I Have a Femoral Neck Stress Fracture. Can I Run?

I have right hip pain. I am 24 years old and saw a doctor last week who did an MRI showing a right femoral neck stress fracture. He told me I needed to be on crutches for four weeks and then would start back slowly with orthotics for my overpronation. I can’t stop running! I have a marathon to do this November! Can I still run? Is there another way? - Jenny K., Seattle

Oh, Jenny, I feel your pain. In fact, this is the most common question I get at the medical information booth at marathons: “My doctor says I can’t run. Can I run?”

Running on stress fractures, in general, is very risky. What can happen is that they break through into a full fracture of the bone, thereby elongating the recovery period. The best rule of thumb is that if you can run with your normal form, you can continue to run. But if your pain causes a change in form, it is time to stop.

Femoral neck stress fractures are the most dangerous to run on. Should they break all the way through, you would need a hip operation and sometimes screws or even (worst-case scenario) an artificial hip. The fact that your physician said not to run is probably good advice until you're healed.

Some physicians allow for pool running on stress fractures. With a femoral neck stress, this just doesn’t work because the muscles attached to this area continue to pull on the bone and not allow the bone to heal.

So, Jenny, I am sorry to give you the bad news, but your doctor is right. Please follow his advice. Coincidentally, the only patient still in the hospital after last month's Seattle Rock ‘n’ Roll Marathon is a young woman about your age who didn’t listen to her doctor and ran with the same stress fracture. She is scheduled for a hip replacement this week! When you're shopping for a second (or third!) opinion that you want to hear, realize that that opinion may not be the most learned.

Please let us know how your recovery goes.

Enjoy the ride.

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Marathon Notebook: Rock ‘N’ Roll Seattle

Dear readers,

I just returned from the inaugural Seattle Rock ‘n’ Roll Marathon and Half Marathon and thought you might like to know what I saw from my medical perspective at the med tent and expo of this exciting event.

With 25,000 participants and a huge, two-day health and fitness expo, this event was amazing. Thanks to all my readers who came to my seminars and to the medical information booth.

A few interesting questions I got at the expo:

"Is it really going to be 70 degrees? That’s warm!"
True, 70 degrees is not ideal for most marathoners. But it's not warm enough to institute our "heat plan," and doesn't increase heat-related complaints at med stations, in my experience. In Seattle, many runners just did not feel prepared to race in 70-degree temps. However, everyone did well. Pre-race jitters!

"How bad are the hills?"
Actually the course was pretty flat, and participants thought it was fast and beautiful along the water.

"Why 37 waves at the start?"
The course was narrower at the beginning than most races and having the waves gave people ample elbow room.

Notes from race day:

• From my Medical Control bunker we followed all medical incidents. Nothing unexpected was seen, and no heat-related illness even though some runners worried they weren't prepared to run a marathon in 70-degree temperatures.

• In order to best spot problems, medical personnel were on bikes -- one per wave. In addition, we had golf carts with medical people every half-mile and medical stations every mile. I had 500 medical volunteers from all institutions in the Seattle community and they all had a great time helping everyone finish the race.

• Participants all did very well with minimal injuries, considering the size of the crowd. The usual blisters and strains but nothing serious.

• The raves from this fist-time event were a pleasure to hear. Elija Nyabuti won the half-marathon in 1:05:14, the fastest half-marathon in state history. (The previous record of 1:05:43 was set in 1994.) Nyabuti actually finished his race before that last wave had even crossed the start line.

Overall: What a great first-time race. Great weather, great course, great city! The best complement I heard was from someone who said it seemed like the race had been there forever. Thanks, everybody, for your support.

If you ran the half or full marathon, please let me know what you thought. We can always get better and your comments are a help.

Enjoy the ride.

Have a question for the Running Doc? E-mail him. NOTE: Due to the volume of mail, we regret that the Doc cannot answer every e-mail.

I Have Osteitis Pubis; What Should I Do?

I read your blog post on osteitis pubis and was diagnosed with this only after I showed it to my doctor. We did an MRI, which showed a “stress reaction to the bone” but no stress fracture. Is this still osteitis pubis? My doctor wants to put me on crutches for four weeks and a second opinion orthopedist says I should just stop running and it will heal “eventually.” What should I do? I want to run again soon! - Jerry H., Brooklyn, N.Y.

Thanks for the question, Jerry. I'm glad runners are taking my blog posts to their doctors and asking the right questions. Judging from the letters I've received, my osteitis blog post has helped hundreds of runners!

It is not uncommon for osteitis inflammation to progress to a stress syndrome or even a stress fracture via the twisting of the bone, most likely from overpronating (more on one side than the other) or a leg length discrepancy. Again, a flexible full-length orthotic is required to correct one or both of these biomechanical issues for you to heal properly. Physical therapy is also needed to gently stretch your adductors and put less tension on the bone.

Both doctors you saw are actually correct with legitimate treatment plans; both ways you will get better. If you go to physical therapy and walk around in the orthotics, apply ice twice daily for 20 minutes, take NSAIDs and do no weight-bearing exercise (no running, walking for exercise, no elliptical, etc.) and no cycling eventually you will get better. Unfortunately, I have found that regimen may continue to smolder the inflammation for months (sometimes 18 months!). I have found that if my patient will tolerate non-weight-bearing crutches for four weeks along with physical therapy, no exercise (not even pool work), NSAIDs and ice, they can get back to running pain free in six to eight weeks. Of course when the bone is not stressed, a corticosteroid injection is also sometimes useful.

I have had patients who insist on running a marathon when diagnosed with this condition. Certainly if they use the standard rule of thumb to run as long as their form doesn’t change -- and if it does change, to slow down and decrease stride length to maintain form -- no permanent damage will be done. If that doesn’t work, then stopping is probably the way to go since the increased inflammation or progression to stress fracture may significantly elongate the recovery.

A common question always arises in these cases: “Why did I get this? Could I have a vitamin or mineral deficiency?” The answer is "no." This syndrome is biomechanically based. Your body's vitamin and mineral levels neither cause nor can prevent this painful problem. (That said, if you are worried about your vitamins or minerals, being checked does no harm and may prevent something else from being an issue.)

Jerry, I hope this helps you choose which treatment plan to go with. Let us know how you do.

Enjoy the ride.


Attention, Readers!
Are you in Seattle this week? Come visit  Running Doc at the expo for the Inaugral Seattle Rock 'n' Roll Marathon and Half Marathon free expo. Dr. Maharam will be giving seminars, answering personal questions at the Medical Information booth and signing autographs. We hope to see you there!

Health & Fitness Expo <http://www.rnrseattle.com/expo.html>
Location: Qwest Event Center
June 25 & 26
Thursday: 11 am – 6 pm
Friday: 10 am – 7 pm

Have a question for the Running Doc? E-mail him. NOTE: Due to the volume of mail, we regret that the Doc cannot answer every e-mail.