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A PSA Regarding Stress Fractures

How does one manage to break their hip?

I’ve read a lot on the subject over the past couple of years, and in the absence of a traumatic injury (like a car crash or a hard fall), it is possible to break your hip by ignoring a developing stress fracture. While doctors have observed and identified several potential risk factors for stress fractures, the most common contributing factor in younger populations is “overuse.”

What does that look like?  I believe it is a different story for every individual. But with a healthy dose of humility, I will give you my version:

In July of 2013 I had just finished performing in Market House Theatre’s production of Les Miserables as a supporting cast member. After spending a transformative five months working countless hours on this project with people I came to know and love dearly, I suddenly had a wealth of free time. Spending a significant number of hours at my day job, and then countless hours in a dark theater on nights and weekends had given me a renewed desire to focus on myself.  I decided I wanted to get serious about getting fit. Sure I had a general desire to improve my appearance, but in reality I just wanted to feel strong. Strong is the new sexy, right? While I had always loved hiking – and in more recent years kayaking – I was looking for something a little more structured I could do every day if I wanted.  So I joined a gym.

This was not my first gym membership, nor was I a complete novice at weight training or physical conditioning. I had played sports in high school and college, and attended a military academy for two years. I had passed military physicals and fitness tests required for federal employment. Generally speaking, I felt like I knew what I was doing. But it had been several years since I had followed a program that focused on near-daily strength training and conditioning.

I started with an intense amount of enthusiasm. I was going to the gym more days than not. In addition, I started a Couch-to-5k (C25k) program after a friend recommended an app for my phone.  Because I was feeling really capable, I fast forwarded to week 3 of the program to start training.

As I began this endeavor, I didn’t really have anyone to tell me what to work on.  I bought a couple apps and read articles trying to fit random pieces of information together to create a workout strategy. I quickly realized I didn’t have proper form or technique for the olympic lifting I attempted at first.  So instead I gravitated towards the stair climbers, treadmills and stationary bikes, and experimented with some weight machines.

In order to get a little more experience, knowledge and base strength, I started taking group classes. I was instantly hooked. There is an excitement and camaraderie in gathering with a group of people who want to work out and improve themselves.  There is also a gentle peer pressure that pushes you to keep going and try harder.

July, August, and September saw me through several regular classes offered throughout the week at my gym, two special enrollment classes (available for an extra fee), and most of the way through the C25k program I had started. By the end of September, three short months after I started this process, I was exercising in the gym and running on the road five to six days a week.  At least three of those days I was both working out in the gym and completing runs of increasing distance.

When my gym offered a three week/six day-a-week boot camp, I jumped at the chance to incorporate that into my routine. While attending the boot camp, I continued some of the group classes, finished the C25k program, upgraded to the C210k app, and skipped my “rest” days to make sure I fit in as many miles as I could. Additionally, after the final week of the program, I started personal training sessions once a week to focus and really kick my results into high gear.

If a little bit of exercise is good for you, a lot of exercise has to be GREAT, right?  [By-the-way, for those of you keeping score, we are going to go ahead and call that Risk Factor #1 – Overtraining, specifically by increasing the intensity, frequency, and dynamic load too quickly]

By mid-October, I had finished boot camp and signed up to complete a 5k hosted by a local running club. I enrolled at the urging of my 11 year-old daughter who had friends running the race. This was the first time my daughter had ever expressed an interest in running a race, and with my own new-found enthusiasm towards running, I wanted to support and encourage her.

Thursday, October 17, 2013 was race day. I remember being tired all day, and coming home after work that afternoon to take a nap. I was regularly getting around five to five-and-a-half hours of sleep a night. More often than not, I was tired. I was working hard and training hard, but I was also trying to maintain the network of close friendships I had just made working on Les Mis.  [Risk Factor #2 – Failure to get adequate rest]

What I didn’t fully understand nor appreciate: when you are working out, you are actually injuring your muscles. You are tearing them down in a productive way so in healing, your muscle fibers grow and you become stronger. However, you must have the right nutrition and rest to effectively accomplish the rebuilding.

After my quick nap, I got ready for the race.  This would be the first 5k I had run since I started training and I was eager to find out what my “baseline” was going to be. I was excited about the opportunity to start measuring my progress in race times.

The last thing I did before I walked out the door was double-knot my brand new shoelaces, because they were bad about coming undone while I was running. I had been working out and training so much my old shoes were pretty worn out, so I had recently switched to new low-profile running shoes. After selecting shoes with the thinnest sole I could comfortably tolerate, I threw the old ones away without a second thought.  [Risk Factor #3 – Ignoring the necessary step of breaking in new performance footwear]

Once we arrived and checked in, I found my energy. The pre-race electricity was in the air. As I started looking at the course, it became clear we were to run two laps around the grounds of a local high school.  I had only been training on pavement and this race took us over a variety of surfaces.  [Risk Factor #4 – Lack of training surface variability.]

Training solely on pavement is particularly jarring on bones. I have also read at least one study that theorized training exclusively on one surface, then running a significant distance over varying terrain can contribute to stress fractures.

When the race began, I started my playlist and my running app and took off.  This was going to be a fun experiment.

