It's been nearly two years since my injury, and the one question I'm asked most frequently about recovery regards how to manage the normal aches/pains of returning to exercise. Let me preface sharing my own experience by writing plainly that you should work closely with the advice of your physician/therapist/etc. You will experience aches and pains. It is frightening. The challenge is to learn to recognize what is normal vs. what is not. This is not an easy thing to do, and as I indicated before it is scary.
I started lightly running roughly 4 months after my injury. I mean lightly running, as in putting on a brand new pair of Hoka Bondi shoes and toe running gingerly. I never felt achy or sore during my running. Never. Had I felt even the slightest pain or ache during my run, I would have stopped without hesitation.
When I started back to even modest distance (e.g., 6 miles), I would later experience a slight ache in my groin at a point over the old fracture site. But...the ache wasn't quite as deep. This is difficult to explain, other than to write that the fracture ache was deep as in located in the dead center of the distance between my groin and my rear end. At the time of the fracture, it hurt when I ran. It hurt notably when I would try to stand up from a chair (or get out of the car). The ache of returning to running after non weight bearing was not quite as deep (even though it was located in the same place), and it didn't hurt until later in the day. I'd take a hot bath, and the ache would subside. I'd do aggressive self massage in the groin area, and the ache would subside. I'd try to do an adduction stretch to help with what I knew were tight iliopsoas tendons in the fracture area, and the ache would get worse. Bottom line: I agree with what most indicate regarding this injury: Everything is connected "down there," and the combination of a fracture and prolonged disuse (at least 8 weeks of absolutely no weight bearing) created a recipe for tightness & etc.
I also developed snapping hip (tight tendon again), which exacerbated the ache in the area.
This (ache and snap) would come and go, and as the months progressed (and my mileage increased), I learned to recognize it for what it was. The ache lasted for nearly one year - sometimes it would be gone for a few weeks and then return. Cycling made it worse, which was reasonable. Cycling places the hip (and as such the flexors/tendons) in a contracted state, and I'm certain this irritated the already shortened and stressed tendon.
As of today, I still can't stretch very aggressively on the formerly fractured side. No big deal. I still have the snapping hip, but it has lessened notably within the past six months.
Running now roughly 40 miles a week. Cycling/swimming/weight training as well. I'm always "aware" of my former injury, not in a bad way, as it seems to be healed. Rather, I never, ever want to have this occur again. Therefore...strengthen the glutes and flexors. Cross train more often. Take days off. Repeat. Take days off. Wear very good shoes. I switched to the HOKA brand 20 months ago. They are terrific. I also use Altra Lone Peak 2.5s for trail running. I no longer care about saving weight on shoes. I'd rather have 12 oz shoes on each foot with major cushion than to go through the injury again. If that's all it takes, so be it.
I wanted to thank you for your help and advice. I had my CT scan this week and it did show it was fully healed. I am over the moon! Now I can slowly start back to running and I mean very slowly! It seems I had very similar symptons to you, though rather than the snapping hip its tendonitis in the adductor which is where the groin pain is coming from.
ReplyDeleteSuch good news for you! Take the lesson you've learned to heart. Expect aches and pains for awhile, and don't take things for granted. One thing I incorporated into my workouts as the year after my injury unfolded and I was getting stronger: Lots of deadlift workouts and squat workouts to strengthen the glutes and hips. I'd run/raced for nearly 25 years and never thought I needed to do this type of workout. Now, after a year of crossfit training, including hip and glute strengthening, I'm stronger on trail races than I've been in years. Most of all, just enjoy being "out there" when you are able. I'm happy for you.
ReplyDeleteI appreciate you documenting your hole story here. I'm going in to have an MRI in a few days bc I have that familiar anterior hip/groin pain and while my pain with walking is low (like 2/10), I cannot hop or take a running step. It started after a marathon I ran July 30 so it's been ~5 weeks since I've run at all, but I've been swimming and riding with no 'pain' though I already feel that deep ache you mention... Anyway, your story just sounds a lot like mine in many ways and I'm dreading 4-8 weeks of no weight bearing. Like you, I'm a lifelong athlete and haven't taken more than a week off in years... It's gonna be a long couple of months I think. Anyway, just appreciate reading your story so thank you for sharing.
