Tuesday, October 15, 2013

A Diagnosis: Femoral Neck Stress Reaction

ETA: A lot of people have been finding this page by search and might be interested in my other FNSR posts:
http://twolittlerunners.blogspot.com.au/2013/12/injury-update-femoral-neck-stress.html?m=1

http://twolittlerunners.blogspot.com.au/2014/02/so-you-have-femoral-neck-stress.html?m=1

Ever since I ran the Philly half marathon, and wound up injured and unable to run, I've been sort of avoiding el-Blog-land. Partly because I didn't know what my injury was (and wanted to wait to blog until I found out how long I would be out of action) and partly because, well, writing a running blog when you can't run can be downright depressing.

But don't worry! I'm much happier now!

Ok, so first, a diagnosis. I went to the doctor with pain in the front of my hip, which was exponentially worse when hopping on that leg. I heard that pain on impact tends to be related to bone-injuries, while pain on push off tends to relate to muscle-stuff (technical term). This was definitely pain on impact. Not good.

I saw my doctor  and he didn't like the sound of my symptoms at all (off topic, but funny story: apparently the good Doc has a few admirers. When I googled his name to get the office address, Google search options suggested "Dr Jordan Metzl married?"]

Dr. Metzl ordered an MRI, and the results revealed a stress reaction in the femoral neck. A stress reaction is a precursor to a stress fracture, and is an inflammation of the bone. A stress fracture in the femoral neck looks a bit like this:

Source
Youch, looks nasty. Well actually, it could've been a lot worse. I only had the inflammation, with no cracks in the bone. A stress reaction takes about 8 weeks to heal. An actual stress fracture in the femoral neck (as opposed to, e.g., the shaft of the femur, which is more common) can take up to 5 months to heal. And usually about 6-8 weeks of those are on crutches with little to no activity. Wowza.

It seems the reaction probably started the week before my taper week for Philly when I was running my highest mileage and did my 6x1 mile repeats. The three days before my race, I felt a little pain in my groin, that felt like a minor strain. I definitely would not have run the race, if I'd known it was a stress reaction. But in retrospect, as I said to my dad, I'm actually really glad I ran the race on it. The discomfort I felt before the race was SO minor, if I had just been training, I would've run through it and probably would've ended up with a real stress fracture. The race just aggravated it enough and pushed it to the edge that I had to stop running in the days after (and would've anyway to recover from the race) but not quite over the edge.

Anyway, now I'm in recovery/rehab/cross-training land. Week 1 after the race had no running or cross training, Week 2 consisted of two days of elliptical and some random arm-weights. Week three, I did two days of swimming/pool running, after which I saw the doctor and got the MRI.

Week 4, I would've been about to start climbing the walls, but after my diagnosis was thankfully  given the go-ahead to begin consistently strength/cross-training. I'm allowed to do anything that doesn't "hurt". Its ok if its a little achey, but I have to stay away from "impact pain."

I guess the mind-numbing, wrist-slashing boredom of pool running and elliptical don't fall into that category of discomfort.

But I should be thankful. I can finally keep up my fitness, and continue to heal properly. In two weeks I will see the doctor again and hopefully will be able to very slowly begin reintroducing running to my hip. Here's how I'm hoping that will go down:

"Running? Meet Hip. Hip, meet running. Please don't spaz out. You two will be the very best of friends."

I'll keep you updated :o)

~Penny

18 comments:

  1. Ugh - so sorry you are dealing with this - I have had a stress fracture in each of my hips over the years - not fun for sure!!! But with rest, you will be back to running before long!!!

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  2. Oh Kim thats horrible that you've had stress fractures... and more than one! Do you have any idea what caused yours? I'm hoping to make sure I never have to go through this again! Thanks for the encouragement. It really does help :) ~ Penny

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  3. I'm in your boat! Get well! Rest, deal with the pool, try not to go nuts. I can't believe it myself sometimes, but..you will heal. You are lucky to have such a fabulous doctor. I just got his book and think it will be a valuable resource once (if?) I return to running. Hopefully he can guide you to a full, fit recovery. In the meantime, I'm sorry, but I'm glad you have a diagnosis. That's half the battle.

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    1. Thanks Gracie. You are soooooo right. Until I got a diagnosis (and recovery plan/time-frame) I was going nuts thinking of all the things it could be, and wondering if I would ever run again (omg, so dramatic!) But dealing with recovery is much easier knowing that it will heal, eventually, and I'll be back out there soon. I dont have high hopes that it will be in two weeks time, but I know it will happen.

      I cant imagine how frustrating it has been for you regarding your leg/osteitis problems. I wish you could come out and see Dr. Metzl. The two times I have seen him, he has talked to me for two minutes, pushed and prodded my legs a couple of times, and has given me a spot-on diagnosis. Having a doctor who runs LONG, and who sees sports injuries all the time is so key to getting stuff diagnosed. And keeping your sanity.

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  4. That stinks! Sorry to hear that. I've had two stress fractures in my foot, so I know how frustrating it is. Just be consistent with your cross-training, and it'll make your return to running that much better. And don't forget your calcium!

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    1. Ah, excellent point! I had a bone density test, and *hopefully* it will show that I have low bone density. I say that, because it is something that is relatively easy to fix, and not a fundamental flaw in my gait or something. I will definitely be blogging about those results too.

