Diary of an Injured Runner, Part III

I’m documenting my process as I recover from a tibial stress reaction, diagnosed in early September. My goal is to track the process so I can provide some insight and information to anyone else in a similar situation. This is my fourth week back to running. I’m documenting my efforts to keep track of what exactly I did to come back from my injury for future reference. Check out Part I and Part II, if you missed it!

Week 4 (10/21 – 10/27) – 40 miles


Run #1 

  • Distance: 5 miles
  • Pace: 8:31
  • Run Type: Recovery
  • Terrain: Emmaus Avenue (Roads)

I was being cautious since I was fresh off of the Runner’s World Festival and this was my first run of the week. It was 5:00am, so besides my legs feeling a little tired, I kept the pace very easy and felt good. No pain besides the usual muscle soreness from starting up again. Any sensation I was feeling last week in my tibia seems to have disappeared. I’m feeling more soreness and little aches in my left leg: my left hamstring and left calf. It’s nothing I feel when walking or running, just every so often when I stretch or flex the muscles afterwards. Since I’m using orthodics (for now) and I worked on strengthening different muscles in physical therapy, I’m assuming I’m feeling soreness in muscles that are working differently as I begin ramping up my mileage again.

Run #2 

  • Distance: 5 miles
  • Pace: 8:39
  • Type: Recovery
  • Terrain: Emmaus Avenue (Roads)

Nothing felt different from the day before: the morning miles on Emmaus Ave felt tough, and my legs still felt tired. The soreness left leg was still present but seemed to be either the same or better, not really sure. I’m very hypervigilant right now and feel every little muscle ache. It isn’t uncommon to have little aches and pains with distance running, but knowing when to rest, modify, or keep running is the hardest part.

Run #3 

  • Distance: 10 miles
  • Pace: 7:54
  • Type: Lactate Threshold
  • Terrain: Saucon Rail Trail

Other than the Runner’s World Festival, I hadn’t done any actual speed work since before my injury. Since I was able to sustain a decent pace for the 5 and 10K races, I thought a 10 mile tempo run would be safe to incorporate into my schedule for the week. I usually like to run my tempo pace at half marathon pace, which would be in the 7:17-7:30 range. I decided to aim for something closer to my goal marathon pace, somewhere around 7:50-8 minute miles. I felt strong and very comfortable running and found the 7:45 range to feel good. I did a two mile warm up, seven tempo miles and a one mile cool down. Many of the tempo miles were between the 7:38-7:40 range, but there were a few that were closer to the 7:48 range. Overall, I was pleased with how the run went.  No sensations in the injured tibia, and I felt comfortable running with a little more intensity. The sore spots in my left leg are still present, but they still feel the same.

Run #3 

  • Distance: 20 miles
  • Pace: 8:28
  • Type: Long Run
  • Terrain: Pavement (Bethlehem)

I don’t prefer or recommend a long run to be 50% of my weekly miles. I really felt the need to get one of these bad boys in before the Marshall Marathon, which is right around the corner. For the past three weeks, I wasn’t sure that a 20 miler was in the cards for me before the actual race. I’d been feeling the usual aches and pains associated with starting back up.  I was afraid of re-injuring my tibia or the possibility of another injury occurring from doing too much too soon. Over the past week, I finally began to feel a little stronger and more like myself. Saturday rolled around and I attempted my first (and last) long run for the upcoming marathon. Success!

I went out a little too fast: the group I began the run with is faster than me. Any regular, middle distance run and I could have kept up for the whole thing. Being fresh off of an injury and already pushing my luck by attempting a 20 miler made me think twice about sticking with them for the entire run. Around mile 7, we were averaging well below an eight minute mile so I chose to leave the group and run my own pace. I’m glad I did. If it were only a 10 mile run, I would have just sucked it up and finished with them. But I still had 13 miles to go, and I didn’t know how I’d handle the high mileage. I’m not going to say it was my easiest 20 miler I’ve ever done, but it wasn’t completely unfortunate, either. The hardest miles for me were from 10-13, when my legs felt a little heavy from the faster start. I broke out the Gu, and got some water and felt much better for the rest of the run. As a matter of fact, I would even go as far as to say that the last three miles felt really good. I was making up the route as I was running, and my watch beeped to indicate that I’d made it to the 20 mile mark about a quarter mile from my car. I considered running an extra mile and my legs felt good enough to do it, but I opted for a cool down walk instead. I wasn’t out there trying prove anything, just to get a little piece of mind. I know I can run 20 miles. I’ve done it many, many times. But before my injury, I only got in a few good 18 milers – not a 20. So that meant the last time I ran that far was June, and I’d just feel more comfortable running Marshall with one recent, good long run.

