Posts Tagged ‘running injury’

Thursday’s it! Just 4 more days till I’m back on the road after (what will be) 29 days sans running.  I’m being rebellious as all get-out by resuming one day earlier than planned because:

A) my park interludes are now brisk 5+ mile walks.  Pfitzinger’s “return after stress fracture plan” says you first need to be able to walk briskly pain-free for an hour which I’ve been doing, and more, for a week (and I didn’t even have a stress fracture).

B) seeing as how that MRI report two weeks ago said my femur was normal, starting one day earlier ain’t gonna kill me.

My doctor allotted me 25% of my previous mileage for the first week back, which means 22.5 miles.  I’m not sure I’ll do that much, I have a soft plan in mind that ends up being more like 17 the first week but it’s nice to know I can do more if I feel good.

I was looking at Jack Daniels’ plan for getting back after a layoff which is too aggressive for me, but interesting.  He has you come back in the same amount of time you were off.  For a 29-day layoff, he splits it into thirds; the first 9 days would be 33% of your previous load, then the next 10 days would be 50%, then the last 10 days 75%, et Voila! 29 days and you’re back to full volume.

What I’m going to do is simply add 10% of volume per week like my doctor suggested which means 8 weeks will get me to 86mi.  That’ll put me in the 2nd week of January; with racing season around here starting in March, that’s perfect.  Of course, at that point the weather might suck sufficiently that I won’t want to go that high anyway, but I’m itching to try.

Meanwhile, I don’t have any follow-up doctor appointments or PT in store – even the muscle adhesions I mentioned (which feel to me like massaging an exceptionally durable Nestle’s Crunch or Kit Kat bar) seem to have been worked out.   So in a few days, I can consider this whole thing done.

I am so incredibly excited to get back to pain-free, worryless running.  I checked back in my log and the first mention of this was on Sept. 12 (though by then, it’d been about a week from the first sign).  I wrote “Not liking my quad.”  What a harbinger of crap to come.

SFX in 3D – A cool link
As you know, I spent many hours reading about stress fractures, stress reactions, MRIs, personal accounts of sfx patients, medical studies, etc.  Through all that, I acquired a good collection of cool links on the subject.

One of my favorites is this page. If you scroll down, you’ll see some excellent 3D models of fractured bone along with their matching MRIs – the 3D models illustrate what stress fractures look like better than any words or medical tests can describe.  Even if you ignore the MRI images, I think it’s good to understand this stuff and see what it actually is, for curiosity’s sake if nothing else.

Spring Destination Race!
Thursday, my friend Jackie from San Diego called (recall, she and Louis were my wonderful hosts for last January’s Carlsbad Half) to tell me the Carlsbad 5000 would be on sale the next day for $19 and would I like to come and do that race? I thought about it for a 10th of a nanosecond and said Hell Yes!  Not only do I savor any chance to hang with my beloved SoCal friends, but this particular race has been on my radar for a while.

The Carlsbad 5000 is billed as the “fastest 5k in the world” though not for the course (which isn’t as flat as the website would have you believe, Carlsbad rollers and all) but for the competition.  It’s a major event!

The deal is, it’s not a single race; it’s a morning’s worth of 5ks starting with the Male Masters, then the Female Masters, then Wheelchair, then separate Male and Female 30-39, a walk, mixed Open and finally at 12:15, separate Men’s and Women’s Elites.  So you’re only racing against your peers! How cool is that?!

Doubly cool is that once I decided to do this race, my Spring season emerged. I’m going to skip doing a Half and really focus on 5ks – finally take a proper stab at sub 20.  I’ll likely also fit in a 10k, maybe a 5-miler and probably the Broad St. Run (10-miler).  Then next Fall will be for something longer.

This is cool because I get to resume where I left off pre-injury, experimenting with a heavy race season with the added benefit of having more time to get into it.  Also, taking what I learned from this past year’s base-building, I’ll add strides and fartlek earlier so speed will be closer when the dedicated workouts start.

