Last post I was feeling pretty positive, right? The past two weeks has been a bit of a roller coaster both physically and emotionally. Trying to keep it positive -- really, really trying.
Since the doctor gave the okay to swim, bike and pool run, I did all three the first second week of May. Great swimming Monday and Wednesday mornings, interval pool running on Tuesday morning, and a nice 18 mile ride outside on Wednesday night. Thursday I wore ballet flats (ie no support) to work, and by the end of the day I was limping again. I did some pool running on Friday morning, and by Friday afternoon I had pain just from walking. I called my doctor, and his PA said that something I did aggravated the injury. Her advice? Stop everything until my leg felt good again. Maybe that would take ten days. She suggested trying yoga or pilates since most of my cardio options were now off limits.
And the pity party began. It was Mother's Day weekend and I had planned to do 80 miles on the bike Saturday morning, then take my daughter folk dancing Sunday afternoon. My body had other plans, and I was not happy with them.
However, I have to admit that it felt nice to sleep in on Saturday morning and cuddle with my kids, who both climbed in the bed with me. Susanna started watching "The Doc Is In" on the iPad while I drifted in and out of sleep. I overheard Doc McStuffins sing "Slow down just a little longer. Kick back and rest. You'll see, the more you rest the stronger you'll be." Susanna looked at me and said "Mom! It's just like your leg!" Wow, here i am learning lessons from a Disney cartoon. "So Susanna, do you think Doc McStuffins can fix me up?" "No, Mom, of course not. You're not a toy. Now go back to sleep so your leg can get better."
We had a great day, packed with swimming lessons and trip to the Children's Museum and the National Harbor. My body showed true exhaustion that evening when I collapsed with my kids at 8:30 p.m. I slept all the way until 8 a.m. the following morning, waking up just in time to get the kids to Sunday School (late, as usual.) When we returned, I fell asleep AGAIN... I napped two more hours. Really, I don't think I've slept that much in years. I decided to go ahead and take Susanna folk dancing at Glen Echo Park (PERFECT way to spend Mother's Day!), though I didn't do any of the sachays or jumps. I fell asleep at 9:30 pm.
Since I wasn't limping, I decided to go ahead and try some exercise after resting up for the weekend. My leg was still incredibly tight, but I didn't have any pain walking. So Monday I did masters swimming in the morning, Tuesday I did intervals on the stationary bike, and Wednesday I did a swimming stroke clinic and some core/ upper body strength. Thursday I cycled, and then had a massage to break up scar tissue and muscle adhesions (very painful, but it really seemed to help.) Friday I swam and was thrilled to see my fastest split times to date -- I managed to hit under 1:40 on the 100 yard repeats. (Note: I need to go back to stoke workshop, because I swam again today and my pace was nowhere near that.) Saturday I spent the day power walking around an amusement park chaperoning a school trip (honestly, that seemed to cause more pain than anything else I did this week) and today I did some upper body/ core strength and swam for 50 minutes. My leg is still tight, but feels a lot better than it did ten days ago. So we'll see if I can add outdoor cycling and maybe pool running to the mix this week. I've been wearing supportive shoes to work, and that seems to make a huge difference.
As far as the pity party, I've had to distance myself from things like Daily Mile and Facebook feeds. While I should be overjoyed to see my friend's posts about how much they love running, or how they achieved a PR at a certain distance, I find myself getting insanely jealous that I'm not out there too. Last year I logged everything I did on Daily Mile, and met my goal of running over 2000 miles. I had a goal this year to run 3000, and I was logging everything religiously. 276 miles in January, 262 in February, 15 (all on the fractured pelvis) in March, 3 (again, on the fracture) in April, 0 (injury diagnosed) in May. I am done keeping track for awhile. This week, I didn't log miles. Aside from Friday's swim, I have no idea how far I biked in place, or how many laps I did.
And maybe that's a good thing. Maybe my body and mind need a break from regimented training.
And maybe I need to remember that the last time I got a stress fracture, I discovered swimming and cycling and became a triathlete. Maybe I need to remember that when I stopped having a pity party and focused on what I could do, I ended up fitter than when I'd started.
