Injury, Doctors, and My Savior

I must say I’ve been one lucky runner when it comes to avoiding injury. I haven’t had a major injury that has set me back for longer than a few weeks. Dear body, please do not interpret this as a challenge.

When in training, I’m very good about listening to my body and taking it’s cues seriously. Of course, like many other stubborn athletes, I am one of the worst offenders of this ever-so-true but common runner behavior.

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However, I rest when I should, strength train, stretch almost consistently and appropriately, and have cleaned up my eating habits, treating my body as any well-maintained machine should be treated. Sure I get occasional aches and pains, but nothing too worrisome.

I’ve only had two notable injuries that kept me temporarily sidelined, one being a blown out knee that reared it’s head at mile 10.5 of my first marathon. At the time, the pain had been hit or miss, but when it came on during my race, my knee locked up, unbending, and any attempts to force it left me with a pain that can only be described as ripping. That meant for a very lonnnnng, pain-filled race of “stop-and-stretch it” moments every few minutes over the next 15 miles. At the time, I had jumped on the IT Band Syndrome bandwagon, certain that was my problem.  Then, as I hobbled to the curb for yet another stretch stop, my Mile 24 Angel saw me and asked the magic question “Is it your IT band?” When I nodded tearfully, he asked “Do you want me to stretch it for you?” Ever-so-grateful and desperate as can be, I nodded and lied down on the sidewalk while a complete stranger tended to my wounded knee. After much resistance and stretching and no relief from my pain, he told me it wasn’t my IT band but my ankle causing my problem. He removed my shoe, adjusted my foot, told me I needed to see a chiropractor, and sent me on my way to cross the finish line.  That day will always remain one of the best days of my life.  

A week later, I had a previously scheduled appointment with my family doctor, who, upon hearing my marathon story, told me what I really needed was an orthopedic specialist as chiropractors were more about stretching than treatment. I decided to heed her advice, and within two weeks, I was sitting on the examination table of one of the “best sports injury doctors/orthopedic specialists” in the Pittsburgh area.  After looking at my X-rays and playing with my knee, he puts his hand to his chin and says “I think you have IT band syndrome.  I’m going to prescribe you a stronger anti-inflammatory. Take one of these before your longer runs.”IMG_1434

What?! He was heading down that route? Wait. Anti-inflammatory?  That went against everything I’d ever learned about running injuries.  Being the assertive voice that I am, I inquired.  “Wait. I thought that was one of the worst ways to deal with an injury. From what I’ve learned, when the pain signal is blocked by medicine, I won’t know when to stop and could possibly worsen the injury.  Isn’t that masking the problem instead of correcting it?”

He looked taken aback and countered, blinking, “Hmm…do you want to try physical therapy?”

Trying hard not to look appalled, I replied, “Is it going to help me?  I’m here so you can tell me what I need to do to fix my knee.  I plan on running for the foreseeable future, and I just want to get back out there.  How do I do that?”  

He wrote on his prescription pad as he went on, “I want you to take one of these anti-inflammatories 20 minutes before your long runs and go to at least six sessions of physical therapy.”

IMG_1848Shaking my head, I thanked him for his time and got out of there before I unleashed my not-so-rational aka injured runner’s  thoughts.  More frustrated than ever, I ripped up the prescription, tossed it, and drove home. Feeling disappointed in what was supposed to be a productive doctor’s appointment, I took matters into my own hands, and through many Runner’s World articles, countless medical research, self-observation and experience, I came up with my own conclusion.

I am an overpronator. Overpronation is an excessive inward roll of the foot after landing, such that the foot continues to roll when it should be pushing off.  This twists the foot, shin, and knee, potentially causing pain in all of those areas. Since I was already wearing the suggested stability shoe, I just needed to change my foot strike. Following a severe ankle sprain that left me on crutches many years ago, I had developed a habit of favoring my inner foot when landing. What I had grown accustomed to in an attempt to prevent another ankle fail had ultimately sabotaged my running form.

