Stuff Hurts

I was fully expecting my next blog post to be a race report from the Firecracker 5K on July 4th. I was going to talk about how my frozen lemonade experiment worked out, how focusing on even breathing helped to reduce all the noises I make, and how I ran my first "hot weather" sub-22:00 5K. But alas, I have nothing to report because I did not run the race.

Injured!
Just two days after my mile repeat workout, I noticed some pain in the lower calf/shin area a few miles into the long run. I kept running, hoping that it would go away, but it didn't.  I know that shin pain is nothing to mess around with so I headed home and ran only 7 miles. I was able to get an appointment with my sports doctor just two days later and he told me it was a bone irritation, on its way to a stress reaction or stress fracture. Sure enough, this is exactly how my shin felt in the weeks before I was formally diagnosed with multiple stress fractures back in 2011. And it was in a similar spot.

In addition to this bone issue, he told me I had "high hamstring tendonopathy" which is inflammation of the hamstring where it inserts to the butt. I had been feeling this problem for about a week prior, but I thought it was just general soreness/tightness and I wasn't too concerned. I basically feel this when I bend over to pick something off of the ground, or when I put pants/shorts on and have to stand on one leg while bending down.

My theory on how I got the shin problem (left shin) is that the right high hamstring area was bothering me while running so I altered my gait to strain the left leg. And my theory on how I got the hamstring issue was

that I started running higher mileage (averaged 54 miles per week in June) with the Mizuno Inspire as opposed to the Brooks Adrenaline that I had been wearing for years. My sports med doctor looked at my shoes and told me they were not nearly flexible enough and that certainly could have played a role.

My feet don't like Mizuno Inspires

Potentially the source of everything is the fact that the Mizuno Inspire was killing the ball of my foot. Once I started to get past 10 miles in these shoes, the balls of my right foot would start to hurt as if there wasn't enough padding. It was actually quite painful and it would make the run unenjoyable for those later miles. At first, I figured I would just develop a callous and get used to it, but that never happened and the ball of my foot started hurting even without the shoes on.

This ball of foot issue was the first "thing" that hurt me when everything else was 100% so I am thinking there might have been some sort of domino effect.


Recovery Plan
My doctor told me that I should run 1 mile per day to "load" the bone and stimulate healing. I waited a few days before taking this advice because I could feel it while walking around, and I didn't want to run until I was pain free. Once I started my daily 1-milers, I felt like it made the shin worse, so now I am back to not running at all. (It's now been two weeks since I first noticed this shin issue and stopped my normal training). The good news is that bones heal and heal well- they aren't nagging injuries so if I just take the time off and let it heal and gradually get back into it, I should make a full recovery within the next 2-3 weeks. Will I be in the best shape of my life for Chicago? Probably not. But I am hoping to be in decent shape so that I can successfully complete it and be able to have that experience.

Exercises for High Hamstring Tedonopathy

As for the high hamstring tendonitis, the doctor said that could take a long time, on the order of months, to heal. And of course I have read internet horror stories of it taking over a year. This is something that you can run through, but it will just prolong recovery. So in a way, it's good that the shin problem happened when it did because it forced me to take time off for my hamstring. My doctor prescribed exercises for this, which I have been doing every day, and he is also performing A.R.T.

I'll need to maintain the strengthening exercises, and move up to weight bearing stuff to make sure I am strong and don't get this injury again. Also, I will not be wearing the Mizuno Inspire for long runs. I will still wear it for runs up to 10 miles, like I had been doing for years, but I need to find another long run shoe. I could go back to the Adrenaline, but that shoe also feels stiff and is still probably too much support. I bought a pair of Asics 2000 which are nice and flexible and provide more support than the Inspire, but less than the Adrenaline. Another reason I hesitate to return to the Adrenaline is because I had been wearing a size 6 for years and lately I have been getting numb feet and black toenails from them. However, the size 6.5 really feels huge in the forefoot, so I just don't like how it feels.

Cross Training
The first week of these injuries (last week) I went to the pool almost every day for pool running and swimming. I was very determined to minimize any loss of fitness. This week, however, I started my new job and have not been able to fit in going to the pool. My commute has been about 1 hour each way because I am driving at peak rush hour and not able drive on 66 inside of the Beltway during those times. In a few weeks I will start "flexing" and hopefully cut my commute in half. I have been able to devote time to strengthening exercises, though, and I am feeling much better in both the shin and the butt.

This weekend and next week I plan to spend more time in the pool, and possibly on the elliptical if it doesn't bug the hamstring too much. I had worked myself up to 57 weeks in June and was on a "cutback" week when this injury hit me. Greg had urged me to take the cutback week sooner but I didn't think I needed it and I wanted to get in as many high mileage weeks as possible before starting the new job. I hadn't been injured in a year in a half (except for the mono) so I was feeling pretty confident about staying that way.

Positive Takeaways
I stopped running as soon as I felt this shin problem, so it could have been a lot worse. I could be looking at a stress fracture, which would definitely rule out Chicago. I was smart and conservative, and put my health above my desire to keep training at a high intensity.

I don't really know when I will be able to run again and at what intensity but I am surprisingly okay with that! For the first time since I started running, I am okay with not knowing when I will get better and just taking things one day at a time and doing my best to cross train. I think it's because I'm not so hung up on my time at Chicago. I really just want to be able to run the race injury-free and have a strong finish.