Pity party concluded. Let's move on.
Sunday, May 19, 2013
Tuesday, May 7, 2013
Pelvis Repair Time!
I had my first doctor's appointment with Dr. Parker this Monday. He's an orthopedic surgeon with specialties in sports medicine and one of the few people trained (and with stellar reviews) in FAI and labral tear surgery, which is the main reason I sought this referral. Luckily, I do not need the surgery. Nevertheless, I'm happy I am under his care. He knows his stuff, and he seems to truly care about my recovery and understand my need to get back out there on the road.
Since then, I feel like a huge weight has been lifted. I know what the injury is, I know what the timeline is for recovery, and I know I'm on track with this recovery.
So this is my pelvis. Apparently the white is where the bone marrow is swelling. My doctor said they were some pretty impressive fractures. Of course they are. Would you expect any less of me?
Dr. Parker gave me a chart showing the different stages of healing for stress fractures in in different parts of the body. One month post-injury in 2010, my metatarsel was almost halfway healed. One month post injury, a pelvic stress fracture is 0% healed. Well, no wonder that marathon hurt and I had to quit after 2 and a half miles. At 2 months, the foot is pretty much healed, while the pelvis is only 29%. At three months, the pelvis is still not even 70% healed. It's a long recovery.
There are three stages to healing, and I think I'm nearing the second. In the first stage, you have pain while sitting, standing on the injured side, and walking. You may walk with a limp. I did limp around for a few days, and I remember when I went to my conference in CT just three and a half weeks out from the initial injury, I couldn't sit through sessions because it was so painful. Walking hurt. In stage 1, swimming, pool running and cycling are encouraged to improve blood flow. As long as you aren't limping, crutches aren't recommended because studies have shown this actually prolongs the healing time. You graduate to stage 2 when you can walk for 10 minutes without any pain.
So really, I think I'm closer to stage 2, but my doctor is not letting me "graduate" until our appointment on June 3. In stage 2, you begin the transition to running. I will start physical therapy again, and use the AlterG treadmill to acclimate my body to running on a percentage of body weight. I also will work with Heather on running form to prevent muscle imbalances and foot strike issues that probably led to this fracture in the first place. To graduate from stage 2 (approximately 1 month) I need to be able to run 3 minutes without any payback pain.
Stage 3 is pretty much the "Couch to 5K" program. It's a 4 week program to get to 30 minutes of pain free running. At this point, the pelvis isn't completely healed, but it's getting there (it may take an entire year til the fracture no longer shows up on MRI) and can handle the transition to land running. So hopefully this will happen in July.
Then the literature says very clearly "Any runner with severe hip and groin pain should immediately be put on crutches until an MRI or Xrays can rule out a pelvic or femoral neck stress fracture. Femoral neck fractures especially can cause long term damage and need to be treated seriously."
Hmmmph. I told both my PCP and my first ortho that I had severe hip and groin pain. Hmmphh again.
This is definitely the biggest running setback I've ever had. But it could have been worse. FAI or labral tear would have put me back to square one and required an even longer recovery time and more PT. Really, even though this totally stinks, since getting the diagnosis I feel like a huge weight has been lifted off my shoulders.
So my May looks like a lot of swimming, pool running, strength and cycling. Not too shabby. I'll get through this, and I'm going to use the time to work on some of my tri weaknesses.
Life is good.
Since then, I feel like a huge weight has been lifted. I know what the injury is, I know what the timeline is for recovery, and I know I'm on track with this recovery.
So this is my pelvis. Apparently the white is where the bone marrow is swelling. My doctor said they were some pretty impressive fractures. Of course they are. Would you expect any less of me?
Dr. Parker gave me a chart showing the different stages of healing for stress fractures in in different parts of the body. One month post-injury in 2010, my metatarsel was almost halfway healed. One month post injury, a pelvic stress fracture is 0% healed. Well, no wonder that marathon hurt and I had to quit after 2 and a half miles. At 2 months, the foot is pretty much healed, while the pelvis is only 29%. At three months, the pelvis is still not even 70% healed. It's a long recovery.
