Tag Archives: stress fracture

A History of the Injury

Overall, I’m a positive person, an optimist. I set lofty goals, and work hard to achieve them. I’m a good news kind of guy. I like to share achievement, whether mine or others, and celebrate what human beings are able to achieve athletically.

I hate talking about bad news. Detest it. But sometimes bad news is part of life. It is a reality, and the best thing you can do is to stay positive and optimistic while going through it. That’s where I’ve been for the last year, and that’s where I am now.

When I changed doctors, I put together a brief timeline with a history of most everything that has happened. It was sobering to read, as this may very well be the most trivial and baffling cycling injury I’ve ever heard about.

The bad news continued on my mountain bike ride this past weekend. As great as it was to experience something new, around halfway through my ride, I began to feel a burning sensation in the groin. No worries, I’ve felt soreness before while riding and been able to suffer through it. I soldiered on, but the sensation became stronger.

I decided to make my way back home. Ugh, that was a hilly six miles away. The more I pedaled, the more it hurt. I took a couple breaks to massage my hip. Still painful. I made my way up the hills slowly, trying to put more power with my left side — not easy to do on a mountain bike with platform pedals.

With just a couple miles to go, I could barely pedal. I tried pushing the pedal with just my left leg. Not really possible. I had to endure the pain and make it home. By the time I was done, I was done. It was excruciating pain. I could barely walk, and had to use the cane again to get around.

This was a devastating setback, and the last thing I wanted to share on this blog. This most likely is going to lead to the next phase of my injury recovery, which I am praying will be surgery. Something is seriously messed up in my hip, and I need to get it fixed.

My Fall plans are most likely going to change dramatically. More on that as I get some answers.

I know, major bummer post. Not the kind I wanted to write.

For those who have not been following the entire saga, here is an updated version of the history I wrote for the doctor:

Climb Description
9/16/2012 Bridge to Bridge. Injury probably occurred. Mild hip pain started day after ride, got progressively worse.

9/25/2012

Saw general practitioner about hip pain. He thought it was tendinitis. Prescribed anti-inflammatory.
9/30/2012 Rode Six Gap Century with excruciating pain to begin with. Could barely move legs outward. Hip warmed up and no pain during 2nd half.
10/13/2012 Took two weeks rest. It felt a little better. Ran a 5k very slowly without much problem.
11/12/2012 Rested most of October then began training again carefully. Asheville climbing ride and it felt sore again the next day. It became worse. Got referral to Sports Med Orthopaedist, rested.
12/10/2012 First sports med appointment. Doctor thought injury was soft tissue in labrum. Got MRI.
12/17/2012 Diagnosed as stress fracture in femoral neck. Rest for weeks. Had to stop anti-inflammatory. Most of that rest was painful, took pain medicine on occasion and it didn’t help much. On crutches. Clicking and popping began during this period.
1/29/2013 Next Sports Med appointment. Still stress fracture not healed. Switched from crutches to cane.
2/19/2013 Another MRI, this time with an injection of dye. Stress fracture had healed. X-ray diagnosis: lateral labrum tear. MRI: Paralabral cyst? No visible tear.
2/27/2013 Doctor canceled appt. Saw PA instead. He gave green light to ride carefully. Clicking and popping continued. Back on anti-inflammatory.
3/27/2013 Saw doctor briefly. He thought I was getting better, can increase activity. Hip was very sore in colder weather.
4/16/2013 Broken rib. Fitness improvements, clicking and popping continue, mild pain. Doctor said get to get bone density scan.
5/10/2013 Bone density scan showed abnormally low density in femurs. T scores -2.1 and -2.3. Made diet changes.
5/21/2013 Assault on Mount Mitchell completed. Had quite a bit of pain during last several miles.
6/21/2013 Started physical therapy, gradually increased activity.
8/26/2013 After little improvement, got second opinion. He confirmed labral tear, suggested a couple other possibilities.
8/29/2013 Cortisone shot.
9/2/2013 Tour d’Apple. Slight setback afterward.
9/7/2013 First mountain bike ride. Major setback, taking break from bike.

