Recovery from Pelvic Stress Fracture

[Cherise Cody]

Hey GB,

I am a 26 year old female hoping to get some outside perspective on an injury I am returning from to help me avoid it in the future. The injury was a stress fracture of the right superior and inferior pubic ramus (on the pelvis) sustained while at officer candidate school (OCS) for the Marine Corps in Oct. 2016. I was non weight bearing for about 6 weeks, and after another 6 weeks of physical therapy I have been cleared to return to full activity. My hope is to be able to return to the full volume of training that I was at before the injury happened, without having it flare up. I am supposed to go back to finish OCS in July. 

Acute vs. Chronic...or both? There were many factors which probably lead to the injury, mostly related to the training environment at OCS. Lack of rest, lack of full recovery, high volume of weight bearing activities such as hiking with load and running. Stress fractures of the lower limbs are very common...but to the pelvis are pretty rare. My DPT believes the injury occurred mostly due to over striding during marching, running, etc. There was one particular point during a hike at night when I stepped in a pretty deep hole, which was rather jarring on my hips, but only seemed to aggravate an existing problem. Within one week of stepping in that hole, I could hardly stand on one leg and walking was rather difficult. This led to an MRI and diagnosis of the injury. Also keep in mind, the MRI returned that no other soft tissue structures were affected, just the bone itself.

The big question is....I am wondering how much my lack of hip mobility also factored into this injury occurring....

Before the Injury

I heard about GB through a friend. I found the courses online, and have been training GB for about 2.5 years now with a main goal of improving my mobility and foundation of strength. I was super excited when the stretch series was released because my mobility has almost always been my limiting factor. I have seen very gradual but great progress (I am still terrible, but that just shows how bad off I was). My back, shoulders, ankles, wrists, and hips have all come such a long way and for that I am so thankful. The only areas where my progress has been microscopic is the mobility in my quads and right medial hip capsule. I still am not even close to getting forward splits, or middle splits. Specifically, the most difficult stretches are the vertical lunges and the pancake work in middle split. Everything else seems to be adapting just fine, except for that right hip. 

Training Load

When I first started doing GB, I was never fully recovering between workouts (even with plenty of rest). This led me to get blood work done and I discovered a nutrient deficiency. I have since been taking vitamin D and iron supplements since Jan 2016 which has helped my progress immensely (although I couldn't take these during OCS, which also  may have contributed to the injury). Suddenly I was seeing the progress in strength that everyone was talking about and now could workout 5x/week instead of 2x. In addition to GB, the volume of training looked like this:

Work: I am very active at my job and I also teach group exercise classes 2-3x per day.

Running: 3-6 miles per day, 3-4 days per week. This to prepare for OCS. Shorter runs were interval training for improving my speed, longer runs were just slow and steady. 

Hiking: I would also do a 3-6 mile hike 1x per week  under load in preparation for OCS.

Speed/Agility/Plyometrics: 2x per week

Recovery: Mobility and soft tissue work 1 hour/day. 

All that to say, I was putting in a lot of good physical effort, getting stronger, recovering well, and feeling really great. Haven't had any other injuries (except a rolled ankle in 2015 due to playing football in high heeled boots...don't ask haha). My mobility was progressing, and GB (although I wish I could have focused on it solely) was doing a great job of keeping me well rounded. I felt ready for OCS and didn't have much difficulty during it except for my overall endurance and the stress fracture.

Now what? 

I will continue the stretch series in addition to specific FRC work for hip mobility. I am starting back up with my GB workouts (back to almost the beginning) and will slowly ease into running. I am already back at work and teaching classes again. Any advice on what else to do or what not to do? Any experience with pelvic stress fractures? Would love to hear your thoughts.

 

Thanks!

Reese

[Everett Carroll]

Hey Reese, 

I am not a doctor so I don't have specific advice on how to safely return to GST. That information should come from a medical professional. Some of the moderators who are medical professionals on here may have some advice from you. I do strongly suggest consulting a physio about this, however. 

[Tanya Hill]

I agree with Everett, check with your medical professional doctor about your training.

Let them know what kind of exercises you will do doing with the GB courses. GST has many great exercises that are very similar to physical therapy.

[Luke Searra]

Wonderful suggestion from Everett and Tanya. Speak to your physician and if he is not able to provide you with a satisfactory answer go and see a sports physiotherapist and show him the exercises you will be doing in GST. Once he has cleared you, come back here and we will help you every step of the way.

[Cherise Cody]

Thank you for your quick responses and suggestions.

I have been cleared from my orthopedic doctor and physical therapist (physiotherapist) after I finished the 6 weeks of rehab. They both mentioned that they have never seen this injury in someone so young and so strong which is why it was rare. I have also seen my chiropractor to rule out any leg length issues. Also, the MRI showed everything is good to go.

From their perspectives, everything is normal and recovered. They also just suggested light hamstring stretches and glute strengthening exercises, but I passed their range of motion and strength requirements easily. I sent my physical therapist some of the GB workouts I was doing before the injury (and ones I would continue after therapy) and he approved. As long as I am pain free. He was surprised I even got the injury to begin with considering the amount of core, glute, and hamstring work involved in the program. 

I returned to work 2 weeks ago, which requires a lot of movement and weight training (the nature of teaching group exercise). Nothing aggravated the injury and my body quickly adapted to the return to activity. Returning to running last week went really well. No soreness or tightness, except for the muscles attached to the affected area. I am hoping my recovery between runs will get shorter as those muscles get their strength and mobility back. 

 

[Darin Phoenix]

Hi Cherise

If you have been cleared by your orthopaedic doctor and physical therapist then I can see no reason not to resume your GB training.

I would make sure to start at a low intensity and give your body sufficient time to rebuild its strength levels.

Take it slow and remember that the stress we place upon our bodies isn't just from workout to workout, it is cumulative and will build up over a period of time if adequate attention is not placed on rest and recovery.

We look forward to monitoring your progress