I'm an australian sports doctor with a special interest in endurance athletes. I generally see about 3 or 4 of these a year - so they are not very common. They occur almost exclusively in overdistance female athletes but this year I've seen two males (one Pro ironman). I'm assuming the diagnosis was made raiologically (marrow oedema on the MRI but with no visible crack in the bone). Most of these get better with rest from running only and most can keep riding and swimming if this is pain-free. It is important to correct whatever metabolic predisposition exists - ie negative caloric balance, low Vit D or even Ca/PO4/parathyroid hormone issues if they are detected. If you still have pain after an appropriate period of rest then it would be wise to get a fine-slice limited CT scan through the area - occasionally cracks in the bone can be missed on MRI and this is one of the few areas where CT is actually more sensitive.
Hope that helps


http://www.semwa.com.au

What is a reasonable healing time? Is it possible fir a muscular strain to cause this versus impact? Is it normal to an and adductor pain?

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Greg Mueller
Level 2 Triathlon Coach
Level 3 Cycling Coach
level 1 Running Coach
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Not sure what your last question in this post is, but it is normal and most common for stress fractures to be from muscular strain/overuse in combination with what the Doc said...poor nutrition or something else lacking. Reasonable healing time depends on you: be a good patient and listen to your body. Not an orthopedist, but I wouldn't expect to go back to impact exercise (running, jumping, cutting, heavy lifting) for AT LEAST 6 weeks (and that is probably low). As the Doc said get a CT if not resolving, also if you truly have a pelvic stress fracture, look for the other one - the pelvis is a ring and therefore if there is a stress point on one side, there is often a second one opposite it. Good luck. Take care.

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Don't Just Live, Thrive!
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I had something similar with 2 stress fractures in my pubic bone area in 2008. Absolutely caused by overuse. I was unable to ride or run for 3 months and had to be very careful to use my ab muscles as little as possible. It's tough not to use your core as almost everything includes core strength which is why this typically takes a while to heal.

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Long story -I train for tris over the summer months but in the fall focus on a good marathon and put in decent amount of miles weekly. Kept having random butt and inner thigh pain and thought it was my tendinitis that flares up from doing too much speedwork. Went to my PT and did my stretching program and even my chiro for adjustments/ART.I was in great shape so just trained through it. It was pretty painful and used to wake me up at night . I wanted to run a sub 330 and did the MCM(09) in 3:32 ( Im a F 34 yrs old). The second half was surreal pain. I took two months off of everything and went for a quick jog that January and the pain was still there. An MRI later I had a stress fracture to the Pubic Rami bone on my left side and a major stress reaction on my right. I took off of everything- no swimming even ( the kick and turns irritated it) and had regular MRIs with no improvement. After 9 months I was approved for a bone stimulater ( exogen). Maybe it helped, maybe not.I started running again this May(19months)- and it still hurt for the first few months. I believe runners world has a huge thread on the subject- Pelvic Fracture Insanity- basically a hundred runners that have not been able to run for at least a year. Hopefully you caught yours in time to heal quickly- that was two frustrating years.

I have an athlete who has one, and I have had a friend of mine who had one, both males. My athlete is not sure exactly how his happened, probably a combination of things, but as you mention, he thinks that it was non-impact and not triathlon training related. Odd story about M&Ms and a vending machine. The other friend of mine got one while training for a marathon several years back. His was a pubic ramus/rami fracture...I believe both were.

In the case of my athlete, he's taking rest. The same was true of the friend of mine, although he was back to activity after about 5-6 weeks. As far as other remedies, I don't know. I don't know that taking calcium would help. You might get Vitamin D levels checked as well as a bone density just to see.

I had a 'stress reaction' where the psoas attached to the femur. For me, I had what I considered extreme radiating pain in my groin/adductor area. It hurt to walk, especially to go up stairs, and then to kick while in the pool. I took a full 5 weeks off of running and 3 weeks of no swimming or cycling. Not a stress fracture, but just another data point.

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Brandon Marsh - Website | @BrandonMarshTX | RokaSports | 1stEndurance | ATC Bikeshop |

What is TRX training?