ReplyDeleteHi Michelle, Let's hope your MRI is negative. If you receive bad news ... so sorry, truly. Read through as many blog sites as you are able to endure. Runner's World has a dedicated site to FNSF, and the stories are inspiring/scary/hopeful/etc. The most heartfelt thing I can express is that you need to take the long view. It's a difficult lesson to learn, but you will likely be back to the point of running well again. Hopefully, you'll be able to gain the insight of what contributed to your injury and learn to avoid it. I'm 50, and just finished my 9th race since March - all trail half marathons or triathlons, however I train much differently now - REST and EAT well. Take multiple days off and cross train. Plus ... something I never did for the previous 28 years of running but I do now consistently is strength training. Twice a week I incorporate glute and hip lunges, squats, curtsy, etc. This has wonders for my trail endurance and power uphills, plus I'm convinced that this is critical for avoiding other problems. You'll make it. It's a scary injury, but there is light at the end of the tunnel.
DeleteEric, thank you so much for taking the time to document your experience. It seems I am having the very same recovery issues, and it gives me hope to know that others have been through this and come out on the other side. I am a 25 year old female recovering from a compressive side fnsf. I was diagnosed August 8, and was off and on crutches for about 12 weeks, and am just now returning to walking. It's slow going! I am genuinely surprised by the amount of aching just from returning to regular activity, though it's nothing compared to the pain before I was diagnosed. It's taken an emotional and physical toll, and I'm just ready to be done! I know that I have to take slow though, because I really don't want to be in this position for longer than I have to.
ReplyDeleteDear Unknown: I wish you a successful recovery. Take it easy, and appreciate the little things like walking without crutches! I'd recommend very squishy shoes for awhile - for the psychological benefits alone. I know the aches/pains are scary when you do start to get mobile again. You'll learn with time how to recognize that the aches are normal. It took me nearly 6 months after being allowed to bear weight/walk/jog for the aches to subside. They were really fairly minor, but after the FNSF - you'll tend to understandably panic. Be SO thankful if you avoided surgery. We were very lucky, and I don't take it for granted, even after two years. You'll be back out there...and I guarantee you'll be a smarter runner/racer. Best of luck, and hang in there. Reach out if you have any questions.
ReplyDeleteHi Eric. Thank you so much for documenting and sharing. I was diagnosed with a Grade 3 FNSF in early September 2016 (I've only been running since August 2015,after having my second child).
ReplyDeleteI am back to 'jogging' now, but no more than 6km (not sure what that is in miles - I'm from Australia!) During my recovery over the last four months I turned to your blog entries numerous times, and I felt so much better for reading them. Thanks again.
Cath
Dear Cath,
DeleteI'm truly pleased for you! Go very cautiously as you return to running, with the belief that your bones will remodel even stronger than they were initially. This injury forces us to take a "long view" of recovery, but I promise that one day you will look back upon your experience with deep appreciation of what it means to train holistically. I use that word intentionally. Before my fracture, I used to pound the miles, with foolishly little regard for sufficient rest, eating, and cross training. Now, two and a half years later, I cross train extensively. (I'm not referring simply to the typically swim/bike/run life of a triathlete). I now do weight training and occasional yoga (the latter is difficult for my type-A personality, but I know the balance and flexibility pay dividends). One thing that has helped since the forced recovery - gluteal and hip stabilizer strengthening. Years of running had me thinking that it was unnecessary, but I was stupidly incorrect. In fact, I was unknowingly so overloaded on my quads and calves that my glutes and hips were insufficiently contributing. Now, I incorporate band work with squats/etc. Nothing major but enough to strengthen the stabilizers. Any rate ... it's a new year now ... Ironman Tremblant is 7 months away! Anyone else going? Good luck Cath - P.S. I wish I could be in Australia now! (It's cold/snowy/dark here in Massachusetts in January).
Dear Eric,
ReplyDeleteI just wanted to say thank you for sharing your story! I broke my femoral neck in early December 2016, however, unfortunately the doctors couldn't find out what was causing the pain in my leg for a whole of two weeks as a femoral neck fracture is definitely not something that happens frequently to 22-year-olds. I am also a passionate runner and I was and still am worried that I will never be able to reach the level I was running at before it all happend. Reading your story made me feel hopeful that one day I will be able to run like I used to. I highly appreaciate you sharing your story as I haven't actually met anyone who had experienced a femoral neck fracture, which doesn't make recovering any easier as no one knows anything about it.
All the best from Switzerland,
Fanny
Thanks for posting this! I am still recovering from a stress fracture. I had high hopes that I would be released yesterday but it looks like it is still not healed. I am trying to have patience and reading your story does help! I hope to be running again someday! Holding out hope in St Louis!
