The Injury Chronicles: Ever Onward

Warning: rampant navel-gazing ahead. Proceed at your own risk.
 
Apparently, David Ortiz of the Boston Red Sox has decided he's going to take the, "play through the pain" approach to his strained Achilles tendon, rather than having ultrasound therapy. While I'm not so sure I agree with his approach, I can certainly understand his reasoning (and it doesn’t have anything to do with the fact he has millions of dollars in an arbitration year riding on it). My sports therapist recommended ultrasound therapy for my "left peroneal tenosynovitis", which is the ultimate diagnosis we reached now that the stress reaction is healed. Coincidentally, my physical therapist pointed out that this is the same injury that caused Ortiz's teammate, Curt Schilling, to grace the world with his bloody sock.

Lucky me.

I think what's bothering me the most is that by most accounts, this is the type of injury that usually takes 6-8 weeks to heal, even at its worst non-surgical diagnosis. Yet here I am, now 15 weeks out from my last long run, and after 4 minutes of slow interval running a week ago, I still routinely feel like the outside of my ankle and foot are on fire. I'm doing everything right. I've been dutifully forking over what has now amounted to a small fortune in copays, popping Aleve like it's candy, wearing only supportive footwear and the world's ugliest compression sleeve and turning every frozen vegetable in the house into an ice bag. I do my exercises diligently, I go to physical therapy and I check in with my sports therapist whenever she tells me to. I've had all the x-rays and an MRI. I have an appointment with a stellar podiatrist on Monday, and he's really my last resort. It’s basically a given that he's going to prescribe custom orthotics, to the tune of $500. I'm doing everything I'm supposed to do and it isn’t solving anything.

It doesn’t seem fair, but that’s life. In the words of my Gramma (and some wise sage well before her), “it is what it is.”

I know a lot of people think I'm crazy, that I should just throw my hands in the air and give it up already, just accept that I'm not cut out to be a runner. Believe me, that thought has crossed my mind more than a few times over the past year. The problem is that the damage is already done. I can't walk for long periods of time, get out of the saddle in spin class, use the elliptical or the stairmaster or wear flip flops without pain. My beloved Zumba classes are out of the question. More importantly, I can’t even stand for the amount of time it takes to do the dishes without paying for it later. And so I sit here, 11 pounds heavier in body and a thousand times more in spirit.

It has never been a secret, to me or anyone else, that I have a problem prioritizing my personal goals outside of work. I always have, and that's part of the reason why I bounced back pretty quickly from my disappointment in my BAA half training and results: sure, I hadn't run the time I trained for, but I was proud that I committed to something and, four months later, saw that commitment through. It was the first time that has happened in almost as long as I can remember. I dream big, but I'm usually afraid to act.

I know that it’s time to start figuring out what other goals I can pursue outside of running. Grad school, home decorating, travel, writing, weight loss – these are all goals that I’ve vowed, time and again, to really commit myself towards achieving. A lot of the problem lies in trying to take on too much at one time, leading to burnout and episodes of anxiety that aren’t any fun for me or anyone around me.

Maybe this injury is a sign to start focusing on something else, something that can both divert my attention and give me a sense of fulfillment. Dedicated GRE study time, expanding my craft corner, an actual writing class, a website tutorial … these are all activities that I plan to ponder over the next few weeks. I’m not sure where I’ll end up, but it’s a start.

As my Gramma was also fond of saying, “Ever Onward.”

The Injury Chronicles: Part Two

This morning, the 2012 BAA Half Marathon sold out in an hour and fifteen minutes.

After a lot of thinking, hemming, hawing, whining, drinking and thinking some more, I made the decision not to enter this year. It sounds like it was a hard call, but really, it wasn't. The fact is, while there is a good chance I would be physically ready and able to run 13 miles by October 7th, mentally it could would be a disaster.

Why? Because frankly, I'm scared to start running again. I'm scared of the huffing and puffing and the snail paces on the clock. I'm scared of the blisters, the band-aids and the bloody socks. I'm scared of the ice baths, the endless energy shots and the Costco-sized gallons of Gatorade that threaten to overwhelm my (tiny) fridge.

Mostly, I'm scared of pushing too far, too fast. Of hurting myself all over again. Of running my feet, quite literally, into the ground.  

I started physical therapy last week. Despite being surrounded by medical professionals for most of my adult life, I was still really intimidated by the prospect of having a qualified professional watch my every move and then instruct me on how to fix whatever I did incorrectly. What if I was, I don't know, bad at it, thus hindering my recovery to the point of never being able to walk, let alone run, again? (You probably think I'm kidding, but Andrew will vouch that I have these kind of reactions often. I'm nothing if not consistent in my paranoia and fear of judgment and failure).

