Paranoia, Paranoia, Injury’s Coming To Get Me...

This week I am finally in the groove. Real training. There have been a of couple signs over the last few weeks that things were returning to business as usual, but this week it’s undeniable. I am running like a normal, injury-free Teal. I love routines and I’m finally officially back in mine:

Back to track practice,

To chocolate milks and Gatorades,

To long, midweek, morning runs,

And shockingly, right on cue, back to paranoia.

Paranoia, paranoia...  

I’m a worrier, a major one. (I had never really considered how loving routines and worrying went together, but then I took the Believe Training Journal “Worrier or Warrior?” quiz. I knew I’d get worrier, but it was basically a joke how ridiculously well the traits fit me. And loving routine is one of them!)

After a few days of "I’m Back, Baby" Euphoria, the worries set in. What if I hurt myself? I know I’ve talked about those fears here already and I don’t want to belabor the point, but honestly… It’s. All. I. Can. Think. About.

More than any other race, I don’t want to sit out the Trials. This is what I’ve worked for over the last decade, what if I screw it up and can’t race?

I actually lost sleep over this last night, which is ludicrous for two reasons: 1. Actually getting the proper amount of sleep will help prevent injuries and 2. Staying up worrying about it won’t do anything. (Yes, of course I’m consciously aware of that fact, but it doesn’t help.)

I’m trying to do everything I can to stay healthy: eat right, sleep enough, do my core exercises, foam roll, etc. I’ve modeled my training plan after the one that got me successfully to the start and finish of CIM and I am trying to learn from mistakes in my training for Grandma’s. But sometimes injuries can be freak accidents. Or they can be bubbling under the surface without any sign until one day: BAM. It’s over. (My stress reaction was that way.)

I can’t not train. I can’t skip every workout for fear that it will be the one that sets me over the edge. But I'm also aware that I can’t do as much as I’d like. (Here’s a superpower I’d want: to be able to run AS MUCH AS I WANT and not get injured. Oh the joy! The freedom! The miles and miles and miles! I’d take the blisters, the exhaustion, the chafing, if I just stayed healthy…)

Alas, we’re not invincible, and a healthy fear of injury can keep us healthy. 

But still, I’m feeling a little too vincible these days. I’m trying to remind myself to be grateful and to thank God for getting me this far and healthy again. I’m doing all I can... now to just stop worrying and go the fudge to sleep.

Dream big,

Teal

Coming Back Whining

I really appreciate everyone’s comments—both here and elsewhere—about how positive I was being about this injury, but I’ve got to be honest: I feel like I’ve betrayed you all in the last three weeks, as I have turned into an incredibly ungrateful brat, throwing temper tantrums because I can’t run as much as I want to, gosh darn it!!

I think at first I didn’t fully accept this injury—I’m not sure I have even now, three months later.

Maybe I was just stuck in the first stage of loss and grief—denial. I accepted that Grandma’s wouldn’t happen and that I had a summer of cross-training ahead.  But my doctors and I agreed on a plan: real marathon training would start—on schedule—in October and I’d be base building by September. Maybe I was delusional, but I wouldn’t/couldn’t let myself think this injury would mess up my Trials training. It took away Grandma’s. No more.

But then four to six weeks without running turned into ten. As the days of August ran out, I started getting worried. And irritable. And angry. And depressed. I may have had more than one complete meltdown. Oddly, my anger and depression (stages 2 and 4; we’ll get to stage 3, don’t worry) correlated with when I was actually allowed to start running again. Rather than feeling elated—I can run!!—I became more and more frustrated at just how little I was allowed to run.

On my first two-mile jaunt on real roads, I felt like a cartoon character running with an anvil on my back—all squished down, like my legs weren’t moving up and down at all. (Welcome back to 100% gravity.) But after a little while, I felt mostly normal again, and then—amazing. I was reminded why I love running so much; it seriously is better than any other form of exercise or cross training. I felt like I could have gone so much faster and for so much longer, but… no. I had to take it slow.

The next run—a week later and a whooping three miles—was an entirely different experience. It was freaking exhausting. I felt heavy and tired, so ridiculously tired from jogging what would essentially be a warm up at any other time of my life. It was frustrating—Had I not been cross training enough? How is this so damn hard? How the fudge am I going to get back to running 80-mile weeks when a three-mile week is this tiring? I felt that anvil again, only now I was dragging it, or--more accurately--dragging a slow, out-of-shape body through a short run.

Cue the temper tantrums. I need to start running for real. I need to get back in shape. I feel fine, no pain or soreness in my leg. **Bangs fists, stomps feet.** I wanna run more!!