I ran the first lap without incident. I pushed through the initial wave of energy, settled my breathing into a regular pattern and focused on putting one foot in front of the other.  About half-way through the second lap, I turned a hairpin corner and felt something pull in my left glute. I immediately thought my muscles were cramping.

I feared a cramp of significant magnitude would stop me in my tracks. I was afraid that if I slowed down or stopped running everything would just lock up. That would invariably ruin my performance. I wouldn’t know what my “personal best” actually was. In that moment, I decided I should keep running to see if it would go away. I convinced myself it was probably just dehydration, and made a point to grab some water at the next water station.

About five strides beyond the water station, I ran up a small hill and started to come to the realization that this was less of a “cramp” and more of a “pain.”  It was a dull burning pain, but it was deep, and it wrapped around to the side of my hip. Here is where my ignorance of anatomy led my rational brain astray. I reasoned, “It hurts, but not so bad I can’t keep running… If it was something really bad, I wouldn’t be able to run, right?”

A few more strides carried me down the hill, across a graveled area and a parking lot when I started to feel a “clicking” sensation in my hip. At this point, I could see the finish line, but I still had to round another corner and run the final yards to pass through the chute.  I remember marveling, “Is my hip trying to dislocate? What am I supposed to do if that happens?” Because I couldn’t figure out the answer to that question, I kept going.

The race course straightened out into the final stretch, and I “ran” towards the finish line. At that point, I was limping heavily. A young boy standing on the side with all the other spectators, ducked under the rope and started running alongside me. I remember looking at him and smiling weakly thinking, “I can’t stop right here in front of this kid… in front of the finish line. I have to keep going.”

After I crossed the line, the timekeeper took my bib tag. I walked directly to a giant cooler full of water and picked up a bottle. My mouth was completely dry. While standing there drinking most of the bottle, I started shifting my weight back and forth, trying to figure out what was going on. There was pain, but it wasn’t sharp pain. To be honest, immediately after finishing the race it was hard to tell what was going on with my body. I assume the adrenaline and endorphins from the race were messing with some of the signals I had been ignoring and was now trying to interpret. Still, something felt very wrong. As I went to take my next step, things started to unravel.

I felt a sickening slippery sensation, and I lost control of my left leg.  By that I mean, I couldn’t lift my foot any longer. No matter how hard I tried, or willed it to move, it wouldn’t budge. I couldn’t figure out what to do other than sit down right where I was standing. And that is where I stayed for a good thirty minutes as a few people gathered around me to try to determine exactly what was going on.

What I now know with research and hindsight is my butt cramp was a stress fracture. Stress fractures of the femoral neck can feel like pain in the groin or the rear end (typically wrapping around to the hip). Where is the femoral neck? I had no clue before this experience. I hadn’t ever really given it much thought.  It’s the “bridge” at the very top of your femur connecting the ball joint to the thigh bone. What I had mistaken for muscle pain was actually bone pain in an area of your body that is subjected to tremendous amounts of pressure (5 – 7 times your bodyweight) every time your foot connects with the ground while running.

The “clicking” I had thought might be a dislocating hip (To this day I am still baffled at why that wasn’t enough to stop me dead in my tracks.) was actually the progression of my stress fracture. It continued deteriorating until finally the femoral neck broke completely through. Even after I sat down on the pavement and checked under my shoe to see what was so slippery and why I could no longer move my foot, I was completely oblivious to the fact I had just broken myself.

While I listed the various risk factors above, I don’t want to leave out another risk factor worthy of mentioning. [Risk Factor #5 – Vitamin D deficiency due to autoimmune thyroid disease.]

I’ve monitored my thyroid health closely over the past 14 years, but autoimmune thyroid disease can lead to vitamin deficiencies. Of particular concern is the prevalence of Vitamin D deficiency and the limiting effects it can have on the body’s absorption of calcium. While my thyroid condition likely contributed to a Vitamin D deficiency, most research I’ve done indicates widespread Vitamin D deficiencies in modern populations due to changes in our diets, greater numbers working indoors, and an increased awareness of skin cancer which has resulted if efforts to avoid or protect ourselves from the sun (which stimulates natural Vitamin D production in the body). Even if you don’t have autoimmune thyroid disease like me, you could have a Vitamin D deficiency significant enough to affect calcium absorption, which can in turn affect your long-term bone health.

My whole point in sharing this painful story, is part catharsis and part public service announcement:

If any of these risk factors apply to you, and/or you experience the symptoms of a stress fracture (occurring most commonly in the lower extremities), I urge you to see a physician as soon as possible. They can run the right tests to confirm a fracture, and tell you how to heal.

Symptoms include:

  • Localized pain that is present when running but goes away with rest
  • Pain and swelling that worsens over time
  • Redness or sensitivity to touch in the immediate area of the suspected fracture
  • Pain at night making it difficult to sleep

The recommended course of action will most likely include rest, and while they may tell you to take it easy longer than you would prefer, I will be the first to tell you: Follow their advice! It could save you from surgery… or worse.

What followed was the single-most agonizingly painful night of my life.

Go back and read the first post in this series here:

http://sevafitness.com/my-seva-story/

For more information regarding stress fractures, feel free to check out the following links:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658382/

https://runnersconnect.net/running-injury-prevention/runners-guide-to-stress-fractures/

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About the Author : Adrianne Gleeson