As of today, I just got back the results of an MRI that I have a ‘pretty significant’ sacral stress fracture. So, seeing that I was all geared up and ready to go for IM Canada next weekend, needless to say, I’m bumming a little…
Of course I’m working with a dr., but I’m just wondering what other people’s experience with this injury has been as far as treatment, weightbearing, healing times, recovery, and return to training?
Also, any good comeback stories from sacral stress fractures would be highly appreciated!
Stress fractures generally take 6-8 weeks to heal. My experience is with metatarsal and lower leg fractures, not sacral - I would think it would be about the same.
Bones need calcium, vitamin D, and vitamin K to heal. Calcium can be absorbed in up to 500 mg at a time with a max of 1500 mg per day. You can get that from food - if a yogurt says it has 35% of your daily calcium, it has 350 mg - or you can take supplements (Viactiv chews are sort of like Tootsie rolls with an odd after taste) which mostly need to be taken with food. Calcium from spinach and other leafy greens count too, but the oxalates and/or in them often bind with the calcium and you don’t absorb as much. Stick to dairy and fortified OJ and soymilk.
I am very sorry to hear of the fracture. Is it from tons of running, or did you have a bike crash or something?
Ask your doctor if swimming and water running are okay at this point. Then maybe cycling in a few weeks. Running is obviously out.
How long have you had pain and how long did you go before the correct diagnosis? Anyone other hx of stress fx? You might need nutritional supplements especially if any hx of eating disorders.
Worked with several athlete that had sacral stress fx. I think most data tells you to rest 4 - 6 weeks. Yes, this is probably no running for 4 weeks and avoiding painfree activity. Most I worked with were able to walk, sit on an upright bike, easy swimming of basic stroke, and some elliptical machines. Pay attention to your doctor! Most of them know best. I’m not a physician and don’t know the location, size of your fx or you previous health hx.
Not sure how flawed data is though of resting 4 - 6 just because I’m not sure if anyone receives the diagnosis right when the fx appears. Usually athlete told rest due to inflammation and given anti-inflammatory drugs(probably want to avoid these drugs with stress fx) Signs and symptoms are similar to piriformis issues, disc, and general SI pain. (Good friend good had same issue several issues and she went 2 months with pain and finally begging doctor to give her a MRI. Her insurance didn’t cover for MRI’s for such things, so doctor didn’t order it even though she had hx of other stress fx)
All that I have directly worked with were back to training in under two months with no complications. (but rare injury and think I have only seen 4 or five including friend above) Now, I have seen some hip(femur) stress that are career ending. (was an elite athlete) Seen several lower leg and foot that develop to full fx or never heal correctly.
Probably not. As you probably know, sometimes hard to treat. Find out what could be causing the issue as maybe weak hip muscles. It is usually rotators or abductors. Maybe tight hip flexors. This is hard to determine and it take a good therapist or athletic trainer to find this. Even some of the ortho will admit the trainer is better at determining the cause. (I really no longer work as an athletic trainer and not the best hip evaluator person - so this is why I say find someone good)
I really like ART, but again find out if you have some weakness or tightness and address that issue. ART, massage, ice, ultrasound, other modalities, drugs, and stretching will help the symptoms. For most sciatic issues, I am NOT A FAN OF REST. Rest just doesn’t seem to work, but could be because people never really rest. If it is one of those issues that is not getting any worse or causing more harm by training - why not train??? Sorry I can’t really help respond to your question. Someone else will and will disagree with me.
Thanks for your insight with this! it is great to hear that there have been athletes that have come back from this injury quite well!!! That alone, is music to my ears right now!!!
I was also told that this is somewhat of a ‘rare’ injury. Fortunately, I was diagnosed ~5 weeks after the initial onset of symptoms. There was some suspicion, but mostly for other things, and the results of the MRI were a bit of a surprise to both me, the dr., and the radiologist. At this time, I have been placed on crutches and non-weightbearing on the fractured side because there is some concern about the stability of this thing since there is a significant fracture line present on the MRI, but have been given a 2-3 mo healing time. Unfortunately, I have no hx of trauma, never had a stress fx before, have no hx of female athlete triad/disordered eating (which seems to be the typical population for this injury…), take care of myself pretty well during training/racing via stretching, massage, core work, etc, and have never had any major setbacks due to injury in my 7 yrs in this sport (including several IMs). So, in other words, the presentation is quite atypical.