      In the interim, Im upping dairy and taking a calcium/Vit D supplement every night!

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  5. Ouch. Just looking at the image is making me shudder. Good thing you caught it at "reaction". *high five* for listening to your body.

    Is spinning on the "approved" list? During rehab of injury in the past, I found spin provided the best outlet for my need to sweat/push myself athletically. It also helped keep my running muscles in good shape. Might be worth a try, if you haven't already.

    Will be sending healing vibes. Make Kristen send you hers now, too, since she's apparently better now...

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    1. High five!! Thanks!

      Thanks for the note about spinning. Its really all about what hurts. I tried the bike, and it really didnt feel good. Same with regular elliptical. I think if its working the quads to any great degree, its putting pressure on the femur, which I feel in my hip.

      With the elliptical (the procore ones) I can crank up the incline, so Im basically only using my calves and gluts (which are weak anyway) and get a really sweaty workout in. And I dont feel it in my hip, best of all.

      As soon as I can though, I definitely will be trying to incorporate spin- I used to love those classes!
      ~ Penny

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    2. I made the same suggestion Holly. Spinning is pretty good. Out of the saddle is very much like running - or elliptical. Kristen

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    3. Dang! Well, take it easy, be careful, and remember that while this recovery may feel interminable, it's really just a tiny fraction of your "running career". And, whenever you feel the urge to over-extend...take a look at that femoral neck fracture picture up there! *shudder*

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  6. I feel your pain--literally. I've had a FNSF in the right hip and a stress reaction in the left. Once I injured the left hip too, i got really into figuring out what the hell was wrong with me--big picture--that was causing this to happen. My mileage was only 15-20 miles a week, so it was really baffling. Long story short, thought I'd been doing chiro and massage all along, Rolfing ended up being my miracle. I went from unable to run 3 minutes on the treadmill without pain, about 8 weeks after my stress reaction, to zero pain for a year and a half with regular Rolfing sessions. The theory now is that a car accident when I was 15 misaligned my back/hips/pelvis and my running was all out of whack. I've been doing Rolfing now for a year and a half and have had zero issues. I've run 2 half marathons and numerous other races with not even so much as a twinge!

    FWIW. Sending you quick-healing vibes!

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  7. Now that I've read the other comments, I'll add: I learned that my bone density was fine, but I had a pretty bad vitamin D deficiency. Once I started taking the prescription-strength vitamin D, my cracked hip hurt worse than from the injury. My doctor said the bone was remineralizing. Holy sci-fi, y'all! Also, other things I now do for prevention (other than rolfing, chiro, massage): rotating 4 different shoes and splitting my mileage between road, track, and treadmill. Those 2 were recommendations from my ortho, who's also a runner. I am totally OCD about varied impact now!

    Ok, the only other thing I'll say is that reading the blogs of people who've come through this injury really helped me--gave me hope! http://www.shutupandrun.net/ and http://www.hungryrunnergirl.com/ pop to mind.

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    1. Please don't use terms like "I am totally OCD" if you have not been diagnosed by a psychiatric professional with this disorder. It only minimizes those who are truly suffering with OCD and require meds (and sometimes even hospitalization for the comorbid effects such as debilitating anxiety and depression). You would not say something like "I am so diabetic today" or "I am so cancerous". So please don't minimize Obsessive Compulsive Disorder, as it only makes you sound uneducated. Thank you.

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  8. I found out today that I have this as well. Have to rest for 6 weeks and take my Mobic. I wonder what kind of runner I'll be after 2 months off. Was previously doing a standard run of 7 miles with 10 mile runs once a month.

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  9. I just stumbled upon your blog (which I love btw). I am a runner struggling with a diagnosis of a stress reaction, bursitis and a labral tear in my right hip. I have to take 6-8 weeks off of EVERYTHING having to do with my lower extremities. I am literally going insane. I can walk with a limp for short distances but use crutches to walk anything longer. My doc told me no activity other than normal daily routine....technically my normal daily routine is walking as much as I can, running, strength training or biking. Any tips on how to get through the next month of no activity?

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    1. I am so sorry to hear about your hip injury. It has got to be terrible! Penny will probably chime in too - but I am familiar with the waiting game of injury. Last year I sprained my ankle and had to take 6 months off of running before I was recovered. I could still do some activity though! One thing I did was take to the water. I went kayaking and stand up paddle board surfing every weekend. If you can't do activities like that - what about some kind of class or art project? Maybe take sewing lessons, cooking lessons, photography? I definitely understand the need to fill the void of running/exercising. It won't be running - but maybe you can develop a new skill! Good luck and let us know how you are doing! twolittlerunners@gmail.com
      Kristen

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  10. Hello there,
    Did your stress fracture start out as a very dull, minimal pain in the upper thigh just below the hip area? Or maybe a little more stressful to do lunges/squats? Thanks!

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    1. Hi Melissa, sorry about the delayed response!!

      It started out as a very light niggle pain in the front of my hip - almost groin. After I raced, it became a very prominent pain in the upper thigh, just below the hip bone.

      It was impossible to do lunges/squats at that time - particularly lunges.

      I think a good test for you would be the hop test. If it hurts on impact, it may be bone-related and warrant a trip to the doctor + MRI. If its a pulling feeling, as you leave the ground, its probably more likely a muscular thing.

      Gosh I hope you're better by now, but if not I hope this helps!
      ~ Penny

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