pubic ramus stress fracture healing

Sorry to add to the worst case scenario side, but mine took a year.

Ugh. Did you cross train aggressively during that time? How did you eventually know it was healed? Prior to the year, did you test it several times and the pain returned?

Thanks.

I had multiple stress fractures in my anterior pubic ramus on my right side last year. From the time I stopped running to the time I resumed a walk/jog routine, it was 4 months (4/17/12-8/20/12). The key is I did NOTHING from April to July. I mean nothing. No stationary bike, no pool, nothing. It really sucked, but it allowed the process of healing to occur at the inital stages, the most crucial juncture.

In July, my orthopoedist cleared me to do light aqua jogging for 20-30 minutes 3-4 times a week (did this for free in my in-laws' above ground pool).

In August, I was allowed to start biking (as by then, a lot of the atrophied soft tissue had gotten some strength/mobility back).

The end of August, I was put on this walk/jog routine:

Week 1-2: 3 x (walk 4:00/light jog 1:00). I was told to do this no more than every other day. When I passed 4 sessions of this with no symptoms, I graduated to...

Week 2-3: 3 x (walk 3:00/light jog 2:00). Same thing, no more than every other day and had to pass successfully 4 times.

Week 4-5: 3-4 x (walk 2:00/light jog 3:00). Same restrictions.

Week 5-6: 3-4 x (walk 1:00/light jog 4:00). Same restrictions.

Week 7: Light jog 15:00-20:00, every other day.

Thankfully, I never had recurring symptoms (although it took awhile for the range of motion of running to feel fully "natural" again). I had also gained 17 lbs during the summer, which took a couple of months to shed.

I slowly added mileage from there (3-5 miles a week) until I reached 50 miles a week, then I slowly introduced informal workouts (strides, hill sprints, random fartleks, etc.) After 4 weeks above 50 miles a week, I picked up my regular routine.

The good news is, I am now in Week 12 of an 18 week marathon program and in as good as shape as when the injury occured. Mine definitely occured from overtraining and not giving myself enough recovery on easy days and in-between workouts.

You have to have TONS of discipline after this type of injury to help it properly heal and to prevent it from happening again.

Best of luck to you.

My wife had one and returned to running in about 10 weeks. She spent 4 weeks in the pool, then 3 on the bike, 3 on the elliptical, and then returned to running. Try to take some time to look into what caused it (most likely nutritional issues and/or overtraining). Good luck in your recovery.

Thank you so much for this, very helpful.

One question -- what was it that had changed in July so that you were cleared to begin pool running? Pain completely gone? Walking without limping?

I am six weeks out right now. I did four weeks of absolutely nothing and have just started some pool running, only done it a couple of times. It does not cause pain but I definitely notice an increase in adductor/groin tightness after I do it. Did you have this kind of tightness when you started pool running?

Thanks again, really appreciate it.

Thanks, that gives me hope.

Definitely not nutrition. I am good there and my bone density scan was completely normal, too. I had a foot issue going on so I believe my gait was off for quite a while and this could have caused it.

My timeline (My goal race was Broad Street May 2012):

Early March 2012 - first symptom of "groin tightness" after a 10k race.

Mid March 2012 - raced a 5k, groin tightened up again during the last mile.

End of March 2012 - paced a friend for a half-marathon at tempo effort, no symptoms during the race, bad groin pain the day after.

Early April 2012 - attempted to keep training, was initially able to run without affecting my running, but the groin tightness eventually became chronic. Became painful to kick a soccer ball, and to lift up my right leg to put pants on.

April 17, 2012 - started a run and the pain was excruciating. Couldn't run at all and decided to bag Broad Street, still thinking I had just a pulled groin.

Early May - when symptoms didn't improve after 2 weeks of total rest, I scheduled a visit with an orthopoedist. After performing some movement and pressure tests, he suspected a stress fracture and ordered an MRI Arthrogram.

Late May - had the MRI Arthrogram, with and without contrast dye.

Early June - had the followup with the orthopoedist who confirmed multiple stress fractures in the anterior pubic ramus. Told me if I saw him earlier than I had, he would have recommended crutches for 2 weeks to help the healing, but by now my body was already starting the process of repairing bone. Recommended no activity for the duration of June (he wanted 10 weeks total of inactivity) before starting with the pool.

July - aqua jogging and some light kicking while holding onto the sides of the pool, 3-4 times a week for about 20-30 minutes.

Early August - had another followup with the orthopoedist. He performed the movement and pressure tests again, this time with much better results and very little pain. At this visit, he gave me the remaining healing timeline and recommendations for re-introducing jogging.

I started with just very easy bike riding for 3 weeks (e.g., I was the fuel guy for my friends' training runs). I then started the walk/jog routine. If I failed at any point, I was to call for a follow-up visit and possibly another MRI Arthrogram. Thankfully, I listened to exactly what he told me to do, always erred on the side of caution, and never had to go back for a follow-up.

