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


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.

6 Replies to “Diary of an Injured Runner, Part III”

  1. Your injury posts are so helpful! I’ve been googling everything I can about tibial stress reactions. I was in the midst of Boston training when I got shin pain that wouldn’t go away and was diagnosed with a mild stress reaction in my tibia. I qualified for Boston in 2011, ran last year still injured with femoral neck stress fractures, and was 200 meters from the finish line when everything happened. After a year of physical and emotional recovery, my training was going so well and I had some discomfort, but nothing I couldn’t run through, in my shin. I got an MRI which shows a mild stress reaction. I desperately want to finish Boston this year, but don’t want to risk a complete fracture. I’m wondering how long you took off from running total, and how many weeks you had to train for your marathon after your tibia injury? Thanks so much for any advice on the timing of your recovery process!

    1. Hi! I’m so glad that my posts are helpful to you – I had such a year with stress fractures in 2013. What’s so weird is when I did Boston last year, I ran it with a stress fracture in my femoral shaft! Crazy coincidence. Before I get into the whole recovery process, I recommend getting your calcium levels checked. I ended up getting a DEXA scan to test for osteopenia and osteoporosis, which came back fine – BUT I got bloodwork done and I was pretty calcium deficient! If you are interested in what supplements I take, let me know. Anyway, I did think the stress reaction took longer than the femoral shaft to heal, but you still have a month until Boston. I took four weeks off of running BUT – my doctor did not think I had a bone injury so I was running on it for 3 weeks before I stopped. The best advice I ever received for training with one of these is to stop running, but to start running again after you can pass the hop test. Both times, I began running well before my doctor recommended me start again. The hop test just means you can hop on it with no sensation, pain, etc. I would definitely not rule out running Boston, either! You can still come back from this. I was a swimmer in high school so I found that swimming REALLY helped maintain my endurance. If you can’t swim, you can supplement with aqua-jogging, but that does get a little boring. If you have no pool access, get on a bike. I know how much it sucks to be down with an injury, but stay positive. I swear that also works. If you are interested, I can send you what I did last year coming back from the stress reaction. Hang in there and keep me posted!!

      1. Thank you so so much for your response! I’ve been cycling like crazy and water jogging a bit, and will start swimming as well. A month feels like such a short amount of time given that I anticipated having a long (leisurely) training season before the marathon this time. I stopped running a week and a half ago, feel no pain when hopping repeatedly, and can walk for 45 mins before feeling any soreness. I’m positive it’s still there as my leg feels very off with some strange sensations every now and then when I sit during the day, but since it was a mild stress reaction I’m hopeful that 2-3 weeks off will be enough. It would be great to see what you did! No one really knows what to tell me with Boston approaching in terms of the return to run. Clearly I can’t hop back in where I started, but I do need to get back out there for a few road runs before the marathon. Did you do long runs soon after your stress reaction? Did it still feel sore when you started back again? Thank you again, I’ve been feeling lost in terms of how to try to make Boston work at all this year.

      2. You are in way better shape than I ever was with my stress reaction, so don’t lose hope!! If you are feeling no pain while hopping, I’d give it another week and a half and go from there. My doctor didn’t order an MRI right away and I didn’t push for one because I really didn’t think it was a stress fx, so I was running on it (I even did a pretty decently paced 18 miler on it) before stopping. Sounds like you caught yours faster. I have three posts about everything I felt – it definitely felt sore, but it was a different kind of sore – I wrote about it a little here – https://invertedsneakers.wordpress.com/2013/10/14/diary-of-an-injured-runner/. What I remember most was when I would run and I had the injury (before the hiatus from running) was that it was pretty painful and almost felt like my leg didn’t belong to me. It was so weird. After some time off, I did feel soreness in the area but it was a different type of pain. More like it was irritated/aggravated but I never felt the initial pain again.

