Femoral Neck stress fracture: your experiences!

Triathlon Forum
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It seems liek there are million different presentations and a million different treatments…but I’d love to hear experiences. A few months ago, I began noticing a nagging anterior groin pain.Typically worse after running, but got to the point where it affected running…and then night pain, pain with driving, etc. Initially thought it was an atypicaly presentation of labral tears (I have multiple tears in both hips; mild impingement in one. Also grade 2 condromalacia, but par for the course). I get flare ups occasionally, esp. if I get neglectful with my core stuff. An increase in those exercises, with or without a reduction in run and ride volume, usually takes care if it. No such luck here.

I stopped running altogether a couple weeks ago, and that seemed to help with a lot of the pain with normal walking, as well as the night pain. Figured it was not the labral tears by this point, b/c riding didn’t bother it (and normally does). No problems with ROM or flexion, no bursitis or tendonitis–all which I useally get witha flare. Made an appointment for an MRI pretty sure I was headed for FNSF city.

Ding ding ding. Medial (compression side) femoral neck fracture…with focal marrow edema along the medial femoral neck extending into medial intertrochanteric femur. No evidence of AVN. Doctor says, “TTWB, 4 weeks. COme back for reevaluation.” He did say I could ride on teh trainer inside–but no riding outside, for fear of falling. I told him I had two big dogs–one of which was new, and had to get them in and out on lead several times a day…he said “get someone to help. If you can’t…be careful and use the crutches as much as possible.”

Honestly, once I laid off the running, a lot of the constant, sharp pain went away. I still have a lot of back pain, and most jarring activities (ueven ground, dog pulling, carrying heavy loads) give me a sharp intake of breath) but walking is usually okay. I start to wonder…do I need the sticks? I feel liek a tool. Believe me, I have spent probably two years of my life on crutches–I am very facile with them. BUt it seems like I should have more pain.

A part of me wants to not use them…but the other part of me (rationally) thinks, this is my good leg. If I cock it up, I am up shit creek. So, I will probably feel like a douche, and use them (except with the dog thing–I can’t help that most of the time.). I wasn’t even racing…my most recent knee surgery was 18 months ago, and I had a nice, gradual return to activity.

Frankly, I’m not sure how this even happened. My running is in the 12-20 mpw range, and b/c of my knees, I do mostly soft surface. I core and strength train. I ride a decent amount–60 to 90 minutes every AM (prob about 20-30 miles, give or take, on the trainer). Longer rides on weekends or evenings. But all low key. So, max week was like maybe 12 hours on the bike, 3 runs of maybe 4,5,5 miles, and then two sessions on the ET. But all low-intensity…and nothing has changed or ramped up. I eat right, take a calcium supplement, etc. This has happened once before–I had a 3rd metarsal sfx appear overnight. Bone density is fine. I had it checked when I broke my femur after my DFO.

So…that’s my story. I guess I was just curious to hear if folks thought his plan was too aggressive or too conservative (I see lots of folks who are allowed to walk). I fully realize the severity of a FNSF, and the shit show it can turn into. I’ve had enough major injuries and very long rehabs to have patience. But I DO feel douchey on the crutches :smiley:

Stories to regale me with?

(Oh, and I should say that aside from all the labral tears, the chondrosis and chondromalacia…everything else was peachy. All balanced, hale and hearty.)

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I was victim to a femoral neck stress fx last year.

Similar to you - I wasn’t training much to cause the injury (in my opinion) - but I found I had other things going on internally that likely were the cause.

I posted a few blogs on my injury that you can check out - linseycorbin.com

My advice:

  1. Take the rest and down time super seriously. This isn’t a text book injury and I found it really hard to “heal” due to its location. In my experience, the typical 4-6 weeks rest + cross training if it doesn’t hurt wasn’t a good resolution for me.

  2. Look into WHY you got this injury so you don’t get it again. DEXA scan, blood tests, nutrition work, hormones, physio therapy, etc.

  3. If you take the time to recover and treat this properly you WILL be back. A year ago I was on crutches, just over the weekend I set the new marathon course record at IM Cairns.

