Ramble on

I’m not even sure where to start. It’s been since November since I’ve written any kind of update about my own training. I was just starting with a new physical therapist then and starting to unravel the issues with my pelvis, sacrum, sural nerve, and starting back to running really slowly after a month completely off running.

 

 

The new physical therapist has been such a blessing and by February-March I was starting to get back to really training and focusing on Grand Canyon 50k. My training took a little longer to pick up than anticipated when I signed up, but I felt confident with how well things were going by March that I wouldn’t be undertrained. In Mid-March I ran NYC Half as a training run and felt strong pacing a teammate to a new PR. By the end of March it had warmed enough that I was able to head out to my local trail. I had some little twinges here and there–in my hip, my hammie, and my back–but PT was keeping everything in check for the most part.

 

Eight weeks to Grand Canyon

The first weekend of April I went down to Georgia to crew a friend running Georgia Death Race. I did 2 runs in the Georgia mountains that weekend. I ended up rolling both ankles and my left ankle in particular pretty badly on the second run. I was able to run the rest of the run, but knew it was going to take some care and rehab. I made a plan with the PT to cut weekday trainings short and just focus on getting in my long training on the weekends which seemed to go okay. I had developed some foot pain in my left foot on some of the longer runs, but we assumed it was too tight shoes and made adjustments.

Five weeks to Grand Canyon

I headed out for my 20 miler at the end of April on a rainy morning and by mid-way through the five hour run the trail become very, very muddy. By the end of the run not only was my left foot aching, but my right ankle had gotten pretty aggravated from the mud running. I limped home and skipped my long run the next day.

 

Three weeks to Grand Canyon

In an effort to save my foot, ankle, and my training cycle I took 2 weeks off of training before my peak weekend of training which was going to be 22 miles on Saturday followed by Broad Street Run 10 miler the next day. My left foot was still a little tender by that weekend so I decided I would run for time instead. I got in 4 hours of training and had some slight shin and foot pain, but all-in-all I felt okay going into the 10 miler the next day. During the 10 miler my foot hurt a little and at one point I walked for a half mile, but I was able to finish it in under 2 hours and was feeling pretty good about being able to finish Grand Canyon 50k. I’d use taper to rehab my ankles and foot and hopefully line up at the start feeling healthy and ready to go.

 

On the way home from Philly, my right foot had a really sharp pain that came out of nowhere and it hurt a lot to walk. (The left was the one had been bothering me to this point.) I limped home and a couple days later my chiro popped my foot (cuboid) and while it didn’t completely calm it down right then, within a day the pain was gone. I again skipped my weekday runs and got in my 14 miler that weekend. Then I had to skip the following day’s 90 minute run because I woke up with a cold.

Two weeks to Grand Canyon

That was this past Monday and the plan this week was to run a few times at low mileage in some new shoes and incorporating a dancer’s pad to offload the 5th metatarsal joint on my left foot. But when I woke up Tuesday, one of my cats was very sick and my cold had worsened significantly. By Wednesday, my cat was at the emergency hospital. Long story short, I did not train all week and was under a lot of stress. I still planned to do Brooklyn Half Marathon and my 90 minute run on Sunday, though. And hoped that my kitty would recover in time for me to head out to the Grand Canyon.

One week to Grand Canyon

Yesterday I lined up at the start of the Brooklyn Half Marathon. I had taped my left foot in hopes of it holding together and didn’t really think about my right foot because it hadn’t bothered me since my chiro popped it. I noticed my right ankle felt a little sore and wished I had taped that ankle, too, but it was too late at that point. I crossed the start and glanced at the clock. 22:22. I took it as a good sign. I’ll spare the details, but by the 10k mark I was walking with considerable pain in my right foot and by mile 8 I had dropped from the race. Later that evening my kitty got to come home. She needs medication twice a day and I have to monitor her eating, drinking, a bathroom breaks. She is still showing some symptoms and if her condition worsens, she will need to go back to the hospital.

So here I am, six days out from Grand Canyon 50k with two injured feet and a sick cat. I can arrange for care for my cat, but will be at least 18-20 hours away from home if anything happens. I’m not sure if I will even be able to walk around the Grand Canyon much less run 33 miles with the current state of my right foot. I’ve never been to the Grand Canyon and this was going to be a bucket list trip for me made even better by the fact I have friends coming out, one of them I am coaching and this will be her first ultra, and I planned to stay a few extra days for adventuring out there and back in Vegas. To say I am conflicted about what to do would be an understatement. Staying home to take care of my baby and myself seems to be the most logical answer, but I’ve invested so much in this race and this trip. Not to mention not wanting to let my friends down. I have no idea what I am going to do.

