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Bruised Ischial Tuberosity... PITA!

 
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n8ball
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PostPosted: Mon Mar 07, 2011 4:57 pm GMT +0000    Post subject: Bruised Ischial Tuberosity... PITA! Reply with quote

Doc,

I raced CAT 2 at Warda and did well placing 1st in my class and all was well with the world. Legs felt great no problems what so ever. I hopped on the bike Monday evening for a recovery ride and did so with a BIG ouch! The weird thing is I have no idea where this thing came from! Felt like I had a lump just over the left sit bone. I have had saddle sores and it is not that at all, its only tender if I prod all the way to the bone. I have had no pain at any other time. Occasionally I feel some tightness in the upper part of my hamstrings, but no pain while sitting or any other movement. ONLY pain I feel is when I am on the saddle. I have had the same saddle on all of my bikes and its the right width. I can't feel any odd lumps or bumps under the skin or in the tissue.

I went to the doctor today, since it still hasn't improved after a week, and she gave me some anti-inflamitories and told me to ice it and take some hot baths. She thinks its a mild bone bruise and possibly some inflamed tendons over the bone. In her mind she thinks I should have dramatic improvement in my condition by next Monday of next week and if not I need to go back in for further evaluation and maybe a cortisone shot.

My question is, should I be doing anything else to promote the healing? Is there any other advice you can give me to recover faster? I am already planning to miss the next couple of races due to the injury, but I want to be able to get back into race shape for the rest of the season, so the faster I can safely get back on the bike the better!

Thanks in advance!

Best,

n8ball
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Tue Mar 08, 2011 6:56 pm GMT +0000    Post subject: Reply with quote

n8ball:

Your doctor has given you some good advice. In the area where you hurt, there are muscle tendons that ancor to that bone. Those muscle and tendons got a major workout in the race and you may likely have a local tendonitis at the tendon - bone junction (insertion point). You will want to go easy on it to allow it to heal. You may have to "drop" the next race to allow for heaing time. For this week lay off the bike and do the soaks and gentle stretching exercises. You may even want to do some gentle exercises in a pool or hot tube, with gentle flexing and extending of the thighs to keep the tendon supple but not over stress. I recommend the excellent book "Stretching" by Bob and Jean Anderson. When your doc gives you the go ahead to get back in the training and racing grove besure to add stretching exercises routinely to your training program. The book "Stretching" is a great how to resource for this.

Thanks,
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n8ball
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PostPosted: Wed Mar 09, 2011 9:46 am GMT +0000    Post subject: Reply with quote

Thanks Doc. I will try and do a short low intensity ride Sunday on the road to see how it's progressing. If its not better I will head back next Monday for a follow up. I am going to start doing more stretching as well. I am very inflexible and that probably doesn't help either.
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n8ball
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PostPosted: Tue Mar 29, 2011 6:54 pm GMT +0000    Post subject: Reply with quote

Doc,

Well its been 4 weeks and still no relief. I gave it 2 weeks rest and went out and rode a 2hr group ride and that was a bad idea as that whole area got really ANGRY! I have been to the GP twice since this started and last week I started Physical Therapy at my Chiro/Sports medicine guy. My GP said if I come back again she is sending me to a specialist, orthopedic I am guessing.

The Chiro has told me that he thinks it was a sprain/strain in the hamstring that pulled everything out of whack and then riding on top of that a few time inflamed everything worse. That coupled with overuse and lack of a proper stretching routine. He thinks he can get it worked out with some electric stimulation, intense stretching regiment, ice, and Graston technique. It seems to be loosening the area and I am feeling better until I hop on the bike for an easy 45 minute spin. I put on a saddle that I know doesn't cause problems and it feels better while on the bike, but the next day its like I am back at square 1.

My question is should I go see an orthopedic sooner than later or should i stick with my current treatment? I am afraid that there is more damage and I have yet to be recommended to have an Xray or MRI by my GP or Chiro. My next step is to just take the next 6 weeks of the bike and continue the Rehab process. Do you think that will be enough?

I have written off my season so I plan on starting up training over the summer again and I want to be fully healed and pain free. After the short ride I did sunday I am having a dull pain with tightness in the area still but nothing severe, just uncomfortable. I can't tell if its Bursitis, tendonitis, a d muscle sprain or a combo of all of the above. I just want to get better and heal properly.

Any thoughts or advice would be greatly appreciated as I want to get back into my routine. Luckily I have some Architecture License Exams to study for and a new project at the office, so I should be occupied coupled with all of the stretching.

Best,

n8ball
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The Bike Doc
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PostPosted: Wed Mar 30, 2011 5:55 am GMT +0000    Post subject: Reply with quote

"My question is should I go see an orthopedic sooner than later or should i stick with my current treatment?"

Yes. The Orthodoc may keep you on the same regimen and that would be fine but the Orthodoc may find something that the others have missed and may alter your treatment.

"I am afraid that there is more damage and I have yet to be recommended to have an Xray or MRI by my GP or Chiro. My next step is to just take the next 6 weeks of the bike and continue the Rehab process. Do you think that will be enough?"

Maybe. See what the Orthodoc has to say to get the answer.

Thanks,
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n8ball
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PostPosted: Wed Mar 30, 2011 6:16 pm GMT +0000    Post subject: Reply with quote

Thanks doc. I will make an appt with an orthopedic. I appreciate the insite. Just tired of guessing if you know what I mean.
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n8ball
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PostPosted: Thu Mar 31, 2011 4:43 pm GMT +0000    Post subject: Reply with quote

Doc,

Went to the ortho today and he said that I have tendonitis. I had a series of Xrays and they didn't show any skeletal problems. I was relieved and upset all at the same time. He told me there is no way to fix it, wants me to get an MRI to confirm, and that I should probably STOP RIDING. I don't know about you, but that made my world stop turning all together. To top it off, while waiting to pay, I got my invite email from USAC to go to Nationals, which was one of my major goals this year.

