What’s Wrong With Me?

I will warn you right now that this may not be the most interesting post I’ve ever written, but I am writing it to help document my analysis on my current running injuries so that I will have it for future reference.  So it really won’t hurt my feelings if you choose not to read about every, aching muscle in my body.  I guess I am really writing this for my own benefit regardless of whether anyone actually cares to read it (which is perhaps what writing is really all about).

So, here goes.  People – mostly strangers in fact – keep asking me “What happened?”  Maybe that’s the easier question because I can recount my mileage and the past and tell you the majority of what has happened to me, but ‘What is wrong with me?’ is an entirely different question with a much more complicated answer.

Over the past few weeks, I have been inundated with opinions from various people – the physical therapist, the chiropractic sports physician, the orthopedic surgeon, my parents (who have read one article on stress fractures and harassed their orthopedic surgeon neighbor), and random strangers.

I started looking for answers beyond my Google searches about three and a half weeks out from the Boston Marathon.  I feared a repeat of the Marine Corps Marathon when I finished the race unable to walk for three weeks (and unable to run for almost three months!), and thus, I wanted to have a professional give me the green light for the Hopkinton starting line.

My complaints coming in to the physical therapist’s office (my first stop) were pain in my hips – especially my right hip, strain in my left ankle, and posterior shin splints in my right lower leg.  After my initial examination ($100), the diagnosis was weak gluteal muscles and inflexible ankles.  The therapist did not believe that I had shin splints in my right lower leg, but instead thought it was nothing but tight muscles that were resulting from my weak glutes.  I breathed a sigh of relief because in the back of every runner’s mind is always the fear of a stress fracture.  After hearing “I am confident I can get these issues cleaned up before the marathon,” I was happy to go home and start my strengthening exercises and return for weekly needling sessions ($75 each).  Total spent = $325.

After four needling sessions and little to no improvement with the pain in my right lower leg, the physical therapist mentions that I may want to get an x-ray to rule out a potential stress fracture after I get back from the Boston Marathon….which was in just four days!  And as far as my pace at the Boston Marathon goes, the therapist suggested I “just cruise.”  When I pressed him on why I should run slowly, the response was nothing to do with injury prevention. Instead, he said, “Well, how fast do you think you can run anyways since you haven’t been training?”

Stressed out, confidence shattered, and a little bit pissed off, I went in to the office of a certified chiropractic sports physician the next day to receive a second opinion and an x-ray in hopes of ruling out a stress fracture and calming my nerves.  Luckily, the appointment ($140) went super!  According to the doctor, while there was proof of two, old stress lines (they were very white indicating the calcium deposits on the distressed bone), these lines were not the source of my current pain and there was no evidence that I have a stress fracture.  Furthermore, he did tests with some sort of tool that created vibrations on my leg, and pronounced that he did not believe I had a stress fracture because the tool was not inciting pain.  While the x-ray could not completely rule out the possibility of a stress fracture, the doctor suggested that I board my flight the next day, Boston bound, and attempt to run the marathon.  Regarding pace, he said that it should not matter.  Instead, I should just focus on getting out of mid-stance as quickly as possible.

Skipping over the disappointing marathon as quickly as I can, let’s just say the race experience was briefer than this paragraph.  After running 11 miles at around a 6:30 pace (official average pace from the 15K checkpoint showed an average pace of 6:32 which was honestly a little slower than the 6:25 I was shooting for but I think part of the problem was the pack was very thick especially during water stops where I slowed significantly, and I just wasn’t trying to push anything that early on.  I was cruising.), I knew I had real problems and bailed.

Hobbling home, head hung low, I believed I most likely had a stress fracture.  Partly because of the pain (I was able to walk but I was struggling and severely limping at times) and partly to expedite the recovery timeline, I put myself on my crutches, a souvenir from the Marine Corps Marathon, before returning to see the chiropractic sports physician.

When I finally got my body in to the chiropractor’s office the next day (everything takes 10 times longer when you are on crutches), I was told that a costly MRI would be able to provide more of an absolute diagnosis of my condition but if I were willing to go non-weight bearing for two weeks, the test really wasn’t necessary.  Since I had already put myself on crutches and didn’t particularly enjoy the pain of walking on my bum leg, I agreed to a two-week sentence with the sticks and to twice-weekly sessions with the doctor to receive treatments such as laser and electronic muscle stimulation ($70 each session).  After all, the doctor was promising that I would be running again in just six weeks – I was willing to follow all orders to give him a chance to make good on the promise.

But, as you may or may not be aware, there was a setback early on in my chiropractic treatment.  Like a government construction project, my recovery’s estimated time to completion had been extended.  My first few steps after I finished my two weeks of non-bearable – I’m mean non-bearing – activity were some of the worst.  My body just sunk down in to that right leg, and my arms were flailing to find a piece of furniture to brace myself on.  After a hot shower, what muscles I did have left in my right leg (following doctor’s orders my only exercise of the leg was a little bit of band work – he didn’t want me doing anything that caused discomfort) did warm up and I was walking much better, but at the end of the day I was back limping around again.