I know I should be grateful to run, and I am. Running a couple short jogs now is better than the zero running I was doing a month ago. But like a true addict, just a taste of it has got me aching for the real thing. I want to run miles on miles on miles. I want to come home exhausted and elated from a two-hour run, not a two-mile run. I want to feel justified in eating marathon-style feasts. (Not that I’m not eating them anyway, but it’s hardly justified). I want to run with my teammates again. I want to run fast and far, tempos and track days, singles and doubles. I want to race.

So the bargaining (stage 3) began. Last week I ran two times, three miles each. Surely this week I could go three times? Pretty, pretty please? But no. I nearly cried when the PT said it’d be another week of two measly runs.

Not that I’m not scared of doing too much. Of course I am. I am painfully aware that if I do too much I risk not making it to the Trials starting line. I’m doing what I can to make that not happen. But also, there’s the overly ambitious part of me waging war with the cautious side. I’d like to make it to the finish line of the Trials, too. I’d like to do well. Six-mile weeks aren’t going to get me there.

This is the push and pull of coming back from injury. On top of everything else, there’s a psychological war going on in my head. But I’m pain free. Surely, I can increase the running a little more…

Randomly, I wasn’t able to get on the AlterG as much as I was supposed to this week, so my PT agreed to let me go on a third run. Victory! Three days a week! And next week, I’ll be on vacation—far from AlterGs and without many other cross training opportunities. (No, I will not attempt “pool running” in the ocean.) So I got permission to go four days. (Still short and slow, of course.)

So things are looking up. I’m still not where I want to be or where I imagined I’d be at this point, and this morning’s four miles were downright exhausting. I know I have lots of time, and I’m trying trying trying to be patient. It is September, and I am building a base, it’s just a much smaller base than I originally planned. I can’t guarantee I won’t have any more breakdowns, but apparently I’m quite good at denying the reality of this injury, so maybe I’ll just regress to stage 1.

Dream big,

Teal

Moon Runnings

The last month or so has been a bit busy for a couple reasons, one of which is twice-a-week treks back and forth to physical therapy. (One underappreciated aspect of running: it often requires very little commuting time. 90% of my runs start from my front door.) But I can’t complain about PT, because I’ve been incredibly blessed to get to run on an AlterG treadmill during this rehab, which is basically the kind of treatment professionals get.

 Injured runners are always looking for ways to “run” without really running, without the pounding that might hurt healing legs/ankles/knees/feet/hips. We “run” in the pool, on ellipticals, even in our daydreams on the bike.

Then one day, someone thought, “Damn, what if you could run on the moon??”

So they made that possible. (No, not with SpaceX just yet.)

The man was Sean Whalen, the year was 2004, and a treadmill, called an AlterG Anti-Gravity Treadmill, was created. It uses air pressure to displace a percentage of the runner’s body weight; running at a lower portion of body weight puts less pressure on joints and bones, allowing injured people to run—at least, kinda sorta—while rehabbing.

Basically, you put on shorts with an attached skirt/tutu that zips into the machine. (Skirt/tutu seen here.) Once zipped in, your lower half is encased in a bubble, which gradually fills with air when the machine turns on. It continues to blow up until you are slightly floating, standing on your toes. (This is to weigh you.) Then you dial in how much percentage of your weight you want to run at, and it adjusts the air—filling up the bubble more to run at less weight, or filling less to run closer to your real weight. The rest works like a regular treadmill—you adjust speed, incline, etc.

The first time I was on it, four weeks post injury, I ran one mile at 45% of my body weight (aka, what I weighed in elementary school). 45% body weight feels like running on the moon. (Supposedly the machine goes as low as 20%, and I seriously don’t understand how you could keep your feet on the ground at that percentage. It was hard enough at 45.) You feel suspended, like you’re bounding along, and you have to consciously plant your feet. It’s hard to feel like you’re running at all, but fortunately we did 45% just that first day, to see how my leg felt.

It felt fine, so the next time we bumped up to 60% and gradually progressed body weight and distance from there. Maybe I just got used to it, but 60+ feels at least semi-normal, although I still have to consciously focus on maintaining a quick stride. The air does push on your stomach the whole time (if you didn’t have to pee before, you will now), your legs get extra sweaty in the combination of regular shorts + shorts/skirt/tutu, and it’s a little hard to keep your arm swing normal with the bubble in the way. But the main problem is that they are wildly expensive so very few facilities have them. (Though, reportedly, Tom Brady owns two.) Thus, the trekking back and forth to use it. 

(One additional awesome thing about AlterGs is you can run much faster on them then in real-life/real-gravity situations. (As free and fast as elementary kids.) But sadly I haven’t actually been able to play with that feature; I’m not allowed to push the pace any faster than a jog.)

Of course, I’ll take having to commute to jog over not running at all. I feel like a professional runner when I’m there, and picture all the running celebrities I’ve watched rehabbing their injuries on AlterGs over the years. Although it’s not quite “real” running, it’s darn close—far closer than other options. And afterward, I feel surprisingly good—happy and calm like post-real-running—not something I’ve been able to capture post-pool.