        Just a warning – I am not a doctor and just a recreational runner and my physical therapist thought I was crazy with how many miles I came back with, so the most important thing is to listen to your body when you try running again. So, let’s say you start again next Monday. That gives you three weeks. I had five weeks before my fall marathon with my tibia, but only 1 1/2 when I came back from my femur. For both injuries, the first week is just testing the waters and it felt slow and difficult. I did a few 3-5 miles runs during the week, and since it felt okay I did an 8 miler on the weekend. Also, probably for about the first month after both injuries I was always thinking about the injury during my whole run and analyzing every little twinge I felt 🙂 Since I had more time with my tibia in the fall, I could come back gradually. For my femur, the week before my marathon (again, only had 1 1/2 weeks to work with) I did a 7 miler, 10 miler, 5 miler, 2 miler, 3 miler and then the marathon. During the marathon, I ran 10 miles and actually ended up having some GI issues and ended up sticking with a friend, and we walk/ran (it was one of my slowest). But just one week later, I successfully paced another friend at the Buffalo Marathon. We ran the whole thing – not super fast, but we ran it all! How many miles per week were you running before this began? Without knowing that, I would recommend starting next Monday (one week from today) and do a 3 miler. If that’s good, try for a 4 miler and a 5 miler, and then 8 over the weekend. If you are still feeling okay, then next week try to get in something like two 5 milers, an 8-10 miler and a 15. Then taper, and do Boston…but run easy!! I had my femoral shaft stress fracture in April and was running marathons by mid-May, and ran a PR in June…with the tibia, I had the stress reaction ordeal from mid-August until the end of September (again, it was not caught as early as yours) and ran a PRs by November and again in December! You can totally do Boston.

        Also, crazy that you were so close to the finish line when it happened. One of my friends was watching the finishers and was pretty close and saw it all. I can’t imagine what that must have been like. My aunt lives in Brookline, so I was already back at her place when I heard. I still can’t wrap my head around it, but I know this will be a special year and I’m excited to be there again. You ARE going to be there too! One more thing – my close friend is a pharmacist and she hooked me up with a pretty great supplement plan since I had some low calcium levels. I had a stress fracture in my tibia in 2010 (coincidentally, during while training for my first Boston) and then the two bone injuries last year. It took switching to a new doctor before someone thought to check for osteopenia/osteoporosis and my calcium levels. I’d recommend talking to your doctor about that! It’s not bad, I just take lots of calcium and D3, and a bunch of omega -3s to help it absorb. I’m 31, so I never even thought osteoporosis was something I should be concerned about!

  2. Thank you so much for the advice! This is incredibly helpful, and gives me a lot of hope I can make it to the starting line. I actually had the same thing with GI issues happen last year, but at Boston, I was already slow from the femur issues, then my stomach stopped wanting to cooperate at mile 9, the rest of the race was a walk/run for me. I’m pretty sure this will happen again as I usually need quite a few long runs with Gu to get used to it before a marathon.

    I also ran 18 miles at a really decent pace with the shin issue, thinking it was shin splints, and had no pain afterwards, continued to run for a few more days, and then walked a few miles to get the MRI, a week after it was prescribed by my doctor because I also didn’t think it was a stress fracture. I’d run for about 4 weeks with calf soreness that turned to shin soreness, but nothing like my previous stress fractures that stopped me in my tracks. I was keeping my mileage really low for me this training season, even lower than I had been running when not training, at about 30-35 miles/week.

    I think I will see how it feels this week, and wait a little over 2 weeks from my stopping running date to resume as you say. I’m trying to learn how to pay attention to my body, but it’s hard when so many little pains pop up consistently when marathon training, how do you know what’s a real injury and what isn’t.

    I’ve started taking calcium and vitamin D supplements and am eating a ton of whole milk yogurt and cheese. I’m also using a bone sonogram for good measure.

    Thank you again! It really helps to hear from someone who’s been there. I hope Boston goes well for you this year! It will be such an exciting year!

    1. You’re welcome! I completely understand your frustration with the whole stress fx thing. I know exactly what you mean about feeling little aches and pains while training. A week before my last marathon (first week in March), I swore I tore my hamstring…but it ended up being fine. Last Saturday, I felt something weird in my foot. It’s so hard to figure out when to actually stop and rest, because part of the whole “training for a marathon” is just being comfortable with being uncomfortable!

      For the GI issues, I started using that app, My Fitness Pal, and I watch my fiber consumption the week before a marathon. The last three that I did, it seemed to make a HUGE difference. I usually like to eat more whole wheat/brown rice/etc but that stuff has more fiber, so a few days out I switch everything out to white carbs, like white rice, regular pasta, plain bagels, etc. It seems to help tremendously. I suffered so bad with GI stuff before I even thought to look at fiber…after most marathons I could tell you how well organized the race was by the availability of bathrooms on the course…so frustrating!

      Keep me posted on how it goes for you. I am so excited for the race and I hope it goes well for you too!

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