Also, I realize that I have more "separation" from running than I have in the past, which has been a goal of mine for the past year. Separation means that I don't define myself as a runner. Running is something I do, not who I am. Before, when I was really wrapping a lot of my identity into running, it would be heart breaking to not be able to run. But now, when I am taking the time to appreciate all aspects of who I am and what I have in my life, running is just a piece. It sucks that I can't run, but I know I will get better eventually and I'm doing the best I can right now.

Although the timing isn't great because I'm supposed to be training for Chicago right now, it's good in the sense that I didn't have the added pressure of trying to run a ton of miles during my first week at the new job. In addition to the long commute times, there have been happy hours and dinners galore, so the days have been extremely long. Enjoyable and exciting-- but also long and tiring. I was thankful that I was able to devote 100% of my mental and physical energy to getting to know my colleagues and diving right into my role.

Bad Things Happen in Three's

Many of my readers already know the punchline from last week's ballad- I do have a stress fracture. Multiple ones, according to the results of my bone scan. Even though it's only my right shin that hurts, the scan apparently detected two stress fractures in the left leg (one on the tibia, one on the fibula) in addition to the one on my right tibia. The nurse called me to deliver the results, so I wasn't able to ask the doctor about the oddity of three simultaneous stress fractures, especially considering that there is no pain in the left leg. I did leave him a message, but he hasn't gotten back to me yet. I always feel like doctors just want to rush you in and out and be done with you, and don't want to really talk you through things. 

I've never been someone to do anything half-way. I've always maintained an "all or nothing" attitude, which often works in my favor, but has sometimes worked against me. So it when it comes to injuries, naturally I can't just have one stress fracture, I have to have three.

My guesses on what's going on:

• It's only a stress fracture on the right, everything on the left is a stress reaction, or something else going on.
• They are all three stress fractures, but only the right one is bad enough to where it actually causes pain.
• It was caused by the introduction of the treadmill after a long period of no treadmill. And they say treadmill running alters your gait.
• Having lower than normal bone density (I was told I was osteopenic in 2003) was a contributing factor.

The good news is that I am getting them all out of the way at once, and now I know I need to be religious about taking calcium supplements. And the treadmill is a definite no-no. 

Doctor's orders were simple (and once again, I didn't have the ability to ask questions). Make a follow-up appointment for 4 weeks. No running until then, but elliptical and swimming are ok. From my knowlege of stress fractures, it's typically 6 weeks of no running, followed by a very gradual build-up. And after 90 days, it should be healed completely. My last day of running was Tuesday, Jan. 25, which means I should be able to re-introduce running on March 9. I don't expect full recovery until the end of April. Thankfully, I hadn't registered for many spring races, just the Shamrock marathon. I'm hoping that by that time I can run the last 1-2 miles with my husband. 

My friend Cristina used a bone stimulator machine to shorten the healing time of the fracture in her foot. These machines have been shown to reduce healing time, so I purchased one for myself off of eBay. (They retail for $4000 and my insurance won't cover it unless it's a full break). So the way to go, recommended by Cristina, it to get one that has been gently used from eBay. The machine is supposed to arrive tomorrow. My appointment with my doctor is on Feb. 25, at which point an X-ray should reveal the progress of the healing. If the machine works as well for me as it did Cristinia, then maybe I could shorten the whole thing by a few weeks. Which is totally worth the investment to me. The only problem I might run into is that I don't know the exact location of the fractures. I have requested copies of the bone scan so that I can see for myself. Apparently the stimulating device needs to be placed exactly at the site of the stress fracture.

Pool Running

As for cross-training, I am going to be conservative and lay off of the elliptical for another week, even though the doctor said it was okay. To maintain my fitness, my main focus has been deep-water pool running (with a flotation belt) with some swimming thrown in here and there. I've read quite a few articles and blogs on pool running, and there is a great deal of evidence out there that when done at the proper intensity, pool running can help you maintain most, if not all of your fitness over a six-week period. Even with all the evidence, I am a bit skeptical because I just don't feel like I am working as hard on my "easy" pool runs. But we shall see.

Thankfully, there is a pool about two miles from my house. This means I can spend up to an hour and a half in the pool before having to leave for work. On the weekends, I have been going to a pool about 30 minutes away to meet up with some friends. Yesterday, I spent three hours in the pool, 2:30 running and half an hour swimming. Afterwards, I was as tired as if I had done an 18-20 miler. And my legs certainly felt it.

So far, this injury has not gotten me down as much as previous injuries. Mainly because I really think the pool running will preserve my fitness and there is nothing more disheartening than the belief that everything you've been working so hard for has gone to waste. Also, I just came off of a fantastic year of running, setting PRs at nearly every distance. I was fortunate to be injury free for 15 months, so I guess I was due. During that time I really maximized it and I can only hope for another long stretch of no injuries again once this is done with. Of course I am upset about this, but I am trying to focus on recovery, and not think about all the races I'm missing out on this season. The outpouring of support of my running friends has been incredible. Without them, I would know nothing of pool running and bone stimulators!

I'm very determined to keep my spirits high and to preserve my fitness. I also need to be prepared to lose some of it. It will be such a letdown if the pool running doesn't work as good as expected, so I need to be cautiously optimistic.