Here's a link to find an AlterG near you. You can pay per session--without a PT's prescription, I believe--although it's not cheap. (Also, after raving about how awesome they are, I feel that I should note I am not at all sponsored by AlterG.) 

Dream big, 

Teal 

Pool Runnings

Since my season-ending injury came at the end of my season, I segued directly into my offseason break (two weeks of zero workouts). This gave both my mind and leg a needed break, but now it’s time to get back to easy workouts and rehabbing that femur.

With this injury (a stress reaction), the best cross training is deep-water pool running (or “aqua jogging”). It’s perfect for lots of running injuries (aside from hip flexor ones, which is why I was stuck biking last time) because you are able to mimic running with no impact. But it’s vital to do it correctly, to both ensure your workouts are quality and you don’t lose your mind.

RunnerTeal AquaJoggerTeal

Steps to Maintaining Sanity While Pool Running:

Step 1: Buy a cute new cross training swimsuit. (Retail therapy is therapy, right?)

Step 2: Find the longest possible pool near you. I’m lucky that DC has an incredible 50-meter indoor pool that I can use. It even has a lane dedicated to leisure and “water walking” which fits me, children learning how to swim, and older ladies just fine.

…Or make do. When that pool closed, I used a shorter, outdoor one full of kids that certainly thought I was a crazy old lady. (The kids arrived just after that serene photo was taken.) But at least they provided entertainment while I did approximately 8,793,259 laps.

Step 3:  Get in the deep end (or, at least, somewhere your feet can’t touch when you extend your legs to jog) and secure your super cool aqua jogging belt just below your ribs. You can pool run without the belt (which just adds an extra bit of buoyancy), but it’s not recommended—especially at first—because it’s much harder to maintain proper form.

Aqua Jogging Equipment: Swimsuit by: Oiselle, Belt by: AquaJogger,
Watch By: Timex, Towel By: Stolen From Parents Years Ago.

Step 4: Speaking of form, it’s the Most Important Step. (Way more important than cute bathing suits.) Replicate your land-running form as best as possible. Don’t lean or slouch forward too much (as shown here); you should be straight up and down, hips under shoulders. Pump your arms as you would when running; don’t cheat by using “swimming” arms.

This step is harder than it sounds. It took me a little while to get it right—not just to tread water, not to rely entirely on my arms, and to get my legs used to doing a running motion in the water.

Step 5: Make it harder. Once I stopped flailing around and got the hang of it, it became too easy to keep it too easy. I realized I was more likely Aqua Walking than Aqua Running, so I have to conscientiously push the pace. Some things I’ve read say you should maintain your normal running cadence —generally around 180 steps a minute—while others say that’s too hard given the resistance of the water. My recommendation is to count your steps (count how many times one leg comes up each minute and double it) and find a rate that keeps you honest. You need to keep your heart rate up to maintain fitness; you should feel like you’re working out, not just splashing around on a tropical vacation. Counting will prevent you from slacking off and keep your mind occupied in what is admittedly a pretty boring activity.

Step 6: Once you’ve got your form down and a comfortable standard cadence, kick it up a notch. Intervals (from 30 seconds up to a few minutes) are the best way to get a good workout and break up the monotony. Since there’s no pounding, you can also do workouts more often.

I’ve found that pool-workout tiredness is a slightly different feeling than running tiredness. You’re not grasping your knees, gasping for air (I hope! That sounds like a good way to drown), but when you get out of the pool you have that all over exhaustion that makes sitting down seem delightful. (Actually, maybe that is a bit like running…) You’re also hungry constantly, so nothing new there.

Step 7: Bat away the boredom however possible. Counting strides and doing intervals help a lot, but often not enough. Watch the kids splash around, look for interesting things at the bottom of the pool, take pity on the lifeguards who are probably far more bored than you. At all costs, avoid staring directly at the sign that reminds you, both painfully and ironically, “No Running.” Yes, Sign, I’m aware. Thanks. Keep your head up (metaphorically and literally, or suffer a mouth full of water). You’ll show that stupid sign; you’ll run (on land!) again.

Step 8: Smell like chlorine, all the time, as it seeps continuously out of your pores. This step is unavoidable. (How the heck do you swimmers do it??)

Dream big,

Teal

Not With a Bang, But a Whimper

This is the way the [season] ends,

Not with a bang, but a whimper.

Part of the reason I love the marathon is the way the season builds towards it; the biggest and most important race; the peak waiting for you to summit after a mountain of long runs, tempo workouts, and track intervals. Race day is a celebration, a culmination of months and years of hard work, a big bang to end the season.

But this season won’t end with a bang. No, instead all you’ll hear from me is a whimper, because I’m officially out of the race. I can’t run two steps, let alone 26 miles.