Moving Forward

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Well, there’s that. I should probably be a lot more concerned about that. But that’s a post for another day.

This week, my plan is to run another 40 miles. In my first week back, I ran three days. The second week was four days, and then the third week had five days of running, due to the Runner’s World Festival. Although the Runner’s World Festival was probably not my best idea, it did help to get me running more weekly miles and boost my confidence.

To accommodate the 20 miler and increase my overall mileage this past week, I ran a total of four days. Since I’m not going to be running a 20 miler this week, I’m going to try another week with five days and keep my overall mileage about the same. I reviewed what Pfitzinger suggests for two weeks out from a race, and based what I’m doing around his training plan but with a few modifications.

Pfitzinger recommends one VO2 max session, but I am not about to start adding track workouts this close to the marathon. Since I’ve done some lactate threshold (tempo) miles, I’m swapping the VO2 max session out for one of those. I have a few recovery miles early in the week, a general aerobic run, and a medium-long run. Pfitzinger defines anything less than a 16 mile run as a medium-long run, so I’m planning to run about 13-15 miles. When I was training for the marathons in Vancouver and Anchorage and was sidelined with a femoral shaft stress fracture, I did 15 miles as my last medium long run and had success with that.

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Runner’s World Half Marathon & Festival Weekend

Three weeks after my return to running was the Runner’s World Festival in my hometown. I registered for the “Hat Trick”, meaning I was signed up to run the 5K, 10K, and Half-Marathon. The 5K and 10K were both on Saturday, and the half was scheduled for Sunday. I participated in the event last year and really enjoyed it, so when registration opened up for the 2013 festival, I had to sign up. Since I’m still recovering from my recent injury, I don’t have much to say about my performance in the races, although I was pleased with my 10K time. It wasn’t even close to a PR but I held half marathon pace for the whole thing, which I hadn’t done in awhile.

Putting all injuries aside, it’s somewhat difficult to race all three of these events. Some of my friends ran some spectacular times for one or all of the races, but the courses are quite challenging.  If you choose to race all of them, be prepared for some tired legs in the days to follow! Last year, I ran the 5K and the half-marathon more aggressively and kicked back on the 10K. This year, due to being injured, I was more aggressive with the 10K and ran the 5K and half marathon at a comfortable pace. The key to being successful in the Hat Trick is holding back from going all out in each race. Even when I’m in my best shape I personally wouldn’t race all three of the events, but it can certainly be done.

The Expo

The expo was held at ArtsQuest, which is an eclectic building by the Steel Stacks on south side of Bethlehem. The expo was decent last year, but moving it to the ArtsQuest building was a nice improvement. They provided a variety of vendors, several noteworthy speakers, and merchandise available for purchase throughout the building. The layout of the expo was odd: bibs were distributed upon entry, but runners had to walk all the way up to the top floor for the t-shirts and swag. On your way downstairs, runners were directed through an area to check out the vendors before exiting. I realize it was set up that way with the intention of getting runners to walk through all of the vendors and spend some money, but I just thought the logistics were strange. The shirts and swag were top notch: as a “hat trick” participant, I received both shirts. They were both technical tees, and the colors were tasteful and something I know I’ll wear often. Gray for the half-marathon, navy blue for the 5K/10K. Doing the hat trick also got you a commemorative hat (a hat for the hat trick, how clever). This year’s hat was navy with white trim.

There were many worthwhile speakers and events going on throughout Saturday and Sunday, but I was unable to hang around the expo. Some of my friends took advantage of the festival and seemed to really enjoy everything the expo had to offer. The Runner’s World crew does a nice job of inviting interesting people to come and run the race: there was an Olympic swimmer in town that ran this year, and Shalane Flanagan ran the half marathon last year.

The 5K

The start time for the 5K was 8 am. I was surprised to find that the course was changed for the 5K this year. I liked the course just as it was last year, but I thought the change this year was an improvement. The start began near the SteelStacks, but a little further down the road from the starting line for the 10K. After the national anthem, the race directors began the “march” to the start of the 5K and we were off. The course started on the south side, but then crossed the Fahy Bridge and did a short loop on the north side. We had to cross the bridge again to get back to the south side but it was a pleasant loop. It’s Bethlehem, so all three of the races were a little hilly. The finish line is the same for all three of the races, and is right in front of the Steel Stacks. It’s a pretty exciting finish line, and Bart Yasso was announcing the runners as they came through the finish line.

As far as my performance, I decided to run the 5K at 10K pace. The 10K was going to start shortly after we finished the race and I wasn’t sure how I was going to feel running a significant number of miles over a relatively short period time at a more aggressive pace. It was a far cry from a PR, but I felt strong and comfortable and zero pain from my recently injured tibia.