I learned so much this year, from taking that 2-week burnout break, to running without workouts which lifted the mental pressure which led to the mileage build and now I’ve got doubles to explore…  It’s like being at an amusement park with a roll of free tickets but without the inbred carnys.  Tons of fun ahead!

The first 2 weeks of this thing, I sat. Really didn’t do much more aside from limping strolls to the store or post office.  A week ago last Sunday, all the ouch was gone and I could walk normally…well, normal but feeling mental about it: taking fragile, measured steps, hyper-aware of how each foot-fall felt.  What a headtrip.  Of course, it could have had an actual physical basis, maybe limping around for a couple weeks leaves a vestige of instability, but I suspect it was partly me being kooky in the head.

Last Wednesday’s stroll to the MRI was the farthest I’d walked in 2 weeks, the hospital being 2.75 miles roundtrip. I made the trip 3 days in-a-row thanks to picking up the disc and then the next day, the results.  The mental thing (or what I perceived to be mental) dissipated more each day and by Friday, my legs were mine again. (probably helped by knowing where I stood finally after the doctor visit)

The doc said I could walk as long as it didn’t hurt, so every day I’ve been enjoying a stroll in the park.  This has made the waiting game about a trillion times better, getting to enjoy the fall colors and sneaking in some people-watching.  It’s a pretty great consolation prize.

I’ve been going for 3-4 miles (4 takes me around an hour or so) which is also taking the edge off me becoming a porker from inactivity.  The food thing isn’t too bad, I’ve gained a couple pounds and this included two junk-food I’m-a-pathetic-loser-sniff-sniff days.

Back to the walks…  It’s funny that while there’s a perfectly good sidewalk on the way to the park, I always stroll on the road between the parked cars and the bike lane, because that’s my running trajectory.  And my wrist has only just lost its magnetic quality that makes me want to look at it whenever I pass a mile marker.  I can still feel the Garmin pull, but somehow manage not to follow through.  Makes me smile, though.

As far as interactions, yesterday, a grizzled character from the park with whom I’ve exchanged nods and smiles for over 2 years, though have never spoken a word to (white-haired shirtless kerchief guy for my local friends, the bigger one [because we have 2 in our park]), was stretching as I walked by.  Took him a sec to realize it was me, then he asked how I was doing and we had a short but friendly conversation.  It’s wild how you can pass people for that long and they become “real” in an instant just by having a voice and a few facial expressions.

Today, I was downright beggarly.  I’m not recognized easily with my hair down and in civilian clothes, walking, so when I passed this one walker who always exchanges Hi’s with me, I pretty much had to yell across the path “HEY THERE” just to get a hello.  Lol.  I was kinda needy this morning.

The Next 9 Days
I’m finally gonna start doing my Pilates DVD today, shame on me for waiting but I haven’t felt like rolling around on the floor.  I don’t have any time to lose though, need to shore up my muscles before I get out there again.

The other thing is that the muscle adhesions the ART lady worked on, in the area where this whole thing started, are still there.  After my tennis-ball self-mauling groin incident, I’ve been really nervous about doing any self PT and laid off completely for a week.  I just resumed but in a much lighter way, no more vigorous “get thee demons out of my body!”, more like a gentle coaxing.

I’m also using the regular foam roller for the main deal, the trigger-point one only sparingly.  If I feel like there’s still crunchy stuff when I start back to running, I’ll go to the ART lady again for one more session.

An Annoying Thing
…is looking up race results from the races I missed while injured.  This’ll sound assholey (woulda coulda shoulda) but I would have won first AG in all of them, even that major Bridge 10k race last weekend.  I’m not seriously bummed but it would have been a fun streak.

If I did want to get bummed, I’d add up the race fees I paid of the all those DNSs, but I’m not gonna.  It’s all funny anyway, no matter how aggravating this period has been, I can’t not see the humor in it.