Although it sucks to not be racing in Canada, and also have racing in Clearwater now be in jeopardy, I will say that I AM glad that I listened to my body, and went to have things checked out before racing an IM on something that was ‘not quite right’. From what I am told, it could have been very ugly if I would have raced an IM on this…
You case does seem even more rare than the “typical case” and I just did a search on complications of the issue. You have got me interested in reading on the topic. It seems like you are doing so, but please pay attention to your doctor. It seems like you have a great doctor since he/she though there was a possible fx. I never treated an athlete with a serious complication of a sacral fx, but I am sure you can find some case studies. I’m still reading articles. It is still good you caught it when you did.
At least two of the women I worked that had sacral fx also had previous history of stress fx and eating issues. One returned successfully to top division I running program. I think the other was a basketball player that returned without issues, too. Had a gymnast with sacral stress/chronic trauma fx that ended up being fine, too. (now I have worked with a runner that started out with a femoral head stress fx, then complete fx, then avascular necrosis, and no more running in college and I doubt she is running much now. The two injuries are different, but still important to rest when needed)
Good luck. Hopefully some others will respond with their personally hx or professional advice.
I’ve had back issues for a while now I tore my ACL 2 yrs ago and my back got much worse I’ve done PT, chiropractors, yoga, pilates, epidural injections, you name it My core is strong
I do agree that it may stem from weak hips and so fourth You need a MRI to really see whats in there I’ve done a bunch of races feeling this way as well Its limited me.
Back pain is no joke. Find out what is wrong and nip it in the bud.
Recently I was told I have no disc material left at L5/S1. Now I have to make a tough decision.
Good Luck
I had a sacral stress fracture in 2006 and it took 2 months until I was able to start any type of running. At first it felt like I had a deep bruise in my hip and I could not figure out what the hell was going on. Ended up going to a sports specialist and had an MRI done to confirm what the doctor suspected. After laying off for a few months he had me run easy for 1 minute, walk four minutes for a total of 20 minutes and then shortened the walk phase until I was running 20 minutes straight. After I got to 20 minutes I got the green light to run all I wanted.
I did 2 Sprint Tri’s this year…I suffered through both…you know, I was trying to work through the pain.
Then finally I got hurt at work again and I had a MRI done.
The herniation I previously had…“went back in”, but now I have further degeneration at L5/S1 level. I’ve been told by one Ortho so far that if I can’t live with the pain, I have to get a lumbar fusion.
I sent my films to Dr. V…he is a Dr. who a lot of people on this forum have used. I haven’t heard back from him yet. I also have an appt. with a Dr. at the Hospital for Special Surgery in NYC. (very good Ortho hospital)
I’m going to see what all three say and make a decision.
I can swim…it hurts sometimes. Cycling hurts but I can suffer through it b/c I enjoy it. Running is no fun at all anymore.
Ironically I was a runner before I started Triathlon and I only started doing Tri b/c I tore my ACL and couldn’t run for a while. Now a love Triathlon and I don’t want to stop.
Like I said, its a tough decision to get the surgery or not.
GerladR- Thanks for your first hand info on things!
It is great to hear about someone having one of these and coming back!!!
When you started running again, did you have any continued symptoms, or were you symptom-free at that point? any symptoms come or go now that it is years later?
I have not had any symptoms with it since. I was diagonised in April 06 and was back to running 30-35 miles a week by the end of July with no issues. I had x-c skied all winter with no running and then after the season was over just jumped into running without easing into it and the doc figures I was pretty fit but the bones, ligaments, etc could not handle the stress going from not much of an impact sport to one with a lot more impact. His words “big engine, no supporting frame”.
Lisa, thanks again for your insight, and for your reading on the subject!
Please let me know if you find out anything good in any academic or peer-reviewed literature on the topic. From my searches, there does not seem to be a ton of publications on the topic and many are single case studies.