There are three stages to healing, and I think I'm nearing the second. In the first stage, you have pain while sitting, standing on the injured side, and walking. You may walk with a limp. I did limp around for a few days, and I remember when I went to my conference in CT just three and a half weeks out from the initial injury, I couldn't sit through sessions because it was so painful. Walking hurt. In stage 1, swimming, pool running and cycling are encouraged to improve blood flow. As long as you aren't limping, crutches aren't recommended because studies have shown this actually prolongs the healing time. You graduate to stage 2 when you can walk for 10 minutes without any pain.
So really, I think I'm closer to stage 2, but my doctor is not letting me "graduate" until our appointment on June 3. In stage 2, you begin the transition to running. I will start physical therapy again, and use the AlterG treadmill to acclimate my body to running on a percentage of body weight. I also will work with Heather on running form to prevent muscle imbalances and foot strike issues that probably led to this fracture in the first place. To graduate from stage 2 (approximately 1 month) I need to be able to run 3 minutes without any payback pain.
Stage 3 is pretty much the "Couch to 5K" program. It's a 4 week program to get to 30 minutes of pain free running. At this point, the pelvis isn't completely healed, but it's getting there (it may take an entire year til the fracture no longer shows up on MRI) and can handle the transition to land running. So hopefully this will happen in July.
Then the literature says very clearly "Any runner with severe hip and groin pain should immediately be put on crutches until an MRI or Xrays can rule out a pelvic or femoral neck stress fracture. Femoral neck fractures especially can cause long term damage and need to be treated seriously."
Hmmmph. I told both my PCP and my first ortho that I had severe hip and groin pain. Hmmphh again.
This is definitely the biggest running setback I've ever had. But it could have been worse. FAI or labral tear would have put me back to square one and required an even longer recovery time and more PT. Really, even though this totally stinks, since getting the diagnosis I feel like a huge weight has been lifted off my shoulders.
So my May looks like a lot of swimming, pool running, strength and cycling. Not too shabby. I'll get through this, and I'm going to use the time to work on some of my tri weaknesses.
Life is good.
Wednesday, May 1, 2013
And the verdict is....
PELVIC STRESS FRACTURES!
Yes, you read that right. There's an "s" at the end. Plural. That photo over there? That's what my pelvis looks like, except the fractures are on my right side.
In retrospect, the February streak was probably not the best idea. I decided that I was going to run every day that month without a break. I ran every single day in February. And on February 28, following my 4 mile run, I was limping. Guess I got a break. Or two.
Apparently this is a very low-risk injury, and accounts for less than 1% of stress fractures in athletes. Both my PT and my sports injury chiropractor have never treated anyone for fractures in the pubis ramus bone. I am delighted to give them that experience of not just one, but multiple pubis ramus fractures. According to my best friend GOOGLE, here are the risk factors:
Pelvic stress fractures seem to predominately affect females. BOOYAH!
Bennell et al8 found pelvic stress fractures only in female track and field athletes, mostly mid-distance and long-distance runners. BOOYAH!
Participants in this study had an average BMI of 21. I'm 5'5'' and weigh 125. BMI - exactly 21. Hmmm....
and were running 40 to 53 km/wk (25-33 miles/wk). I was running 70. I guess that might up that risk factor.
In both collegiate and military studies, a history of amenorrhea has been found to be a risk factor for stress fractures in general. This is a big ????. TMI perhaps, but for you ladies, DOLMP was 9/9/2010. Yeah, that was pre-Jack. But, I'm also taking preventative measures to stop at two children, AKA Mirena. So again, a big ???.
This may be due to direct effect of decreased estrogen on bone and subsequently low bone mineral density. Last stress fracture, incurred in 2010 during winter marathon training -- diagnosed on March 18, so pretty much exactly the same time -- revealed osteopenia, AKA very low bone density.
A history of previous stress fractures may also be a risk factor in the development of recurrent episodes. Did I mention I had a stress fracture in 2010?
I had a long talk with my PT today. We concluded that perhaps 5 weeks where I barely got four hours of sleep in order to make sure I got in my 70 miles a week, while completely giving up strength training, was probably not the best plan. I trained smart in the fall. I trained stupid in the winter.
