad has subsided completely. Last time this was when I started jogging again. Only pain is closer to the hip (is the hip fractured too?)
- Still can't think of a single cause for the fracture, no real change in training intensity or volume over previous 3 months. Guess it must have been a small issue that gradually got bigger.
Wednes/Thurs July 15th and 16th
- Pain still mostly felt in the middle of the bone when standing on one leg (eg. putting on the shoe)
- Walking with a walking stick helps a lot (practically no pain unless I trip up)
- Very easy swim on Thursday to see if there is any pain. Kicking hurts a little so using a pull buoy between the legs so I don't have to kick. Pushing off the wall gently has no pain.
=== Weekend of July 12th ====
- Go to Mont Tremblant to train
- Day 1: swim, 90k bike and 5k run (no pain)
- Day 2: swim, 90k bike and 10k run (no pain)
- Day 3: swim and 30k run. Felt a couple twinges during the run but thought it was dehydration as it was hot and my left leg didn't feel 100%. Drank some electrolytes and felt great and ran the rest of the run. No pain for the rest of the day.
- Wake up on Monday and leg is starting to hurt again. The first few steps of the day hurt the most but after that pain subsides.
- Book appointment with the doc


=== Intermittent Weeks ======
- Assumed it's a muscular injury and some stabiliser muscle as it only hurts when balancing. Zero pain when cycling or running.
- Saw a physio and they didn't refer me to a doctor
- No running for a week or so but continue biking as no pain then.
- Gradually reintroduce running into regime. Pain practically gone but put it into the 'can-train-through-this bucket'
=========================

Thurs June 25th
- Put on backpack to run 9k to work. Within the first 4-5 steps I realise something is wrong.
- Stop and walk for a minute and then attempt again, another 5-10 steps and it feels bad
- Abandon workout and rest.

First feeling of pain - Wednes June 24th

- Finished 90 minute intense bike session on stationary trainer. No pain at all when cycling
- Jogged 100 yards slowly (not part of training, just to give someone a key) and noticed it felt strange.
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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Wow thanks for all that information. It's great to learn about what other people are going through with their injuries like this. It sounds like you felt some strange soreness as well but it always went away. It's great you went from 80% on the Alter G to getting outside. I'm not brave enough to try yet. I did run 77-88% on the Alter G this afternoon and it felt good. I do have orders from the Doctor to only do the Alter G and swim (with 2 rest days a week) until my MRI on Dec 30th. And then I hope to be cleared to run/walk outside.

Congrats on doing Austin! I hope you had a great day! I had to withdrawl from PR 70.3 this March. If I had been running outside sooner I think it would have been OK. My doctor and coach feel I should just focus on the Mont Tremblant half and full Ironman this summer. Takes the pressure off a bit. I was stressing out worrying about not healing quick enough. But it seems I should be able to be outside in January and slowly start training.

I noticed you were in MT this summer training from your notes. Did you do the Lisa Bentley training camp?

Well hopefully this thread can help others going through stress fracture/reaction recovery too. It's really tough but there's light at the end of the tunnel!

Death is easy....peaceful. Life is harder.
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Re: Proximal right femur stress fracture [Herding Cats] [ In reply to ]
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No problem, I took notes and overcommunicated with my doctor and PT because otherwise I knew I would wake up one day feeling fine and just go too hard (which I did marginally once anyway). Patience was definitely a virtue and it at least forced me to try to improve the swim a bit :)


Herding Cats wrote:
I did run 77-88% on the Alter G this afternoon and it felt good. I do have orders from the Doctor to only do the Alter G and swim (with 2 rest days a week) until my MRI on Dec 30th.

Speaking to friends who went through the same, some doctors took this same approach to get the MRI confirming the bone is healed before being allowed out. My SF (more of a reaction) was quite mild so I think my doctor/physio were willing to let me run outside earlier.[/quote]
Herding Cats wrote:
I had to withdrawl from PR 70.3 this March.

That sucks, sorry to hear! I think I'd be too hard headed to not race if I was back running by January...

Herding Cats wrote:
I noticed you were in MT this summer training from your notes. Did you do the Lisa Bentley training camp?

No, I went up there with a friend to do race recon (first time I went to that effort) for IMMT. I was hoping to KQ so embraced my OCD by going up there and taking photos/trying multiple wheels/gear ratios/etc. I loved the course and I'm gutted I can't race 2016 (logistical reasons this time).
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Re: Proximal right femur stress fracture [dado0583] [ In reply to ]
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dado0583 wrote:
No, I went up there with a friend to do race recon (first time I went to that effort) for IMMT. I was hoping to KQ so embraced my OCD by going up there and taking photos/trying multiple wheels/gear ratios/etc. I loved the course and I'm gutted I can't race 2016 (logistical reasons this time).

What a fun trip to make and check out the course! MT is a great one for sure! If I ever do Lake Placid I'd want to spend a weekend there before the race and ride the course since it's within driving distance.

Death is easy....peaceful. Life is harder.
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