Best of luck to you...I know the waiting part can be very frustrating, but in the long run, you really have to be patient and do what's best for your body.

Thanks again. Really appreciate all this info and it is very encouraging to hear you healed and are running well again.

Thanks for posting. I am tearing up Google to try to find information on this injury.

I was just diagnosed a week and a half ago with a fracture at the junction of the inferior and superior pubic rami. I had spent two months with no real diagnosis, and while I was happy to find out it wasn't a labral tear or something requiring surgery, I am now becoming pretty frustrated.

Timeline: February 28, 4 days into taper, tried to do a tempo run after my hardest week of training. Felt off. After the run, I couldn't walk - I was limping. Took the next day off.

March 2 - Attempted my last long run. Started off as a dull ache, in the groin, but by 7 miles it was excruciating. Limped for three days. Took two weeks off completely (no cross training, either.)

March 17 - Attempted to start the marathon. DNFed at 2.5 miles.

March 18 - Began PT and Xtraining. I have been cycling and swimming since then.

April 8 - PT put me on the antigravity treadmill. Alternated 1 minute walk/ 1 minute run for 14 minutes. Felt okay, but the next day I was limping again.

April 16 - PT let me try the treadmill again, but only 6 minutes total. Felt okay that night.

April 17 - Did a running gait analysis at PT on the treadmill. 3 minutes, times 2. Next day, I was limping again. I asked for an MRI at this time.

I have not run a single minute since April 17. I got the MRI results last Wednesday and there is at least one fracture, but swelling on both the superior and inferior bone marrow. MRI only showed bone irregularity where the inferior and superior connect.

I was feeling pretty good about the fact that I was swimming and cycling without pain, and that I was walking without any pain. Wednesday I swam in the morning and cycled in the evening, which I've been doing for the past three weeks. Yesterday I was in so much pain standing that I felt like I had backtracked three weeks. I took Thursday off completely and today I did some aquajogging. Today feel a little better than yesterday, but not much.

I guess I'm just wondering what is the best cross training - what will aggravate this the least? Everything I've read from a professional website says that cycling, aquajogging, and swimming are great cross training for this injury, but then personal accounts say they didn't heal until they quit everything. I guess I'm wondering why any of these three things would aggravate it, since I'm doing more weight bearing by walking around than I would be in these exercises?

Also, as an elementary school music teacher, I am pretty much on my feet walking around all day long. I wonder if that is prolonging the recovery as well.

I am SOOOO frustrated and wish I could just figure out the right thing to do to make this injury heal as fast as possible. I will repost this on the forum as the start of a thread, but I wanted to start here so I made sure others with experience saw it.

Thanks in advance.

Thanks for posting. I am tearing up Google to try to find information on this injury.

I was just diagnosed a week and a half ago with a fracture at the junction of the inferior and superior pubic rami. I had spent two months with no real diagnosis, and while I was happy to find out it wasn't a labral tear or something requiring surgery, I am now becoming pretty frustrated.

Timeline: February 28, 4 days into taper, tried to do a tempo run after my hardest week of training. Felt off. After the run, I couldn't walk - I was limping. Took the next day off.

March 2 - Attempted my last long run. Started off as a dull ache, in the groin, but by 7 miles it was excruciating. Limped for three days. Took two weeks off completely (no cross training, either.)

March 17 - Attempted to start the marathon. DNFed at 2.5 miles.

March 18 - Began PT and Xtraining. I have been cycling and swimming since then.

April 8 - PT put me on the antigravity treadmill. Alternated 1 minute walk/ 1 minute run for 14 minutes. Felt okay, but the next day I was limping again.

April 16 - PT let me try the treadmill again, but only 6 minutes total. Felt okay that night.

April 17 - Did a running gait analysis at PT on the treadmill. 3 minutes, times 2. Next day, I was limping again. I asked for an MRI at this time.

I have not run a single minute since April 17. I got the MRI results last Wednesday and there is at least one fracture, but swelling on both the superior and inferior bone marrow. MRI only showed bone irregularity where the inferior and superior connect.

I was feeling pretty good about the fact that I was swimming and cycling without pain, and that I was walking without any pain. Wednesday I swam in the morning and cycled in the evening, which I've been doing for the past three weeks. Yesterday I was in so much pain standing that I felt like I had backtracked three weeks. I took Thursday off completely and today I did some aquajogging. Today feel a little better than yesterday, but not much.

I guess I'm just wondering what is the best cross training - what will aggravate this the least? Everything I've read from a professional website says that cycling, aquajogging, and swimming are great cross training for this injury, but then personal accounts say they didn't heal until they quit everything. I guess I'm wondering why any of these three things would aggravate it, since I'm doing more weight bearing by walking around than I would be in these exercises?

Also, as an elementary school music teacher, I am pretty much on my feet walking around all day long. I wonder if that is prolonging the recovery as well.