The 10K

The 5K went off at 8 am, and the 10K starts an hour and a half later, at 9:30 am. It’s very similar to the 5K course, but with two extra loops. One on the south side that runs by Lehigh’s campus, and one on the north side that ventures up main street and through the historical district in Bethlehem. Of the three races, this is my favorite . It’s beautiful, challenging, and truly showcases what Bethlehem is all about. It’s pretty much part of my usual running routes so it’s really exciting to see it as part of a large, organized event. I’m excited that out of towners had the chance to experience what I get to experience regularly. The 10K is also a bit hilly, but it’s such a cool route that you barely notice it. If I had to make one complaint, it’s that the 5K and 10K both utilize the Fahy Bridge. However, I can’t think of a better way to run those courses without the Fahy. There are two other bridges in close proximity that serve a similar purpose (the Minsi Trail Bridge and the Hill to Hill Bridge) but neither would really be logistically possible to use for the race. There were plenty of water stops and lots of places along the course for people to stand and cheer on their runners. The finish is the same as the 5K, and Bart Yasso was announcing names again for the 10K as each runner crossed the finish line.

I was the most pleased with my performance for the 10K. I was a little slower than half marathon pace (close to the 7:30 range) and really felt great when I was done. I wasn’t sore or tired afterward and felt like I still had energy left at the finish, which was a nice surprise.

The Half Marathon

I really like this half marathon because it’s run on roads that are very familiar to me. The course is almost always part of my long runs and offers many challenges. The starting line is completely different from the other two races, beginning in front of Sands Casino (about a mile from the finish line). It runs through historic neighborhoods and down some of my most favorite roads in Bethlehem. It passes by two local college campuses, Lehigh and Moravian. It weaves through some of the historical Bethlehem landmarks, such as Bethlehem Steel. There are some tough hills but they are all worth the climb, because it’s relatively downhill after mile seven. It’s really more of a net descent from mile seven until the finish, but it feels like a real treat after all of the climbing. If I had to pick one of the three events to run, I would have a hard time deciding between the half marathon and the 10K.

There are plenty of water stops, and a station with GU around mile nine. Around mile seven, there is a water station sponsored by a company that produces running skirts, and if you choose to stop they will give you a free skirt. I don’t wear them so I didn’t take one, but a lot of people did – even some of the guys. The finish is the same as the 5K and the 10K, and Bart Yasso was announcing names for each runner as they crossed the finish line.

I plan to participate again next year, but will I do the hat trick again? Undecided. I liked doing it the past two years, but depending how 2014 goes, I might choose to pick one (or two!) events and actually race.

Diary of an Injured Runner, Part II

I’m documenting my process as I recover from a tibial stress reaction, diagnosed in early September. My goal is to track the process so I can provide some insight and information to anyone else in a similar situation. Click here to read Part I, if you missed it!

Week 3 (10/14 – 10/20) – 39.9 miles

Run #1

  • Distance: 4 miles
  • Pace: 7:55 pace
  • Terrain: D&L Trail, cinders

It felt good to run, but I feel a slight sensation in the general site of the reaction. I’ve been feeling this consistently since I began running. It’s not at all the same sensation I felt when the injury began. It’s more of a pinching feeling and it feels slightly superficial, almost as though it’s my skin. It doesn’t worsen as I run or hurt when I stop, and I suspect I’m feeling the effects of the scar tissue. My MRI from several weeks ago showed edema in the area of the reaction, so I  hope any sensation I am feeling is coming from the tissue surrounding the bone. My pace is unaffected and the only real concern I have is each time I run that I’m going to re-injure myself. I still have zero pain or sensations before or after running, or with the hop test. I also feel completely normal if I go through any of the clinical exams that the doctor and physical therapist used to clear me to run again.

Run #2

  • Distance: 8 miles
  • Pace: 8:40
  • Terrain: Pavement (Roads) and hills

Pace was somewhere in the 8:40 range but I’m not exactly sure since my watch died. It felt good to run on the hills and streets of Bethlehem, as I’ve been confined to trails since the end of August. Everything seemed to feel okay, and the sensation I’ve been feeling was still present but seems to have subsided since my last run. I still have a slight tender spot on my leg but that also seems to be decreasing. It felt fine immediately after running and the next morning (I’m always fearful that I will step out of bed and feel pain). It actually feels the closest to normal that it’s felt since I returned to running. I felt stronger and more confident on this run, but I know I won’t feel totally comfortable until I feel completely normal: no sensations in the general area, and back to running my usual mileage and workouts. My pace was better yesterday, but the overall run felt better today.

