Stress Fractures in Disguise

What do you do when a stress fracture doesn’t ACT like a stress fracture? When I last updated this blog, I was pondering the “injury question mark”.   With my personality I tend to have the toughest time when things are up in the air. My mind tends to spin on questions that I have no way of answering (“Will this get better in a week or two? Can I get back into training without sacrificing too much fitness? Will I have to sit out the entire fall season??”). My leg was still hurting, but felt like it might be getting a tiny bit better since I’d been giving it some TLC and days off.   I was able to run on it, but not very well and not without discomfort.

As I mentioned in my last post, most of my symptoms were consistent with muscular injuries (sprains/strains/tears) and the area I was feeling the pain was deep in the calf. I could hop without pain, and I was still able to run.   My compression sleeve seemed to help.   It even seemed to warm up during the run and actually felt the best towards the end of the run. My running friends (and the sports doc herself) were almost positive it was muscular in nature and I’d be getting a negative result on the bone scan I’d requested.   But, as the title of the post suggests, that was not the case.

I agonized over having the bone scan – I even called and canceled it, and then had to reschedule! I hesitated in part because it was so expensive (thanks to a high deductible), and in part because I rationalized that it MUST be muscle since all of my symptoms were pointing towards a strained/slightly torn calf or posterior tibialis. The sports doc had diagnosed an irritated posterior tibialis several weeks ago. Plus, almost every runner I spoke to agreed with the “it’s muscle” diagnosis.

And yet….something still nagged at me that it may be more than just muscle. When I didn’t heal as quickly as I thought it should given the days off I’d taken and the cross training days, I decided to act on my gut and scheduled the scan.   I’m very glad I did.

Tibial Stress fracture/reaction. Ugh. During the bone scan I could see the screen and saw the area light up on my tibia. At that point I knew I wouldn’t be getting good news.   I went down to radiology after the scan and requested copies of my images. Sure enough, I could see the spot on my left leg with the increased uptake. I immediately started doing the math in my head for when I’d be able to run again (October best case, November worst case), and signed up for a cycle class the following day. Time to jump on the cross-training bandwagon!

I had to wait until I saw the sports doc on Thursday to get the official results. And when I did, I was pleasantly surprised. I’d been preparing for the usual stress fracture party line of “6-8 weeks no running” but my doc said that since I had listened to my gut and we caught this thing so early, I’d only need 3-4 weeks off before I could start easing back into running. While 3-4 weeks without running is still no picnic, it was SO MUCH BETTER than I had anticipated so I was (relatively) happy.

The marathon is still out of course, but I’m happy that I’ll be able to get back into training with enough time to build up a solid base before starting my training block for the spring marathon (Tobacco Road on March 15).   I am not going to go crazy on the cross training, but will try to do something (core work, Body Pump, cycle, walking) every day. I’m already counting the days until I can run again, and I’m most bummed about missing this wonderful fall weather we are starting to get. Those are some of my favorite days to run.  I’ve been keeping myself busy with studying my texts for my ACE group fitness instructor exam and trying to enjoy sleeping in a bit in the mornings.   I’d rather be running, but since I can’t, I’m trying to make the most of it!

I’m glad that I went ahead and got the scan and didn’t try to push through.   Most likely I would have rested for a week, run a bit, felt pain again, rested for another week, etc. – and limped along on it for another month or two before finally landing back in the sports doc’s office.   I could have set my recovery back by several months.

The moral of the story? If you have something that your gut tells you is wrong, or warrants further investigation, listen to it. Even though it can act like muscle, walk like muscle, and talk like muscle…..sometimes it’s not muscle.   You are the person that knows your body best. Trust your gut. We are all an experiment of one.

I’ll update soon on some of the cross-training I’ve been doing, as well as my own attempt at a root-cause analysis as to why this stress fracture happened in the first place (spoiler alert – I don’t really know and am frustrated).

Training week in Review - 9 & 8 Weeks out from Harrisburg (9/1/14 - 9/14/14)

Unfortunately, there hasn’t been much running going on over here at “Fox Runs Fast”. Right now a more appropriate title of this blog would be “Fox Cross Trains a lot and Tries Not to Go Insane”. But that would be awfully long. So we’ll just stick with what we’ve got and hope that I’ll be back to running more miles soon. The leg is feeling….better? Kind of? Maybe? It’s hard to tell. It’s definitely improved from the weekend after Patrick Henry (3 weeks ago), so that’s encouraging. But it’s not improving as quickly as I’d like, given the amount of time I’ve taken off/cross-trained. After seeing the sports doc two weeks ago, the area of soreness seems to have moved from the posterior tib region on my left leg (where the doc thought the problem was) to the lower part of my calf – almost where the calf meets the achilles. But the soreness kind of radiates through my lower leg so it’s tough to pin down where it hurts.   This makes me a little nervous that it could be not just muscle, but something a bit more sinister that’s lurking (stress fracture!), so needless to say these past 3 weeks have been a bit of a frustrating exercise in trying to determine if I can/should run, how much I should run, and my next step.   I’ve been trying (unsuccessfully) to self-diagnose if this is muscle or bone, and made this handy chart of my symptoms and if each symptom is more characteristic of muscle (tear or strain) or bone (stress fracture):