A Supremely Sweet Thing
An online friend whose posts I’ve always enjoyed (he’s got that funny/smart thing going on) but whom I don’t even know that well, did something that totally blew me away; he sent me an iTunes gift certificate so I’d have some new tunes when I get back on the road.  It made me tear up when I received it, so unexpected and touching.  Thanks again G, that was a super-dude move.

And that’s it for now.  Lots and lots of words to describe how nothing’s going on.  How does she do it?    Have a great day, folks.

On Friday afternoon, a few hours after the doctor called with the test results, I walked over to the hospital to get a copy of the MRI report for myself. I wanted to see exactly what it said.

What is said was “The femur demonstrates normal signal intensity without bone marrow edema…”  Normal.

Seeing this conflicting information in black and white, I couldn’t help but wonder about the hierarchy of medical knowledge: Does a radiologist reading an MRI make a more accurate diagnosis than a doctor looking at an MRI…or vice-versa? It seemed possible that a radiologist’s specific experience and education might produce a more reliable assessment.  And if that was the case, perhaps I could consider splitting the difference in remaining rest time – cut it from two weeks to one.

To be clear, I genuinely like, respect and trust my doctor, but this was a first for me: opposing views on a major medical test.  So I posted the situation on Facebook to see what people thought.

Within minutes, I received a barrage of emphatic replies, totally well-meaning of course though largely dismissive, as if I was being childish or irresponsible for considering anything other than my doctor’s original plan.

Meanwhile, I’m sitting there with the radiology report in hand, personally acquired from the Medical Records dungeon of Hahnemann Hospital, that says my femur is normal.  Wouldn’t it be natural to wonder about this?  I would think it’d be strange not to weigh it out.

Anyway, as the replies swarmed in, the general consensus was clearly unanimous, so I wrote “Thanks everybody, got it, I’ll stick to the original plan” but the replies continued, some with INTERNET YELLING and it was getting me down in a big way – like I’d killed a puppy or something – so I deleted the post to make it stop.

My takeaway was this: 1. Radiology reports can be wrong so I should assume mine is because 2. Doctor’s opinion > radiologist’s.  OK, case closed.

On a lighter note, I neglected to mention that on Wednesday night, while I was strapped to the table of the MRI machine, feet taped together, clutching the emergency “let me outta here” bulb while those deafening clangs filled the room like a scene from a sci-fi movie (albeit an enormously boring one), I farted.  Twice.

And while it was happening (god, I really did fight to keep it inside), I had a genuine worry that the passing of gas – or more particularly, my vibrating butt – might ruin some of the images, rendering them blurry and unreadable.  In fact, now that I think about it, maybe that’s what those spots were on the MRI: artifacts introduced from letting ‘er rip.  Fartifacts.

I think I’ll ask about this on Facebook…

Oh, before I do, please everyone, do me a huge favor and don’t tell me in a comment anything like “better safe than sorry, why risk it, you really should take the full two weeks, what’s the hurry, don’t rush it, definitely follow your doctor’s advice, please be careful…” or anything along those lines.  It will only make me want to kick you in the face.

No fracture, whew.  The report from the radiologist won’t be available till later today or Monday, so there’s a slight possibility the diagnosis might differ, but “stress reaction” is the doctor’s determination.  EDIT: just heard back from the doc, the radiology report doesn’t even say stress reaction!  But the doc thinks I should continue as planned, so I will.

It’s a spot on the upper third of my femur that I’d already noted on the MRI yesterday, so it wasn’t a surprise (I kept it to myself since I don’t know shit and didn’t trust my observation).

On the left is my hoo-ha. Many thanks to Kristin for providing hours of hoo-ha humor.

This is a not such a bad result; since it’s only a reaction and I’ve already completed 17 days of rest, I only need to take off 2 more weeks.  I can handle this, no problem! (FYI, stress reaction is the precursor to a stress fracture, run on it long enough and it will become a full-fledged sfx.)