Run #3

  • Distance: 5 miles
  • Pace: 8:04
  • Terrain: Pavement (Roads) and hills

Everything felt much more normal today, and I ran a bit faster to see how it felt. I spoke to my physical therapist and he actually suggested shorter runs at a higher intensity. Less time out pounding on my feet. I’d planned to do five to seven miles, but decided to do five at a more intense pace. I did it tempo-style: the first and last mile were somewhere in the eight minute range, and the middle three were in the seven minute range. Overall, I felt great. The tender spot on my leg was not present before running, but was present at the end of my run but was very minor. It went away quickly and felt great during my yoga class after the run.

Run #4

  • Distance: 9.3 miles (Runner’s World Festival, 5K & 10K)
  • Pace: 7:09 for the 5K, 7:27 for the 10K
  • Terrain: Pavement (Roads) and hills

I woke up feeling fresh, and my legs felt good. Today’s run(s) were part of the Runner’s World Festival Weekend, and back in the summer I signed up for the “hat trick”. This meant I was running the 5K and 10K on Saturday, followed by the half-marathon on Sunday. I was nervous because I know myself: I felt good, so I was afraid I’d run a little too hard. I started the 5K way too fast, and kept an eye on my Garmin. Although I felt fine – no sensations or pain at all – I was nervous that I was going out too fast for several reasons. I haven’t run a lot of miles lately, and hadn’t done any speed work since August. I also knew that I had 19.3 miles of races left after the 5K over the next two days and didn’t want to tire myself out and completely blow up by Sunday. Lastly (and most importantly), I really didn’t want to re-injure myself.

In the first mile, I knew I was going too fast. My watch was showing a sub-7 minute pace, and I originally set out to run 8 minute miles. I realized quickly that I wasn’t going to do that, so I forced myself to slow down to 10K pace. The last race I ran was a 10K in August, and that was my PR for that distance: a 7:08 pace. I thought that would be reasonable, and then I could comfortably run the other two races around an 8-8:30 pace. I crossed the finish line with a 7:09 registering on my watch. A far cry from a PR, but I felt like I still had a lot left in me. When the 10K went off an hour later, I began the race running with a group of friends. We agreed that 8 minute miles would be a nice goal, but we went out pretty fast. By the third mile, I realized we would likely come in around a 7:30 pace instead of the 8 minute miles as discussed, but I was still feeling great. No pain, and my legs still felt fresh so I went with it. We crossed the finish line in under 47 minutes, and my pace registered as a 7:27 on my watch. No pain afterward, and the sensation I’d been feeling all week long seemed to have disappeared. Although I wasn’t going at my all out race pace for either distance, I ran harder than I expected to, so I knew the half-marathon would be a challenge in the next day. The spot on my leg that felt tender earlier in the week was not present. Even though I felt fine, I iced and rested my leg for the rest of the day.

Run #5

  • 13.1 miles (Runner’s World Festival, Half-Marathon)
  • Pace: 8:36
  • Terrain: Pavement (Roads) and hills

I jogged to the starting line from my car, and it was about a half of a mile. I was a little concerned because I thought I felt some pain in my leg, but it seemed fine once the race began. I ran the race with Emily, which she was doing as part of a 20 mile run. She logged a decent amount of miles before the start of the race. After the race, we were planning to run a few more miles but I chose to call it a day. After we stopped at the finish line, it was a little chilly out and I tightened up. The first step I took to begin running again didn’t feel great. Almost like a warning sign – so I listened. I decided that I pushed it enough this weekend and asked enough of my poor leg and called it a day after the half marathon. It was definitely the right choice. Even though I felt fine, I iced and rested my leg for the rest of the day.

I was surprised that my legs weren’t more tired from Saturday,and were only a little stiff as I began running on Sunday. All things considering, I felt pretty good. I hadn’t done any speed in weeks, so I expected to be more sore. It was nice to run a comfortable and relaxed pace for the half, and to not worry about racing or running a PR. It is always a little discouraging to come through the finish line at a time that is slower than what I’d normally run, but this was not a normal weekend. Three back to back races, and coming back from an injury changes things. I was pleased that I was able to participate and finished feeling strong. I was excited that I was able to push the pace a little on Saturday and still run the distance on Sunday. Even though I wasn’t running any spectacular (for me) times, it felt like a success. I’m hoping this means that things might be a bit more “back to normal”. I’m not going to go crazy and start running 70 miles per week again, but I feel like I’m taking steps in the right direction.

I’m only HALF crazy.