Coming late to this thread as I was just (3 days ago) diagnosed via MRI with a dual (yes, two) sacral stress fracture/insufficiency fracture. Here’s another data point for others who may be going through diagnosis - but as yet I have no hopeful words about treatment and recovery.
My story is remarkably similar to that of GeraldR – I spent the winter (Oct-Feb) off of running because of some lingering Achilles issues, figuring I’d let it rest before diving back in when the snow melted. I kept up the fitness in the pool and on the bike as well as with some XC skiing.
Come February when the Achilles was good to go I got out there and was pumped to be running again - hadn’t realized how much I’d missed it. I planned a slow ramp but was following a coached plan that had me going from 0 to 23 mi/week over 3 weeks. Under normal conditions 23 mi is a mellow week but coming off of such a long period it was a lot. I had some aches in unusual places but figured it would all blow over.
Then one day I was out for an 8-miler and all hell broke loose in my lumbar - spasms in the back and glutes and even hip flexors and I could barely make it home. I saw a chiropractor who did some ART and diagnosed SI dysfunction. Saw him about 5 times over 2 weeks and the back started calming down but I had a strange lingering twinge/bruise deep in the right hip that sometimes also showed up in other minor muscles. 3 weeks post injury I went out running again but had some aching in the SI. The next week I got out for some (5-6) miles and felt okay. The next week less so. All the while I was biking & swimming with no real pain.
With IMLP on the schedule, though, I needed answers because this thing wasn’t clearing up, and as much as I wanted to believe it was a simple soft tissue problem that I could train through, no one could figure out why it was lingering with such a minor but persistent pain level. So I had the chiropractor order up an MRI and bingo – the stress fractures. I had no prior history, am a male, eat well, have never even broken a bone. No red flags that I can identify.
Aside from coping with the demise of a season that had me super psyched, I’m now trying to sort out the right activity level. It might be zero for a few weeks. I’m 6 weeks post injury but have been doing 13-16 hours/week in the pool and on the bike – not exactly resting.
Gerald if you catch this post I’d love to know whether you used pain as an indicator of go/no go as this is what my chiro has recommended – no running, but swim and bike as long as there is no irritation. I want to believe this is smart but am not convinced yet because everything I’ve read about sfx says rest is the only answer.
Afwhit, my doctor had me doing the same as what your Chiro has recommended. I could swim and bike all I wanted but absolutely no running for 8 weeks if I remember correctly. After that I was allowed to do some very short run/walks every other day increasing in time until 20 minutes straight running caused no pain. If I felt any pain at all, or even that deep bruise sensation, I was to stop and take another week off and start over.
Just cleaning out some old emails and realized I never followed up with the conclusion from this whole thing.
Recovery from the sacral sfx was as others have said – long, finicky, and generally a pain in the…er…sacrum. I ended up doing no running at all from the day I was first diagnosed via MRI (Apr 30) for the next 9 weeks. During that time I swam 2-3 days/week and biked as much as I could without causing pain. This usually meant 100-150 miles/week although there were some funky lower back/facet joint tweaks that acted up from time to time. I got ART a few times during the recovery period but didn’t really do much else other than make sure I was gettting 1000-1500 mg of calcium a day plus Vit D.
About 3 weeks after I picked up running again (very slow ramp, and I mean slow as in 1 mile, 1.5 miles, 2 miles, etc.) my lower back started bugging me so after a couple weeks of uncertainty I went back in and got another MRI to make sure the sfx were cleared up and they were. That was mid-August and since about November I’ve back to running as much and as fast as I want – FINALLY. I probably played it conservatively with the comeback but once I wrote off the 2011 season that seemed like the best course.
Incidentally, in September I cracked/badly bruised a rib somehow with no real trauma. Mentioned this recently to a friend (42 y.o. male Kona qualifier) who had had similar incidents and just found out he has advanced osteoporosis, which his docs attribute to both training and unfortunate genetics. Recommended bone density scans to those of us who train with him so I’m doing that next week to rule out bone disorder as the root cause of the sfx and rib issue.
But as far as I know now, everything is back together and the season starts soon…