ReplyDeleteRebekah
What a great blog! Thank you so much for documenting your journey with this injury. I just posted in Runner’s World regarding exactly this topic….aches and pains when healing. I was diagnosed via MRI a FNSR (reaction)-no visible fracture. This is unlike any injury I’ve ever had (it also took me 2-3 weeks to see an ortho-thought it was a quad strain) – and I’ve had two major fractures. I’ve been 8 weeks NWB and go in tomorrow for a check-up. I was told I will go 2 more weeks walking with crutches then PT – I received basically the same diagnosis/prognosis from 2 orthos. Oddly, they both do not do follow up MRIs. I will request one though as I need to see proof of healing. I’m super body-aware. Thank you for posting about your discomfort levels while coming back – I feel I should be completely non-achy by now, but every now and then, depending on how active I’ve been on crutches or with my sad little gym “work out”-arm bicycle, core on floor and swimming with pull bouy, I tend to be a bit sore the next day (not always, but sometimes). I rest and it goes away, but it worries me. I had a glute medius and minimus tear, too so biomechanics is in play here – one thing leads to another. I am thinking that all this soreness is due to soft connective tissue, even scar tissue, tightness etc.
ReplyDeleteBesides running, I practice/teach hot yoga – go at least 4-5 times a week (well, did go) and am anxious to get back to it. I think the heat and stretching will work wonders along with PT. This is my 3rd time on crutches and I have been an obedient patient for the most part. There have been instances that I have put weight on my affected leg, but briefly.
SO, thank you , thank you, thank you for posting – it’s an annoying injury and my yoga mind has been helpful for keeping me somewhat sane. Acceptance and being grateful it isn’t terminal. I realize I will not be running until the end of the year and that is ok….I would be happy with yoga and walking for now. Glad to hear you came back and are doing well after two years. It is inspiring!
Hi Steph -
ReplyDeleteThanks for your nice reply. Was just down your way a couple months ago running Kennesaw with a buddy! Beautiful area.
My snapping hip took nearly two years to diminish. It began to fade after a year since the injury, but it wasn't completely "gone" until roughly six months ago. I'm firmly convinced that the recover from the FNSF took a full two years to complete, meaning that while my bone structure (density, etc.) had likely strengthened after 8 months or so, the remaining soft tissue took longer to get back to normal. I SO deeply respect this injury, and I so deeply fear it. BTW - tried hot yoga once - thought I was going to die after 90 minutes in that environment! Keep running. Go jog around Kennesaw Mtn. for me.
Hi E - Thanks for the reply to the reply. I now live in San Francisco - a big difference, but in a good way. Kennesaw Mtn. is a beautiful place.
ReplyDeleteSnapping hip sounds interesting and challenging. I am glad you are recovered from it. Biomechanics of the body are fascinating. One thing leads to another. I tore my glute minimus and medius and I am sure it caused the stress reaction as it pulled from the femur bone. My ortho gave me the ok to walk with crutches on Wednesday! Small win. I don't use them at home or work, but use in between - mainly traversing the city which is not far in my current position. A few blocks at most. My affected leg is sore, but I'm 99% sure it's to non-use of muscles for 8 weeks. It's not that dreaded FNSR feeling. I have a bit of fear surrounding this injury and am trying not to give it too much power over me - mind over matter or something along those lines. I have rehabbed all my injuries through Bikram yoga! No joke. That is how I got into it - I need to stretch. This injury though is different and I will wait a few more weeks to toss myself into the hot room. I get it though - you either love it or hate it. Anyhoo, thanks for sharing! Thank goodness for the Runner's World forum. LIFE SAVER.
Thank you so much for posting this. I've just finished week 1 of (mostly) NWB and it's helpful to have someone else's experience to follow along. I too ran on my FNSF for several weeks before realizing I had a serious problem then went almost another month before getting diagnosed. One week post-diagnosis it's still very sore but I'm already thinking about everything I need to do differently once I start running again so that I don't wind up back in this same miserable place. Before the injury I was averaging 130 miles per month. I've been told that after this injury I shouldn't go back to more than 75% of my maximum pre injury. Did you return 100% or more of your pre-injury mileage?
ReplyDeleteHi Pet Mom - I'm three years removed from my injury. Prior to diagnosis, I was running approximately 100 to 160 miles per month (25 to 40 miles per week), depending on training blocks (which included swim/bike training). I still run approximately 25 to 30 miles per week, but my biking has increased. I also continue to strength train (cross train) hips, hip flexors, glutes, hamstrings, etc. The bottom line: I returned to full use of my femoral neck. Still...I am mindful of keeping things strengthened. I cross train more than I did before. I also try not to run four days in a row (meaning that if I run three days in a row, I take a mandatory day off). Last year I did six half marathons, two olympic triathlons, and one trail 50K (with lots of elevation). This year I've done ten races, including Ironman Tremblant and several difficult trail half marathons. Big difference between now and three years ago - I listen to myself carefully. I take more time off, and I simply enjoy being "out there." I'm a little slower now, and this is likely a combination of adjusting after the injury and also turning 50. Who cares! I don't take my running for granted at all. I hope that you have a full recovery.
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