What would you do?

The longest year ever

I’m not a big crier, but last night I cried a little. They were tears of relief.

This past year has been stressful–and painful. Ever since my back and neck pain started last November, I have been in some form of pain. I seemed to have gotten the back and neck pain maintained to a point to where I could train, but then my shin flared up and I was diagnosed with a tibial stress reaction. I had to drop my goal race–my first 50k–after the most intense training cycle I have ever done. I was running 8-9 hours (40-45 miles) a week and that doesn’t include time for yoga and strength.

My last real run was September 27th. After a month of dealing with lingering foot issues after the stress reaction diagnosis, I decided to just bike for awhile to try to let everything heal. The foot issues got worse including a nerve flaring up causing constant pain and eventually my hip joined the party. I stopped working out completely for a couple of weeks and that didn’t seem to help either. In the past few weeks, determined to find answers, I’ve seen an orthopedist, a podiatrist, my chiropractor, and 2 new PTs (same office). I feel like I am finally starting to get some answers.

It seems that my pelvis and sacrum have some issues. They are rotated in weird ways. I don’t understand all of it, but evidently in addition to causing a slight leg length difference, it is also contributing to one side not activating and being weaker. I also have a weaker ankle on that side from a roll earlier in the year. All of this has put more stress on my back and that hip/leg/foot that is freaking out.

I finally feel like the mystery of my injuries is starting to be unraveled. And I’m relieved. Not just to have some answers, but to finally have some confirmation that this was not overtraining. This wasn’t my fault. Some of my choices likely contributed–my shoes and nutrition–but the underlying cause was structural and not something I could have known about. Several doctors missed it over the past year. And even if I had been in the right shoes and nailing my nutrition this all probably would have happened eventually anyway.

2016 has been tough. (For many reasons.) But it has also been an awesome year in that I know I have gotten so much stronger physically and this diagnosis is going to make me even stronger. I’ve also become much more confident in my running and my coaching knowledge. I’m proud of myself for not just taking a diagnosis, treating the symptoms until they were manageable, and moving on. I chose to stop running and chase down an answer.

All of this has made me realize that running is no longer just a hobby for me. Running has become my lifestyle. I am a runner. And I can’t wait to get back to it and see what happens in 2017.


Timeline of injury and rehab

(For future reference for myself and my doctors, but feel free to dive in if you are interested)

April 12 2015: Ran a trail race and hit the downhills hard. Had lower back pain a few days after that went away with some ibuprofen and rest.

July-October 2015: Marathon training. Had some lower back/glute pain isolated to one side which was (mostly) relieved by my sport massage therapist when I saw her once a month. Therapist told me a few times that my back felt really stiff and that I should get some deep tissue massage to loosen it up.

November 1 2015: NYC Marathon. Ran pain-free until mile 24 where the downhills aggravated my knees was fine on the flats and sprinted to the finish. Felt good the next week. Post-race cold had me in bed for a few days and I had neck pain on right side after that.

November 14 2015: 8 mile trail race with some light back pain. I didn’t stretch and was out in the cold for hours after then in a car for a couple hours for the ride home. The next day my right shoulder and right side of back hurt enough that I thought I had a pinched nerve. Saw a PT two days after the race who told me I just had some muscle tightness.

November 2015 – February 2016: PT. Focus was on treating symptoms, strengthening the core, and stretching the back and neck. Progress was slow and after a sneeze in early January, I was set back and had to stop running again. By late January, I was getting back to running.

January – May 2016: Started acupuncture once a week. This brought me some relief and kept me maintained as I started to build my mileage back up and started training for Broad Street Run and building a base for 50k training.

April 24 2016: Ran a trail race with lots of mud and rolled my ankle. It felt fine to continue running on and there was no pain by the finish. Pain returned the next day and hung out for a week. RICE resolved it in time to pace at Broad Street Run on May 1st which I ran with no pain.

May – present: Started seeing a chiropractor. This was the most promising treatment yet. They noticed that I was not rotating equally when running and walking and that my left side wasn’t activating like it should. I was also diagnosed with a breathing issue. Homework included breathing exercise, some strengthening, and some rotational drills.

