Stress fracture?

[Mardi]

Last week I was doing my last long run of the the training cycle for IMC. I was going slow and easy, knowing my potential for injury, I was being very cautious. 16km into the run I got a weird pain in my right hip and my leg kind of gave out. I stopped and stretched and resumed running thinking it was a muscle spasm.  By the time I got home I could hardly weight bare on my right leg.  That night I stretched, and iced and took some NSAIDS expecting to feel better the next day. The next day I did not feel great.  My hip felt very unstable and it hurt to put pressure on it at certain angles. I was walking around, but very slowly and guarded. I really felt as though I needed to see my physio but Monday was a holiday and she could not see me until Wednesday so I decided to see a my chiropractor on Tuesday.  He attempted to adjust my hip but my hip flexors were too tight.  He said that I had transient synovitis and that with rest and NAIDS I would be good to go on the weekend. On Wednesday I saw my physio who agreed that my pain has something to do with the joint.  She assured me I would be fine and did some pressure point releases and hooked me up to the tens machine for a while.  On Thursday I was in bad shape.  I could barely walk and was now dipping into an old supply for T3s to go along with my 600 mg of ibuprofen every 6 hours.  I asked a Dr friend of mine if I could get an xray which showed nothing.  I was suspecting arthritis.  I went camping that night and was so miserable that I went straight to the ER the next day as I had a fever and chills and was sure I had an infection in my hip. My white cell count was slightly elevated and to make a long story short was sent to see an orthopedic surgeon who immediately felt as though I had a stress fracture in my right hip or pelvis.  He sent me for a CT which was normal but he said after taking a closer look at my xray he saw some areas in my hip that looked suspicious.

So as you can probably guess I am in shock.  At no point in this training program have I had any problems with my hip.  I did have groin a and pelvic discomfort on my bike but I thought that was from doing a lot of biking and would go away with taper.  Is it possible that the biking caused the bone to get weak and that last  run was the straw that broke the camel's back so to speak?  I just can't believe this was caused by running as I was sooo careful not to over do it.

I am having a bone scan either tomorrow or Tuesday.  I hope to have more answers then.  Has Anyone here ever had a hip pinning?  What can I expect recovery to be like?

I feel like a failure as my number one goal was to not get injured and it happens on the very last long run of the training cycle. I don't get it.

Thanks for listening to me vent.

Mardi

[Andrew]

Keep us informed on the bone scan results. The negative CT scan is a good start. But the recurrent stress fractures leads to a few more questions regarding calcium intake an bone health, which is something we often do not discuss, but should be high on your priority list of "nutritional interventions". As the orthopedic physician pointed out, you are the "typical" athlete that suffers from stress fractures. Very light, with little to no fat reserves, working shift work that does not support healthy eating at times, and putting in long hours on your feet.

Other things to consider in the back of our minds when discussing the "Why me?" question.
Is there a metabolic disturbance messing with your calcium regulatory system? Are you getting enough minerals and vitamins to support your training regime (magnesium, Vit D etc.)? Are you resting enough to allow recovery between long runs?

Once we have a firm diagnosis, we can talk more about recovery. It may mean some modifications to your long term run training, or a more fundamental shift towards low impact sports, depending on the cause of your hip pain.

I do hope you are feeling better, and beginning the recovery phase already. It is odd to me that you would have INCREASING pain through the week without further trauma, which may be pointing towards a more inflammatory process, vs an acute injury. Lets see what the bone scan shows.

[Mardi]

Thank you so much Andrew for your info.  And thank you Ginny for your email.  I have a bone scan in Vernon tomorrow at 11:30.  I was disappointed to know that it takes 5 to 7 days to read. I hate the waiting! 

Will update as soon as I get a result.

Mardi

[Andrew]

How is your hip feeling today?
Getting better, or getting worse?
If there is a stress fracture, it really should not hurt at all if you are resting. We know you do not have a small crack, as you had a negative CT scan. So, if it is still hurting when you are lying down, then there must be something else going on. Ask your GP to recheck the ESR to see if it is climbing or falling. The trend is more important than the number itself.