During my assessment, my PT echoed the thoughts expressed by every doctor I've seen; I have a really flat right foot and a really, really flat left. He even went a step further and said that the left arch has entirely collapsed. Like all those before him, he assured me that this is not my fault, that it would have happened in due time anyway, that running just accelerated the need for a good podiatrist and custom orthotics. Like my sports med doc, he thinks that the stress reaction itself was likely a result of severe overpronation and that  the trauma of whacking my foot was just a catalyst, the proverbial straw that broke the camel's back (or almost broke my ankle, if you will).

Thankfully, he also used the phrase, "already turning the corner" and gave me a referral to a very highly-regarded podiatrist, whom he guaranteed would not give me the one-glance-and-done routine perfected by the last pod I saw. Unfortunately, said M.D. is unavailable to see me until August 20th, which is a really long frickin' time from now. In the meantime, I've been a good little doobie, paying thrice-weekly visits for electrostim, massage, stretching, strengthening and ice. I do my little exercises three times a day (err... I try, anyway), tying my little rubber band to a desk chair and miming the alphabet under my desk. And, to the horror of most women I encounter, I have abandoned all sense of fashion and overhauled my collection of summer footwear.

Tangent: This is week 11 of wearing sneakers. Did you hear that? WEEK ELEVEN! OF SNEAKERS! I admit to a minor indiscretion involving a pair of three-inch wedges and the occasional fling with flip flops, but for the most part, I've been wearing holes in every pair of pseudo-supportive sneakers I own. And by that I mean I've been purchasing every kind of over-the-counter insoles known to womankind in the hopes that they will somehow miraculously provide the arch support my failing feet crave, thereby saving me several hundreds of dollars next month. So far, no dice. By the time I'm done I will have amassed enough CVS Extrabucks and CitySports Rewards to finance my entire apparel-shoe-sock-and-gel budget for a year, let alone pay for custom insoles. But I digress.

Today, the 2012 BAA Half Marathon sold out in an hour and fifteen minutes, without me.

And I am relieved.

The Injury Chronicles: A Run To Remember or, That Time I Booted

As I alluded in my grand re-entry to blogging, I've been rocking some really fancy new footwear off-and-on for the past month or so.

I've also been on a bit of an emotional roller coaster, as the only effective stress reliever I'd found that didn't result in a pounding headache was cruelly ripped out from beneath me. Granted, it's not like I lost a limb or anything, and in the grand scheme of my life it's just a blip on the radar. Basically, I'm going to take the opportunity to prattle on simply because I can (and all of my other friends and family are sick of hearing about it). So, if reading about running or my privileged problems isn't your bag, feel free to skip this one. I'll understand.  

And now, my pathetic tale of woe.

I know at least some of you were reading a year ago, when I started training for the BAA Half Marathon. A few more were reading when I actually ran it in October (and by ran, I mean shuffled).

I was proud. I was defeated.

A week after the race, I went hiking with a few of my friends that are also recreational runners. At one point, while discussing my crash-and-burn the week before, my friend mentioned that Boston's other big half, the Run to Remember, is touted as being a bit easier than the BAA, while still holding the elusive challenge of 13.1.

Those who aren't local or aren't into running might not know that the "new" BAA course is known for its psychological brutality; apparently somewhere along the line the race organizers said, "Hey, you know what?! We're known for running one of the world's most notoriously tricky marathons, let's make our half match!" As such, they designed the course to be 4 miles of mostly downhill on Suicide Alley, aka the Jamaicaway, followed by 5 miles of gradual incline past Jamaica Pond, which you can't see because of a wall of trees. A brutal cross-back over the sweltering hot bridge with a view of Forest Hills brings you back to Franklin Park and the 9-mile mark, where you get to endure 2 miles of flat loop on a sketchy golf course, a mile of steepish incline on a transit road, a mile through a God-forsaken zoo, and, just as you see the banners and balloons and think to yourself, "OH THANK GOD! THE PROMISED LAND!", you realize that some asshole decorated the 13 mile marker and you still have to run .1 around a track while an overcaffeinated announcer bellows your name.

