Fractured pubic rami in superfit sportwoman

by Deryl
(Southam, Warwickshire, UK)

Fractured pubic rami in superfit sportwoman running 100 miles a week invites questions about diet and walk up routine.

4 months ago my 100 miles a week runs ended in crippling pain; I could barely WALK home. After many visits to Osteo, chiro, physio, acupuncture I finally had an X Ray which revealed the above stress fracture. The X-Ray also showed that it was almost healed.

What puzzles me is the changing nature of the pain. At first I had a marked limp; now I no longer have the limp but a deep aching stiffness (still very painful) in my pubic area. It feels as though it is actually getting worse rather than better. I am currently swimming (not breast stroke) in a futile bid to maintain my very high levels of fitness.

I am a 64 year female with exceptional bone mineral density.

Hello Deryl,
Even top athletes have stress fractures if they over do it, and particularly don't go through a proper warm up routine before setting out. I would recommend sitting down with a biokineticist to figure just how a super fit woman with exceptional bone density finds herself disabled with a fracture of the pubic rami.

Incidentally, it's interesting that calcium density is not the only determinant of bone strength. Research on sheep for example that have been put in a feed lot on very high protein diets have fractured limbs despite high calcium density in the bones. Look to your diet too.

Meantime, though, there are a lot of muscles that attach to the pubic rami, both internally the deep pelvic muscles and the thigh muscles. Every step you make they are pulling on that healing fracture of the pubic rami; whenever you bear down on the toilet or sneeze.

What's need is deep tissue work on these tendons; you may be able to do it yourself. If you run your thumb from the iliac crest down through the groin towards the inner thigh is it extremely tender?

Then both the hip and sacroiliac joints need to be checked; I'll bet that one or both are complicit to the pain and disability you are experiencing.

Then, have any of the branches of the femoral nerve been affected?

A sports orientated chiropractor with a FICS qualification is trained to deal with injuries like this. Contact the local association.

Dr B

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Sep 06, 2016
Anything to oblige
by: Anonymous

Consider that done. My husband who is considerably more computer savvy than me has sent said Newsletter link to a variety of contacts including his tennis coach, his Rugby Club and assortment of friends. All of whom are of a certain age where injuries of the overuse variety are creeping up on them!

Many thanks!

Sep 02, 2016
by: Anonymous

Hello again Dr B,

I am just beginning to run again after nine months on the sidelines and it is all down to both you and Craig S-D . I am so very very grateful to you both, I always will be.

On a point of interest to you, I hope, when I stopped the Citalopram after 20 years the nervy type pain in my pubic region got worse and I read that this drug has ACTUALLY been prescribed specifically for this type of pain. Nevertheless I decided the pain was preferable to going back on this drug so I went on St. John's Wort about a month ago and it seems to be helping. This is the most positive I have felt since before the injury. THANK YOU

Some chronic medication is inevitable, Deryl, but always some side effects, and often serious. It's sad that 200,000 people die every year in the USA from side effects and wrong perscription of meds. Awsome; glad you've found another way. Running will help too.

Would you forward my newsletter to a few friends who might be interested; readership not what it ought to be.

Dr B

Aug 09, 2016
Re NOT running with dogs
by: Anonymous

Hello Dr B,

Indeed it is Craig Scott-Dawkins and I shall pass on your regards. SA can be very proud of you two at least, as far as I'm concerned. He has made me feel much more confident after seeing him. I will not run with dogs and neither will I renew my relationship with Citalopram. My very best regards.

Goedzo, I'm a Dutchman too!

