Pity Party

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.

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.

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.

Still no better, still no answers.

It has been over eight weeks since this initial injury.  I have run a sum total of 5 times, and never over 2 and a half miles.  I've been getting ART massage.  I've been going to physical therapy three times a week.  I do my strength homework every day, at least twice a day.

And I don't seem to be getting any better.  In fact, it seems to be getting worse.  In the beginning, I couldn't sit for long periods of time without radiating pain down my right leg, and this eventually spread to my left leg. Then standing began to cause pain.  Last night I couldn't sleep because my right side hurt so much.

The spinal MRI was "not remarkable."  There wasn't anything revealing a source of pain.

When I first visited my chiropractor, she mentioned possibilities including impingement, a labral tear, stress fractures, and strained muscles.  I didn't think much of what she said, but after six weeks of treatment and the same symptoms, I spent quite a bit of time researching them.  Here's what I have come up with.

-Strained muscles?  Possibly but eight weeks would provide significant healing time.  They aren't healed.  At all.

-Pelvic stress fracture?  Possibly.  But again, there would be SOME healing that would have taken place in the past eight weeks, and I actually feel pain now in the very first few minutes of running as opposed to after a mile or two.  Pelvic stress fractures take a long time to heal, but they don't require surgery.

- Impingement.  My chiropractor performed manual tests for this at my first visit and it was a possibility.  I had to do a lot of research on this one, and it seems to match my symptoms pretty closely. Here they are (and I have all of these), stolen from an Irish website:

• FAI often presents as hip and groin pain with restricted range of hip movements.
• Symptom onset can be acute, following injury, or insidious after prolonged exertion. It is generally not disabling, except in sporting activity. 
• ‘Payback pain’ after participating in sporting activity is common
• Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be on the side of the hip or the buttock.
• Movements can be restricted particularly high flexing and trying to cross the legs.
• Pain is often provoked by these manoeuvres, by exercise, or by attempted return to sport and relieved by rest and inactivity.
• FAI may occasionally present as groin pain after prolonged sitting. There is no rest or night pain.

- Labral Tear.  Initially my visit with the chiropractor presented this as a possibility but subsequent manual tests have been negative.  This really is the worst case scenario.  The symptoms are basically the same as FAI except for an addition:

• Groin pain
• Clicking and snapping sensations in the hip
• Limited motion of the hip joint

My hip clicks and snaps, and pops.  Only on the right side.  Right at the hip joint.  The first doctor I saw on March 7 diagnosed me as having "snapping hip syndrome", which is a symptom of an underlying problem. Possibly this.

I never thought I'd be wishing for a stress fracture or muscle tear.... but bones and muscles heal.  Joints don't.  They get worse.  You ignore FAI or labral tears (or quite possibly, both) and you can end up with a hip replacement down the road.

Recovery time for just the FAI procedure without a labral tear?  Optimistically looking at a couple weeks on crutches, then slowly returning to swimming, biking and finally running by 3-4 months post op.  If it is the worst case scenario (well, the worst case I'll even allow myself to imagine at this point) -- FAI and a significant labral tear -- it could be 6-8 months before I can return to "normal" activities.  If I'm one of the lucky 95% of patients who can return to "normal."

The good news is that although the FAI or FAI with labral tear surgical procedure is relatively new, the DC area has some very skilled doctors with this specialized training.  I've spent hours researching them, reading their online reviews, and asking around the PT, Chiropractic, and triathlete community.  

So what's next?  On Monday I have an MRI with IV-contrast.  This will hopefully get to the root of the pain.   At this point, I want it to show SOMETHING.  For the past 8 weeks I've had no idea what is wrong with me.  Whatever it is, let's just figure it out and get on with it.   If I need surgery, let's just do it.  Let's get the bed rest part over with, start the aqua therapy, get back on the bike, and be running by late fall.

I was reading forums of other triathletes who have been through the surgery, and one of them mentioned the handicapped hang tag for your car.

Wow.  From a 3:31 marathon, to a few months in the handicapped car space.  

And how does a mother of two little people with a job that demands playing classroom instruments, folk dancing, and sitting on the floor with kindergartners find the "right" time for hip surgery?

Maybe the MRI will show something completely different.  Maybe it will be something that they didn't see, but has a much easier fix.

Realistically, though, I know where my symptoms are pointing.

I have an appointment scheduled with one of those top hip surgeons a week from Monday.  My MRI results will be back in a few days.  Until then, my mind is swimming. 

MRI

It's MRI time. Six weeks with no improvement... Let's hope this at least gives me some answers.

This Injury

It's unbelievable how one week your biggest exercise consideration is how you are going to manage to fit in 70 miles despite your busy schedule of working full time and caring for your family, and then four days later you wonder if you'll ever be able to run even one mile without pain.  But let's back up.