In contrast, the R2R course is comprised of rolling hills, but it's Boston, so anyone that runs here regularly is used to that. It starts at the World Trade Center in the beautiful Boston seaport, runs through the shiny buildings of the Financial District, over by the historic Garden, over the river into Cambridge, then runs basically flat (minus a few bridges) for five miles in a loop along the iconic Charles River. Loop back over the bridge, run around the Common in full bloom, cut through the Downtown Crossing area back to Southie and you finish back at the World Trade Center, collecting your medal against the backdrop of the gorgeous Boston Harbor.

Rough view, no?

Not that I'd know, or anything.  

That's because on a gloomy Saturday morning back in the beginning of April, I bounded out of bed at 7am, stoked to go on a nine mile run. Obviously, there was something already wrong, because 1) I don't bound. Anywhere; 2) Least of all at 7am; 3) And definitely not for nine miles' worth of torture. I'm actually pretty sure that I had a mild hangover, if we're being honest, but for whatever reason, I was STOKED to start my run. And therein lay the problem.

In my haste, and by that I mean in my laziness to reach my arm approximately 12 inches to put on my glasses, I terribly misjudged my bounce. And then all I remember is an explosion of pain. Ankle, meet iron bed frame. HOLY. HEAVENS. I haven't felt such agony since the time I stood up too fast on a tour bus and hit my head so hard I literally saw stars. I stood there for a few minutes as tears stung the back of my eyelids and bile rose in my throat. Faster than I thought possible after an episode like that, though, the pain began to dissipate and I decided to wait a few hours, ice it and see if any bruising or swelling happened. 

It never did.

So, three hours later, off I went on my nine-miler which, coincidentally, turned into a 10-miler because I'm a math idiot and miscalculated the distance it would take for me to get home. I was happy with my time and over all, I felt good. I did my usual post-long run stretch, ice bath, shower routine, got in the car, and drove up to NH to spend Easter with Andrew's family. No harm, no foul.

As the week went on, I started noticing a bit of stiffness happening in my left ankle after short runs, but didn't really think anything of it. It was a drop-back week anyway, so the furthest I went was five miles. I knew I was pushing my shoes, the very same ones that caused so much drama in the BAA half, to their limit as far as wear and tear -- and by that, I mean the foam on the back of the left one had completely worn out. So, I started with what any runner does when leg pain starts: I bought new shoes.

[Source]

In a brand spankin' new pair of Brooks Ravenna 3s, I did a few shorties, an 11-miler ending at the finish line the day before the Boston Marathon, PR'ed a 5-mile race, and did a leisurely 9-mile run with Andrew. Unfortunately, I had to take more and more time off between them to recover. The crazy thing was, it didn't hurt AT ALL while I was running, save for the occasional twinge of discomfort and, well, what one would expect while running 11 miles. It was only afterwards, typically the next morning, that I would get a dull but persistent ache right above my outer left ankle bone. RICE became my best friend. The only cause I could think of was the new shoes; I honestly forgot that I had ever whacked it three weeks before.

And then, one day on a 2-mile treadmill jaunt, the area right above my ankle bone started to sting. Obviously, this paranoid hypochondriac had been WebMDing and Runner's World Forum-ing every twitch and tingle, so I immediately got off the damned machine and stretched my lower leg out. It felt a bit better, and I had no pain at all as I walked out of the gym. The next morning, however, was another story; I could barely put any weight on it and couldn't make it two feet without wincing from pain shooting up the outside of my leg. At that point, I called the doctor and made an appointment for the next day.

With four weeks to go until my big "Revenge Race," I went to a GP at my office's urgent care, who ordered x-rays and a walking boot. The x-rays were negative but the pain persisted, so I scheduled an appointment with a Nurse Practitioner specializing in Sports Medicine and non-operative injuries. After feeling along the bone and realizing it was an extremely localized pain, she diagnosed a stress reaction (fancy name for "bone bruise"), but would not rule out the possibility of a fracture. I'm planning to do a follow-up post on this stuff, but I was blown away by the care I received -- I walked in there expecting to be told to quit running for months and scrap the race, but instead I found support and a solid plan: 7-10 days in a walking boot, a short test run, a follow-up appointment, another test run -- all with the hope of being able to not only start, but finish, my 13.1.

Boot, Elevation, Ice... check!

As you might have surmised, it didn't work. I did a short run the week before the race and while it felt amazing mentally to be pounding the pavement, my ankle still ached enough afterward that both my NP and I weren't convinced there was not a small stress fracture lurking deep in the bone. With that in mind, I made the incredibly hard decision to skip the Run to Remember to let it heal. My Memorial Day weekend was bittersweet; Andrew made sure to get me out of the city and down the Cape, but I still shed more than a few tears over the lost opportunity of seeing all of my hard work and training finally pay off.