Assault on the Carolinas, 2013, Brevard, NC

No turning back now.

After rolling through the outskirts of Brevard, we descended into a flat valley. There was a large farm on the left, a few cows scattered about, with lush green grass nearly as far as the eye could see. The sun was shining bright, highlighting the beautiful countryside. We pedaled together in a massive pack, the flatlands giving us a momentary reprieve from the punishment.

I recognized where we were, and knew instantly what was coming next. After pedaling through the flats for a couple miles, we reached the other end of the valley, and then turned right at Walnut Hollow Road. That would be the first challenge of the day, and the one that I had really been worried about.

As most readers of this blog know, I had been sidelined for months with a freak stress fracture in my hip region. The hip is still healing, and I have only been riding for approximately a month, gradually increasing the mileage and intensity. The Assault on the Carolinas would be my longest ride of the year, my first organized ride of the year, and my first time in North Carolina since December of 2012. Since I was still in the healing process, I was nervous how the day would go, yet still thrilled to be back on the bike.

Walnut Hollow comes early in the ride, about 8 miles in. While it is a tough climb, it did not give me too much trouble in 2011 or 2012. The road pitched up slightly, and I could see dozens of riders ahead of me fighting the steep grade. It gets steeper as you go. At it’s steepest, the grade is around 14-16% (depending who you ask).

There were a pack of locals on the side of the road, somewhere around the steepest section, one of whom had a trumpet and another had a baritone. They were hooting and hollering. I’m still not sure whether they were cheering us along or laughing at our struggles. I’ll pretend it was the former. The trumpet would just belt out a sharp tone repeatedly, while the other guy played the melody of Black Sabbath’s Iron Man. It was an amusing distraction from the pain of the climb, but I most certainly did not feel like an Iron Man today.

These guys made Walnut Hollow even more memorable.

These guys made Walnut Hollow even more memorable.

This was tough. I simply don’t have a lot of climbing power at this stage of my recovery, and I’m careful not to ask too much of my hips and legs. I struggled on the climb, wobbling a little bit (sorry to the riders near me). After a lot of panting and a few grunts, I made my way to the top.

After the big descent, we turned onto East Fork Road, one of my favorite roads in the area. It follows a small stream where you can often see a number of fishermen in the water. It is just a relaxing and pleasant journey. We then turned onto Highway 178 to make our way toward the Continental Divide and SC state line.

Highway 178 is a gorgeous road, with a lot of short climbs and some exhilarating descents. While I still had a little trouble with the climbs, I was in prime form on the descents. I remember my first Assault and what a reluctant descender I was. It was even a little nerve-wracking because people would bomb past me. This time the tables were turned. I was the guy zooming down the hills, carefully navigating around the nervous, uncomfortable riders, politely telling them I was “on your left,” and thanking them after I passed by.

The first descent from the Continental Divide to Rocky Bottom, SC, was two miles. A couple short climbs followed, and then came the big 4-mile drop down past Jocassee Gorges, and into the foothills of South Carolina. If I ever make a list of my favorite descents, this will be somewhere near the top. It isn’t too steep. Some of the curves can be a little tight, but they are easy to maneuver through.

Fortunately I had some friends waiting for me at the next rest stop. This would become my longest ride of the year somewhere on Pumpkintown Rd, still with a big freakin’ mountain to climb, and I was starting to feel a little tired. They put together a nice pace-line. I was fortunate to be behind Ricky Soxl, one of the tallest cyclists I know. There wasn’t much wind behind his big frame. That was the only way I could keep their pace. As we got closer to Caesar’s Head, he backed off for some reason, and that was it for me. I dropped off, not wanting to punish myself further. We caught up at the rest stop, but I knew that I would be on my own for the climb.

Our Pumpkintown Rd paceline. Thanks Ricky for the draft.

Our Pumpkintown Rd paceline. Thanks Ricky for the draft.

