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The Broken Hip Chronicles: Everything the Cyclist/Triathlete Needs to Know About a Fractured Femoral Neck

I have been incessantly Googling since my hip started bugging me in April, finding several super helpful forum posts and other sources regarding all things cycling, broken hips, fractured femoral necks, etc. I thought I’d add my own experience to the conversation to hopefully help out those who are going through similar experiences.

For those of you for whom this post has no relevance: run for the hills! Avoid breaking your hip at all costs! For those of you interested in reading on: enjoy the saga.

TriathLauren - Eugene and Lauren in the Blue Ridge Mountains

The Actual Injury: April 2016

Eugene and I went cycling in the Blue Ridge Mountains of Virginia on a slightly rainy Friday morning – it was one of those glorious rides – quiet, rolling country roads, my legs felt strong and awake the entire time, and I was in a wonderful mood….up until mile 40, when I rode over some of the super-wide, freshly painted, very wet white line and proceeded to wipe out. I fell on my left side and slid a bit on the wet road. Thank goodness for my helmet! I immediately popped up and yelled to Eugene (who was riding in front of me) that I was fine.

I had a tiny bit of road rash on my elbow and was pretty dirty, but generally felt okay — just a little bit shaken up from my first-ever real crash. We cut the ride short and rode the five miles home where I took an amazing shower, cleaned out my road rash and noted that I had some bruises to look forward to on my left leg and hip (I bruise really, really easily so this was not at all surprising).

The next day, I went for a 90 minute run on an extremely hilly course. I was a little sore and kept things nice and slow (even walked up some of the super hilly portions), but generally felt totally fine.

TriathLauren - AOR Running 2016

Identifying the Injury: April/May 2016

This was/is a saga. Let’s hop right in:

  • Four days after my fall, I went for a run and had my first nudge of hip pain in my right hip (not the side I fell on). It didn’t feel great, so I extended my warm up (walking) a bit, then did some more dynamic exercises and tried running again. It felt only marginally better, so I ended up walking home and stretching instead of going for the run.
  • I continued to stretch my leg throughout the week and then participated in the American Odyssey Relay that weekend — a 200 mile, 12 person running relay similar to a Ragnar. I stretched a ton before my first 6 mile leg and felt okay. My other two legs? Not so great. During (and after) my third one, people were asking me if I was okay — so I was visibly limping. Running followed by stuffing myself into a car was not a recipe for a happy hip, though I had no idea why at the time.
  • I spent the next two weeks resting my hip and taking it easy as much as I could. I still swam, taught indoor cycling classes, and rode my bike. After two weeks of continuing to feel worse and worse (hip pain, especially when standing up after sitting for a while, but also while putting weight on it in bed, while getting out of a car, etc.), I decided enough was enough and that I needed to see a professional.
  • First stop: My PCP who referred me to a physical therapist! The PT eval showed something was definitely wrong, but they didn’t know what. I was certainly not displaying the traditional signs of a broken hip – I had heard before that I have a very high pain tolerance and tend not to display symptoms normally, and this entire experience confirmed that.
  • Next up: an osteopath, who did a diagnostic ultrasound (they inject you with dye, then have a better view for the imaging). The osteopath thought he saw a labral tear — basically, a tear of the connective tissue in between your leg bones and your pelvic bones. He recommended prolotherapy — an injection that encourages your body to grow tissue in the affected area. It’s technically still an experimental procedure and is not covered by insurance, but does seem to be a widely accepted treatment — at least to attempt before proceeding directly with the surgery route.
  • I felt a little unsure of the labral tear diagnosis (mostly because the osteopath didn’t seem so sure himself!) and took myself to an orthopedist for a second opinion. He insisted I do an MRI, thinking I perhaps had a stress fracture.
  • By the time I had the MRI, it had been just about a month since my fall. I knew whatever was going on was likely related to the fall, but was still befuddled given how minor it seemed, and that all of the pain was on the side that I didn’t even land on. I had the MRI on a Monday morning, and the technician ensured me that my orthopedist would get the report from the radiologist by the end of the week.
  • Just an hour and a half later when I got to my office and sat down at my desk, my phone rang and it was the orthopedist on the line. The radiologist called him immediately when he saw my results — as it turned out, I didn’t have a stress fracture at all — I had a REAL fracture. My femoral neck (aka the bulb shaped part at the top of your femur) was fractured 3/4 of the way through — a complete break would cut off blood supply to the bone and basically cause my femur to die.

Fractured Femoral Neck MRI - TriathLauren

Treatment/Surgery: May 2016:

  • My orthopedist put me into his next available surgery slot – Wednesday morning. He told me he wouldn’t be able to sleep at night until then — that’s how bad it would be (and how likely the possibility was!) if I were to somehow slip and fall or do something else to “complete” the fracture and cut off blood supply to the bone.
  • My surgery was fairly complicated — they cut through my quad on the outside of my leg, but then inserted three screws more towards the inside of my upper leg (let’s be real — my crotch/groin area). It took more than an hour, but I woke up from the anesthesia to the good news that everything went about as well as it could have gone.
  • I was sent home with very few limitations — no swimming/water submersion for 3 weeks (because of the incision), no shower for 48 hours. I was allowed and encouraged to climb stairs (thank gosh – my house does not have a bathroom on the main floor) and walk around as I was able. I was to decide when I felt okay to drive a car, but should wait until I wasn’t taking painkillers and had enough strength in my right leg to jam on the brakes if needed.

