Recovery from Osteitis Pubis

My recovery from this Osteitis Pubis injury has been more involved than any other injury I've ever had. To recap, I have a partially torn adductor with "moderately severe" Osteitis Pubis according to my MRI from April 25. You can read my previous post for all the details. 

Physical Therapy
I started seeing a pelvic floor physical therapist in the middle of April, twice per week. Each time I go she gives me a new set of exercises to do. She started with simple, easy exercises such as the Kegel (pelvic floor contraction) and abdominal squeezes. I don't know the official term, but it's basically just sucking in on the lower abs. Over time she has given me more strengthening exercises like squats, adductor raises, clams, and more. 

In terms of treatment she's done dry needling which hurt so, so much, as well as blood flow restriction therapy. Blood flow restriction therapy wraps a tight band around your quad that feels like a blood pressure machine. It squeezes just like a blood pressure machine while you perform squats to help make greater strength gains with a lighter load. The dry needling, painful as it is, has really helped me feel more normal when walking around. 

I do the exercises nearly every day, in combination with the other items below. These exercises are designed to build strength in the areas around the injury so that when I start running again, everything will be strong enough. 

Strength Training
While the physical therapy exercises are designed to rehab anyone with this injury, I am working with the same strength coach I've had for over a year on making sure I maintain my overall body strength during this time. I would be doing this even if I didn't have an injury, and she has tailored the program to focus on the areas that need the most help: deep core, glutes, adductors. These exercises are more challenging than the PT exercises, involving weights and resistance.

The OP Clinic
I was referred to the OP Clinic in Australia by a friend who also had this injury. He does virtual sessions over Skype. He specializes in OP and the purpose of his program is to rewire your mechanics and movement patterns so that you don't overload your pubic bone. The sessions are a very small part of the program. He has given me a self-guided program with "homework" exercises that I learn through videos. I send the videos to him as soon as I am able to complete the exercises properly and he reviews them and lets me know if my form is correct or where I need to improve.

The program starts with basic core breathing, establishing a strong center of gravity, and having correct form for basic exercises like the deadlift. It's an extremely intense program and so far I've spent over an hour each day watching all the videos and going through each exercise. Stability is the key focus, and in order to be stable you have to engage your core and glutes. It's challenging to upload videos to this blogging platform but if you follow me on Instagram, I post videos to my story all the time. 

Right now I'm focused on learning how to do the perfect deadlift. This involves breathing properly, having the right center of gravity, engaging the glutes, moving slowly, keeping a straight back (not hunched or arched), and feeling the "fascial tension" as I slowly perform the movement. I am doing deadlifts with bands and on my forefeet to ensure I am not rocking back into my heels. 

The OP Clinic is a 10-stage program and by the end of it, I should be able to run as much as I did pre-injury. Because my mechanics will have changed, I will no longer be overloading my adductors. There is no timeline for how long this will take. I can get through the program at whatever pace I am able to. The program isn't necessarily designed to heal; the body does that on its own. It's designed to help patients stop overloading their adductors and pubic bone. Here's how I see all of these working together:

• Physical Therapy: Helps the injury heal with different therapies and exercises
• Strength Training: Ensures I have the strength needed to support an intense training load
• OP Clinic: Overhaul of my running mechanics so I don't keep injuring the area

Cardio
In addition to the above, of course I want to maintain some level cardiovascular fitness. I started swimming two weeks ago, once I felt like it would be safe to kick my legs. It turns out I don't have a great freestyle kick to begin with so swimming is 100% fine. Due to Covid, I have to reserve a lane a few weeks in advance so planning has been tricky. 

Swimming
I've been swimming 3-4 times per week. I swim freestyle, and that's my only stroke! I know how to do the others but the breast stroke kick wouldn't be good for my injury and I'm only good for about two laps of butterfly before I fatigue. My typical swim is 20-25 laps, lasting about 30-40 minutes.Yesterday I introduced pool running with the belt. I did 5 minutes yesterday and 10 minutes today after my swim. My plan is to very gradually ramp up the pool running because I do not want to strain the adductors. 

I enjoy swimming, but it's a high maintenance activity. I have to reserve my lane in advance due to Covid capacity restrictions at the pool. Once I get there I have to lather up with pre-swim lotion so that my skin doesn't get irritated. And then get all situated with my swim cap, googles, and waterproof mp3 player. And when I am done, I have to shower there to immediately remove the chlorine from my hair and skin. I think I spend more time driving to and from the pool + getting ready and showering than I actually do with the swim. 

Walking
For the first few weeks I was hobbling around and not properly balanced. I could feel the injury with each step even though it wasn't painful. About a week ago I got to a point where I could walk and not feel the injury! Huge progress. I have been taking 2-3 mile walks and loving it. The weather has been gorgeous and Greg and I even went to Burke Lake park one afternoon to walk. We also took a few days off work to go to Annapolis and I did a lot of walking around there. All pain free!

I'm averaging about 60-90 minutes of strength/PT each day and then another 40-60 minutes of cardio (walking and/or swimming). It's more time consuming than running but it's what I need to do to get back out there again while preserving my sanity!