Here’s the story of the most drastic taper ever, from gunning for a PR to settling for a DNS*:

A week and a half ago, I did my last hard workout of the season. I didn’t hit the pace I wanted, but with help from the ever amazing GRC guys, I stuck it out. I didn’t feel anything (except maybe anger at DC’s relentless humidity). No unusual pain.

And with that workout in the books, the taper began. But so did all the trouble.

That night I was more sore than usual, but it was a hard workout, so perhaps that wasn’t so surprising. If anything, the soreness reminded me that a workout at a slower pace than expected in searing humidity is still a tough workout. The next day (Sunday) I went for my normal post-long-run recovery jog. I was tight, but didn’t think twice about it. In fact, by the end, I had put the previous day’s disappointing pace behind me and was back to dreaming of PRs at Grandma’s. But by that evening, I was as sore as I am after a marathon. What was worrisome was that it seemed worse in one leg, my right quad. This might not just be lingering soreness.

I took the next day off. The taper was starting, so the schedule had an easy run anyway. No big deal to skip.

Tuesday I tried to go for a run. I felt okay at first, and made it a few miles. But it gradually got worse, until I gave up and walked home. The Oh-Crap-I-Might-Be-Injured-So-I-Better-Walk Walk is a miserable experience. First of all, it takes forever to walk the few miles you just jogged in seemingly no time. Second, your thoughts are a scattered mess of freaking out, denial, guilt, and berating yourself. Maybe I’m being a baby giving up on this. Maybe I should run again, this walking is taking forever. Maybe I can’t run again. Maybe the marathon is out of the picture. What’s wrong with me? What did I do wrong, when did I cross the line? I remember thinking that I would take it easy again that day so I could recover before a hard track session the next day. But by the time I finally got home, I had come to accept the track session probably wouldn’t happen.

But even over that long walk, I hadn’t yet accepted—or considered beyond that fleeting thought—that the marathon wouldn’t. I emailed my physical therapist and he immediately responded that he could see me if I came in right away. So I headed straight off to see him, without preparing myself for what might be coming. Surely he'll just massage this away.

He listened to my symptoms (incredible soreness in my right quad, just above the knee, pain when running and going up and down stairs) and suspected it was a stress reaction in my femur. (Trouble in the bone might be causing the surrounding muscles to spasm.) But he tried to remain positive; it might not be an issue with the femur, and if it was anything muscular we could rehab it and run the marathon on schedule. I was to take the next two days off from running and get back to him if the soreness didn’t subside.

It didn’t. On Friday I saw another doctor to get a referral for an MRI the following Tuesday. As my constantly fidgety self was strapped into the MRI scanner, hating every claustrophobic minute, my worries started to snowball: what if this was something worse than expected, a full-blown fracture or some other unknown problem? Over the previous week, I had come to accept the serious possibility of missing this marathon. That wouldn’t be the worst thing, so long as I can run the next one. Now I worried about that.

On Wednesday, the MRI results came back: I have a stress reaction in my femur. No marathon, no more PRs this season, no running at all for 4-6 weeks.

It’s bad news, yes, but it's not the worst news. There are always silver linings, so let’s focus on those:

1. It’s a stress reaction, not a fracture. A reaction is the precursor to a fracture (which would mean being on crutches and out for much longer). We caught it in time, and I was smart to walk home those depressing few miles, so let this be a reminder to all you runners: LISTEN TO YOUR BODY. When you’re hurt, you’re hurt. Don’t do any more damage.

2. My doctors have been amazingly helpful and completely understanding of my commitment to running. They didn’t have the knee-jerk reaction of other doctors I’ve had who have said, “Well, you run too much. Stop doing that.” No, they worked with me to get a diagnosis as quickly as possible and are doing whatever they can to get me healthy for the big race next February.

3. It’s going to be hard to let go of the goals I had for this season and the time I wanted to hit before the Trials, but this race was always sort of a freebie; I have my qualifier and that’s all I need. (Thank you, God, for letting me get that out of the way last December!) Now that I’ve done nearly all the work (just that last 26.2 remaining…) it doesn’t feel so free, but I’m reminding myself that I’ll be stronger next season from the months of hard work I put in this season; that won’t just disappear.

4. Obviously getting injured less than three weeks from your marathon is not ideal. Injury is never ideal. But Big Picture, the timing is actually kinda, sorta… good. I was going to take my end of season break anyway, and that would be followed with a few weeks of easy running. That post-season recovery time will now be co-opted as femur recovery time, but it will look pretty similar. I’ll be running in the pool instead of on the ground, but if there was a time to have to take it easy, this is a pretty good one.