So, as you can see, I’ve got points on either side. While I do think that it’s most likely muscle since I am able to continue to run on it (albeit in a limited capacity), I know that stress fractures can be sneaky.   KrisLaw (one of my favorite speedy ladies) recently had an injury that sounds eerily similar to mine and unfortunately, she has confirmed a stress fracture.   So on Thursday of this week I finally got fed up with trying to diagnose myself and made an appointment for a bone scan on Monday.

So hopefully that will confirm if it’s a stress fracture of not, and then I’ve got an appointment to see the sports doc on Thursday to determine next steps.   I’m hesitant to get the scan since it’s quite pricey, but if it IS a stress fracture, I don’t want to be running on it and making it worse. Plus, I’d like the clock to start NOW on any total rest I need to take so that I can hopefully ramp the training back up in time to run a spring marathon.   And that brings up the confirmation that….

I will not be able to run the Harrisburg Marathon this fall.

Ugh. Just typing that sentence makes me a bit sad. Even if my bone scan comes back clean and my leg magically felt better immediately, I know that 8 weeks is not enough time to get in a solid enough block of training to race Harrisburg. But all is not lost! I am going to use this time to build a solid base and to work on two goals I’ve had in my mind for a while now:

1)   Studying for and completing the ACE Group Exercise Instructor Certification process

2)   Taking (and passing!) the training to become a Les Mills Body Pump Instructor

Having some goals outside of my marathon training will hopefully help me get through this period of time where I’m unable to run as much as I’d like to. It’s been tough to miss my group runs and to hear about how well everyone else’s training for Harrisburg is going. But I know that this is only temporary and that I’ll hopefully be back out there soon enough.

In the meantime, I’m going to focus on getting these certifications.   The fitness industry is a totally new direction for me, as my background is in technology and project management. But I’ve very passionate about physical fitness and I’m hoping that by getting these certifications they will help educate me more about being an all-around athlete and will provide a solid background as I build my running credentials in hopes of one day helping to coach others.

And just for kicks, here’s how the running (or lack thereof) shook out during these past two weeks:

Week of 9/1

Monday: 4 miles (a.m.) + 5 miles (p.m.) – tested the leg a bit on the treadmill – felt okay in the morning, but the afternoon was rough

Tuesday: 1.35 miles - painful, so I shut it down.

Wednesday: Elliptical + Core

Thursday: Body Pump

Friday: 4 miles – easy run to test the leg. Didn’t feel great, but wasn’t horrible.

Saturday: Sweaty spin class (25 miles on the bike)

Sunday: 5 miles easy (leg still the same) + Body Pump

Week of 9/8

Monday: 8 miles with a friend – leg actually felt a bit better! Encouraged, but later in the day it was tender.

Tuesday: Body Pump

Wednesday: 7.35 miles – still sore, but holding steady. Not any worse, but not better.

Thursday: 6 miles – leg less comfortable than the day before. Could be two days in a row is too much.

Friday: Spin class to give the leg a break + Core

Saturday: 10.3 miles with the group – leg better than Thursday, but could still feel it on the run.

Sunday: 8.3 miles with the group - I could tell I ran yesterday as the leg was slightly more sore.  I'll be taking tomorrow off to cross-train and get the scan.

Up Next: An Answer?

Bone scan is scheduled for Monday and I go back to the doc on Thursday to get results and discuss next steps.   If the bone scan is clean, she’ll do more diagnostics in-office to try to determine what muscle is giving me the trouble and how badly injured it is. Depending on what we find out this week, I’ll know if I’ve got several weeks of cross-training ahead or if I might be able to jump back on the running bandwagon (in some capacity).

How was YOUR week?

