Injuries and the lessons learned
February 1, 2013
During a run this week, it occurred to me that my Achilles was not tight, sore, or achy. Wow! It has been 15 months since surgery and I can say it has finally healed. What a great feeling. Two months ago I thought I would always deal with a tight and aching Achilles. I thought it was my new normal.
It made me think about all the injuries over the years and the lessons learned from each one. Each injury changed the way I trained or approached training. I also learned patience along the way with a few tears thrown in the mix. The following is a run-down of my injuries over the years and the lessons learned. Some lessons are common sense that I obviously needed to be hit over the head with to learn.
Ankle sprain – everyone’s first injury in any sport
I learned from a sports medicine friend of mine to always be prepared. He taught me to always have a U and ace bandage on hand to wrap the ankle to keep the swelling up in the leg. The U can be made out of think felt, rolled up paper towel or a think towel. You put the bottom of the U under the malleolus (ankle bone) and use an ace bandage to hold it in place using tight wrapping on the foot and gradually looser wrapping up the leg. This helps to keep the swelling out of the ankle and foot. Then R.I.C.E – rest, ice, compression and elevate.
However, I learned that if the bruising and swelling is above the ankle then it is probably a bone fracture. I got that one from running on a very rocky trail that my coach/husband told me not to run on.
You can strengthen the ankle and the accessory muscles to be able to react to misplaced steps. Doing proprioceptive work or thera-band exercises will help to cut down on ankle sprains.
Achilles tendonitis – this has been an ongoing problem since middle school
At first I was told not to run on the same sloped side of the roads in rural Indiana for every run. I should mix it up and run on each side. This idea did not go over well with my parents since it meant running with traffic and not against it for half my runs.
As the Achilles problems followed me to college I tried orthotics. Then one winter we did a long run on the artificial turf in the football practice facility. I then flew to Indiana and ran on the icy roads and sidewalks. I partially tore my Achilles from too much slippage. That was a 10 week ordeal in a walking boot. However, I did learn to cross train like a crazy person in that boot. I used the stationary bike and aqua jogging to stay fit. I have also avoided Indiana winters since that time. The treadmill is now my friend if the roads are too slippery. My sleeping pattern also changed following that Achilles injury to include night boots to keep the Achilles stretched.
As a professional the Achilles continued to be an issue. I tried a few different orthotics and got race orthotics for the longer road races. However, I did not listen to my body and back off when I should have. I raced a 5k, did a long run the next day on pavement, flew back across the country that night and did a hard 200 repeat session in spikes on artificial turf the next day. That was the end of the Achilles. Many mistakes were made in that 3 days. First, I never do my long runs the day after a hard race in spikes. I also never do my long runs on pavement. Plus, I always take a day after my long run between workouts. Then the 200’s were on the artificial turf with tighter turns. Lastly, the coach told me I was not giving it my all that day. He said that everyone else had more intensity than I did. Thus, I ran the fastest 200s I have ever done.
I knew I shouldn’t have done that workout but my fear of not meeting a certain standard shut down the internal voice. The Achilles was shot from that point. I had 2 cortisone shots and ran on the alter-g the rest of the season to get me through Nationals.
I didn’t learn the first time to listen to my body. The rush to get back and meet another time-line caused the Achilles to have many setbacks. The stitches were taken out too soon and the incision broke up causing me to start over with the healing process. The scar on that Achilles looks worse than my most recent Achilles surgery.
Coming back from the first Achilles surgery lead to a strained calf and a stress fracture in the metatarsal. The leg was too weak for what I was asking it to do. My head, heart and lungs were ready from all the cross training but the leg needed more time.
The other Achilles was injured from compensating for the strained calf and metatarsal stress fracture. After the second Achilles surgery, I developed nerve damage in my ankle that would not allow me to do anything for 4 months. The water pressure in the pool was even too much for the ankle. In a way, that time off allowed my Achilles to heal without me overdoing it. We decided to let my body get out of shape. For once, every part of me would be rehabbing and coming back at the same speed without any part of me playing catch up. So far that idea has been working.
Bursitis – inflamed bursa
These are located in many parts of the body and I have had a few different spots flare up. The one I am most famous for and won’t live down is my rear-end. The night after a race, in a hotel, I got up to go to the bathroom in the middle of the night and didn’t turn on a light. I was in a handicapped room for some reason and there was a lot of space between things. I somehow missed the toilet and landed on the floor. The bursitis in my glute lasted for a really long time. I now travel with a night light for the bathroom.