5. This is not a silver lining, but a lesson in perspective: the week I realized I might be injured got many orders of magnitude worse when we got the news that our dear teammate, Nina, had died. I can whine about injuries, humidity, or poor races, but in the end I am incredibly lucky to run and luckier still to know the people I’ve met along the way. As I said in my post about Nina, running has given me some of my best friends—for example, friends that understand how terrible injuries are, yet simultaneously make them seem less terrible. This injury isn’t so bad in the grand scheme of things; now the focus is getting healthy for the Trials, so I can bring my two dear running friends, Lauren and Nina, to LA with me.

6. And finally, whether the race ends with a bang or a whimper, there will always be ice cream.

Dream big,

Teal

*DNS = Did Not Start. I’ve been fortunate to have not used that phrase here… until now.

Five minutes

On Tuesday, I ran for five minutes.

It was exactly five minutes longer than I've gone in over six weeks. I haven't been running seriously in over two months.

To clarify, it was actually a ten minute "workout," alternating between one minute of walking and one minute of running. So I have yet to even run two minutes consecutively. This is a precipitous drop from eighty mile weeks of the past.

When my physical therapist told me last week I could attempt running this week--and then revealed my plan--I was simultaneously overjoyed and disappointed. At my first appointment, the prognosis was that I'd be running again within 4 weeks. (I was even told I could still compete in the Philadelphia Marathon, but I abandoned that idea.) The four week deadline came and went. The appointment the week before was bleak: I was to tack on additional appointments and running still wasn't on the radar. But armed with new exercises, I seemed to make a turnaround. I could run.

Back in five... 

But five minutes? Really? I didn't know I would be starting so slowly. In the past, no matter my fitness, I have always assumed a baseline of four miles. I can not workout for months (namely in college), but I can always struggle through and make it four miles. But this isn't a problem with my fitness. This is a very real injury, and caution is key.

And so, I embarked on my Big Run:

Minute 1: Sheer bliss. It may seem like an exaggeration to be so enamored by running that one minute can transform you, but that is how addicted I am. Just speeding up from a walking pace to a slow jog felt amazing. Damn, I've missed this. I knew I did, but this reminds me how much.

Minute 2: Still feeling great, the morning is just breaking. The weather is perfect autumn, shorts and long sleeve tee weather. I make it to the trail, there are leaves underfoot, pure joy.

Minute 3: Geez, it's already time to turn around. Oh wait, what's that? My hip?! I feel it, working. It doesn't feel like sharp pains like it used to, but I feel something, and I'd really rather feel nothing at all.

Minute 4: My hip feels like it does when I'm doing my exercises. Maybe it's just out of shape and/or tired? After all, that's the point of the exercises, to get it working again. In the old days, it was letting the surrounding muscles (quads, hamstrings) do the work and that was the beginning of the problem. It doesn't feel like it did when I first realized I was injured, so that must be progress, right?

Minute 5: Almost done. The hip feels as it did in minutes 3 and 4, no better but no worse. I'm still loving the running, as the early minutes, but the carefree attitude is gone. Everyone told me that coming back from injury would be filled with paranoia (among other not-so-pleasant emotions), and they were right. It's starting.

My physical therapist was clearly right to be so cautious, if a quick five minutes can begin to trigger something. It was certainly a mixed bag of emotions and a reminder--as if I needed one--of a long road ahead. But overall, it does seem like I covered all the bases of a solid run: both pure joy and discomfort, both moments of doubt and moments of triumph. Okay, no triumph with that run, but maybe when I tackle ten minutes.

Dream big,
Teal

Science Friday: The Ten Percent Rule

As I recover from an injury the questions loom: What caused this? Will I make the same mistake again? Was  "too much, too soon" to blame? I've admitted before that I sometimes break the ten percent rule. Is that where I went wrong?

The ten percent rule--that the safe, injury free way to increase mileage is by ten percent each week--is repeated often by running experts and in training books. It's simple, concise, and easy to remember. But is it true? What does the science say?

Unfortunately for ten percent rule advocates, the science isn't on their side. There aren't many studies that examine the rule, and, to date, none that agree with it. The study that is often mentioned as the best test of the rule was published in 2008 by a group in the Netherlands. 

The participants in the study were 532 novice runners that signed up for a four mile race. The researchers divided the runners into two groups, carefully accounting for past history of sports and previous injuries. The control group was assigned a "frequently used beginners training program" that was 8 weeks long, with an average weekly increase of 23%. (The increases each week varied greatly and included a down week.) The intervention group was assigned a more gradual program that was 13 weeks long, and carefully increased the time spent running by ten percent each week. (One week had only a 2% increase but the rest were pretty consistent.) Both groups were to run three times a week.

The injury rates were shockingly similar. In the control group, 20.3% of runners became injured. In the intervention group, 20.8% were injured. A gentle ten percent increase didn't help.