Hello again, Caesar’s Head. I have ridden this climb quite a few times before, but never had it been as difficult as today. The sun was bright, and the temperature had creeped higher, which didn’t help matters. The most important thing was getting through the climb without hurting myself. I went very easy. People passed me constantly. I carefully watched my heart rate, trying to keep it between 165-175. Since I don’t have the best cardio fitness at this point, that meant I was not going very fast.

My goal was to not stop no matter what. Even though I may not be in peak shape, I still don’t consider myself to be a quitter. Part of getting better is maintaining the mental toughness required to persevere when things are tough. However difficult, I maintained my momentum, and kept turning the pedals until I reached the top. It was easily my slowest climb of Caesar’s Head ever, about 30 minutes slower than my fastest time. As slow as I was, I did not set my foot down.

I reached the top in a state of exhaustion. I was completely spent, but day was not over yet. There were still about 15 miles to ride back to Brevard.

A group passed me as I was struggling in the headwind on Highway 276. I hopped on, glad to have a reprieve from the wind. Pulling us along was a gentleman with an Asheville Racing jersey. We kept on passing people, and they would join the line. I expected him to back off to rest, but he kept on going, pulling us almost the entire way back to Brevard. I passed him on a descent, thinking I had lost the group, then he caught back up with me a few miles later. Whoever you are, sir, thank you for the pulling.

Phew. I finished. Because of my recovery, this may rank as one of the toughest rides I’ve done. I was not going for time, but happened to notice that I finished an hour slower than last year. No complaints there. Just finishing was a win for me.

Thanks to the Pisgah Rotary Club and the entire Brevard community for making this such an enjoyable ride. This is among my favorite rides, and I’m glad to see that it has grown so significantly over the years. See you guys again next year.

Strava GPS Link

IMAGE GALLERY

The Good News Continues

Today was my first time seeing the sports med doctor in two months. He had been out of the country for my last visit, so I saw the PA.

The news was encouraging. After talking to me about my symptoms and checking my mobility, he told me he thought I was getting better. This was somewhat of a surprise, as I felt slightly better, yet had not improved as much as I had hoped. A lot of that can be attributed to the cold spell we recently suffered, which hopefully is near the end. The hip always struggles in colder weather.

What’s even better is he gave me the go ahead to increase activity and intensity. He said I can go faster and farther, but cautioned me to be careful. I should listen to my body, and make sure I am aware of my symptoms.

He also cautioned me not to go too far at once. He reminded me of the 10% rule that runners obey — not to increase weekly load by more than 10%. That will be difficult to follow to the letter since the weather has thrown a wrench in my training schedule, but in the next week or two, I should have a baseline idea of what I can handle.

Next week I will be in Spartanburg for a couple days. A few weeks later I will be in Brevard. I am okay to ride on these trips, but again, while being careful not to overdo it. He said that I should be prepared to take a day off in between rides in Brevard.

We ended by him saying to come back in 8 weeks. I did some quick math, and realized that would be towards the end of May. What about the Assault on Mount Mitchell? “Make it 6 weeks,” he said. The next appointment will be about a week and a half before the main event. While I feel it is possible, and even likely that I’ll be able to participate, the ultimate decision will be made then.

What is most encouraging is that the further along I go, the better chance I won’t require surgery. So far the recovery schedule is proving the original diagnose of a stress fracture. Since I have been riding without any setbacks, it also calms any concerns that this could have been an overuse injury.

Hips are notorious for healing slowly. I’ll just have to be patient. However difficult it still is, I’m grateful to be back on the bike for the warmer, spring weather.


The Good, the Bad, and the Angry

The Good

I’ve been long overdue for some good news. It came today. No labral tear. I repeat: NO TEAR!

My orthopaedic doctor has left the country, and my GP had the day off, so I had to smooth talk the imaging company to get the MRI results. The X-Ray results concluded that there was a likely lateral labrum tear. As I opened the envelope of the MRI report, I fully expected to find more bad news waiting for me. Not only did I expect a tear, but I thought there was an outside chance there would still be signs of the stress fracture.

The MRI definitively ruled out the stress fracture. It is gone. I won’t miss it.