After my 2 weeks of rest are over, I’m to start at 25% of my mileage (working off 90mpw) and increase around 10% per week from there.  I love my doc.

The doctor btw, is totally cool with the mileage volume I was doing, never once raised an eyebrow or suggested I alter it.  Today, I asked him about my theory, if it could have started with a simple muscle strain that grew from lack of attention.  His response was “Absolutely!”  though not because of muscle pulling on bone as I envisioned (a la shin splints), but because the muscle tweak started affecting other muscles and that would have altered my gait.  So mechanical, but situational.

It’s wonderful to get that confirmation, it means I don’t have to worry about this happening again, there’s nothing inherently weak or that needs changing.  I just have to deal with it earlier – if I can’t find the problem myself, call the doctor at the start.

As for the next 2 weeks, I’m not going to join a gym.  He wants me to avoid lower body stuff anyway, so I figure I’ll do my pilates and yoga dvds just to feel like I’m doing something.  Lost fitness is not a pressing worry since I have the winter to regain it, though my friend Jackie has put the notion of the Surf City Half on February 5th in my mind, so I’m toying with that.

The other cool thing about the timing of this is that in a month, I’m going to Vegas for the Half and would have gone whether I could run or not since it’s going to be a huge gathering of beloved forum pals.  But here’s the deal, some of those crazy pals will have spent their morning doing another full marathon, then hopping on the plane to run Vegas (it’s a night marathon).

My friend Matt is one of those doubling kooks, but he’s doing the Vegas Half for his second race.  He plans on going reeeeeal slow (like 9min/mi) since he and the rest of those crazy cats will be hurting.  This works out perfectly for me: I don’t have to worry about fitness loss or pounding my legs – it’ll be a fun and funny run with someone I adore.  I imagine lots of alcohol will be involved.  Good times.

I’ll close with more thanks to everyone for following this soap opera.  You kids are great.  Later, gators.

First off, a big thanks to all who responded to my question from Sunday’s post, both here and privately.  I received so many informative stories and experiences that went far beyond the initial question but were all fascinating.  What I learned from it is that there are tons of variations for symptoms, pain levels and layoff time, thus you really can’t compare anything.

Walking around these past few days, feeling like a healthy normal person again has been troublesome for my emotions.  It’s one thing to be sidelined when you’re in pain, you know full well that resting is the sensible thing to do.  Once you feel good again though, it’s like “How can I possibly need more weeks off?  It can’t be that bad”.

I admit to asking my friends in the 3:20 thread that, if I didn’t get an appointment and have a diagnosis by the end of the week, would I be an ass to try a test run on Friday?  I got a good mix of answers for yay and nay, but in the end, I was hugely relieved when the insurance came through yesterday so this isn’t even in my psyche to consider.

I would have chickened out anyway.  I haven’t even run across the street in two weeks, that’s how paranoid I am.  Besides, from all the responses to my question in the last post, I know full well that just because it doesn’t feel like anything doesn’t mean shit. It was just me being hopeful for a day.  Since then, I vacillate through hope and resignation every few hours.  It keeps me busy.

Last night, I prepared myself for the worst and figured out the gym situation.  The swankier club in my neighborhood has a trial month for $30 so that should cover most of the remaining time off, should it come down to that.  FYI, today is my 15th day of rest.

The MRI is at 5pm today and I’ll have the full report on Friday morning at the doctor’s appointment.  In the meantime, they’ll give me a disc with the images.  I’ve been Goggling MRI images so I have a clue about hot spots and how they appear.  It seems pretty straight forward on bone: if it’s a dark image, there’ll be a light spot and if it’s a light image, there’ll be a dark spot. Please, let there be no spots.

Btw, I have to apologize for dragging this thing out, I had planned not to post anything till Friday when I had the final word but I’m going a little stir-crazy from waiting (the last two weeks have been all about waiting), writing a post is a cathartic time-waster.  I’ll be back in a couple days with the dealio.  Wish me luck.