(Not entirely relevant but interesting: They followed up their work with another study looking specifically at a preconditioning program. Prior research suggested that people who participate in sports that involve jumping and pounding to the joints (soccer, basketball, or volleyball) get injured less often when they start to run than those who participate in sports with less pounding (swimmers and cyclists.) They designed a four week program that simply included a few sessions of hopping mixed with walking. The preconditioning/hopping program was completed before the running program began. The hopping had no effect on running injuries, however, as the control group and the hopping group were injured just as often.)

Recently, a smaller study was published using GPS watches to track increases in mileage. The authors wanted to do away with the subjectivity of subjects self-reporting how far and fast they ran, so they gave them Garmins (Forerunner 110s), asked them to run for ten weeks, and tracked their injury rates. The Garmins couldn't lie: runners who became injured tended to have a greater weekly increase in mileage. But the increases--for healthy and injured--were higher than ten percent; injured runners increased mileage an average of 32% while runners who remained healthy increased mileage by 22%. The difference between the two groups' mileage wasn't quite statistically significant, however, which means that while it's interesting, it's not quite enough to make sweeping generalizations. They also calculated that injured runners had a large (and significant) jump in their mileage the week before symptom onset, with an average increase of 86%*. It may be surprising to the ten percent folks that people can get away with greater than 20 percent increases and remain injury free, but injury following an 86% increase isn't terribly shocking.

The authors of the GPS study summarize nicely: "No clear evidence for safe progression of weekly volume exists." The ten percent rule may be convenient, but it's not accurate. In fact, some people can safely increase weekly mileage over 20 percent and remain healthy. But others (1 in 5 in the first study) get injured even with an increase of just 10 percent. It seems like it's up to you to know your body and what it can handle, which unfortunately is learned by trial and error (and injury.) It's probably best to err on the side of caution, and maybe not try to bump up by 86% in one week. 

Dream big, 

Teal

*It should be noted that the number of participants in this study was small, and the number of injured was even smaller, only 13. So while this may seem like a high number, it's probably because of the small number of people. 

Injury Is A Pain In The Butt

Fall is my favorite season, mostly for the perfect running weather. Yes, the overabundance of all things pumpkin flavored is delicious, but it's that other smell in the air that is so inspiring. It smells of cross-country season, of marathon season, of running season. 

But, for me, it's biking indoors season. My hip is not yet healed enough to run, and although I am still thrilled I don't need surgery and thankful it isn't a worse injury, I'm not exactly enjoying my time away from running. I try to keep my head up and continue to look forward, but I do have some observations to share. Okay, they are mostly complaints, but perhaps other injured runners can share in my misery. 

One unsurprising discovery is my jealousy when I see other runners running. They don't know how good they have it as they trudge up that giant hill, red faced, struggling in sheer desperation to get to the top. Oh how I miss that agonizing delight. I want to jump in and jog alongside them while raving, "Isn't this wonderful?" (The irony is that this does not mean I don't want to go to races. When invited to cheer on friends in a November half marathon—the same weekend that I was to run my marathon—I couldn't say yes fast enough. If I can't race myself, there's no place I'd rather be than cheering others as they race, even despite my jealousy.) 

What was unexpected—to me, at least—was how much seeing my running routes would make me jealous. I run some of the same paths all the time, to the point of monotony. But now, I'll drive past one, and the grass has never looked greener, the path never more inviting. That cross-country/marathon season smell wafts in through the window, teasing me. I want to be out there! 

Since I'm biking to stay in running shape, I use very low resistance and very high RPM. Most experts would say that's a dangerous recipe for runners (i.e. inexperienced bikers) to get seriously hurt on the roads. So I'm stuck indoors, watching terrible television and cursing the inefficiency of biking. To get a similar workout to running, you have to bike about 1.5 times longer. But it's awful, particularly because it's incredibly boring and early morning television is the worst. I can't watch the Kardashian sisters fight over something blown out of proportion one more time. (Oh, but there's a marathon on, with new episodes? Okay, then, well I just want to see what happens with Khloe and Lamar...)

Fortunately I have a wonderful husband who listens to my complaints,
and, instead of getting annoyed by them, draws motivational pictures.

And dieting, forget it. There are many reasons I run and one of them is I really love cupcakes. Biking doesn't allow me the same gluttony. (That'd be too many Kardashian episodes to handle.) But despite working out at a fraction of what I'm used to, I still want to eat everything in sight. What do you mean I don't deserve a large stack of syrup covered pumpkin pancakes?! I ran a twenty miler six months ago, that doesn't still count?

Even chores are harder. Living in the city, sometimes it's just easier to run somewhere. On weekends I run to work or to do errands. But now I take some combination of buses and subways and can't help but calculate how much faster it would be to run, and how much more enjoyable. 

