Anatomy Of A Sacral Stress Fracture

The last few blogs I've written have been about the emotional turmoil of injury.  Probably important to write about but enough about feelings for now!  In THIS blog, I thought I'd talk instead about the actual injury and how I've progressed thus far with it.

As soon as the doctor told me I had a sacral stress fracture, the first thing I did (obviously) was google it.  (seriously, I DID live in a time where google didn't exist, but I'm not really certain how...)  What I wanted to know was things like how long until I can run (even though the doctor gave me guidelines, I wanted to know what Dr. Google said)?  Should it hurt when I start back?  Is some pain okay?  What supplements should I take?  Do I REALLY have to stop caffeine intake for my bone to heal?

I scoured the interwebs for blogs, literature reviews, etc... for any and all information I could about having a sacral stress fracture.  Of course everyone's experience is different, but I figured if I told mine, it might help someone who, like me, is looking for information about how this all turns out.

So first, actual anatomy:

On my MRI you could see, clear as day, a fracture line down the holes on the left side.  "Holes" is the technical term, by the way.  :)  

My fracture apparently presented somewhat rare.  I didn't have any pain and then one day I went out on a run and my lower left back started to hurt.  By the end of the run it REALLY hurt.  And then for the next several weeks I couldn't walk without grimacing.  I didn't "do" anything on that run - step in a pothole or jar my back in any way.  It just started hurting.  Or did it hurt before and I ignored it?  Strong possibility.  We are conditioned, as athletes, to deal with pain and so, perhaps it was there and I just didn't "feel" it.  Regardless, on January 5th, I felt it all right!  And it hurt like @$V#@$!!

For the next couple weeks I went to PT, a chiro, I swam and biked, and I took Motrin like it was going out of style.  The pain was pretty bad.  On January 21st, the doctor called and told me that my sacrum was most definitely busted.  Boo.

Starting January 21 through Feb 8 I did nothing.  Like absolutely nothing.  I sat on the couch and tried not to gouge out my eyes or crawl up the walls.  I was successful at these things only.  But barely.

By Feb 8 (5 weeks in), I no longer had pain walking around.  This was amazing.  Stopping all activity together for 2.5 weeks is when the pain finally started to go away.  I stopped taking the Motrin on January 21 when when I found out about the stress fracture (can inhibit healing) and was also glad to get off this medication so it didn't burn a hole through the lining of my stomach.  Progress!

Feb 8 I spun easy on the bike.  I also started to swim again but all pull as kicking seemed to bother my back.  I would try a little kick in the pool and my back would get sore.  So we'd hold off for a while.  I'd try again and it would get sore again.  So we'd wait a while again.  This was somewhat baffling to me because swimming is obviously no impact and walking/biking didn't hurt so range of motion should have been there to kick.  Who knows though.  My body said no so I tried to listen.

All the while, I was doing PT exercises every day.  Weak hips are the root of all evil.  All triathletes have weak hips.  So strong hips were my goal.  As an aside, the labral tear I had/have in my left hip 2 years ago is the primary suspect in this sacral stress fracture.  (at least in my own uneducated opinion - stupid hips!)

I saw the doctor in mid February again and she gave me the go ahead to try running.  So on Feb 23 (7 weeks in), I tried a 20 minute (VERY EASY) run.  The run itself was fine but afterwards, not so much.  My back ached and got sore and hurt sitting and I got scared that I did a bad thing.  By a day or two later it was back to it's normal self but it's reaction to the run scared me enough that I didn't try running again for 2 weeks.

At the same time, I started to do a little elliptical at PT with the thought that it could break up some scar tissue and give me some range of motion back without the impact.  I didn't do much - 15-20 minutes a few times a week.

I tried running again March 9 (9 weeks in) for 15 minutes.  This time better.  It still got a little sore afterwards but not scary sore.  It was around this time that I also started a little kicking in the pool without my back getting too sore.  I went back to masters (where I NEVER pull and I swim HARD) for the first time on March 11.  Back hung in there.

I haven't talked much about riding.  It, all along, was good.  Even in the very worst stages of my back pain early on, riding felt okay.  Once I started working out again in February, riding was always something that I could do and my back wouldn't react negatively.  Even in aero position.  I got a new road bike built up during this time and I'm in LOVE with it so I rode that sucker outside about 4 times a week from late Feb up until the current time - 2-3.5 hours at a time.

Which sort of brings us to the current.  At this point, I'd say swimming and biking are pretty much back to normal.  This was the first week (12 weeks in) that I would say I didn't have any pain swimming or biking and my back didn't get sore after either.  I almost "forget" about the fracture when I'm swimming and biking.

Running at 12 weeks in, is a bit of a different story.  For the past 3 weeks, I've run 3 times a week for 15-25 minutes each.  Each time my back feels pretty good running but afterwards gets a touch sore.  My hip (labral tear hip) is also a bit grumpy right now when running, but that is not out of the ordinary.  My running mechanics feel quite off, although that's to be expected after close to 3 months of no running/very little running.  Each run feels a bit better but I would say that, even if all goes really well and smoothly, I'm looking at another month before I can actually run "train", which would be 16 weeks in.

Moral of the story, a sacral stress fracture, at least in my experience, is not the fastest healing injury around!  And as I come back, it's not without some pain and ache still in the bone and surrounding areas.  Patience is most certainly, key.  (oh goodie, my strong point!)

I hope this helps someone dealing with the same type of thing.  If you got here by googling sacral stress fracture, take heart!  You will get better!  But when in doubt, play it conservative.  And know that it's going to be a while.  But just like with all things, time heals.

Now, for some pictures.

I have to brag on one of my athletes a little.  He dealt with his own injury in the fall but still came back to run a 20 minute PR and Boston Qualifying time in his marathon a few weeks ago.  I enjoy coaching immensely because when you see hard work pay off, well, that's just a darn good feeling.

Rode the train to NYC and caught a rainbow on my way there.

Once in NYC, I got to meet and cheer on some of the amazing Smile Train athletes that were racing in the NYC half marathon.  They raise tons of money for a great cause all the while working and training and living their busy lives.  Honored to work with this great group!

Also, you should know that New Bedford, Mass has a zoo.  And that zoo has river otters.  #boom

This here is Wandar.  He's a shelter cat and he wants to be adopted!!

Masters workout the other day.  Reverse IM is the devil.  #truestory