[Mardi]

GREAT NEWS!

No stress fracture!  I am so happy!  But as you pointed out Andrew, I am going for repeat blood work on Friday to see if there is something else going on.

As for my hip, psychologically I think it feels "better"  know for sure that I am not trying to protect a fracture. That being said it doesn't feel that stable.  I am walking with a walking stick as per Dr advice.  I have also wrapped a 6 inch tensor around my hips for stability. It just feels better for some reason.  I have been told not to bike this weekend but I can swim.  I have done NO activity for one week. If I continue to feel get better, I would still like to be hopeful of participating in the race.  Have I lost too much focus and fitness in the past week to even entertain this tought?

Mardi

[GinnySellars]

That is really good news Mardi.

Don't worry about a drop in fitness. I've given one athlete that I've coached 5 days off right at the beginning of August...you may end up stronger for it.

Just a thought...I once had a pinch of hip capsule for a few months. I would be running along fine, then get a stabbing pain, have difficulty weight bearing. It felt unstable, but it was really limited by pain, not strength. I ended up having some traction on the joint, and then doing strength and stretch to improve it. It was very unpredictable. Thankfully, it was short lived, though recurred a couple of times over a decade. It would be good if yours was as simple as that. Got a GOOD physio?

[Andrew]

Your fitness has been built over months of training, and I can assure you that one week without exercise will NOT make you weaker. Remember, recovery makes you stronger.

I can remember the first time I raced Ironman with Ginny. Ginny and I took 3 days of rest about a month out from the race. After 3 days of complete rest, I felt not only sluggish and slow, but could feel every little muscle ache that had been suppressed during my training routine. Not exactly a most confidence-building exercise. Our steps were better after the rest, and it gave us some support that if we had the confidence to do the same in the days leading up to Ironman, that we would be able to race well. So, a month later, we found ourselves going for a 1km jog on the Friday before Ironman through the streets of Summerland. It was crazy...we felt AWFUL. Our feet weren't moving properly, and it just felt strange to be trying to run after 3 days of rest. I think I even decided just to walk back to the hotel, and sleep off the uneasy feeling I was getting about my preparations. Come race day, everything worked fine. I was rested, and when it came right down to it, I had not forgotten how to run. And I can assure you I had needed the rest. It just feels wrong at the time.

[Mardi]

Ginny and Andrew thanks for the reassurance and advice.

I tried swimming today and did fine but needed to stretch after each 1000 metres and then I felt super drained for the rest of the day.  Your right, I just don't feel right and can't imagine doing an ironman at this time.

Hopefully my body will get back into the routine after a few days.

Ginny I do have a good physio and I will see her again on the 20th. A bit late but it was the best I could do.  In the mean time I need to do light exercise, stretch, core and hope I will feel better soon.

Can I say it again...I am so happy  it is not a fracture.

Mardi

[Mardi]

So I am slowly improving and I say slowly. My repeat blood work came back as completely normal. Yahhoooo!

My hip however is still giving me grief.  I managed a 2 hour bike ride today with no pain then slipped on my runners to see if I could tolerate a slow jog around the block and 10 steps in my hip said no way.  I stopped, went back in the house, stetched, did some core work and iced my groin which improved my discomfort tremendously. I am not out of the woods but I still have 2 weeks to get to the bottom of this issue. Off to physio I go on Tuesday.

[Andrew]

Oh Mardi...my heart goes out to you. From an outsiders point of view, they might say, why on Earth would you push this hip issue and try and race. Those of us who train for endurance sport, and particularly a 1 day event like IM understand that you have put your heart and soul into preparing for this event. A couple of thoughts...