I really don't know what to do. He did say that I am doing all the right things, but he just said being honest about the prognosis was the right thing to do so I don't get my hopes up. I really don't know what to do without a bike under me. Its a major part of my everyday routine and I am lost without it.

My Chiro/PT tells me he can get it fixed, but the Ortho says I can't do anything but hope it gets better, but its not a very good possibility.

Any thoughts?

Thanks for all of your advice thus far, I hope I am not becoming a PITA. That's as close to humor as I can get right now as I am still in a state of shock from being told I can't ride anymore at a competitive level.

n8ball
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The Bike Doc
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PostPosted: Thu Mar 31, 2011 6:13 pm GMT +0000    Post subject: Reply with quote

n8ball:

The orthodoc must have had a bad day. Tendonitis can be healed but it does take a dedicated rest period. Broken bones heal faster and can be stabilized with a cast or a brace. Tendonitis takes longer to heal and requires a concerted resting time. The problem is resting makes it feel better, so the tendonitis sufferer starts working the tendon too soon and more serious injury results. With tough cases, the orthodoc may put the injured limb in a cast to force rest and allow healing. Given the location of your tendonitis, this is not a practical approach. But taking a prolonged rest off the bike for 3 months or more would be appropriate.

What you should ask when you visit with your PT, Chiropractic and Orthodoc is what activities you may participate in and to what extent to allow the tendon to adequately heal. I am just now getting over an elbow tendonitis and I have had to rest the elbow from strenuous activity for 3 months and used an elastic support to keep the swelling down and to protect the tendon and bursa. I tend not to use anti-inflammatories meds because they impede the formation of new blood vessel formation that is part of the healing process.

You may benefit from a 6 inch wide ďACEĒ wrap in a figure 8 fashion (your PT can show you how to do this) to provide compression and support to the tendon. You may even be able to wear some firm fitting elastic shorts with extra padding with 4x4 gauze pads to protect then tender area when you are up and about (but not on the bike). I used 4x4s under the elastic support to protect my elbow area this way.

Also, ask the orthodoc what information could be gained from the MRI that would change the management plan. If the answer is no additional information but confirmation of the diagnosis, then the MRI is not necessary, it just gives the "see I told you so" kind of information. Now, if the MRI may provide information that would change the diagnosis and management such as detecting an early bone infection that is not yet evident on the plain X-rays or an early tumor that was not yet detected but led to a local weakened area in the tendon insertion point that led to the tendonitis, then the MRI would be worth pursuing. Early bone infection would warrant appropriate antibiotics. A tumor would warrant excision of the tumor.

Itís is also okay to get a second opinion from another orthodoc who treats cyclists. Ask some of your cycling friends or even here on the forum for a recommendation in your area. They will have tested the pudding for you already.

I hope for your slow and steady recovery, but not speedy, lest you reinjure the tendon.

Thanks,

BTW, you are not a PITA, just ur ars is! Wink
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Scott S
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PostPosted: Fri Apr 01, 2011 7:18 am GMT +0000    Post subject: Reply with quote

The Bike Doc wrote:
Itís is also okay to get a second opinion from another orthodoc who treats cyclists. Ask some of your cycling friends or even here on the forum for a recommendation in your area. They will have tested the pudding for you already.



N8, not sure who you went to, but Eugene Lou of the Fondren Ortho Group has treated quite a few cyclists, including me and WB. From the first time I saw him with a leg broken in three places, it was all about "how soon can we get you back on your bike." Call me if you want more info. If I had a doctor tell me to quit riding, I'd find another doctor.
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n8ball
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PostPosted: Fri Apr 01, 2011 11:48 am GMT +0000    Post subject: Reply with quote

Well guys, I talked to my chiro today about the ortho's opinion and he told me it was a bunch of BS. He said that he thinks another 6-8 weeks and we will see marked improvement, but its going to take time and patients. My chiro/pt guy had the same reaction as the Fondren guy saying when can we get you back on the bike. I tend to believe him over the guys who tells me to stop doing something I am passionate about, thats for sure. I have talked to Toni already about the Fondren group and I will pursue that in a few weeks. I appreciate all of the support! In the mean time, I will keep the core and upper body strong and I hope to be back for the fall series and try for the overall again. I think I can make it back and by changing my riding routine to allow more recovery I should be better off. As I look back at my typical week on the bike its usually 200-250 miles and I ride 7 days a week rain or shine. I turned 30 last year and I guess I need to stop thinking like an 18yr old and give myself some recovery time! So I plan on working out a more structured routine with my coach and trying to give myself more time to recover. I think I will come back hopefully stronger and healthier than before!

Thanks again guys. Scott PM me with your number if you don't mind so I can get the info from you on Fondren since you have personal experience.

Doc, as always, thanks for all of the time you have spent on the forum helping people like me! I can remember when I was a 14 yr old junior racer and I had bonked at the top of the Kerrville course on a 100degree day and you appeared out of know where and took care of me and rode with me all the to the finish line. Without you I think I would have been in some seriously bad shape. Out of water and no food I was in a real pickle. I have never forgotten that and here you are helping me again when you don't have to. You sir are a true hero in my book! Thank you again for everything then and now!
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