This whole getting injured thing has really got to stop. Not because I’m frustrated with the actual injury, but because it’s is really bad for my bank account and productivity. See, when I get injured, I cross train. When I start cross training, I start signing up for events that I normally wouldn’t sign up for. Like in April, I started biking and swimming because of my stress fracture. By the end of my four week hiatus from running, I fancied myself a triathlete and signed up for the Steelman Olympic Distance Triathlon. Because god forbid swimming and biking were just about cross training and maintaining my endurance. That would just be absurd.

There are no local winter triathlons (that I am aware of), so I’ve completely gone off the deep end.  I’ve taken it upon myself to sign up for a half Ironman in June. Stupid stress reaction in my dumb tibia must have somehow traveled to my head.

I knew my friends were planning on signing up for it. They are amazing triathletes – that’s what they train for, and they are extremely talented individuals. I joked a few times and said I was going to join them, but I wasn’t serious. At all. I’ve expressed an interest in doing one, but I always figured I would sign up for a fall event because it would be easier for me to train for it during the summer months.  You know, the summer time: when I’m off from work and can spend all day training if necessary. This past Saturday, my friends were all talking about it during our long run. Discussing how they were going to sign up sometime over the next few days and who would be joining them at the starting line. They egged me on a bit, and I kept joking that I would be signing up. JOKING. On Sunday, I’m out for a pleasant bike ride with Emily and start thinking, “It would be pretty fun to train for that!” Fun. To swim 1.2 miles, bike 56 miles, and then run 13.1 miles. All in one day. 70.3 miles. What. Was. I. Thinking.

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When Monday rolled around, I kind of had an outer body experience. The kind where I see myself filling out the registration and whipping out my debit card to pay the hefty registration fee. I think I expected to get to an extra screen that said, “Are you really, really, REALLY freaking sure you want to do this?” before it actually charged my card and registered me for the event, but I didn’t. I hit  the “Complete Registration” button and felt a little like throwing up when the screen said “Thank you for your registration for the 2014 EnduraFit Ironman 70.3 EagleMan Triathlon.”

So, June 8th. Half-Ironman. My goal is simply just to finish the race. I’m not going into the race with any time goals or pace expectations. I’m still putting together a spring schedule of marathons, and those are still my priority. The half Ironman is about getting me to cross train on a regular basis, and about doing something I haven’t done before. It’s about spending a fun weekend with great friends doing the things we love to do the most. That doesn’t mean I’m going to take the distance or the training lightly. I am fully aware without a doubt that this will be the hardest thing I’ve ever done. But seriously, I really can’t get injured anymore. At the rate I’m going, I’m afraid of what I might get myself into!

On Cycling: I don’t want to turn the clocks back.

On Sunday, Emily and I went out for an exploratory bike ride. No pace or time goal, just  a few hours for exploring and easy riding. When I first got injured back in April, I halfheartedly dusted off my bike and did some of Emily’s training rides with her. She was training for a half-Ironman in June, and I tagged along since I was sidelined from running and needed to maintain my endurance. I hated biking, so initially this felt like torture.

Until one day I realized it actually didn’t feel like torture. As the summer wore on, I found myself willingly tagging along on her general aerobic and long rides. When I went back to school in the fall and was handed another time-out from running, I found myself heading out riding all by myself. This past Sunday, as we were trying some new routes and climbing and descending mountains on beautiful back roads, I actually spoke these words:

“I really don’t want to turn the clocks back in a few weeks. I’m not going to be able to get in as many miles on my bike after work anymore.”

As soon as the words left my mouth, Emily and I both cracked up. A few months ago, you couldn’t pay me to take my bike out of the garage and inflate the tires. I realize that most dedicated cyclists probably don’t let a little cold weather or dark evenings cut their rides short. I’m not quite there yet, but I did start investigating bike trainers to put on my Christmas list. Speaking of which, that list is beginning to really seem as though I might actually like cycling and triathlons, since it’s full of things like shoe covers, wet suits, bike computers and riding gear. I’m still a fair weather cyclist, but my interest in the sport increased tremendously over the past summer. 2013 was certainly not my year as a runner, but I made up for it by spending time on my bike and learning to enjoy it.

As we fought the wind and the hills all afternoon, I thought about why I claimed to dislike biking. As a kid, I loved it and spent all of my free time riding my bike with my friends. I had everything from your typical first bike with the streamers on the handlebars to an old school ten speed and a crappy mountain bike (which I still have). It used to be my favorite way to spend my summer days, weekends, and afternoons after school hours. Why did I hate it so much as an adult?