Aug 08, 2016
Pubic Rami et al
by: Anonymous

Hello AGAIN Dr B,

I have just returned from my consultation with Craig S-D. Exactly as you suspected my problems are both in the sacroiliac joint and pubic bone on the opposite side to the fracture. If I recall correctly, the iliac had both tilted and slightly rotated seemingly as a result of shearing forces imposed on my hips by the awkward running angle with different dogs. (I can't recall if I told you that I ran with 3 dogs). He thought that the right PR fracture while being a contributory factor, the current problems are the result of dysfunctional running pattern. He was also very surprised to find that there was no lower back issue at all so that with a couple of adjustments a week for around 6 weeks I could reasonably expect positive results. I am delighted with this news. There are no muscular issues nor indeed more widespread mechanical ones. Hip joints good and movement good. I am sorry that this is quite a long note but I am trying to recall all he said. Incidentally, you were one of his lecturers back in the day. He qualified some 20 years ago. How's that for a small world? I can never find the right words to express my gratitude to you for both your incredible patience with me and recommending that I seek chiropractic help. Thank you.

Is that Craig Scott Dawkins? I remember him well. Send him my regards. I'm sad to say he made the right decision to leave SA. Nasty country now, although we've created a happy nitch.

Perhaps not a good idea to run with the dogs, or at least all three at this time.

Keep looking for other solutions to your mood disorders; citalopram is obviously not for you.

Take care,

Dr B

Aug 04, 2016
Still Citalopram free
by: Anonymous

Hello Dr B,

Two things. I have had tearful days with my slow progress but have resisted the call of Citalopram, I feel a little better today. And the second is that I am seeing a Chiropractor on Monday with my SIJ (????) who just happens to be a South African would you believe. I will let you know what he says if you are interested.

The SIJ is central to so many lower back issues. Getting the sacrum and ilium behaving is half the battle with a difficult back; perhaps two thirds.

Great to hear you are seeing a colleague. We are the diaspora. I'm in Holland right now doing a locum for another SA friend.

Are you faithfully doing lower back exercises before getting out of bed EVERY morning? I do them myself.

Dr B

Jul 20, 2016
Citalopram update
by: Anonymous

Hello again Dr B,

Once again you are absolutely right I do have a niggling sacroiliac issue (on the opposite side), but I am doing exactly as you suggested walk a little , run a little and letting pain be my guide. The pain has almost gone, what is left is what can only be described as a dentists drill type zzzzz in my pubic area if that makes any sense. I am more concerned with the SI thing and will seek help with this. I thank you from the bottom of my heart for all your help and encouragement. I am Citalopram free and while I get waves of melancholy I have never felt better.

I have no intention whatsoever of going back on SSRI's. I am looking after my bones the natural way . Again THANK YOU.

It's wonderful hearing of folk finding victory over their complaints and taking responsibility for their own health. We've become far too dependent on doctors, chiropractors, pills and the like.

Sadly, we healers are often at fault, making a meal of your complaints.

Well done!
Dr B

Jul 01, 2016
Exit Citalopram
by: Deryl

Dear Dr B,

I have read the Newsletter already, all of it, and I found it very interesting and supportive. Of course I don't mind you using my example I really hope it helps others as that is the main objective.

I am doing quite nicely without the Citalopram, my only problem has been difficult side effects of withdrawal but knowing they will pass helps enormously as does incredibly encouraging words from you, thank you they mean such a lot to me.

Start walking as the pain permits; then walk and jog a little. Gradually walk less and run more, letting pain be your guide.

It's very painful but using your thumb with a little oil to run from the pubic bone down the tendons in the thigh will help; it takes time so don't rush it. You'll only become depressed and cause increased pain.

You really need professional help for this because it's probably done stuff in your sacroiliac joints too.


Dr B

Jun 27, 2016
Antidepressant use linked to broken bones
by: Deryl

Dear Dr B,

I found the information concerning Antidepressant use on the UK's NHS Choices Website which also gives details of the original study and where it was published. Click on this link for more information:

I hope you find it of interest.

Kind regards


Most encouraging in all this, Deryl, is that you are obviously thinking and taking responsibility for your own health; that to my mind is huge.

I've taken the liberty of mentioning you and your problems in my latest newsletter, obviously respecting your privacy. I hope you don't mind, and if you do, please say so, and I'll remove it.