Feel free to email me with any questions you may have! Happy healing! I had a really frustrating time coming back from mine, and made some silly mistakes combined with bad luck. It dragged on and on… but eventually it healed (as all broken bones do).

linsey

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And yes, I would use the crutches.

I was the same as you - thought I was the exception to the rule and didn’t really need them as I was pain free walking. Well, I ended up having to go onto crutches 8 weeks after diagnosis as my follow up MR showed I wasn’t making any progress with the healing.

You’re better off to use crutches now and get it over with than deal with the up and down roller coaster I did. I regret not taking the first 4-6 weeks of recovery super serious and having this injury drag on all summer and early Fall.

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Who cares about other people’s experiences. Your doc ( the one that actually looked at your MRI) said TTWB. Follow his advice or don’t but be willing to live with consequences if you don’t

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Thanks for the reply! ANd yeah…I can see that. The dog thing i sunavoidable…but for the rest of it (including the week at the cabin :p), I can deal. But I stil feel lame-o. Funny thing: I’vespent a LOT of time on crutches–probably two years total, at least. But ALL for my left leg. I am hopping around on them tonight…and I realize I’m favoring the WRONG leg out of habit :smiley:

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I had a stress reaction in the same place. Went to the orthopedic surgeon right away after the first time I had to stop a run because of the pain. It kind of came out of no where. He took xrays, didnt see anything and put me on physical therapy. after 6 weeks things were not any better so we did a high resolution MRI with enhancement (that was fun) and discovered the reaction sight. my mileage was fairly low at the time, but the intensity was pretty high (followed a bad running plan). was also a pretty bad heal striker. i know that works okay for some people, not for me apparently.

I was allowed to walk without crutches or do things with a pain threshhold limit of 0.5 on a 0-10 scale. Not allowed to take any pain killers or else i had to use the crutches. absolutely no running until i got clearance from him or being chased by a bear and i didnt have a friend to trip. So I swam 4-6 days a week for 4-5 months. I was just running when this happened, so this swim block is what gave me the idea to try a triathlon. saw some nice swim improvement over that time, going from zero swimming to swimming most days.

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I see that you are taking calcium.
Look into adding MK-7 (Vitamin K2)(~180mcg).

The MK-7 helps direct the minerals to your bones and out of your vascular system.

There is also potential benefit from adding Strontium in addition to Calcium. This should probably be discussed with your Dr. There is evidence for decreased fracture risk, but the potential for other effects as the body substitutes it for Calcium.

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Who cares about other people’s experiences. Your doc ( the one that actually looked at your MRI) said TTWB. Follow his advice or don’t but be willing to live with consequences if you don’t

Yeah - this is a pretty good approach IMHO.

But if you want some stories…

I had a stress response r/side femoral neck three years ago. Started running from a very low base. Ran as hard as I could a lot. That didn’t go so well. Sort of burning pain in my groin that often as not would be present during the swing phase of the stride rather than the impact. Could run it off in the first five minutes of a run, but it kept coming back. Started seeing a running coach. Didn’t mention this. I remember the first session was 8 in the morning. I had to get up at 7 to mobilise it enough so it didn’t “show” by 8. A couple of weeks later I went on a tempo run trying to lengthen my stride (a lot) rearwards. Pretty sure I ended up running with a limp. Within 20 mins of getting home I couldn’t put any weight on my right leg. Nor the following day - unbelievably painful. Went for an MRI and got diagnosed with a stress response. Oedema was halfway through the neck - the consultant thought from the MRI it was a certain fracture but a CAT scan said otherwise.

Took about 4.5 months to clear. By the time I saw the consultant it had calmed down enough to be able to walk on, and he didn’t suggest crutches. But he did rule out running or anything above low impact!

The following year I picked up a femoral shaft stress fracture on the left side. Less painful by a mile, but niggling. The consultant I saw that time wanted me on crutches. As this was 7 weeks or so pre IMC, I ignored that advice, stayed off it and hoped. By a week before the race I was ok on the “hop test” (the litmus test IME. Hop on the affected leg - if it provokes groin pain, you’re still in the woods). Did the race, and a couple of weeks later had an MRI that showed it was still there but greatly reduced. Probably aggravated it.