After several weeks of conscious efforts to adjust my foot strike, I created a new habit and slowly but surely, my pain started to dissipate. I also ended up taking my Mile 24 angel’s advice and  enlisted the help of a chiropractor, who did wonders for my pained knee and never once suggested medicating my pain. I went on to run two more marathons without problems, and have been pain-free since. I have had minimal problems since, minus the occasional ache or twinge when overdoing it on the hill work. Until now.

After taking the past year and a half off from marathons for a number of reasons, I recently felt the need to jump onto the Pittsburgh Marathon bandwagon at the last minute. With only eight weeks to train, I thought I would prove my superhuman powers and break the cardinal training rule and increase my mileage more than the suggested 10%. I have been running a minimum of six miles five to six days per week, not going much farther than eight miles. In an effort to get caught up in my training, I went out and ran 15 miles of rolling hills just to see if my body remembered how. I know – genius, right? IMG_1757Well, I pulled it off, but at a price. Enter outer edge foot pain and limping for the next day or two. The following week, I went out and ran 20 miles like a champ with no problem (except for the normal problems like the running wall that often come with that distance). Around mile 13, I had slight foot pain that quickly subsided. Upon finishing, I was thrilled to see that I had run 25 minutes faster than my last 20-mile training run in 2012. TWENTY-FIVE minutes!! I happily fist-pumped the air to celebrate my beast-mode accomplishment IMG_7170and excitedly headed home to recover/calculate my race day performance goals.

Satisfied that I was officially where I was supposed to be in my training schedule, the following weekend I hit the hills for 13 miles. After finishing, my foot pain returned with a vengeance, sticking around for several days this time. I decided to tread carefully and took the next four days off from running, and worked on strength training and stretching. On day five, the pain was almost gone, so I hit the treadmill for speed work, and afterwards, my foot was angry yet again. Not wanting to make the problem worse, I took another four days off until the pain was nearly gone, and as I set out for another 20-miler, I made it to 12 before the pain stopped me in my tracks.

Fearful of the consequences of my unwise training choices, I immediately packed my foot with ice and repeated those treatments throughout the rest of the day, staying off my foot as much as possible. I researched foot pain and performed my own tests on my metatarsals and tendons, becoming increasingly overwhelmed and frantic at the two possible causes my pain pointed to: tendonitis or worse…a stress fracture. 03836d3eAfter some tears and coming to the realization that I am not quite the superhuman I hoped I was, I knew I was indeed dealing with an overuse injury. A foolishly self-inflicted overuse injury. I thought of every risky behavior I had engaged in recently that could have contributed to this: my higher mileage shoes, trying out Yaktraks. Now just four weeks out from my comeback marathon, I found myself in a panic about what steps to take next. Fearing a stress fracture would sideline me for the next few months, I sadly pondered selling my marathon bib. Then my inner fighter unleashed it’s fury, reminding me that I needed to secure my “Runner of Steel” medal I so desperately desired. When I ran the Pittsburgh marathon in 2012, that title was one of my favorite parts of the race, and in 2013, they created a medal that reflected it. That was enough to get me to return to secure my own. It’s the simple things… 😉

After the frantic mind dust settled, and before resorting to putting my tail between my legs or even entertaining the possibility of having to pull out of my race, I decided to get help. I started with my chiropractor, who I felt would give me the guidance I needed and best route to recovery. 

The morning of my appointment, I was telling my school nurse about my woes when she offered to wrap my foot and ankle for me. Figuring it was worth a shot, I gratefully turned over my injured foot to her for taping. Ironically, it made my pain worse, but trusting her judgment, I left it on.

At my chiropractor’s office later that day, he removed the tape as he made the comment, “School nurses are good at what they do, but they don’t know anything about running injuries.” I felt almost instant relief once my foot was freed from the tape, and even more relief when he told me he was fairly certain that we were looking at a possible tendon issue and not a stress fracture. He didn’t even mention taking my marathon off the table, saying with confidence, “We have a month to get this taken care of.” He was careful not to guarantee my pain wasn’t the result of a stress fracture, given it could take up to six weeks for an X-ray to show it, but he felt strongly it wasn’t. He told me no running for a week, adjusted my foot and performed an ultrasound treatment, taking my pain level from an eight down to a four within an hour’s time. Besides the whole “no running” order, IMG_1398for the first time in over a week, I was feeling hopeful. A few days later, I started to feel lower back pain which gradually increased in severity. My chiropractor took all the credit, saying we probably stirred up some inflammation with the adjustments and that it would pass.