Tuesday February 18, messing around on the floor with my family, my right leg gets bent in a funny position.  I was a little concerned, at first, but then no worries, the next day my slow easy run went just fine.

Sunday February 24, I ran a 10 mile race in hilly Columbia MD on very tired, already-ran-52-miles-that-week legs, set a PR (which I wasn't that thrilled with, as my goal was a couple minutes faster), then ran a slow 8 miles to finish off the day.  My legs felt pretty dead from the race the next morning, but I felt okay.  Sore Tuesday, so I skipped my speedwork and did an easy run instead.  I had a deep tissue massage that night, and my therapist noted that my right leg had really, really tight muscles, which he worked on for quite a bit.  After his intense session, I decided to keep the run easy on Wednesday morning.

And then came Thursday February 28.   I had a tempo run on the schedule, but my legs were still feeling pretty dead, so I decided to try a few intervals ladders instead.  When I got to my four minute ladder and saw I couldn't get my pace under an 8 minute mile for that length of time, I decided to scrap it and jog back to work.  I went to the restroom to change clothes and freshen up, then went to a meeting at 8:40.  When I stood up 50 minutes later, I couldn't walk.

Throughout that day, I had a visible limp in my right leg.  I couldn't figure it out.  I had felt okay during the run, though my legs were obviously not recovered from the race.  I was in terrible pain, even after three Advil.  I declared Friday a rest day, and did a long soak in an Epsom salt bath instead.

Saturday I felt fine, so I figured I'd start my long run by doing a 1.5 mile out and back, and if I was still feeling pain free, start the 14 mile loop with the DC Road Runners group.  3 miles, no pain, so we headed out.  At 4 I started to feel some discomfort.  At 5 it was pain.  I decided to turn around, but I still have two miles to go.  By 6 it was radiating further down my leg, and when I reached my car I had excruciating pain in my inner adductor.  This was not good.

Sunday in church I was hobbling.  Not just limping.  Hobbling.  People made comment after comment.  I was sure I'd broken something.

Monday I made an appointment with my GP.  She diagnosed it as IT Band Syndrome and told me to stop running.   Seriously?  First of all, I had IT Band Syndrome when I was 27, and it did not stop me from running.  It was a pain, but I could run through it.  Whatever I had now, there was no running through it.  And the pain was in completely different places.  Shooting pain in my hip, glute, and adductor.  Not my outer knee.

Tuesday I sought a second opinion with a Sports Injury Orthopedist.  He took x-rays and said he couldn't see any fractures, and he diagnosed it as Snapping Hip Syndrome and Piriformis Syndrome.  He said I could try to run and just cut my mileage down, and prescribed Physical Therapy.

I tried to get an appointment with the PTs at the office where I met this doctor, but they had nothing available for a month.  Really?  A month?

In the meantime, I made an appointment with a Sport Chiropractor who does Active Release Therapy, which I had heard good things about.  But I couldn't get in to see her until after the marathon, either.

I mentioned this previously, but on the Friday before the race, I attempted 3 miles.  And it hurt.  I went home and started googling stuff on recovering from running injuries, and read about this thing called the AlterG (antigravity) treadmill.  It allows you to run on a percentage of your body weight, resulting in much less impact.  I found out that two PT clinics in my area offer this, and one of them accepted my insurance.  I sent them an email, and got a response the next day that they have a fabulous therapist who is a runner, Ironman, and specializes in running injuries, AND she happened to have an appointment on Monday.

The day after the marathon DNF, I sadly walked into the PT office, where I met my therapist, Heather.  She spent about ten minutes poking and prodding my legs, and told me she was like a body detective and her job was to figure out what the root of the injury was. She agreed that I had "piriformis syndrome" and "snapping hip syndrome", but they were probably symptoms of the real problem.

And then she discovered that my SI joint was out of rotation.  She didn't seem surprised.  She said "Now I'm going to put it back into place."  She bent my knee, pushed a certain way, and I immediately felt some relief.  No more snapping hip.

That was almost a month ago.  In that time, I have seen Heather twice a week.  She begins our sessions with something called "Dry Needling", similar to accupuncture, where she sticks needles in my muscles and faschia.  I can't say it is comfortable, but it does seem to relax my angry muscles.  On Monday, after three weeks of absolute rest from running, I was allowed to try the AlterG Treadmill.  I didn't feel any pain during the actual 14 glorious minutes I was allowed to run, but the following day I could feel my SI joint and hips flare up.  Big time.  I had more knots on my right side then I'd ever known possible.  She spent a good 30 minutes doing the most painful dry needling session I'd had thus far, but it worked.  I could feel the trigger points release, and today (Thursday) the swelling is completely gone.  I was put on another week of running rest, and hopefully will be allowed to try the AlterG again on Monday.

