When I was diagnosed with a pelvic stress fracture in February, I was devastated. I was just about to begin training for my first marathon in two years after dealing with a nasty calf strain for half of 2017. And the prognosis, at least according to the Internet, was grim.
My injury, to be exact, was a non-displaced stress fracture of the right inferior pubic ramus. What that means in English is that I had a stress fracture on the bottom of my right sit bone. Right here:
This was scary for a couple of reasons. First, pelvic stress fractures are rare! A pubic ramus stress fracture is among the rarest of the rare for runners. Most injuries to this bone are trauma based—think car accident or falling off a horse. Second, when you search the injury, you get almost nothing but horror stories—people who needed 6, 9 or 12 months to get back to running again. That was terrifying given I had just taken six months off running last year!
Making matters worse, my doctor was unfamiliar with the injury, so he referred me to a “specialist” who was also unfamiliar with the injury! (In his defense, he does deal with hip fractures, just the trauma kind, not the stress fracture kind.)
As a reminder, here’s a quick rundown of my symptoms at the point of diagnosis:
- Dull pain at the top of the hamstring / glute insertion
- More of a shooting pain down the adductor when putting on pants / socks
- Pain on adduction against resistance
- Pain when pushing the door open with my leg / foot
- Rolling over at night causes pain in the glute area
- Sneezing or lifting something heavy causes pain in the glute /pelvis area
- Jumping on the right leg (where all the pain is) feels fine, but jumping on the left leg causes pain on the right side
As such, my initial treatment plan was kind of self-directed based on what I read about the injury online. As I mentioned in my initial post about the injury, I had noticed a common thread for those who saw their injuries persist for months vs. weeks: they cross-trained. Many of those who complained about their injury being stubbornly persistent used elliptical or biked from the moment of diagnosis. Those who recovered quickly rested.
So my initial recovery was pretty aggressive. I tried to stay off my feet as much as possible for the first four weeks or so post-diagnosis. No walking, no cross-training, no standing up, no bearing weight/carrying or lifting heavy things. I would sit down to put on pants. My goal: Stay entirely under the pain threshold. No NSAIDs, since they can slow bone healing. All the calcium (aiming for 1,500 mg a day).
The problem with a pelvic stress fracture is that a lot of important muscles attach to your pelvis. You’ve got your hamstrings, groin and adductor/abductor muscles connecting from the bottom and your back and abdominal muscles connecting from above. For the inferior pubic ramus bone in particular, you have the adductor minimus, adductor brevis, adductor magnus and gracilis muscles all connecting. This is why it hurt to lift my leg to put on pants or socks without pain.
The best description I saw was one comparing the injury to a paper cut on that skin between the thumb and forefinger. It’s really difficult to heal because every time you use one of those fingers it reopens the paper cut! With this injury, when you use those muscles that attach to the bone, you are irritating the stress fracture location. To let the bone heal, I needed to limit the use of these muscles.
I will say that I’m fortunate the have a desk job and the ability to work remotely. I talked to my boss and arranged to work from home for at least 2.5 weeks. I later extended that to about four weeks because it was winter and I didn’t feel up to risking walking in the snow. My boss was very understanding.
Working remotely was important because my commute requires a lot of walking. I have a FitBit, and the minimum number of steps I can get a day from just going to the office with a packed lunch with no errands or extraneous activities is about 7,000 steps (or about 3.5 miles).
When I was working from home, I didn’t use crutches around the house, but I tried to keep my steps as low as possible. Generally, I ended up at around 2,000 steps a day, and that was just from me walking around the house, going to the bathroom, the kitchen, etc. My husband was a saint during this period, because I depended on him more when it came to grocery shopping and preparing dinner.
After that initial four, ultra-conservative weeks of treatment, I slowly started to ease back into more activity. When I first went back to the office, I would take the bus or a cab to help limit my walking. Six weeks into my recovery, I began introducing some light cross-training and strength work. I started with just 10 minutes of low-resistance biking every other day with hip work (clam shells, leg raises, etc). I’ll tell you: it didn’t always feel so great, particularly the bike. The seat hit right where the injury was, so I was constantly worried about it. But I slowly progressed as long as it felt “uncomfortable” vs. “painful.”
Nine weeks in, I tried running on an Alter-G, an anti-gravity treadmill that offsets some of your body weight, but after two sessions, I decided it just didn’t feel right, so I decided to give it another two weeks.
At 11 weeks post-diagnosis, I was back on the Alter-G, and I had found a new doctor—this one was actually familiar with my injury! She encouraged me to keep at the Alter-G while we got a follow up and another MRI on the calendar as long as it felt okay.
At 13 weeks post-diagnosis, I began running outside after progressing to 30 minutes pain-free on the Alter-G at 85% bodyweight.
At 15 weeks post-diagnosis, I officially got the all-clear: “The previously demonstrated mild high signal in the right pubis extending into the inferior pubic ramus is no longer present.”
I also got more instruction on what might have caused the injury: nutrition. My body likely just wasn’t getting everything it needed to fuel my workouts and sustain the natural bone remodeling process at the same time. The next step is to see a nutritionist and to figure out what might be missing. That appointment is coming up in a couple of weeks. (More on that in a later post!)
Until then, I’ll be continuing my gradual build. As of this week, I should get to about 16 miles. If I’m lucky, I’ll be up to around 22 miles a week by the end of the month and 32-25 miles a week by the end of July.
Moral of the story: If you are on this page because you’ve been diagnosed with a pubic ramus stress fracture or other pelvic stress fracture, don’t lose hope. You CAN recover in 3 months, but you will have to be diligent. Don’t cross train for the first couple of weeks. Eat really food to ensure your body has the nutrients it needs to recover and remain patient. The more diligent you are up front, the sooner you’ll be back out on the roads.
Stay healthy, my friends.