The report also ruled out a tear. One thing I have to remember is that this is a radiologist’s report, and not an orthopaedic surgeon. While I have to take these results with a grain of salt, they are encouraging.

No stress fracture means no more crutches, no more cane, and most importantly, I can take Advil and anti-inflammatory drugs. It is simply amazing how much these drugs help. My pain and soreness diminished significantly with the first swallow.

The Bad

There are some other things that still need to be dealt with.

I’m reluctant to self-diagnose. I’ve learned the hard way that reading too much on the internet can sometimes do more harm than good. To be honest, I do not understand half of the report, and I agonize myself trying, but there are some things that give me cause for concern.

One issue has to do with the bone marrow in my hip. It may be related to the stress fracture, maybe not. I have no idea, and will try not to worry about it.

The other issue is that I have a small cyst in the labrum. This isn’t the cancerous type, just some swelling, which is likely the cause of the popping, snapping, and the pain. Some of my internet research shows that this type of cyst is often accompanied by a tear, so I’m not out of the woods yet, but my fingers are crossed.

This means that surgery may still be necessary, although there could be alternate methods. From what I understand, the cyst could be zapped with a shot. Physical therapy might also help work it out. While I’ll consider all options, surgery is now more of a last resort.

The Angry

When I first heard about the potential tear, I’ll be honest that I was a little miffed. Why was this not discovered months ago? If the doctor had ordered a different sort of MRI the first time, could he have seen this? Why did he give me short shrift when not seeing healing marks on the X-ray, and make me go another month on the couch?

After reflection, I’m not angry with the doctor. In fact, I feel the opposite. He actually got it right. He told me that I had a stress fracture, and that my hip labrum was ‘off.’ That appears to be the case. He said that when the fracture heals, we’d deal with the rest, which is where we’re at now.

Instead, I am diverting this anger to my recovery. I’m going to be smart, sensible, and listen to my doctor’s orders, but I am going to attack my training and recovery with vigor. This was an unfortunate and uncomfortable setback, but after riding angry, I will emerge stronger with more focus.

Ready or not, here I come.


Not So Fast …

The new ride

The new ride



After a long seven weeks off, I had been looking forward to yesterday’s doctor’s appointment. My expectation and hope was that we would X-ray the hip, see that it is healing, and move on to the next step towards my recovery.

My hopes were dashed by the results. Unfortunately there were no signs of healing.

Stress fractures are strange and perplexing injuries. They often will not show up on X-rays. Mine didn’t show up initially, and we didn’t know it existed until I had the MRI. When a stress fracture is healing, there are visible and distinctive signs that will show up on the image. Mine showed nothing, which means I’m not there yet.

The fact that there were no signs of healing does not mean I am not healing. I know just from the way I feel that the hip is improving. All we know is that the process is a little bit slower than we had hoped. The fact that I am still experiencing soreness, walking with a limp, and having popping instances, all show that the healing process is still ongoing.

The doctor advised me to take another month off. As he put it, I need to ‘respect’ the hip. He looked at my walking gait, and found it to be unnatural. “Is that how you normally walk?” he asked. Nope. Even though crutches are no longer necessary, he suggested using a cane just to keep weight off of it.

While this was disappointing, it was somewhat expected. I could already tell a couple weeks ago that healing was taking longer than I had hoped, which was the reason I canceled my plans in France this year. That turned out to be the correct move. This is a process that I have to be patient with. I’ll follow the doctor’s orders, and hopefully everything will continue to improve.

This sets back some of my spring plans. My heart is set on completing Mitchell, and I will optimistically register next week. However, if the news is not better in a few weeks, I may have no choice other than to be smart and back out.

I can’t complain too much, as there is always someone out there facing tougher odds. Today I heard about Christian Haettich, who is taking on both Haute Route challenges. And by the way, he’s missing an arm and a leg. By comparison, coming back from a measly hip injury seems pretty insignificant.

Time heals all wounds, and this one will be gone eventually.