Two years ago I had what may have been a pelvic stress fracture or stress reaction, along with psoas tendonitis. It took so long to get into see a specialist that by the time they ordered an MRI and then a bone scan, the only thing that we could see was psoas tendonitis. With the amt of pain I was in when it initially happened, I would not be surprised if it were a bone injury. However, 4 mo after the initial injury, a cortisone shot cleared up the tendonitis and I could run again.

Ask for a bone scan to rule out a fracture - I know you didn't see it on the MRI but a bone scan is a good test - does your MRI show inflammation around the psoas tendon, tendon sheath, bursa (is there a bursa in there? I forget)? If so ask for an ultrasound-guided cortisone shot. If for some reason your MRI was not a contrast-dye MRI, get them to redo that with contrast.

PM me if you need to.

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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

I had a fracture of the right inferior pubic ramus in May of 2008 and the left in July of 2008. I took the remainder of the year off. Vibration from the road really hurt after I rode the bike. I ended up doing a ton of stretching and began running again the next January. I also started taking a calcium supplement. My main issues were a severe lack of flexibility in the hamstrings, hips, quads and lower back. The PT and doc also recommended I strengthen my core. Unfortunately, I think I cracked the right side again in Kona this year.

Most triathletes are singularly focused on forward movement in whatever exercise we are doing (swim, bike, run, lunges, etc.) and we forget to strengthen the muscles that allow us to move laterally. We all grew up using these muscles playing around the house, but as we age we use these less and less. I'm starting to perform the same abdominal bracing and core work, and more stretching. When I feel I'm ready, I'll start adding the lateral movement.

I'd be interested in any research you find on the topic.

cjw

I had a pelvic sfx during 2010. Doc said it was due to overuse, but I believe it was mostly likely due to a fall skiing.

In any case, the recovery time was very long....six months which is typical with this type of injury due to the location.

The following blog was sometimes helpful to me: http://pelvicstressfractures.blogspot.com/

Happy to help if you have questions.

Adductor pain is normal. Mine was pretty intense for the first month.

Recovery is individual. My research and experience told me you pretty much just have to stop exercising until there is no pain. Then start with the lowest impact, no pain activities.

cjw,

I was diagnosed with a fracture of the right inferior pubic ramus 4 months ago. I stopped running as soon as it happened and now, as of a week ago, I am finally healed and running again pain free.

My question for you is: do you have any advice on how to avoid fracturing the pubic ramus agian? I am taking calcium and vitamin D supplements and starting to stretch more, and even doing some yoga. But have you been able to avoid re-injury since 2008, and if so, how?

nao,

Glad to hear you caught your issue early.

I strained the area at one point, but have been good otherwise. I had not been as diligent on my core work or stretching. I increased the abdominal bracing and core work, but still don't stretch enough. Planks are a big help, especially on the side. 1 minute front, 1 on each side, and 1 front again. I started doing two sets of jumping jacks, one at the beginning and one at the end, of my strength workouts. I gradually built up to 2x50. I also started doing lateral lunges; 2x20. When the kids are playing soccer or basketball i try to move laterally. Following my runs, I'll walk sideways and cross over my leg (I'm sure there is a name for this drill, but I don't know it.) for 20 or so seconds on each side. It stretches the hip and ITB. I think yoga would be good, but I'm so inflexible I don't think you could tell I was attempting to do it.

Good luck!

cjw

Not directly related to stress fractures but I fractured one or both of my pubic ramus bone on the the left side (superior and maybe inferior) early this week. Hit an object on the bike path and came off my bike at fairly low speed. My hands slipped forward off the hoods and my bottom slid forward off the saddle then I fell over.
I sat on the ground for maybe 10minutes feeling that sick/light headed feel I get when I’ve broken something. Bike was ok ! Some people checked on me etc then I got on my bike and rode the 10km to the hospital. Ouch and very slow.
Got an X-ray which inidicated the fractures and now I am waiting til next Friday for my follow up appointment with the doctor and start seeing a physiotherapist. I am getting around on crutches to take weight off the bone(s) while they heal. Supposedly, healing time is 6 weeks or so.
Obviously I can’t ride or run for a while but, does anyone have any idea when I may be able to swim again with a pull buoy ? 2 or 3 weeks ? I normally flip turn so may need to swap to open turns for a bit but that is fine. It is difficult to fully engage my core because the lower stomach muscles will pull on the bones which were broken.