Pubic Ramus Stress Fracture, An Update

Not exercising doesn’t make for very interesting blogging, but I’m overdue for an update. I was kind of hoping that if I waited a bit long, I could come to you with news of a triumphant return. Alas.

In my first post about my most recent injury, I laid out what led up to my diagnosis of “a healing nondisplaced transverse stress fracture of the anterior aspect of the right inferior pubic ramus, with moderate marrow edema and periosteal reaction.” I also laid out a tentative plan for my recovery.

My plan for 5-7 weeks post-diagnosis went, well…according to plan. I got LASIK and focused on recovering from that. My eyes recovered perfectly, and I don’t even feel like I ever had eye surgery, so at least that went well.

At one month post-diagnosis, I noted that there was no pain with walking or using the leg against resistance (think pushing a door open with your leg), and I no longer had pain when putting on pants, which was a huge improvement. I still had pain when sitting for long periods, however, or when rolling over at night.

Six weeks post-diagnosis, I began a series of light hip exercises—clamshells, leg lifts, brides etc., with just 6-8 reps of each on both sides. Then, six and a half weeks post-diagnosis, I began to reincorporate spinning, starting with just 10 minutes on the bike. I was a bit sore in the pubic ramus area after that, but felt better after a night of sleep, so I did another 10 minutes of spinning two days later, before bumping it up to 15 minutes.

At 8-9 weeks post-diagnosis, things got off course. As planned, I went for a follow up with the hip specialist on April 4. I had another x-ray that didn’t show any problems. In the exact words of the report, “No evidence of acute fracture or dislocation. Joint spaces and alignment are maintained without significant degenerative change. Unremarkable soft tissues.”

The Physician’s Assistant (the doctor didn’t even grace me with his presence at this appointment) said, “Resume your life.” I was skeptical. I had told them that while I was asymptomatic 90 percent of the time, I still did have some symptoms. Also, I said, shouldn’t the x-ray show something, like a bone callus, some sign of healing? They just brushed me off.

I wasn’t happy with that, so I scheduled a follow up appointment with my orthopedist, the doctor who sent me for the initial MRI and referred me to the hip specialist. I voiced my concerns and he listened. He said there won’t always be a noticeable callus if the healing was mostly within the bone, or something like that. He also said that while he didn’t like that I still had some symptoms, he said some of it could just be the result of an overactive brain-nerve connection.

Anyway, he said to give it a week and then try the Alter-G. If it felt good, then good, but if it didn’t feel good, he said to take another two weeks off and try again. (For more about the Alter-G, check out my post Building a Base with the Alter-G.)

So on April 16, just shy of 9 weeks post-diagnosis, I ran for about 20 minutes on the Alter-G at 60 percent of my body weight. It felt pretty good and liberating to run again, though it was definitely work for all the soft tissue since I didn’t exercise at all for 7 weeks, including minimal walking. After all, I had only begun commuting to work five days a week two weeks prior.

On Wednesday, I returned for another 20 minutes, but by that point I was kind of sore and experiencing general discomfort in the pubic ramus area. It’s worth noting that this is a VERY uncomfortable place to feel discomfort since it’s basically right in the crotch, basically. At the suggestion of my friend/PT from my calf strain days, who I ran into briefly in the bathroom on my way into the office to use the Alter-G, I did 2 x 10 minutes on Wednesday with 5 minutes of walking in between.

When I woke up on Thursday, the general discomfort was more severe, so I decided to cancel a Friday Alter-G session that I had scheduled and take another two weeks off. None of the discomfort was all that bad and it didn’t match any of my prior symptoms. But it just didn’t feel “right,” so I don’t want to risk it.

I took it very easy the next weeks, backing off the spinning as well. After a week off, I reintroduced some lighter spinning and some general strength and stability exercises. On the recommendation of a friend, I’ve been using Nike Training Club. I love having a structured 20 minute workout on the app. I find it makes me more likely to actually do the exercises.

I still get some random aches and pains. They tend to be very sporadic and short lived, but it’s enough for me to question everything and worry about whether I’m actually healed. So, I did a bunch of research and decided I want to try another (a third for those keeping track) doctor to see if I can find someone to help me through this issue.

It took awhile to get an appointment, so I won’t be seeing the newest doctor, a female sports specialist, until May 15. Maybe I’m healed, maybe I’m not. I just want a definitive answer, and I want to know why. Why did I get this random injury? How can I prevent it from happening again?

In the meantime, I am back on the Alter-G after my two week hiatus. I ran for 20 minutes at 65% last Thursday, 25 minutes at 65% on Monday and for 25 minutes at 70% today, Wednesday. (yesterday, May 8th, marked 12 weeks since my diagnosis, by the way). It feels better this time. I don’t feel anything bad on the Alter-G, but like I said, I still get those flashes of not-quite pain as I go about my day–or sometimes just sitting on the couch!

Anyway, I’ll continue the Alter-G for now and hope I’m just having a bunch of weird phantom pains. Fingers crossed for my appointment next Tuesday! Hopefully I’ll have something more definitive for you after that.