I’m beginning to think this is not a sfx after all or if it is in that family, maybe it’s his friendlier cousin, stress reaction.   It’s day 12 of rest and I just went for a walk to the park, about 2 miles, and had no pain or need to limp.  Also, the testing stance that has elicited a twinge since this thing began gives nothing.

Most happy-making is that descending stairs, which has been a no-fail way to get a grimace or 12 outta me for weeks now,  doesn’t produce a thing.  It’s weird to automatically brace myself for that first step only to find nothing bites and I can just walk down the damn things.

So now it’s a waiting game for the MRI appointment (hopefully insurance will let me call for one tomorrow).  If, knock on wood, the results are clear and they tell me what’s what over the phone, I might cancel the 5 minute appt. on Friday, since between co-pay and getting a car it’ll be about $65, though I’d still stay off it till the end of the week.

OTOH, I am interested in seeing the MRI if there’s something to see (not just for worst case scenario), so if there’s some crappy stuff to look at, I’ll go.

Speaking of moolah, for interests sake, here’s the lowdown on the cost of this.  I have an HMO through Aetna so the specialist copay is $50 and if I’m reading the plan correctly, it’s $50 for x-rays and $250 for an MRI.

Money aside, I’ll never put off calling a doctor again for something like this again.  I’m kicking myself for not doing it 6 weeks sooner but my aversion to (what I thought would be) red tape was enough to put me off.  Had I known how straightforward the process was…anyway, lesson learned.

But I’m getting ahead of myself since it’s still up in the air.  For now, I’m just thrilled to finally be wince-free.

Soft Tissue vs SFX
I’ve read in numerous forum posts over the years and well-meaning folk have said to me that perhaps a sfx is not worse case scenario because at least it’s over in a finite amount of time.  I can totally understand this reasoning and have even offered it to friends who’ve had sfx’s as an “upside” because compared to chronic or serious soft tissue injuries like plantar fasciitis, achilles tendonitis, a Grade 3 muscle/tendon tear or an issue that never gets properly diagnosed then yes, a sfx is definitely preferable.

But here’s the dirt on a femoral sfx:  providing everything goes smoothly, there’s generally about 4 months from diagnosis till running semi-regular mileage after a slow, drawn out ramp-up in the 3rd month.  The road to return is usually accompanied by tons of self-doubt, fear of reinjury and an ongoing sense of fragility.

In contrast, a non-chronic, non Grade3 soft tissue injury, when given time to rest/heal, will usually resolve itself within a period of weeks, not months.  I know I don’t have a Grade 3 injury and it’s highly unlikely to be chronic since the ART lady gave me immediate relief and my current state is pain-free. Thus, I’m sticking to my “hope this is soft tissue” druthers.

If it is a stress fracture
I don’t think it’s my shoes, my gait, the surfaces on which I run or even my mileage (caveat below) that caused it.  You can tsk, tsk in your mind and I know some will, but I’m convinced that the underlying cause was a muscle strain that grew out of control, the way shin splints can cause a sfx on the lower leg.

I can easily find that set of affected muscles now but I couldn’t then.  So the next time I can’t locate the source of a problem, I’m not going to hope for the best, I’ll call a doctor.  Period.

As far as mileage, I don’t think the level I reached was to blame and I’m raring to get back to it.  However, the mileage I kept after the injury had been planted…that was greediness and I screwed up.  I should have been happy with 5 miles a day but I kept pushing the envelope till it tore.  I take full responsibility for that.

In my defense (defending myself to myself, lol) I’ve had 2 real injuries besides this one: ITBS and an ankle injury.  Both lasted a couple months but I was able to run through them.  I thought I could do the same with this and perhaps I could’ve if I’d cut back more sensibly.  But I didn’t. Live and learn.

A Question For Those Who’ve Had Stress Fractures
What is your experience with declining symptoms?  Did your symptoms disappear soon after you stopped running or did they last a few weeks? I know everybody’s different but I’m looking for masochistic ways to kill time, so this question is a good start.