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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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