But the most tangible problem with biking is the bike seat. The bikes at the gym have wide, cushioned seats; although they aren't exactly Lazy Boys, they are much more comfortable than what true cyclists use. But thanks to kind triathlete family and friends, I currently have a real cyclist's bike with a real cyclist's seat set up in my living room. The first day wasn't so bad. This is so convenient! The second day, if I even tried to shift one inch, a wave of pain went through my butt, punishing me for anything anti-biking I've ever said. If this is some cruel torture device to force me to have more respect for cyclists and triathletes, congratulations, it worked. (Thank you family and friends??)

Of course, there are psychological struggles, too: the questions of getting back to where I was, how far behind I'll be when I can run, if the injury will return, how the recovery seems to be taking longer than originally anticipated. But it's simpler and easier to repress those worries and to focus my anger on that bike seat, because it's a serious pain in the butt. 

Dream big, 
Teal

Science Friday: Diagnoses and Discoveries About Hips

Note: This is not a typical Science Friday, but Part 2 in the unexpected series identifying what is wrong with RunnerTeal.  (Let’s hope for no Part 3 anytime soon.) 

Last week I told you about my not-so-hip hip and my upcoming doctor’s appointment.  Everyone’s well wishes and thoughts paid off, as I do not have a surgery-requiring labral tear, but tendonitis in my hip flexor instead. (Yippee!!) Tendonitis means no running for a few more weeks, being forced to confront my hatred for biking, and no fall marathon. (The Philadelphia Marathon has now stolen my money for the last two years. I’ll get you back some day, Philly…) But, it isn’t surgery, and that is a huge relief that indisputably makes a few run-less weeks and hours of boring biking seem like a blessing.

Given the crash course I’ve had the last few weeks, I thought it might be nice to share some of the things I’ve learned about hips, both their tears and tendons.*

The hip is a ball and socket joint, like the shoulder, where the head of the femur (the ball) sits in the pocket (called the acetabulum, the socket) of the pelvic bone. This allows for motion in almost all directions and allows us to walk, jump, and of course, run. It absorbs a lot of forces; when we run, the forces are many times our body weight. The hip is the superstar of joints.

The acetabular labrum is the cartilage that surrounds the socket, helping to keep the femur securely in place. Running repeatedly over years and years (as marathoners are wont to do) can cause the labrum to wear thin and tear. (This can also occur more instantaneously in contact sports or accidents.) The pain occurs on the inside of the hip and it may present as stiffness and tightness or it may feel like it’s clicking or catching. The latter is the symptom that had me (and Dr. #1) convinced I had a tear. If the tear is bad enough, arthroscopic surgery may be required, where the torn portion is cut out. After seeing my x-ray and hearing my description—when the pain was worst, what time of day it hurt, etc.—my doctor was less than convinced that I had a labral tear, and did an ultrasound to check. If I had a tear big enough to need surgery, he’d see it on the ultrasound. Fortunately, he found a healthy looking labrum! He diagnosed me with tendonitis of the hip flexor instead.

The hip flexors are a collection of muscles that mainly function to pull the leg and knee upward, towards the body. Two of these muscles, the iliacus and the psoas major (together referred to as the iliopsoas), are the most susceptible to hip flexor injuries, and tendonitis can occur in the tendons associated with these muscles. (Tendons attach muscles to bones.) When under repeated stress, tendons can degenerate and become inflamed. (The suffix “-itis” means inflammation.) The stress could come from doing too much too soon or from overuse, pushing too hard for too long—again as marathoners are wont to do. If the tendons are inflamed or aggravated, most likely the surrounding muscles are as well. During my appointment, the tightness and stress on these muscles was obvious. The psoas major connects the lumbar part of the spine (the lower back) to the front of the pelvis. When my doctor pressed on my lower back, I could feel pain in the front of my hip—a strange sensation that convinced me he knew what he was talking about. (An interesting side note: only about 50% of people have a psoas minor. It seems not to matter whether you do or do not have this weak muscle.)

Treatment for tendonitis includes anti-inflammatories, physical therapy, massage, and, of course, the most hated treatment: a break from running. The tendon is able to heal itself; the purpose of the initial inflammatory process is to promote healing. As with all injuries, the trick is patience: let your body work its magic (and have a really good PT to help coax it along.)

Here’s a quick run down of other hip issues that affect runners:

Bursitis:

Bursae are lubricating sacs that cushion areas where muscles and tendons slide against bone; bursitis is an inflammation of these sacs. Trochanteric bursitis will cause a dull ache or rubbing on the outside of the hip. Again, the treatment includes rest and ice/anti-inflammatories.

Stress fracture:

In the hip region, the most common place for a stress fracture is the neck of the femur. A stress fracture causes a throbbing pain that gets worse with more running and will probably leave you limping. If you can’t hop on the affected leg, a stress fracture is probably the issue, and you should immediately stop hopping and stop running. Here the treatment is 6-8 weeks of no running.

