Tuesday, March 22, 2011

Stress Fracture News

Elvis Aaron Presley had the nickname "Elvis the Pelvis" because of the way he would back off the microphone and gyrate his lower body.

I wonder had Elvis lived to see his golden years, would he have experienced any issues with his pelvis? As he died suddenly in 1977 at the age of 42, we'll never know. I rather think Elvis....young Elvis, not fat Elvis....would have been a pretty good endurance/multi-sport athlete. Again, we'll never know but I'm pretty confident he would have had a really cool speed suit.

Well, I have a stress fracture now. A nasty one. On a scale of 1-5, with 5 being the worst, I was told this ranks as a 4 or 5. Let me remind everyone, as you read the report below, that I ran a 19:36 5K with this injury. I say that again to state my Neanderthal-like pain tolerance and my Neanderthal-like stupidity in even running it. Click on image for larger view of the reports below:

I hope to be able to display some actual MRI images later this week as soon as they release those to me.

So why do I have a stress fracture? And just out of the blue with no other warning signs? I can think of three possible reasons. The reason for my stress fracture may be a combination of all three. Let's break these down:

  1. Over Training: The later half of the 2010 season I was really on fire and competing at the best level yet in my comeback to the sport which started in 2007 after being diagnosed with low testosterone. I took a few weeks off in November and then started up base building training in December incorporated with some speed work. When February hit, my running mileage increased from the 25-30 mile/week range to 50-55 mile/week range. Yes, this is way above the "Don't Increase by More than 10% per week" rule. However, I was experiencing no issues with fatigue or muscle soreness. The pain first surfaced the Monday after a 10.5mi Saturday run and a 8mi Sun run/30mi bike. Could the heavier run mileage have done me in?
    1. Assessment: High probability. But it is damn disappointing if this is indeed the case. I'm a guy who ran 100+ mile weeks through college at the high end and 70+ miles routinely. Being in the 50-mile range should not have proved to be a detriment for me now. Especially since I was thinking about concentrating solely on running during the 2012 season and let triathlons take a back burner for one year. Now, I wonder if I just need to keep the multi-sport lifestyle and keep my running to a minimum.
  2. Endurance Athletes & Bone Density: There was a recent article on this topic in which researchers have studied endurance athletes and whether or not they have a higher rate of osteoporosis (thinning of bone tissue) than the average sedentary person. Studies have shown that perhaps cyclists develop more instances of low bone density than sedentary people and suggest that the lack of weight bearing activity is the cause.
    1. Assessment: Probable, but not sure this is in direct proportion to my issue. I had a bone density scan in 2007 and it was perfectly normal. Yes, I should probably get another as a lot can change in ones body in four years. However, the reason I feel this my be a indirect, rather than direct cause of my pelvis stress fracture is this. When reading the research behind the aforementioned article it states: Activities that produce high strain magnitudes and high strain rates distributed unevenly across the bone provide the greatest osteogenic stimulus. Furthermore, the degree of mechanical strain applied to bone in weight-bearing activities increases proportionally with increased ground reaction forces. Evidence from cross-sectional studies of athletes from a variety of sports, including gymnastics, volleyball, karate and running, supports the notion that bone undergoes a positive adaptive response to high impact activities. Intervention studies, most of which are reported for women, have shown increases in bone mass induced by high strain activities such as jumping and running in children as well as older adults. In stark contrast, weightless environments experienced by astronauts or individuals participating in bed-rest studies cause rapid and marked bone loss. Similarly, non-weight-bearing activities such as swimming and cycling afford few, if any, benefits to bone health in young adults. So, two of the three activities that we train for in triathlons are non-weight bearing and afford no benefit to bone health. How much of this is offset by running? I would like to see a study of bone health for triathletes.
  3. Low Testosterone: Osteoporosis is a significant problem in older men, 30% of all hip fractures occur in men and the mortality rate following hip fracture exceeds that of women. Testosterone is thought to be important in the development of peak bone mass but its role in age-related bone loss is not established. What is known is that osteoporosis is a significant complication of low testosterone. As mentioned before (and long time readers know), I was diagnosed with low testosterone in 2007. Normal total serum testosterone levels for a person of my age are 600 - 900 ng/dL. Mine in 2007? 70 ng/dL.
    1. Assessment: Probable and the most worrisome. A bone density test should be able to confirm or alleviate my worries with this possibility. Am I destined for a life of stress fractures? I think I should be able to stave off any such worry with the right amount of exercise, testosterone & calcium replacement therapies. But this possibility certainly will never be eliminated. To be honest, my physical therapist stated he is 95% certain this fracture was not related to bone density as he saw no indications of osteoporosis. So, I may be worrying over this possibility a little too much. We'll see if my primary physician is agreeable to scheduling a bone density scan and we'll go from there.
So, what are the steps anyone can take to help prevent bone loss? Let us start with dairy products. There exists a direct relationship between dietary calcium and bone health. The best source of bioavailable (highly absorbed by the body) calcium is from dairy products such as milk, yogurt and cheese. In fact, 1 cup of fat free milk has 86 calories and a whopping 302 milligrams of calcium! Three cups of milk per day supplies almost all of the dietary calcium most of us need. The recommended intakes of calcium are:

It is possible to acquire calcium from other food sources but remember that milk, specifically, also contains vitamin D, vitamin A, protein, potassium, riboflavin, niacin, vitamin B12 and phosphorus. Each of these 9 essential nutrients play a different role in your body to help regulate body processes and maintain good health.

For those of you not too keen on milk, here are some other food sources that contain calcium:

This means the 10K in London I have been looking so forward to, is to be missed. Additionally, the following events are in jeopardy of being missed this season:

Apr 30 - Iron Mountain Du; Arkadelphia, Arkansas (USAT) 2mi run, 11mi bike, 2mi run

May 1 - Iron Mountain Tri; Arkadelphia, Arkansas (USAT) - 880 yard swim, 16.2mi bike, 3mi run

May 14 - Lakes to Pines Triathlon; Park Rapids, MN 500 yard swim, 14.7mi bike, 5K run

May 28 (signed up) - Apple Duathlon; Sartell, MN (USAT) - 5k run, 33k bike, 5k run

Jun 5 (signed up) - Pigman Sprint Triathlon; Cedar Rapids, IA (USAT) - Swim .5K, Bike 25K, Run 5K

If my recovery is to be 6-8 weeks, then I would be able to start training again sometime in mid-May. So realistically my possible first event back would be:

Jul 2 (signed up) - Minneman Triathlon; Oak Grove, MN (USAT) - 0.3 Mile Swim, 13mi bike, 3 mi run

There will certainly be up days and down days as I struggle through this setback. I know I will be blogging about progress, and such as that is all I can do. And frankly, I could use any helpful comments from people who have suffered from stress fractures as well as positive input to keep me sane. I received a nice Tweet from Mr. William Jenks that lays down my approach to this injury: Bummer about stress fracture. Recover like you train.

Well said.

Additional Reading:

Evaluation and Management of Stress Fractures of the Pelvis and Sacrum (Ortho Super Site)

Osteoporosis -Maybe You Have It But Don't Know It (John Post, MD)


Adam Beston said...

The paleo stuff has arguements about cheese and processed dairy(your milk is fine) that shows that after your kidneys process you blood you actually leach more calcium then you get. This is combo with other foods we get is why the US has such a high rate of bone related problems but one of the highest processed dairy consumption as opposed to just plain milk. Prolly a combo of a lot of little things. I do thing jumping the mileage might have been the most probable in relation to the controllable parameters. Thats the biggest red flag that I see. Good luck anyway and I think it will get better. Bone things tend to heal with rest whereas tendon (your achilles) sometimes just dont.

Jumper 2.0 said...

The tweet from William Jenks is an awesome quote!

I worry about bone density as well due to my sweet tooth which includes pepsi or coke. I only drink one a day max, but technically, thats too much as well. The Japanese have the same age demographics as us in the US, they don't drink milk, yet bone fractures are practically unheard of until they adopt our US diet.

And thank you for the comment on my blog!


Christopher Hawes said...

So sorry to hear about your stress fracture. I know how you feel. I ran my fastest 8K and fastest splits since high school on my tibial stress fracture. A month after the race I was show the x-rays and told to stop running and that I should immediately wear a walking cast. I did not run again for 9 months. Sorry. Hope you recover faster than I did. Your write up is fantastic. Great detail, thought, and explanation. Look forward to hearing about your recovery and getting back to it.