When I got my road bike and began riding, I felt like I should be able to go out and ride upwards of 40-50 miles at a moderate pace every single time I went out. I didn’t know the first thing about riding, but since I was so involved with running I felt as though I shouldn’t be considered a beginner cyclist. I’m a runner, so naturally I should be able to go out and keep pace with people that have been riding and training for years, right? Wrong. I always felt like cycling never felt comfortable and I couldn’t figure out why. I started thinking about how I first began running, on a treadmill at the gym. I remember when 30 minutes of running felt like an eternity. Now, 30 minutes of running sounds annoying simply because it isn’t far enough for me.

The difference is that I started running eight years ago with no expectations except to get in shape. At the time, I don’t even know if I knew how far a marathon actually was, and I didn’t care. I started biking a few years after I began running,  but with the expectation that I was already an expert and didn’t need to put in the work.  My arrogance led me to try to go out and ride far and fast each time I got on my bike, which resulted in my inevitable frustration with the sport. In retrospect, I hated cycling because I was a beginner with an ego. Since I’ve had to rely on cycling often over the past year to maintain and increase my endurance, I dropped the whole ego. I realized that just like everything else, you have to put in the work to reap the benefits.

I always talk about how different situations humble me. Running and being sidelined with injuries is one way to break down an ego, and my ashtanga practice never fails to put me in my place. Now that I’ve taken the time to appreciate the sport, I am realizing that cycling is also humbling. I’m a beginner cyclist, and once I embraced that reality I began to enjoy the simple act of riding my bike with my friends, just like I did during my childhood. And hey, if I happen to go far or fast every so often, that’s just a bonus.

Diary of an Injured Runner

I’ve had aches, pains and injuries in the past, but this year really takes the cake for beating myself up. I’ve dubbed 2013 as the year of running disasters. Two nasty injuries in one year, both dealing with bones and the whole Boston Marathon ordeal. After a series of tests and blood work I’ve learned that part of the reason for the multiple bone injuries has to do with my calcium consumption. I also realize that I probably need to train a little smarter. Regardless, as I begin to resume my regular running routine I find myself thinking, “Did it feel like this when I was coming back from my femur? Is this normal?” I’ve never documented the healing process in the past, and I keep wishing that I did. I keep wishing I could remember details about how it all began, the symptoms, treatment and recovery process. I hope this can serve reference for anyone that finds themselves sidelined with a stress fracture or stress reaction.

The Making of a Stress Fracture/Reaction

I’ve actually had three of these bad boys: one in my tibia a several years back (higher than the one I’m dealing with now), my femur, and the recent stress reaction in my right tibia. Though they all presented themselves quite differently, they all began very much the same. It always comes on out of the clear blue, and I can distinctly remember the first time I felt each one. My inner dialogue is always the same:

Eh, it’s just a little nag. Actually, I think I’m imagining it…it’s just a phantom pain. It’s all in my head. I mean, if it is really there, it’s probably something so minor. I probably just tweaked something. I’ll just do one of my easy runs tomorrow and I’ll be fine by the weekend for my long run. 

Even though I always start with the “glass half full” outlook, I always have a sinking feeling in my gut telling me otherwise.  Each time, the same course of events follows that train of thought: I continue running and it stays about the same for 1-2 weeks, at which point I convince myself that it’s a strained muscle. Maybe it’s even starting to heal, because I’m not pushing the pace – and then I do something stupid, like run a race. Begin the downward spiral.

Stress Fracture #1: Femur (Femoral shaft, left side)

For my femur, this process all began about two weeks before the Boston Marathon. I was doing hill repeats on Honeysuckle Road (which, if you know that road, you’ll know that’s a really dumb idea in itself) and decided to up the ante since Heartbreak Hill was right around the corner. I added a significant amount of time sprinting uphill on my repeats that day and felt indestructible. As I cooled down and ran down the mountain back to my house, I felt the little telltale nag in my left groin. And thus, a stress fracture of the femoral shaft was born. I continued to run, and even ran a fast paced 20 miler on it right before Boston. It didn’t get worse, so I shipped up to Boston and ran a great race, requalifying for 2014 and missing a PR by a few seconds. I was limping for a week after the race and knew something really wasn’t right.

Here’s what I remember about my symptoms:

  • When I would run, it would hurt less.
  • My pace was never affected due to pain or discomfort.
  • When running, it was more present when stopping and starting up again. It wasn’t exactly painful, but it was uncomfortable and awkward.
  • I felt the most pain after a run, when my muscles cooled down.
  • I’d feel a sensation when I would try to get up from a seated position, or when I hopped on it.
  • It would hurt the most in the morning, when I first got out of bed. As I walked around, it seemed to loosen up and feel better.
  • I could push on a spot deep in my leg that was painful, but I could never really find the exact location.
  • The sensation was a “traveling” pain, meaning the pain was in my femur but often felt like it was in my hip or groin.
  • It responded to nothing: heat, ice, graston rods, ultrasound, massage.