- you have done medical procedures to rule out the worst, so now know it's a soft tissue injury
- find a good physio. if you can't get into yours immediately, use every contact you have to get in with another. I say this because if the mechanics of the problem can be figured out, your efforts to rehab will be appropriate and not wasted. For instance, if you need traction, or a particular movement to deal with the problem, your physio will help you find it.
- plan on racing, but know that the day prior, you ought to have made up your mind as to whether you'll attempt the run, walk the run, or omit the run all together, and save it for another year.
- it's possible any one of us may not make it to the start line, or will have an unfortunate mechanical or stumbling block day of race. That is why we focus on enjoying the process. Even right now, you are showing grit and determination as you work through the problem. Be proud of your journey to get your prepared for IM

GOOD LUCK and keep posting!!

[GinnySellars]

That last post was from Ginny....if you were wondering how Andrew suddenly turned into a softy...

Mardi, I hope you are getting more comfortable every day, and that you might even be able to walk/jog the marathon. I might be right alongside you with this silly achilles issue!

[Marc Nimchuk]

Hey Mardi, Andrew & Ginny,

Just wanted to let you know that for those doing IMC, Active Release (ART) practitioners from all over the continent will be at the race site for the 3 days leading up to race day.  I will be there as well, so if you are having issues still, I would be happy to see you there. Treatment is free for all participants and you can also request specific people.  I am glad to hear there was no stress fracture though!
Thx,
Marc.

[GinnySellars]

Mardi, it may be worth a trip to Kelowna to see Marc in the next 2 weeks to get started. I have had Active Release Therapy with him, and with other practitioners at Ironman. It can be a very successful approach to improving movement around a joint. It's different than stretching because the practitioner controls which muscle group is lengthened by putting pressure on certain muscles or tendons, then moves the limb to affect a specific muscle group. (sorry Marc....I probably have this all wrong, but this is my impression)

[Andrew]

I am planning to sneak in for some ART on a brand new heel issue that has just cropped up. Seems that Ginny passed along her chronic injury to me, just in time to have me start worrying about running pain free, when just last week I was thinking about how nice it was to be finally entering an Ironman knowing that I can outrun most of my competition on a good day.

Mine started after just one missed step in the trails. I actually tripped on my right foot, and stepped quickly to my left, jammed my heel, and still went down on my face. No real injury, other than a bruised feeling heel. NOT a stress fracture, as it only hurts on stretching or active flexion of my flexor tendons, but certainly noticeable after racing on Sunday.

I still have 4 weeks, so it is all about balance between rehab, ice, Trigger Point Therapy, and maybe a few visits to Tamara Dantzer and Marc Nimchuk.

You are NOT alone Mardi...stay confident, and do everything to make it better.

[Mardi]

Wow.  This is all very helpful information.  I don't know how I missed these posts from the last 2 days. Marc I will request you at the race site.  We are coming into town on Thursday so I will have lots of time to get in som ART in the days before the race.

Ginny, thanks for the great encouraging words. I thought Andrew was going through early taper madness or something!;)

Andrew I am sorry about the heel and I guess your right I am not alone. But like you told me, if it is not a serious injury, 4 weeks is time enough to recoop.

I have had some great successes this past week.  My hip has gotten tons better thanks to my superb physiotherapist Amy from Helios Physiotherapy in Revelstoke ( plug for Amy).  She has spent 4 soild chunks of time getting me back into action along with massage, I as almost pain free.  I did a 1.5 jog/walk on very flat trails on Monday and got away without any distress. However, I am anticipating that my hip will flare up when the rest of my body gets tired, so ofcourse after the bike.  Amy has suggested I wear my SI support band/belt thing on the bike. You know the thing that goes around your lower hips super tight and makes your icky bits bulge? Well that is the one.  That thing works wonders for making my back and hip feel supported so I will likey take her advice and cycle with it on.  I did a 1.5 hours on the bike with it today and it did not cause me any grief and actually felt good.

That's okay right?  To wear supportive stuff if you need it?  I will not get kicked out for wearing a girdle right? Amy also wanted to come to the race and offer to tape us up along the way if we were having trouble.  Is that allowed?
Oh the questions spinning through my head!

Mardi