The Freakish Femoral Neck

First off, thanks to all those who reached out to me after the injury news. I received a lot of encouraging comments here, on Facebook, Twitter, and a lot of text messages and emails. Whether the comments were simply well-wishes or constructive advice, they were all appreciated.

Now that the shock of the diagnosis has worn off, I’ve been able to come to terms with the injury.

One thing I discovered pretty early is this is a freak injury for a cyclist. I scoured the internet for examples from others, but found only a legion of runners. Unlike running, cycling has no impact whatsoever, so it is boggling that any type of broken bone can occur. Even though I had run a couple times leading up to the climbing events, it was not nearly enough to suffer an injury of this nature. There is no other possibility than for this to have happened while climbing, probably out of the saddle as the doctor suggested.

Here is the best description I found of the injury.

Another common subject that came up when I talked with others was that I trained on the stress fracture. While it would be easy for me to brag about riding around with a broken bone, it really was not as impressive. The symptoms of the injury were more like tendinitis. When my body warmed up, I often would feel very little, if anything. There were only a few situations where it hurt during the activity. Six Gap was notable. Beyond that, it often hurt quite a bit after the events, but would improve with rest.

Speaking of rest, that’s what I’ve been doing, and will be doing for the next number of weeks. Kelli worked with me to find the best vitamin recipe to get the Vitamin D, Calcium and Magnesium to help heal my bones. I’ve been making it a point to eat things that are richer in nutrients, specifically calcium. I’m also walking around with a crutch for the time being. I could function with a slight limp, but the doctor thinks it is best to keep weight off the hip as much as possible.

I feel pretty good about the recovery process and getting back on the bike. So far I have not noticed a significant difference, but that’s to be expected. Bones are slow to heal. One thing I noticed when reading a lot of the testimonials from runners is that it is difficult for them to return to activity. Fortunately I will not be running. I found many examples of runners that will cycle to get their legs into running shape. Even though the doctor hasn’t told me this, I’m pretty sure I’ll be able to start some light pedaling after the initial healing process. That’s a good thing. Climbing may have to wait awhile.

On the brighter side, my friends at Vork Cycling showcased their amateur Photoshop skills to make light of the injury. This was hilarious.

aaron recovery


Diagnosis: Broken Hip

hip_stressfx_anatomy01

Today was the day I would get the results of the MRI. After doing plenty of internet research, I figured that the best case scenario was further inflammation of the same hip flexor strain that my General Practitioner had diagnosed months back. The worst case scenario would be a tear somewhere in my hip labrum. Depending on the severity, that could require surgery. Whatever it was, I was looking forward to getting an answer and starting the path towards recovery.

It turned out to be neither of those.

“How does the hip feel?” the doctor asked. A little sore today, but not as bad as this last week.

He came right out and said it. “You have a Femoral Head Stress Fracture.”

Wow, I thought, not really understanding what he said. It turns out the fracture is in the plate of my hip, the right side, not far from the socket (labrum) that connects to the pelvis. He said that the labrum is also off, which points to another injury. Whatever I did to that poor hip, I did it real good.

He asked questions about my activities, trying to figure out how this happened. I never noticed a snap or any moment where this could have happened. He said that it’s more common with running because of the impact. When we discussed some of my rides in a little more detail, he said that it could have happened when riding out of the saddle on a steep climb. That is when I would be most at risk for this type of injury. That jives with my Grandfather Mountain theory.

The only prescription right now is rest, and lots of it. I will not even think about treatment for the next six weeks. The only activity that is at all acceptable is swimming or upper body exercises.

My first question was whether my plans in France are still possible. Yes, he said, with some work. We’ll revisit this again at the end of January, and I’ll work myself back into shape slowly. The goal is to resume training sometime in March. Since the event is in the late summer, my recovery fits within the training timeline.

Even though this is somewhat of a bummer, I am relieved. Finally I can stop training and aggravating this injury, which to be frank, has not been a lot of fun. The next time I ride, it won’t be on a broken hip, and it’ll feel a lot better.

Whatever happens, this story ends in the Alps.