Stress Fracture (Reaction) #2: Tibia

The straw that broke the camel’s back was the Steelman Triathlon. About a week and a half before, I had a pretty high mileage week – 71 miles. My legs were heavy and tired, so I took the next day off of running. Following the rest day, I headed out for a 14 miler and felt the first little “nag”. I remember it clearly: I stopped along the route to take a picture and when I resumed, I felt a weak sensation in my right calf/ankle area. I actually said out loud, Uh oh, that isn’t going to be good. Once I got a few strides back into the run, I was fine and felt nothing. I took another day off, and resumed training. The sensation was present with each run, but it didn’t seem to get worse. This time, the pain and onset was different:

  • My leg felt weak and dead, like it didn’t belong to me. I actually thought it was a pinched nerve because it wasn’t exactly painful, but it felt numb.
  • It would start hurting as I began running and would stay fairly consistent throughout.
  • If I stopped running, my lower calf would tighten up and feel like it was completely cramped up. The tightness and cramping would not subside for about 5-10 minutes post run, which made the doctor suspect compartment syndrome.
  • I felt like I was limping when I ran, which one of my friends confirmed on an 18 mile run.
  • The pain felt like it was deeper than my Achilles but I could never actually pinpoint where I felt it.
  • I thought I found a sensitive spot I could press on but it always seemed to change.
  • It responded to nothing: heat, ice, graston rods, ultrasound, massage.
  • It slowed my pace considerably and was so painful that it forced me to walk in several runs.
  • Hopping was difficult. Not painful, but not comfortable. I could not actually jump up to hop. Once I got off the ground, landing was fine but the act of lifting off was difficult. Not painful, just like those muscles didn’t want to work.

The Treatment

I recently changed doctors, so I had two different rehabilitation programs for these injuries.

Stress Fracture #1: Femur (Femoral shaft, left side)

My previous physician gave me the following treatment guidelines: stop running, cross train like crazy with any activity that doesn’t hurt, and come back for a follow up in four weeks. Since I was having no pain, I was cleared to run at the four week follow up. She cleared me for five miles, three times per week. Now, if you were reading my blog in the spring, you’ll know I started a bit earlier and actually ran a marathon before getting cleared. My impatience is likely the biggest reason that I get injured in the first place, but that is a post for another day. I did spend close to four weeks cross training my tail off, and ran some pretty successful spring races. I got lucky – the bone healed quickly and I really didn’t lose much endurance.

Stress Fracture (Reaction) #2: Tibia

My new doctor had me going to physical therapy, which I recommend. They would treat me with graston and massage to bring down any inflammation around the bone, and then work on strengthening exercises for the surrounding muscles. They would finish off with ice and electronic stimulation, which I felt was very beneficial in the healing process. The week before my follow up with the doctor, my final two physical therapy appointments had me going through a series of clinical exams to test how ready I was to run. It would gradually put some stress on the leg and see if I felt pain.

Another difference in the treatment: my former doctor said no running, but that I could use the elliptical. I had a full on stress fracture in my tibia years ago and I was allowed to use the elliptical. However, this doctor said no elliptical until the guys in PT thought I was ready for it, which was the week before I went for my follow up. I’m not sure why, because the elliptical never hurt. I think he was more conservative, which I liked because I got extra attention. Since I’d worked with someone with a more radical approach, I could also use my own judgement and feel comfortable with making decisions on my own, too.

The Return to Running

I’m not a doctor and everyone needs to listen to their own bodies and use their own judgement when coming back. I had a good base and kept up my endurance through biking, so when it was time to start running again, I kind of do my own thing. In the spring, I went to the Rothman Institute with my femur and saw the doctor for the Philadelphia Eagles and the Pennsylvania Ballet. His rule of thumb: if you can hop, you can run. I listen to the doctors and take their advice with a grain of salt. I also realize that by not listening to exactly what the doctor says, I run the risk of re-injuring myself. With my femur, the doctor I was seeing cleared me to run after four weeks. She said five miles, three times per week. My new doctor was more conservative, and said ten minutes of running every other day. I never really listened to either of them. I’m eager to get back to running and training as quickly and as safely as possible, so here is what I’ve done:

Week 1: 18 (19) Miles (9/30 – 10/6)

Run #1: Five miles, on a trail. No pain. 8:21 pace felt easy and comfortable. I stopped after every mile, and checked in with my leg. I’d do all of the things that would aggrevate it when it first started. A stretch from physical therapy that I could feel some pain, hop, and walk. While injured, I could feel it the most when I was running and would stop and then try to resume again. So I kept stopping and starting to see what I would feel nothing.

