Return to Cycling After a Multiple Pelvic Fracture: A Case Report of a Strength and Conditioning Based Approach to Rehabilitation

Abstract

This case report describes the integrated rehabilitation and strength and conditioning approach that was adopted after the diagnosis of a fracture of the inferior pubic ramus, as well as a fracture to the lateral aspect of the superior pubic ramus, in a semi-professional triathlete and cyclist. The male athlete also incurred a minimal displacement of the medial acetabular, fracture of the superolateral acetabular and a fracture of the left sacral ala. Bleeding into both adductor muscles, and sacroiliac joint dysfunction were also diagnosed. The athlete suffered these injuries within a standard field-based training routine. No surgery was performed on the athlete. He was prescribed a progressive, yet structured, rehabilitation and strength and conditioning program by an allied health team. The program was adhered to by the athlete for four months. The strength and conditioning program included adaptations in the execution of most of the prescribed exercises. It required the athlete to initially perform the exercises twice weekly. At seven weeks post fracture, the athlete’s weight bearing capabilities were increased to partial weight bearing on the injured side. Over the following month a gradual increase in the athlete´s level of strength and conditioning, as he performed both upper and lower body isometric exercises, occurred. These exercises were subsequently followed up with various isotonic exercises. The athlete reported no pain when he returned to spin cycling. On clinical follow-up, three months post-accident, a healing fracture was confirmed via radiographs of the athlete´s pelvis. Bone healing was assumed, on review, when no evidence of a fracture gap was obtained.