I am SOOOO frustrated and wish I could just figure out the right thing to do to make this injury heal as fast as possible. I will repost this on the forum as the start of a thread, but I wanted to start here so I made sure others with experience saw it.

Thanks in advance.

Hi Gretchen. Sorry to hear that you have a pubic ramus fracture.

From what I understand it is tensile fracture, as the pubic ramus is not a weight bearing bone. This is one of the reasons why it is so difficult to heal. The adductor and hamstring attach on the bone and when your leg moves the fracture site gets tugged at and this can delay healing.

I was diagnosed at the end of January with a complete fracture of the inferior pubic ramus.

I did absolutely nothing for over a month. After that I began pool running, then biking, then the arc trainer (like an elliptical). At 12 weeks I tried doing short runs. After a week I began having pain so I went back to just the arc trainer, no running. I plan to try running again next week (15 weeks for me). My last x-ray showed lots of callus and most of the fracture was filled, but not completely. While this may seem like a long time pubic ramus fractures are notoriously bad healers, so I think things are going well relatively speaking.

Two things that I think help are an initial period of complete rest and an Exogen 4000 bone stimulator. If you can get one of those I would highly recommend it.

Best of luck to you dealing with this awful injury.

Please let me know if you have any other questions.

I've had this a few times. Don't even try to test it by running. You can get in the pool or bike probably, ask your doctor.

Hi all. Diagnosed w. inferior pubic ramus stress fx on oct 1, 2012. Did nothing for two weeks. Started w. recumbent bike. Did that for up to one hr a day through dec. I was told not to do pool running or the elliptical. Swimming was o.k., but no access to indoor pool. I found the bike helped (I got quite depressed w/o my endorphins and of course, it happened nine days b4 my big race!). The bike helped my mood but also the blood flow made a difference in the pain - which initially was unbearable! And, I hated the recumbent bike before all of this. Got subscription to nine magazines and just read the whole time. Now I look at that equipment a bit differently! Started spin classes and elliptical in January. Aggressive power walking also in January. Initially on crutches through November then a cane through mid-dec. started running very conservatively late February. Finally ran five miles march 27th (bday). Started my long runs two weeks ago, and the injury site started talking to me. No pain, just a hi, remember me. Long run was nine miles. Same thing this week, only talking lasted all day after run. Woke up today, nothing. So, I may go back and get an MRI just to be sure all is healed and healed well...but I suspect the conversation will continue for a bit...will update.

LFSruns-I also have a pelvic fracture, and have only been riding the stationary bike for exercise. When did your site stop aching? My MRI also showed marrow edema in my ischium, and that site continues to ache, I am wondering if this is due to sitting on the bike? My fracture site still aches, I am 8 weeks out.

It's interesting how so e people were told not to cycle but to pool run, and vice versa. I am extremely tight still - it's not constant pain, but it is like my leg is locked up and all the muscles around the fracture are angry. I was having PT twice a week including dry needling before I got the diagnosis, but cancelled it until my next doctors appointment when he will assess if I can return to running (very gradually.). That will be just over three months from the initial injury. I wonder if the dry needling was speeding the healing process. It certainly made my muscles less tight.

I absolutely hate the idea of doing nothing. Ugh. My doctor said anything without impact was okay but.... Ugh again. Wish there was a way to look inside my body to know exactly how healed I am at a u given moment. What a frustrating injury.

Depending on the severity of your injury. Mine was a freaky accident. It takes at least a year. There will be micro fracture of the bones so two years total healing. The treatment is no weight bearing.....meaning total rest. I know it is frustrating but hang in there.......

Just checking back. After starting running again I developed shin splints on the right tibia (same side as stress fracture). I really had to slow down the running. I have spent the year trying to figure out what imbalance/weakness resulted from the stress fracture and how that might be causing the shin splints. Really a bummer of a year. Gradually, over time - the injured area stopped talking to me. I kept my runs under 5 miles for six months. Trained very conservatively for a half marathon (which I completed - slowly!) and have been off and on ever since. A bit bummed at the whole situation. Every once in a while (like while jumping off a play structure) the site whispers a bit to me - but nothing like the aches I had for a few months after I was walking/running again. I'll keep trying. But I do miss my regular running!

I was diagnosed with the same thing but it's been 4 weeks with no running and they told me I could start these 2 weeks slowly but the pain was BAD. I couldn't stand on one foot at all whatsoever at one point. (I had to lay down to put on pants) I'm only 14.5years old by the way... Not sure if it's really a stress fracture of Van neck disease. How long did yours take to heal?

I had one in July 2014, kept running in some pain until August, when MRI showed fracture. Cross trained for about 6 weeks, intensely. Airdyne, stair master, elliptical and rowing. No time off. Eased back into running in the fall, slowly. Like 14 min pace. Then 13. Etc. Gradually increased mileage and pace and ran well at Boston.