Run #2: Five miles, on a treadmill. It felt awkward and slow, and I kept it set around a 9 minute mile. I wasn’t sure if it was pain or just awkward because of the treadmill, but I did all of my “tests” and still passed. I wasn’t sure if I was ready to go back to running after this run.

Run #3: Eight miles on a trail, 8:29 pace. Had the intention of running 5-8 miles if I felt okay. I felt great the entire time. Did my “tests” every few miles. Later that day, I ran a mile by accident at a 7:30 pace at a cross country meet. I met up with a friend, her meet was canceled and I ran one of her miles with her. Bad idea. The increase in pace aggravated my leg, so I stopped and iced.

General Observations: I noticed general muscle soreness walking downstairs, but more in the front of my ankle – not in the area of the stress reaction. There is still a specific spot in the area of the reaction with some slight tenderness. When practicing yoga, I can feel some sort of a sensation in the area during the Marichyasana postures, when you initially ground the right foot into the mat.

Week 2: 27 Miles (10/7 – 10/13)

Run #4: Three miles on a trail, 8:48 pace. It felt okay, but aggravated. The discomfort is different now than during the initial injury. Instead of the weak “dead leg” feeling, I just felt a bit of pain during the run, but nothing severe. I planned to run five miles, but I cut it short to be on the safe side. On a side note, it was raining out. Fractured bones or healed fractures often feel more sore when it rains, and I’ve experienced this in the past. Following the run and the next day, everything felt totally fine and I was passing all of the clinical tests that my doctor/physical therapist would do.

Run #5: Five miles, 8:16 pace. I was nervous about running since yesterday didn’t go as well as I’d hoped, but I really wanted to see how my body responded to running on back to back days.  I wasn’t feeling any pain so I completed the whole five miles. I stopped around 2.75 to see how things felt and everything seemed okay. I still felt really awkward and clumsy, until about the last mile. I had a good song on my iPod and opened my stride up a little, and forgot I was injured for a few minutes. Part of me is wondering if I’m over-analyzing everything I’m experiencing, because when I just let go I felt a lot better. Afterward, I went home and did a nice yoga practice to stretch out. Certain motions that used to bother it felt fine. For example, when I would turn my foot out for virabhadrasana (warrior) I used to feel a slight twinge, but that’s gone. Also, when practicing ashtanga you step out to the right for each of the standing postures, and then come back to standing. When I would push off of my right leg to come back to standing, I used to feel a twinge. I notice some tightness as I walk downstairs, but it is a different sensation and doesn’t feel the same as when this whole injury began. I can still hop on it with no pain, and I can do the clinical tests that my doctor and therapist did with no pain.

I was nervous as to how it would feel on the day following the two back to back runs, but surprisingly everything felt good when I woke up the next morning. I’ve been wearing the orthodics that the physical therapist made for me and it seems to help. I’m not planning to continue to wear them after I am completely recovered, as I look at orthodics as more of a “band-aid” and a temporary fix. I need to address what the actual issue is and correct it through strengthening and stretching.

Run #6: Seven miles, 8:34 pace. I felt good, but it was pouring. I don’t mind running in the rain, but two of my runs this week were in the windy, rainy weather. I barely stopped throughout the run and felt fine in the hours after and the next day.

Run #7: 11 miles, 8:30 pace. Double digits! It felt great. The one thing that I am noticing is that though I can do the distance and I’m feeling better and better each day, I get fatigued easily. This surprises me because even though I wasn’t running, I was biking longer than an hour and a half most days. My legs are strong, but it’s definitely taking me some time to get my stride back.

General Observations – The muscle soreness in the front of my ankle seemed to subside this week. I’m noticing that my left leg is more sore in the calf and hip flexor, but it’s sore muscles. I think I’m fearful of re-injuring the right tibia and I’m subconsciously compensating.  I’m still feeling a slightly tender spot in the general area but it seems to have subsided a bit, and seems closer to the surface of the leg, rather than a deep ache. When practicing yoga, the sensation I felt in the Marichyasana postures seems to have subsided.

I’m impatient. I want to be back to my normal mileage and normal running routine. I want to be doing tempo runs and speed work. I find myself thinking, “I just need to get through this fall season and then I can start fresh”. Well, that’s what I said in the spring. I don’t want to “just make it through the season” anymore, so I am rethinking  my schedule for the spring. Right now, I feel very delicate and worry that just stepping the wrong way on a run will cause re-injury. I am looking forward to resuming my regular mileage and restoring my confidence.