Repaired Femoral Neck - TriathLauren

Recovery: June-October 2016:

  • My surgeon sent me home with crutches but I only used them for a few days before ditching them entirely, since I was allowed to be weight bearing. I didn’t wear sandals once all summer, except while at the pool or in the gym shower. Too much of a tripping risk!
  • I started PT again a week after surgery & started with about 40 minutes of manual treatment and 20 minutes of exercises. My entire hip/glute/upper leg area was SUPER tight and my twice weekly physical therapy sessions were a godsend in helping me loosen up (DC-area people — go to Gavin at Fast Track!). I did PT exercises every single day and stretched/foam rolled/used a stick to prevent my IT band/incision area from getting too tight.
  • After 3 weeks I began swimming again. Slow and steady at first, gently pushing off of walls, no breast kick – just easing back into what felt good. I did go back to Masters practice almost immediately, but just took it easy when I needed to. My swimming came back quickly and seamlessly and I was so thankful to be able to hop right back in.
  • I started aquajogging once per week for half an hour — it was by no means fun, but the waterproof iPod I gave Eugene for Christmas last year was a lifesaver in making time go by faster. While I never really enjoyed aquajogging, it was nice to have another form of physical activity that I was able to do, and I am convinced it helped both my recovery, AND maintained some of my running fitness, so I would highly recommend it to anyone recovering from a hip surgery.
  • The two main things I had to focus on in physical therapy were re-learning how to walk (without a limp), and re-activating my leg muscles, specifically my quads and glutes. When you go through a major injury and/or surgery, the neurons in charge of firing those muscles can (yes, that is a highly scientific description! #futuredoctor). Turns out learning how to walk without a limp is really hard when you’ve been doing it for more than a month – so I had lots of little exercises to work through on that front. And, even more exercises to activate my quads, my glutes, and to a lesser extent, my hip flexors/abductors/adductors. I’ve always been one to love physical therapy even though lots of people dread it, so I enjoyed this process and found comfort in the fact that I was progressing slowly but surely.
  • After about 1 month I was approved to get back on the bike on a trainer or on an indoor cycle. This was great since I’d been teaching my indoor cycling classes off the bike — which actually was not as bad as I expected it to be. Getting back on the bike felt different, but not uncomfortable. I took things easy at first but quickly found that my strength had not evaporated – it only took about a month to get right back to where I was in terms of power/watts. Yay! Standing up on the pedals did feel a little weird at first, but got better quickly as I got stronger.
  • 6 weeks out from surgery my orthopedist approved me to ride my bike outside – more great news. Getting on/off of the bike was a bit weird – “opening” my hip felt weird, but not painful – but besides that I felt pretty good when seated. Just like with indoor cycling, standing up in the pedals took a little longer to come around.
  • At my PCP’s urging, I got a bone density test. As Joe Friel has covered in several posts, low bone density seems to be more prevalent amongst cyclists than amongst the general population.  This was an interesting experience as they’re typically reserved for older people, so the form asked me questions like “when did menopause begin?” #awkward. Luckily, my bone density was totally normal, and the test confirmed that it was just a freak accident.
  • Vitamin D levels were another concern from my PCP – but that too tested normal (I take a Vitamin D supplement as I am militant about applying sunscreen).
  • I got approved for running 4.5 months out from surgery (even though my orthopedist had told me it would be 6 weeks) and immediately got a gait analysis done with my physical therapist (read more about the gait analysis here). From there I started running 1:1 run/walk intervals for 10, then 15, then 20, then 25 and 30 minutes. After one month of progressing through that, I’m up to 2:1 intervals and still working on my form. Running felt weird at first but now feels fine, and I’m convinced the aquajogging helped A LOT in terms of maintaining my speed.

Nashville Running - TriathLauren

What’s Next

  • I’m still working on improving my running form and slowly easing back into running. No rush there!
  • One of the main considerations with getting screws put in is if they’ll stay permanently. So far, I haven’t had any issues with the screws bugging me, so I am hoping to be able to avoid a removal surgery and keep them in. (FYI, I have been through a handful of airports with them and they haven’t set off one metal detector).
  • I continue to work on my strength as my left and right legs/hips are still somewhat imbalanced, but I have made major improvements and am confident that I’ll get to where I need to be slowly but surely.
  • Now I’m working on improving my body composition since I gained some weight throughout this ordeal. You can read more about tracking my macros/actually increasing how much I’m eating to lose weight here.

This is quite the saga, but I hope it will prove useful for at least one person out there who stumbles upon it. I know it was extremely comforting for me to read about other people’s experiences when I was deep in the throes of the injury and hope this can serve that purpose for someone else.

Any questions? Similar stories from others? Happy to provide more info to anyone who might be facing a similar injury!

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