I'm actually still in the walking boot as I type this -- when the ache didn't fully go away, I called my NP back and we scheduled an MRI. Thankfully, it turned out that her original diagnosis was right on the money: a lateral tibial stress reaction, rather than a stress fracture. For obvious reasons, that is great, but there is a down side... bone bruises can oftentimes take twice as long to heal as actual fractures. There is also a bit of fluid in the area, and the MRI indicated mild tendonitis, although we aren't sure if that is secondary due to the primary trauma or because my gait has been whacked out since I got hurt. Today is Day 14 in little Bootsykins, although I am going to keep it on for a few extra days because I was a bit, err... lax with it on vacation last week (Like there was ever a chance in hell I was going to wear it to the beach. Right.). I actually have to call and make an appointment for physical therapy later this afternoon, as well as a follow-up with my NP. She thinks that, with any luck, I should be back to running again in about five weeks.

To be honest, at this point, I'd be happy just to walk. But I have big plans once this thing is gone:

I want to go to there.

Revenge Run: Double or Nothing.

Rumplestiltskin Ain't Got Jack

Today, I took my first spin class since I started half training. Oh, and lest you be confused, I haven't started training for any 2012 halves yet; I'm referring to the one I ran in October.

So yeah, since June.

Spin was always one of those mysterious feats of athleticism that I planned to view strictly through the paned glass in the group studio door. As if my crippling fear of looking like a jackass during group exercise wasn't enough, the horror stories alone were enough to keep me away  -- people who had taken an introductory class and been unable to sit for a week, coworkers who burned off half a box of Dunkin's finest in a single session, friends from the weight loss forum I used to haunt who relayed stories of how little estuaries of sweat pooled into "Lake Username" beneath their bikes.

If you hadn't guessed by now, I'm kind of lazy. I prefer to maintain the use of the tree trunks attached to my hips. I believe that anything that burns 650 calories in an hour should be illegal. And the prospect of a "Lake Caitlin" forming beneath me? Thanks, but no thanks.

And then my good friend, the same good friend who would later convince me that 13.1 miles was a good idea, talked me into attending a lunchtime class with her. And by that, I mean she threatened to go over my head and blurt out to my boss that we were going spinning. Nothing says "workout motivator" like a little corporate passive aggression.

Yes, my ass hurt; no, I couldn't walk afterward. I burned 550 calories in that first class and had a little great lake to call my very own. And I loved it. I went twice a week for almost a year after that first class, when my schedule allowed and the stars aligned over my lunch break. And then that same friend who introduced me to this burgeoning love of my life sadistically ripped it away and made me start running.

How rude.

Since it has been three months since I ran anything over a 10k and my hips' expansion is currently giving the national inflation rate a run for its money, I declared today the day that I took back spin. After scarfing leftover lemon basil chicken pasta, I marched my (not so) little bum across the street, planted it in the saddle and spun like Rumplestiltskin*.

During that 55 minutes of glorious torture, I had a chance to refresh my memory regarding the top five lessons I have learned about spinning. In the event that anyone reading wants to bring this special kind of hell upon themselves, I thought that I would share what I wished someone had told me before I started.

Five Facts Someone Should Have Told Me About Spinning

1. If you have a lunchtime class that is scheduled to last 55 minutes, negotiate with your boss to take a 75 minute break. 5 extra minutes to change and claim a bike; 15 to rinse off and get dressed. The extra 20 minutes of work is worth it.

2.Some well-timed Michael Jackson can make all the difference.

3.Phrases such as "I love you," "will you marry me?" and "it's a girl!" are overrated. The best words in the English language are "Back in the saddle."

4. You might not think you need to rinse off after, but trust me. No one wants to be the stinky kid!

5. Sorry, Al Gore. The internet is snazzy and all, but dry shampoo is the greatest invention of our time. Perfume samples are a close second.

Yes, that about sums it up. Of course, the usual lessons that other people always go on and on about probably apply too; I'm sure that padded shorts, clip in shoes and a nice expensive gel seat cover probably all make the process a little bit easier. I wouldn't know, because I prefer to take my exercise with a side order of pain. 

Now excuse me while I go unclench my hamstrings.


*I am aware that Rumplestiltskin partook in a different kind of spinning. I was once in an ice show based on classic children's fairy tales. Plus, I've seen every episode of Once Upon a Time, which totally qualifies me as an expert on the matter.