I also feel I'm in good hands with the Sports Chiropractor team.  They have a certified athletic trainer who works with me on strengthening exercises, and the ART massage and adjustments seem to help.  Two weeks ago, I couldn't sit for more than 20 minutes without excruciating pain in my back or sciatic nerve.  Now, the only time I have pain is when I run.

Of course, all I really want to do is run.  It's hard for me to believe how much I was running six weeks ago, because right now even a half mile isn't possible.  I haven't signed up for any triathlons this summer because I am not convinced I'll be able to do the final leg.  I am swimming or cycling 6 days a week, and trying to stay positive.

Race Report - Shamrock Marathon - DNF, but BOSTON BOSTON BOSTON!

It's interesting how a week after I blogged about being addicted to exercise, everything came to a crashing halt.

I haven't written anything in awhile because I've been too frustrated, but here is a recap from where I left off.

Following my visit to the sports injury doctor, I tried to get a PT or ART chiro appointment but couldn't get anything scheduled until after the marathon date.  So I just took complete rest and hoped that I could heal and get through the race.  I was hoping for a miracle, I guess.  On the Wednesday, I ran a half a mile.  It felt okay. On Friday, I attempted two miles.  By 1.5, I was hurting a bit.  26.2 would be a long shot.

Brittany, Jamie and I arrived to Virginia Beach and I pretended like I was still going to race.  I went to the expo, picked up my packet, carbo loaded with them, and got into my awesome race attire.

There wasn't a 3:30 pacer, and I couldn't find my Garmin, so I was depending on Brittany -- I'd just have to stick with her.  The gun went off, and I was feeling pleasantly strong for the first two miles.  Then, just as we passed our hotel for the first time, I started to feel that niggling annoyance in my hip that I knew would probably turn to excruciating pain within another few miles.  We were heading away from the beach, and we wouldn't pass my hotel again until mile 13.  As soon as I stepped off the causeway bridge at mile 3, I felt a shooting pain up my thigh.  "I'm done, Brittany.  I'll see you at the finish." 

My first DNF.  Ever.

It was 41 degrees, and I was wearing next to no clothing (thank goodness I had the leg warmers!) so I ducked in the first hotel I saw and registered for text messages updating me on Brittany and Jamie's progress.  Then I walked back to our hotel and was thrilled to find they were still serving their amazing brunch until 10 a.m.  I sat down and had fresh waffles, coffee, and eggs, and started chatting to some of the other folks in the hotel.  I met a woman on crutches who was waiting for her husband to finish.  She also had trained for the marathon, and couldn't run.  She had torn her plantar faschia in January. Yikes.  

The first text came in and Jamie was running at a 7:24 pace.  He needed a 7:26 to qualify for Boston, so that was a good sign.  I finished breakfast and went to the lobby.  

There I met a man who had done the half marathon earlier that morning as a tune-up race for Boston.  He said he'd qualified for Boston three times, and still hadn't run, because he'd never made it to the start without an injury.  

Text #2 -- Jamie crossed the halfway mark at a 7:22 pace.  Looking good.

I sat down in front of the fireplace and started talking to a woman who was tracking her husband as well, and also had registered to run the race.  She had a pelvic stress fracture.  Sheesh.  My hotel was like injury central for running spouses.  

Text #3 -- Jamie crossed the 18 mile mark at a 7:21 pace.  Time to head to the 26th mile and wait.  

The finish clock read 3:08 when I passed it.  I walked a little further, and waited for Jamie.  I saw a couple people from his running team, and then was a little surprised to see him, all by himself on the boardwalk, at the 26 mile marker just around the time the finish clock hit 3:10.  I wasn't sure if I could keep up with him, but I'd try.  

And there you have it.  3:11:29.  Average pace of 7:19, negative splitter, my husband, new Boston Qualifier.  How did we ever qualify in the same year?  Well, as much as I hated to be injured, and as stupid as it probably was to run the last .2 miles with him at under a 7 minute pace (he did the last mile at 6:45!), that moment was priceless.  Had I run, I wouldn't have gotten to see him cross the finish line.  

This was my third Shamrock marathon, and I don't even remember the post race party at the first one, I was so out of it from the run, and in 2010 I broke my foot somewhere along the 17th mile (my only other significant running injury to date... apparently Shamrocks do not bring me much luck...) and skipped the festivities altogether.  This time, I figured I paid $110 for the Irish Stew and beverages, and I was going to enjoy it.

So that was two and a half weeks ago.  I saw my PT the following day, and found out my hip was out of rotation.  Probably a good thing I stopped at 3 miles.  I haven't run since.  More on the injury later, but for now, I just wanted to share that BOSTON 2014, WATCH OUT!  THE LYNCHES ARE COMING!