Iliotibial (IT) band syndrome:

This can present as a jabbing pain on the outside of the knee, but it starts up in the hips. IT band syndrome is from irritation of the ligament that runs along the outside of the thigh from the hip to the shin. You can get it from doing too much too soon (always trouble!) or even from running the same direction on the track (too many left turns!) IT band syndrome can be helped with rest, ice/anti-inflammatories, and massage before starting a program that strengthens the surrounding muscles.

Piriformis syndrome:

This is literally a pain in the butt, as pain shoots from the butt down the back of the leg. It can be treated with massage and physical therapy.

Staring at images of skeletons, muscles, and joints and learning all the things that can go wrong makes me appreciate how amazing it is that, most of the time, things work smoothly to allow us to move around. And, someday soon, to run again.

*Note: I am not a doctor, just a scientist who likes to teach herself things. You should see an actual doctor if you’re having hip trouble.

Dream big, 

Teal 

Broken

I have never been injured. 

When I admit this to someone, it is not to brag. Rather, I confess it sheepishly, full of guilt, fully aware that I don't deserve to be an injury-free runner, fully aware of all those runners who have been frustrated by injury for years. (My sister, who will always be a far superior runner to myself in my eyes, has been hit with one too many injuries. Why can I run and she can't? It isn’t fair.) 

In high school I had a problem in my foot that flared up a few years later while training for my first marathon. Before my first Boston, my Achilles started acting up. In these cases, the remedy was a few days off and then carefully resuming running. I've never been to the doctor for these minor glitches. 

When asked how I remain injury free, I list the usual reasons: I watch my mileage and have built it up slowly over years. I take careful inventory of what hurts and stretch/ice/rest when anything feels off. I know what works for me and what my body can handle. But honestly, I'm just lucky. I've broken the ten percent rule. I've gone weeks without a day off and felt a sense of pride about it. Busy mornings mean skipped stretching and icing. The injured runners reading this now hate me. Don't worry. Karma will get me soon. Maybe it already has. 

While training for this spring's Boston, my hip acted up a bit. Some days it would feel tight and go away, some days it would be a quick pang of pain, and then disappear. Looking over my log, there is one day it bothered me enough to cut a workout short. Instead of logging 15, I cut it to 9. Still, I ran 9 miles; I wasn’t debilitated. I worried about it a bit, but it wasn't serious enough to slow me too much. 

After Boston, I took off more time than usual. I did a short test run; the hip was still tight, so I took some more days off, and repeated this process a few times. By June, I was aching to run and getting out of shape. I started slowly and built back my mileage. My hip made its presence known a few times, but nothing to sideline me. I religiously did hip exercises and iced it. It seemed to be going away. Three weeks ago, I did a tempo run that wasn't a complete disaster. I was coming back. 

The next day, while visiting Brother in Philly, he took me on a run along the river, following the same course the marathon would. It was a gorgeous day, the kind of beautiful morning that makes you glad to be a runner. My hip was tight in the beginning, but loosened up. I hit a pretty decent pace, and felt happy with it. Afterwards, I did my stretches, grabbed some ice and hopped in the car for a wedding in the Hamptons. 

On the drive the hip stiffened and throbbed. But after we got out of the car, it felt fine. We danced and celebrated, all fine. The next day, Husband and I tried to go for an easy run. It tightened immediately. “Maybe it will loosen up like it usually does,” Husband said. But I couldn't even make it two steps to try and see. I was hurt.

I took a few days off before testing it again with an easy jog. After five minutes of pain-free running, it tightened. I could have pushed it to see if it would stretch out like I have in the past. But remembering not being able to take two strides a few days before made me realize it wasn't worth it. At that moment I switched from someone who defied injury to someone who was injured, and accepted it. Time to see the doctor.

I called the best hip doctor around, as recommended by a teammate. I couldn’t get an appointment for three weeks. Three weeks? That seemed like an eternity. I am supposed to be training, what the heck do I do with myself?

After the aborted test run, I cross-trained to maintain sanity. On Friday (day 7 of no running), I saw my doctor to get a referral to Dr. Hip Specialist. She thinks it may be a labral tear, to be confirmed by the specialist with an MRI. She warned me a tear could require surgery, although it may be possible to rehab it with physical therapy. She also said I can run in the meantime, provided I decrease mileage and avoid hills. I can run? This happy news clouded the rest of the appointment. But as I walked away, the reality of what else she said dawned on me. Possible surgery!?

I was able to run for five pain-free, glorious days before the tightness was back and I was sidelined again. Tomorrow I have my appointment; the three weeks of waiting are over. I’m eager to get a real diagnosis: will I need surgery? Is cross-training aggravating it? When and how can I get back to running? I’ve come to accept my immediate goals may need to change, but I want to get started fixing this as soon as possible, so my long term ones don’t need to.

Dream big,

Teal