After three chiropractic treatments and a steady decrease in pain, I was given the green light to run five miles. He told me if I have no pain, I get to run another five the next day, returning to my doctor on Monday for further analysis. I improvised and took one more day off, then went out and tackled six hilly miles. I had zero pain but slight tenderness afterwards, but awoke to pain the next morning. When I returned to the chiropractor, he looked unconcerned and told me, “Go run 10 tonight and see what happens. I want you to build back up to 20 before the weekend.” Shaking my head, I told him that wasn’t what my training plan called for, and that I wasn’t going to risk my last 20-miler by pushing it too hard during the week. He shrugged, clearly not understanding how marathon training works. I went home and ran seven miles with minimal issues, but awoke the next morning to even more pain.

Disappointed, I returned for two more chiropractic treatments and took the next few days off from running, hoping the combination would help my problem and assure my pending long run would be possible. When my chiropractor started dropping comments like flawed running form and needing orthotics and several months of rehab after my race was over, my defenses went up full force. I informed him that, while I’m sure my running form isn’t perfect, I was certain it was not the cause of my injury, reminding him of my poor training choices. He tried to argue his biomechanics theory, which I immediately shut down, and we debated briefly before I finally said I stand firmly in my belief, backed by years of injury-free running days. Irritated, I left his office and canceled the rest of the week’s appointments, stubbornly clinging to the notion that I know my body better than anyone, and I refused to listen to one more word coming from someone who not only knew little about running, but viewed it as  “bad for you.” To each his or her own opinion, and while I appreciated the expertise he had in other areas, it was time for me to move on. 

By Thursday, my pain was back up to an eight, and I was feeling bleak. Once again, I was talking with my school nurse about my issue and wondering why the treatments stopped working. She asked me to let her wrap my foot again, to which I agreed, figuring it couldn’t hurt. I was wrong, because it did hurt. A LOT, but still I left it on. Later that night, I removed the tape again, and was shocked to find that when I put all my weight on my foot, I felt no pain. In fact, I had to really press on my foot to feel any pain or tenderness whatsoever. imageIt wasn’t my chiropractor who had helped my foot – it was my school nurse!

I set out the next day for the ultimate foot test: my last chance at a 20-miler before taper time. I attempted my own foot and ankle wrapping job, and while slower this time, I managed to complete my 20 miles with minimal foot issues. It wasn’t my strongest run, and it certainly came with its low points…but I did it.

On Monday, I gave my nurse several grateful bear hugs, thanking her endlessly for being my savior, and especially for taking the time to listen to and help me in the first place. She asked about my lower back pain, and I told her it was still gnawing at me, but it seemed to be worse at different times, and especially after running. She suggested it was related to my foot injury, being on the same side, and said it would probably resolve once I got back to my normal running form without having to compensate for the ailing foot. I shared my own theory, but being the wise one she is, I took her word for it and hoped she was right. She said something silly about me being crazy for running marathons, and sent me on my way. image-2

While my experiences are mine alone, I am living proof that a doctor’s opinion is sometimes just that. An opinion. And it isn’t always accurate. Sure they have a wealth of medical knowledge and experience that the average person does not, but that doesn’t mean they know everything. That doesn’t mean that you do either. My advice is to first listen to your body. Keep track of any changes you make in your running or workout and note how they affect you, and know sometimes the consequences aren’t always immediate. Seek help when you need it. When in doubt, get another opinion. I highly recommend those school nurses – they know it all. 😉 I ❤ you, B! And for heaven’s sake, refrain from taking foolish risks you know could lead to injury just to prove your superhuman powers. Save that for race day. 😉

Ready or not…Pittsburgh, here I come!

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