Hernia or torn oblique? – a lump in the lower part of the abdomen could be either
I was having pain on my left side. It hurt to sit up, roll over and run. A doctor told me it was a sports hernia. I wanted a second opinion before surgery. The next doctor said it was a torn oblique muscle. After 6 opinions and an inconclusive MRI it was a tie. The surgeon convinced me it was a hernia that needed repaired. I woke up from surgery with a sore belly button and the nurse telling me it was a torn oblique after all and I just needed PT. Livid is not even the best term to describe my reaction. However, I did learn from the PT how it happened. I was racking my brain to figure out how I managed to do it. We went over training, etc. Then I remembered I was running on a trail and tripped over a root the week before it started hurting. I had falling and was cut up and bruised. My sprained ankle and cuts hurt more than anything else. I had just assumed I was bruised from the fall.
I learned that if you catch your toe on something and it stays still and the rest of your body continues in motion there is a good chance you can tear the oblique. I was told it is actually pretty common. The PT for that ball of scar tissue was fun.
Strained hip flexors – both at the same time
I was having pain high in quad and groin area on both sides. The first thought was femoral head stress fracture but the MRI showed both hip flexors were inflamed at the bone. The inflammation was too close to the bone to get cortisone shots. Everything irritated the area even sitting. This was caused by adding a new intense lifting program and speed drills in the middle of a season. New lifts with heavy weights combined with intense track workouts don’t mix. When the lifting makes you so sore that you can’t do your running workout there is a problem in the priorities of the program. The lifting program should have been added in the off season with a gradual progression of weights. However, when you are 10 years older than some of the athletes you want to try and keep up.
Sciatic nerve – literal pain in my butt
Sitting and hamstring stretches are not pleasant with an irritated sciatic nerve. This was caused by learning a new glute strengthening exercise and being too aggressive. The weight was light but the move was new. Too much of a good thing can cause issues. I am now sticking with a slow progression of any lifts or activities.
Plantar Fasciitis – every runners worst nightmare
This can come on and last a long time. The typical protocol for treating plantar fasciitis involves stretching the calves, using a foot roller, deep foot massage, rolling the foot on a frozen coke bottle and sleeping in night boots. My foot would not tolerate spikes or getting up on my toes. The doctor said that I might rip it eventually in practice and that would be the cheap fix. Oh, medical humor. I was not willing to push that hard on it to actually rip it. I tried cortisone shots which I had to be held down to receive. It was January 2008 and I was running out of time to train for the trials. I had the plantar release surgery from Dr. Amol Saxena. It was the easiest surgery. I woke up pain free and was never in that much pain again. Dr. Saxena did say I was the poster child for it because it went so well. I was in a walking boot to let it heal but felt better than ever. I trained on the alter-g, bike and pool to stay in shape. My first workout outside was March 10th. (I will always remember that because my dog died the same day.)
I spent months working my way back into spikes. I actually raced track in my racing flats. I even had the Nike lab put a spike plate on my racing flat. That gave my foot time to adjust to racing in spikes. To give my foot extra protection, I did and still do an arch tape job on my foot when I race or do speed workouts. I have slept in 3 different types of night boots. The plantar fascia socks don’t hold my foot, I need the sturdy boots. However, since the nerve damage I have not worn the night boots. I still do foot and calf strengthening exercises including toes scrunches, calf raises and eccentric calf raises.
Stress Fractures – the cracks that stop you
I think I am the only athlete that goes into an MRI or bone scan hoping for a bone injury and not soft tissue. The bone heals on a predictable time scale unlike soft tissue. The lower legs have had a few stress fractures over the years. The first ones came really close together. I learned about osteoblasts and osteoclasts cells. Osteoblasts build up the bones and osteoclasts tear down the bone. You need to give the body time to heal and supply the body with the materials needed. The back to back stress fractures did lead me to my Celiac and osteopenia diagnosis. Osteopenia is a lower than normal bone density. I now run a majority of my mileage on soft surface. I also use a prescription calcium nose spray to help in the healing process when I have a stress fracture.
I do count myself lucky that my knees and IT bands have stayed healthy. I have only had very brief encounters with discomfort in those areas. I do dynamic stretches once or twice a day to keep up my flexibility. I also do a core routine a couple times a week and add various physical therapy exercises to work on “talkative areas”. My chiropractor and massage therapist help to work out any “crunchy” or tender areas. They also seem to find those spots that I didn’t know were tight yet.
My take away from the trip down injury lane is to progress slowly with any new activity, let the body heal after surgery, learn from each injury, and listen to the body. The mantra I use is: a day now could save you weeks later. That means if a part of the body is talking to you, maybe you should listen and give it a bit. However, there is a fine line between tired, normal training soreness and injured pain. Injured pain is anything that causes you to limp or is unilateral, only affecting one side. Those two signs should never be ignored.
This was a long injury history lesson but if it helps anyone avoid a long layoff from injury then it has done its job.
RUN SMART, RUN HEALTHY, RUN HAPPY & I will see you on the roads again soon.