In the fall, I followed the Pfitz 12 week/ 70 miles per week plan to a T. Yes, there were 70 miles a week involved, but I also had a rest day in there, two strength sessions a week, and only one day of speedwork. Most of the runs were done at an easy pace. I ran my fastest races ever last fall, and qualified for Boston. The Pfitz plan has my utmost respect.
In the winter, I got this crazy idea that I could do two speed sessions a week, run every single day (my idea was that not taking a day off would allow me to do less miles on a given day, as long as it all added up to 70), throw in a ten mile "tune up" race after I'd already run 60 miles that week, and totally give up strength training....
Lesson learned. Self: Do not think you know how to train better than someone who wrote the book on how to train. You don't.
I meet with my new ortho, who is a hip specialist, on Monday so we'll see what he has to say. Treatment could be some time on crutches, perhaps some time of complete rest, perhaps I've healed enough that I can continue to walk around and swim and bike...
For now, I'm popping vitamin D and calcium citrate like it's candy, drinking my milk, and trying to get more sleep.
Yes, you read that right. There's an "s" at the end. Plural. That photo over there? That's what my pelvis looks like, except the fractures are on my right side.
In retrospect, the February streak was probably not the best idea. I decided that I was going to run every day that month without a break. I ran every single day in February. And on February 28, following my 4 mile run, I was limping. Guess I got a break. Or two.
Apparently this is a very low-risk injury, and accounts for less than 1% of stress fractures in athletes. Both my PT and my sports injury chiropractor have never treated anyone for fractures in the pubis ramus bone. I am delighted to give them that experience of not just one, but multiple pubis ramus fractures. According to my best friend GOOGLE, here are the risk factors:
Pelvic stress fractures seem to predominately affect females. BOOYAH!
Bennell et al8 found pelvic stress fractures only in female track and field athletes, mostly mid-distance and long-distance runners. BOOYAH!
Participants in this study had an average BMI of 21. I'm 5'5'' and weigh 125. BMI - exactly 21. Hmmm....
and were running 40 to 53 km/wk (25-33 miles/wk). I was running 70. I guess that might up that risk factor.
In both collegiate and military studies, a history of amenorrhea has been found to be a risk factor for stress fractures in general. This is a big ????. TMI perhaps, but for you ladies, DOLMP was 9/9/2010. Yeah, that was pre-Jack. But, I'm also taking preventative measures to stop at two children, AKA Mirena. So again, a big ???.
This may be due to direct effect of decreased estrogen on bone and subsequently low bone mineral density. Last stress fracture, incurred in 2010 during winter marathon training -- diagnosed on March 18, so pretty much exactly the same time -- revealed osteopenia, AKA very low bone density.
A history of previous stress fractures may also be a risk factor in the development of recurrent episodes. Did I mention I had a stress fracture in 2010?
I had a long talk with my PT today. We concluded that perhaps 5 weeks where I barely got four hours of sleep in order to make sure I got in my 70 miles a week, while completely giving up strength training, was probably not the best plan. I trained smart in the fall. I trained stupid in the winter.
In the fall, I followed the Pfitz 12 week/ 70 miles per week plan to a T. Yes, there were 70 miles a week involved, but I also had a rest day in there, two strength sessions a week, and only one day of speedwork. Most of the runs were done at an easy pace. I ran my fastest races ever last fall, and qualified for Boston. The Pfitz plan has my utmost respect.
In the winter, I got this crazy idea that I could do two speed sessions a week, run every single day (my idea was that not taking a day off would allow me to do less miles on a given day, as long as it all added up to 70), throw in a ten mile "tune up" race after I'd already run 60 miles that week, and totally give up strength training....
Lesson learned. Self: Do not think you know how to train better than someone who wrote the book on how to train. You don't.
I meet with my new ortho, who is a hip specialist, on Monday so we'll see what he has to say. Treatment could be some time on crutches, perhaps some time of complete rest, perhaps I've healed enough that I can continue to walk around and swim and bike...
For now, I'm popping vitamin D and calcium citrate like it's candy, drinking my milk, and trying to get more sleep.
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