So no crutches here but then no fracture either. From what I read here allied to my own experiences, it seems that UK doctors tend to be a bit more relaxed with their treatments that US doctors.

I’ve also managed to fracture my 5th MT rolling my ankle. That hurt like a mofo, but I ran home on it. For that one I was in a boot for 6 or 7 weeks and on crutches fully non weight bearing for the first two. Crutches were a gigantic PITA, but having had the consequences of overstressing the affected area explained to me in vivid detail, I was happy to suck that one up. And realised I’d had a very lucky escape running on it.

Subsequent DEXA revealed low bone density; on the WHO border of porosis and penia.

Subsequent physio targeted my glute med, which on my right side had oddly atrophied. Not unrelated, perhaps, but when told to activate my glute med I had simply no idea what to do, or what it felt like - the physio would say “yep, you’re doing it, no, you’ve stopped, you’re doing it again” but to me I wasn’t doing anything different.

A finisherpix photo at a HIM last year of me during the run showed very clearly my hip collapsing downwards and my elbow sticking out on one side. Hip instability. FWIW my personal view is that if you have weak/poor running form, you can mess yourself up on pretty low mileages. All the more so if you have a rowing/cycling background, as the rest of your will have the ability to go reasonably quickly for quite a while, while your untrained running musculature goes to shit leading to all sorts of other problems.

I’ve been ok now for a while. Things that have helped with running: getting a coach to structure my run sessions; initially trying to do a country & western hip hitch on each stride to overcompensate for the hip dropping; concentrating on activating my entire back line from lumbar to glutes to hamstrings (which made me realise how quad-dominant my running had been); and tucking my elbows in (my idea is that elbows stick out to provide balance against unstable hips, so tuck your elbows in and you will force your body to recruit the balancing muscles in your hips. Bit like improving a tightrope walker’s balance - take his balance pole away).

The nagging sense I think I’ll always have is being ok for now - it’s difficult to shake the feeling that recurrence is only ever just around the corner, especially if you can’t establish a clear and obvious single cause.

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Another thread with some info: http://forum.slowtwitch.com/forum/Slowtwitch_Forums_C1/Triathlon_Forum_F1/Proximal_right_femur_stress_fracture__P5607829/
.

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I had a lot of anterior hip pain six years ago. It started as soreness then all of a sudden I couldn’t run. It took a really long time to get in to see a specialist (several months). They did an MRI and I definitely had tendinitis, and very possibly had a healed FNSF. Looking back on it given the pain I was in, I probably did. Because it took so long to see a specialist no one ever put me on crutches, and I think my mind was unwilling to think that I was 23 years old with a possible hip fracture, so I swam and rode on the trainer and walked a lot. The specialist said there was tendonitis, and gave me a cortisone shot. That cleared up the tendon issues, and it had been enough months that the fracture, if there was one, had healed.

Use the crutches. If people give you funny looks, tell them you have a hip fracture. I think of it this way, ANYTHING SO YOU CAN RUN. If it doesn’t heal right and you didn’t use the crutches, you’ll regret it.

It seems super strange that you’re getting these fractures with low intensity, bone density is fine, etc. Have you had a calcium excretement study done? I think it’s called an NTX study.

many (((hugs)))) and wishes for a speedy recovery.

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FWIW my personal view is that if you have weak/poor running form, you can mess yourself up on pretty low mileages.

^^^YES. Most likely a huge contributing factor to my FNSF last year. A quick run gait video analysis with a trained set of second eyes can help with this. Good luck!

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Sorry to hear. I had one a couple years ago and this injury is no joke. I started with crutches for a couple weeks. Then I continued with total rest and limited walking. Was able to start cycling and eventually run again after 4-5 months but I was very conservative. I took calcium supplements and was also prescribed and used an Exogen ultrasound once a day which I think helped. Good luck!

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I had 12-years ago. It took 6-months to get it right. A couple false starts with early attempts. In the end, running short on golf course for the first month really helped. Avoiding hard pavement may allow you to start a little earlier and if you can couple with aqua jogging you get things started without compromising your healing.