Go well, and I hope you find better ways to manage your stress.

Keep in touch periodically, this has been a very interesting discussion.

Dr B

Jun 21, 2016
Beware prescription meds
by: Anonymous

Here I am again Dr B,

I am in shock after reading some research about long term use of SSRI's and their weakening effect on bones. I have been taking Citalopram 20mg for 20 years on and off and am now wondering how much this has contributed to my fractured pubic rami. I alone am responsible for this and I am not blaming the medical profession at all, but I am wondering if I can rebuild weakened bones successfully through diet. I have stopped the Citalopram and am still making sound progress with very little residual pain just tightness. I merely want to warn other women.

Hello again Deryl,
Medication is the third most common cause of death after heart disease and cancer; especially when taking them for an extended period. I'm sure you've been reading up on the other side effects of Citalopram; it's scary stuff.

Where did you find research on the weakening effect of SSRIs? This explains the mystery does it not?

But it's also time to look at other ways to manage your anxiety; a psychologist would be a good place to start.

I'm pretty sure going off the medication permanently will slowly contribute to strengthening your bones again. Keep in touch.

Dr B

Jun 06, 2016
Heartfelt gratitude
by: Deryl

Dr B,

At long last I have turned a corner. It is no longer 1 step forward and 2 back, it is 3 forward and a half step back. Everything you said has made so much sense to me especially where diet is concerned. I really believe that my diet was impeding if not preventing the absorption of calcium given the digestive problems I have been experiencing alongside my PR fracture. I am slowly getting there and now I have a positive outlook for the first time in 5 months and I thank YOU for this.

Great news, Deryl.

Dairy remains problematic; when half the scientists are saying it's good, the other half bad, then it just means the jury isn't out on the subject. Is milk only for babies?

Certainly getting your calcium from veggies, legumes and freshly squeezed orange juice is proven and known.

Get a bit nuttie about your diet!

Dr B

May 25, 2016
Fractured pubic rami in Long distance runner
by: Anonymous

hello Dr B,

Once again a huge thank you for your response and understanding of my problem. It is such a relief and great comfort to know that I am discussing this with someone who really understands in a truly comprehensive way. Yes I do consume energy drinks because of the distances I cover. I am currently looking at a gluten free diet as I have had some digestive issues - to put it mildly - and I believe this can interfere with the absorption of calcium and other bone nutrients. I will also look into the thyroid as you suggest and once again thank you, I am so grateful I found this site. Deryl

Hello Deryl,
Speak to a nutritionist about the potential affect of phosphates in energy drinks on your calcium. Perhaps they have some ideas.

Parathyroid, not thyroid.

Dr B

May 18, 2016
Fractured pubic rami in Long distance runner
by: Deryl

Hello again Dr Lewis,

First of all let me say how very very grateful I am for your extremely helpful comments about my dilemma. I found them all relevant and interesting. I was particularly taken with your statements about muscle attachments in the pubic area - that is EXACTLY what it feels like, that every step is pulling on the healing fracture and I have an overwhelming urge to give myself a deep tissue massage. Unfortunately, I have lost a lot of confidence and feel now that I am my own worst enemy, I am fairly sure that my anticipation of the pain is actually making it much worse so I not only have to take your advice on seeking the help of an appropriately qualified chiro but I need to relax and de-stress as well. Once again a huge thank you.

It's a pleasure, Deryl, that's my job, or should I say my passion. Have you signed up for our newsletter by the way; at the bottom of any page at Chiropractic Help.

I'd also have your parathyroid hormone levels checked.

Phosphates in many colas and energy drinks are the enemy of calcium; do you drink a lot of them whilst running? Look to getting more of your protein from chickpeas and lentils for example.

I hope it works out well; this is a very painful fracture by the way. You're not whingeing about nothing. Give it a chance to heal. Let me know in a month or two how you are getting on.

Swimming for a while might be an idea.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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