Stress fracture of the pubic Ramus

[Borntovault]

I got this injury at the end of my sophmore year and it has healed and reoccured 5 times now. I'll sit out a several weeks and then I'll come back and workout for a few weeks and then have to sit out for a few more weeks and then I'll come back and do the same thing. I haven't really had a consistent workout schedule for over a year now. It has been shown that it is two stress fractures in the pubic bone. Please no jokes, I've heard them all... So I was just wondering if anyone has had this injury and if they have, then how long did it take to heal and what did you do for it to heal, cause currently I'm doing nothing. Thanks for any help that you guys have.

[rainbowgirl28]

It sounds like it's not really healing each of those times.

Have they tested you for any deficiencies, like maybe calcium or iron or whatever that might make your bones have a harder time healing?

[Vaultiletics]

Honestly that is the most difficult area of the body to heal...
From your condition to ligaments and tendons down there.
Time and rest, and Becca makes a great point with nutrition and recovery.
With all that said, I too currently have an adductor or growing ligament, tendon problem...
it has now lingered 4 months, and i rested it for weeks and gained ten pounds.
All right after hitting a PR at the age of 32. I am so ready to train again. Good luck.

I really do sympathize and wish there was more to do... I know doctors have machines that help bones heal, but thats tough to come by...
ICE DOWN THERE IS NEVER GOOD, But GIVE IT A TRY TOO!!!

[Borntovault]

well I have a machine that helps the bone regrow. I also have been checked for low calcium, iron and all that good stuff as well and it came back fine. I'm just glad I'm no longer depressed anymore and now just ready to get back. thanks guys for the help. Currently at 8 weeks of nothing again and getting another MRI in about a week or 2 to see where my progress has me. Definitly gonna be at least 4 weeks and maybe 8 or more. Can't wait to get back doing what I do.

[decanuck]

It sounds like you have exactly what I had. I'm sorry to hear that, because this one SUCKS. I presume this is on your takeoff/swinging leg? I have to ask, what medical imaging have they done on you and by whom (i.e. what level and area of expertise) were the results interpreted? Have they done any bonescans or pelvic-specific X-rays? Have they done a diagnostic ultrasound to rule out a sports hernia? It was mentioned that the area is one of the most difficult for the body to heal (because it is so central). It is also one of the most difficult to diagnose. The same set of symptoms are indicative of any number of radically different injuries with totally distinct mechanistic causes.

Over a period of about two and a half years (which included one successful season) I had two bone scans, a diagnostic ultrasound, about four rounds of x-rays, and two MRIs. The diagnosis went from groin strain, to enthesopathy of the adductor tendons (this basically means that the tendon is inflamed and pulling away from the bone), to osteitis pubis (which is inflammation of the symphasis pubis--that is, the tissue that binds the two spheres of your pelvis together) ,to stress fracture of the superior and inferior ramus, and finally back to osteitis pubis which is what I actually had all along.

The reason that diagnosis is so hard is because the medical imaging is an inexact science and often the technicians and physicians merely take their best guess given the pictures and the symptoms present. Sometimes this is misleading. For instance, I was diagnosed with stress fractures of the superior and inferior ramus because, on one of my MRIs, those areas "lit up" on the picture. This "lighting up" could indicate a stress fracture, but not necessarily. Being a vaulter the pelvis takes a lot of stress in this area from takeoff and swinging which may be enough to cause it to "light up" on the MRI but isn't necessarily the cause of the pain, nor is it necessarily even a problem if you have healthy bones. Another confounding problem was that the inflammation of the nearby pubic symphasis "bled" down into the ramus on the MRI, thereby causing the misdiagnosis.

Remember that the people who take and interpret your MRI are general diagnosticians and almost never have specialized expertise in something as unusual as usual as chronic pelvic injuries. Their diagnoses are just opinions based on what they see. I am NO medical expert and obviously I would be talking out of my a** to speculate as to what your injury is, but it seems to me on a general level that a stress fracture of the pelvis is highly improbable. Not only is this one of the strongest bones in your body, it is both surrounded by weaker tissues that are more likely to be the chain link that breaks and very distal from the actual forces of impact. You would think that, if something goes, it would be at the ankle, knee, or the some of the weaker tissues surrounding the pelvis and not the bone itself. If you do have a stress fracture then I feel really bad for you because it's a horrible place to get one and it will take a ridiculously long time to heal. It also makes your recovery much more tricky. If you don't, the other possible causes are not so bad.

I was finally given what I believe to be the correct diagnosis when I was sent to see a pelvic orthopedic surgeon for his take on the problem. All he needed were X-rays, but he had me do them standing on one leg in a funny position with the other leg externally rotated. This was apparently all he needed to affirm that I had osteitis pubis and not a stress fracture. Just shows you that sometimes it's not the technology but the user that is the hang-up (not that I would blame any of the other diagnosticians and technicians--like I said it's an extremely hard area to diagnose and they just do their best).

Whatever it may be, possible causes could include:
- bone weakness (which apparently you've addressed already)
- running/jumping technique (does your foot land underneath or in front of you? do you land toe-heel-toe or heel-toe? etc.)
- muscular strength and flexibility imbalances between adductors and abductors
- lifting technique (e.g. when you do squats, is your stance sufficiently wide and your toes pointed out at 30 degrees? do your knees stay over your toes for the whole motion?)

The safest solution, I would think, would be to try and address all of these at once, even if you don't think one of the is a problem--strength in one area may help with weakness in another. In my case, I think the injury was caused by having adductors that were too flexible and too weak (I could nearly do the splits sideways and yet my knees would collapse inward when squatting). I finally beat my injury with a regimen of:
- an initial cortizone injection to get the inflammation under control
- yet another period of time off training
- light PT-style work on weak muscle groups (particularly theraband exercises for my abductors and glutes)
- progressions through basic non-impact lifting movements (i.e. bodyweight squats with a loose weight belt around my knees to assure I kept my knees over my toes. later I added a lateral balance board, then a bosu board, and finally a bongo board--these will help engage ALL of your muscles to stabilize. then I added weight and built up)
- a very VERY slow return to highly technical running. I basically re-learned how to run, concentrating on landing first on my toes and landing with my feet directly underneath me. I would very slowly ramp up volume and intensity on grass before slowly moving to a harder surface. after I while I came back to full training and have been hunky dory ever since


Take everything I've said with a grain of salt, but hopefully this is of some use to you. I do hope you don't really have a stress fracture, because if you do it precludes you from most of the above types of treatment until it is sufficiently healed. I'd love to hear what finally becomes of this when you get it resolved. Good luck.