May 15 2016: Random calf pain made me cut a run short. It was fine within a few days and I paced at Brooklyn Half (5/21) with no issues.

May – August 2016: 50k training. Mileage climbed to 35-40 miles by June and remained pretty consistent aside from a few planned cutback weeks.

July 2016: I ran out of calcium supplements and all of my running shoes were over mileage. I was suspicious of my shoes being part of my back issue and wanted to research new ones. I started running my longer long runs (20, 22) on road instead of trail in an effort to be on my feet less time and for a little easier terrain. Ended up buying the same shoes on August 4th.

August 2016: Continued to run long on road. Still no calcium and I started to struggle with getting enough calories based on the mileage that I was running.

August 13 2016: On my 22 miler, I started to have shin tightness around mile 14. We took a few breaks to stretch and hydrate (it was super hot that day) for the rest of the run.

August 14 – 25 2016: No running. Saw an orthopedist who did an X-ray and diagnosed me with stress reaction. He said I can run HTC based on pain. Got a second opinion and MRI that confirmed the original diagnosis. Doc prescribed oral and topical anti-inflammatories and said I can run HTC cautiously.

August 26 – 27 2016: Hood to Coast relay. Shin felt fine for the first 2 legs of the relay. I made sure to ice directly after each run and didn’t push the pace. On the third leg–my hardest and longest, almost 8 miles of hills–the outside of my lower leg started to hurt, then my inner lower leg, then the top of my foot. I ran the last mile through the pain. It hurt a bit as we ran to the finish and the next day, but the foot seemed to be better by a few days later.

September 2016: Headed back to PT for help with my shin per orthopedist’s recommendation. My foot pain returned when I start running again after Hood to Coast. PT diagnosed me with extensor tendonitis and treated my symptoms for that, as well. Attempted a long run on 9/5 with run-walk intervals and made it about 2 hours and 15 minutes before pain set in. Three days later, I started to notice ball of foot / big toe pain. PT taped me and I ran a marathon relay at a nice pace with no pain a few days later. Iced directly after and I seemed to be okay. I started cutting back on mileage and using elliptical and bike to supplement in an effort to speed up the foot healing. Bought a pair of Hokas and ran a few times in them. My back and neck started bothering me again from sitting to work so I start standing to work again by the last week of September. Purchased an exercise bike during last week and noticed my left hamstring going numb after about 15-20 minutes of riding. Started taking new calcium and other supplements that last week, as well. By end of month, I was able to do planks in shoes without foot pain.

October 2016: First week of October I traveled to Portland for a week. I wore converse all week and didn’t tape at all and my ball of foot pain and some arch pain returned. I didn’t run at all on my trip or when I returned. Traveled to Florida the second week and did a mile test. Afterward while doing yoga, I had sharp pain in outside my foot. I also noticed for a few days that my big toe was swelling and wouldn’t bend. I was able to restore mobility and reduce swelling with massage. Back home the third week, I start riding the bike again and after a ride while doing yoga the nerve pain returns very sharply. My ball of foot pain and arch pain also got worse. I booked an acupuncture appointment and he discovers a lot of tightness in my shin and ankle which relieves the pain in my foot. The nerve pain starts to aggravate me all the time. I started to have painful hip tightness on the same side as all my other leg issues and my back on the opposite side was acting up again too. A few more sessions of acupuncture provided some relief, but I still didn’t know why all this is happening and was frustrated that I didn’t seem to be getting any better.

November 2016: Saw my orthopedist who referred me to a podiatrist for the foot issues and recommended physical therapy for the residual shin pain. Podiatrist diagnosed me with sural neuritis and sesamoiditis. He prescribed NSAIDs and an anti-seizure med and recommended no running for a few weeks. I had a horrible reaction to the anti-seizure so I stopped taking it. Went to see new PT who did some tests for alignment and believes I have some pelvic issues. Prescribes a nerve flossing exercise, metatarsal pad for my sesamoiditis, and some stretches. On my second visit a sacral issue is discovered and some strengthening exercises are giving. On the third visit I get a gait analysis in 2 pairs of shoes and my pelvic/sacral issues are confirmed as well as my old shoes being not ideal for me. Pelvic issue is causing a slight leg length difference and one side to not activate causing it to also be weaker. Protocol will be piriformis and glute strengthening and some neuromuscular training to bring the pelvis back into alignment. This should help with both the back/neck pain and my leg pain which are both being stressed by the pelvic/sacral issues.