Sunday, March 23, 2014

Injury Update

Well friends, it's been a long and slow process, but I'm confident I'm making progress. Since North Face 50 in early December I've averaged less than 30 miles per week of mostly just light jogging on the roads and treadmill. Against my better judgement, I did "race" Mtn Mist 50k in January but I haven't done any races or trail runs since that time. I have continued to jog a few miles every day, but looking back it's probably easy to say I should have completely taken off a couple months. The problem is, the level of pain I've experienced is not indicative of the severity of the injury. I almost wish I had an incapacitating stress fracture that hurt so bad that I had no desire to run. My injury has never been like that. Although limiting, it has always been more uncomfortable than painful. I want to share a few more details in case it would help someone avoid the same injury in the future. 

First, a little background information. This whole story starts sometime last summer when playing with the dog out in the yard I pulled/strained the adductor in my left leg. The adductor is a muscle in the groin that allows you to squeeze your knees together (remember the Thighmaster?). It's also a very important muscle in running, and especially trail running. Unfortunately, I didn't realize the significance of the injury and continued my normal training. It felt like some tendonitis in my groin, but something I thought would gradually heal on its own. It stayed like this for months, but slowly started to cause me to overcompensate and alter my stride. Eventually it started to cause discomfort in my lower abdominals and affected my ability to stabilize myself on trail runs. It really wasn't until October that I really understood the root of the problem, but it was effectively a chronic injury by that point. I rested enough to get through North Face respectably, but ran through some pain, and realized I had to back way off afterward.

Fast forward today and after several months of no real training, I'm 90% there. I never felt that I needed to go to the doctor. I was confident that I had an adductor strain turned sports hernia. Complete rest or surgery...I knew those were really the only options...and I wasn't ready for either choice. But this week I finally decided to go see a doctor just to make sure it wasn't something more serious like a pelvic stress fracture that I needed to know about before I started ramping back up. I got an informal referral with a sports med doc that had experience treating sports hernias. He took an x-ray and diagnosed me with osteitis pubis. 

Any amateur radiologists our there?

Osteitis pubis is a noninfectious inflammation of the pubis symphysis that causes varying degrees of lower abdominal and pelvic pain. The symptoms are nearly identical to a sports hernia. The doctor also observed that my hip mobility was very limited. He prescribed physical therapy to improve my hip mobility and ordered an MRI just to rule out other possibilities. We are still waiting on the results of the MRI. He did not tell me to stop running, just to not make any big changes in what I'm currently doing.

If you get really curious about my diagnosis you might want to check out this article. It really helps explain why I've struggled with this issue for so long. It will also scare the crap out of you.
Groin injuries can be the most difficult sport injuries to accurately diagnose and treat. Osteitis pubis is a painful, chronic syndrome that affects the symphysis pubis, adductor and abdominal muscles, and surrounding fascia. If misdiagnosed or mismanaged, osteitis pubis can run a prolonged and disabling course. The abdominal and adductor muscles have attachments to the symphysis pubis but act antagonistically to each other, predisposing the symphysis pubis to mechanical traction microtrauma and resulting in osteitis pubis. These antagonistic forces are most prevalent in kicking sports, such as soccer or football.
...or trail running apparently.

The article describes four classifications of the injury with the 4th being the worst. Symptoms of stage IV include pain in the adductor and abdominal muscles with sneezing or walking on uneven surfaces. Check, check. I can proudly say that it no longer hurts to sneeze as it once did. Unfortunately, no one in the referenced study group had stage IV osteitis pubis. The lone stage III athlete required 10 weeks to fully recover. It's all beginning to make sense now.

I've been running competitively since the 7th grade...20 years now. Up until now, I had never had a serious running injury. Although I don't believe the root cause was directly related to running, it clearly became a running injury over time. It's really hard to talk about running and my injury when I am unable to perform like I once did. I have largely withdrawn from the sport and haven't been reading magazine or internet articles like before. On the positive side, I've tried to make good use of my extra time and invest in relationships outside of the sport that I had previously neglected. In any sport I have ever played, I've always been more of a participant and not so much a fan. Running is the same. I want to participate. I want to compete again. 

I'm only sharing this information in hopes that it might help someone else struggling with the same issues. The bottom line is this: If you have a groin or pelvic injury, do not ignore it. The pelvic region is incredibly complex and too important to the running motion to let it get go as far as I did.

I wanted to wait until the MRI results were back to publish this, but I'm heading to Paris for work this week, so I needed to get this post out today. If the MRI changes anything, I'll let you know.

Au revoir!


  1. Hi Dave

    Definitely looks like an osteitis pubis to my eyes. Differential in a runner would include athletic pubalgia, labral tear or femoral neck stress fracture. Agree with the MRI. An US can be helpful too rule out a true hernia, if there's a long delay to MRI.

  2. This is an informative post review. I am so pleased to get this post article. I was looking forward to get such a post which is very helpful to us. Keep it up.
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  3. That's a really troublesome issue to deal with. Osteitis pubis is very rare, and is mostly seen in male athletes. It's unfortunate that you are suffeing from it. Anyway, I hope that you are faring better these days and that you have found a better solution for your condition. Here's to high hopes that male athletes who are dealing with the same problem will get to read your post, for thorough information and sharing. Feel better, David. All the best to you! :)

    Ramona Walters @ OMNI Health and Rehab Clinic

    1. Ramona, the MRI that I had following the x-ray revealed that I actually had a pelvic stress fracture. Hard to say if the OP was a result of the stress fracture or the cause though. Thanks for your comment regardless. It's been 10 months since I posted this and I can confirm that it has been a very troublesome issue indeed.

  4. I am in the same boat, years of pain but still able to do everything including long runs, squats, 150 mile hikes with 45 pound pack... trying to decide between sports hernia repair and hip surgery. You certainly have some amount of cam impingement which certainly matches your symptoms.

  5. I am in the same boat, years of pain but still able to do everything including long runs, squats, 150 mile hikes with 45 pound pack... trying to decide between sports hernia repair and hip surgery. You certainly have some amount of cam impingement which certainly matches your symptoms.