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.

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