Training Week in Review – 10 weeks out from Harrisburg (8/25/14 - 8/31/14)

Annnnddddd…..I think I’m officially injured. I was in denial for the first part of the week and tried to press on as normal, but by Wednesday there was no denying that something was definitely NOT RIGHT with my left leg. It’s the calf/posterior tib area that’s bugging me and as the week wore on it became increasingly apparent that I needed to listen to my body and give it some TLC and time off.   I threw in the towel and called the sports doctor since I’d rather nip it in the bud as early as I could so that I could possibly avoid a long layoff.   Ended up getting in with her on Thursday morning.   But let’s back up a bit - here’s how the week shook out:

Monday: 10 miles easy (8:26 pace)

Tuesday: 9.85 miles w/8 hill repeats + Body Pump

Wednesday: 8.75 miles easy (8:22 pace) + Core

Thursday: 8 miles recovery (8:31 pace) + Body Pump

Friday: OFF + Core

Saturday: Sweaty spin class (26 miles on the bike)

Sunday: OFF + Body Pump w/heavy weights

Total miles: 36

Monday’s 10-miler - (Still in denial at this point) After plenty of massage/foam rolling Sunday night, the left leg felt much better on Monday, but still not 100%. I'm definitely aware of it at times when I'm running and it feels similar to when I had a slight tear in my calf muscle (on the other leg) many months ago. I decided to wait and see how it felt on Tuesday before doing any hill repeats - if it's still tender I would skip the repeats and just run easy. If this is the same thing I had last time, the process for healing is just to reduce hills/speed until it feels better - or mileage if the reduction of speed/hills doesn't seem to improve it. I'm hoping it's just a tight muscle though (and not a tear) and it'll continue to rapidly improve.

Tuesday’s Hills – (Denial, take two) Leg was still tight and a bit sore on Tuesday but not terrible. Opted to do the hill repeats anyway since that morning was actually 58 GLORIOUS degrees! I did end up cutting the set down from 10 repeats to 8 repeats since the leg wasn't 100%. It actually felt the best on the actual repeats, but I did feel like I was running a bit tentative and kept expecting the leg to hurt. After the hill repeat portion the rest of the run I could feel the leg tightening up a bit - it's the Tibialis Anterior muscle that is tight on my left leg. It seems to be referring pain to another spot on my calf. Decided to try to run very easy Wednesday and if it was painful then I’d take Thursday off and rest it. At this point I was crossing all of my fingers that the massage and stretching I'd been doing would be enough to coax it back into shape! 
Repeat Splits: (hill is 0.19 mi) 1:16, 1:14, 1:10, 1:11, 1:10, 1:08, 1:06, 1:05 (Splits were much better this week due to the cooler weather!)

Wednesday - (Reality starts to set in) Kept this easy, but unfortunately could feel the leg. Seems to be something around the calf that's causing the tenderness more so that the tight tibialis anterior. Ugh. Since the left calf is sore, I am apparently overcompensating and the right quad is sore from taking the weight. I'm a mess.  Made an appointment with the sports doc for Thursday and I'll see what she says. I'd like to nip this in the bud early!

Thursday - Ran early in the morning before seeing the sports doc. I had a double run on the schedule today but figured I’d probably be unable to get to the second part of this since I had a feeling the doctor would tell me to cross-train. Leg felt a bit better today, but it's still tender somewhere deep in my calf. I've been icing and I've taken Aleve and have tried to massage/foam roll. On the run this morning I did most of the miles on the local high school track for some flatter terrain. I saw the sports doc and she diagnosed it as an irritated posterior tibial tendon on the left leg, and a quad with some giant knots on the right leg.  No running tomorrow (and therefore no double run for me) and cross-train for a few days. She also did the cold laser in office, and told me to ice later and that I should try to get in to see a massage therapist for some manual work for at least 3 times over the next two weeks. (Yikes - that's expensive!) So I'm going to focus on massaging what I can myself with the foam roller and stick and then try to get in to get a professional massage next week. I'm hoping that I can run a little on Saturday or Sunday if it's feeling better. I'm bummed that it's the first few weeks of training and I'm not able to do the mileage, but it is what it is.

Saturday - Since I couldn't do the 16 miles I had planned for today (thanks, leg!), I opted for a cycle class in the morning. I don't know what it is, but during those classes I am DRIPPING sweat. I don't know if I'm just out of cycling shape or if the other folks in class aren't working as hard but at the end of it I had a puddle of sweat under my bike! Sign of a good workout, I guess! Definitely got my heart rate up, but I sure did miss my long run this morning.  I got my post-long-run coffee at Starbucks but felt like I didn’t “earn” it since I didn’t really run. But at that point I needed a little boost since I was kind of down in the dumps from having to miss my long run.

Up Next: Maybe a run or two??

So….not sure how this next week will shake out. I’m going to try to run on Monday and see how it does. I’ve been religiously icing and rolling and elevating and compressing while all the time trying not to stress out about it. Fingers crossed that the calf will corporate enough to perhaps allow me to return to some training this week.   But the name of the game is to listen to my body and not push it too much. No sense in making the injury worse! Any happy healing thoughts you could direct my way would be greatly appreciated!!!

That was my training week in review – how was your week?