So, it was no surprise to me that the doctor (after consulting with another doctor at the practice) put me back on crutches for another week after just one day of reprieve.  Also as expected, he confirmed that my total recovery time had been pushed from six weeks to seven.  He upped my calcium intake to help expedite the repair of any bone damage.  (I am currently taking 2,000 mg of calcium each day, which is 200% of DV) in addition to what I am receiving naturally from my organic skim milk and Greek yogurt.)  If I wasn’t better in a week, then a MRI would be needed to make sure they weren’t “missing anything.”  By this time, the doctor had gone from believing I didn’t have a stress fracture to believing whatever I was experiencing was bad enough that it should be treated as a stress fracture, to finally thinking that I did indeed have a stress fracture – just no hard proof evidence of one.

I first went to the physical therapist and then the chiropractor to give myself some sort of piece of mind – let someone else figure out my injuries and tell me what to do.  But yet I was wide-awake at 3:30 am the morning after being put back on crutches, questioning whether I was on the right path.

I never went back to sleep Friday morning and as you can imagine it was a very long day, but I am hopeful it was a productive one…I took my treatment back in to my own hands and began analyzing – obsessively I’m sure – my whole running history and every ailment I have had in the past year.  If I am going to continue to run and train, I need to figure out what is truly wrong with me, where I made mistakes in the past, and what I need to do going forward to prevent these injuries.

While the doctors of chiropractic appeared to be a bit unfamiliar with my particular case, I realized, even with just one good one, I may still have a leg up on these guys – I’ve been here before.  After the Marine Corps Marathon, it took FOREVER for me to be able to comfortably walk again.  I was on crutches for a solid three weeks or so.  Fortunately, I didn’t do nearly as much damage at the Boston Marathon as I did at the MCM.  At Boston, I bailed as soon as I realized I had real problems.  Unfortunately, at D.C.’s MCM, I ran another four miles or so in order to complete the race.  My lower right leg and ankle were completely trashed after completing the marathon.  There was no way I could have even limped around on that leg.  However, it seemed that I made greater progress back in fall with returning to walking than I currently was experiencing.

Thus, two days after being put back on crutches, I decided to go against doctor’s orders and began weaning myself off the crutches the same way I did last fall after the MCM – by putting weight on the right leg using two crutches, then just using one crutch, then one crutch just part of the day, and finally going crutch-free (unless you count my IPAs).

Feeling like my laser and electronic stimulation treatments were helping about as much as an O’Doul’s can give you a beer buzz (ok – research says if you drink 50 O’Doul’s… https://answers.yahoo.com/question/index?qid=20080422195207AA72K5I ) and concerned that I still had no real answers on what was causing my pain – Do I have a stress fracture?  Or is this just muscular?   I decided to stop seeing the chiropractor (I felt like I was dumping the poor guy, but honestly, I think I was the one who was played. Total cost = $560 and worse – loss of half the muscles in my lower right leg due to prolonged time on crutches and disallowing cross-training.  My lower right leg is now noticeably smaller than my lower left), I gave in to my parents’ nagging and went to see an orthopedic surgeon.

I entered the surgeon’s office armed with a typed summary of the medical history of my running injuries (he asked if I was a lawyer) and prepared that an MRI would be needed to reach a diagnosis.  However, after reviewing my x-ray from the sports chiropractors – you know, the one that showed no signs of a stress fracture, the surgeon entered the examination room and made reference to my stress fracture.  My reaction was something like, “Um what?  I’m sorry?”  He agreed that the area above my ankle where I have been experiencing considerable pain was not a fracture – he did state that it was a stress reaction and even though the bone showed calcium deposits, it was evidently still the source of my pain.  However, in another interesting twist, I do have an actual stress fracture as well, but, as the surgeon pointed out on my x-ray, it is actually further up on my lower leg.  Perhaps the chiropractic sports physician was only examining the part of the x-ray where I was complaining of immediate pain, but the stress fracture had previously been missed.  My first appointment after Boston, I did tell the chiropractor, that, as odd as it sounded, I thought I felt pain higher up on my lower leg, but I wasn’t sure if I was imagining it – like perhaps it was coming from the troubled spot above my ankle and something was just screwed up with my senses that made me feel it higher up on the leg.  The doc pretty much brushed it off, but I now believe that what I was feeling may have been the actual stress fracture.

Overall, the orthopedic surgeon (total cost unknown as press) acted a bit like my stress reaction and stress fracture were no big deal.  I am scheduled to return in a little over three weeks for another x-ray to check the healing of the bone.  At that point, hopefully I will be able to slowly return to running.  As for the time being, I am thankfully done with the crutches!  And I can do non-impact exercises.  The surgeon’s instructions went something like “Do not run. You can aqua jog.  Do not run.  You can use the elliptical. Do not run.  You can go to do any non-impact activities, but DO NOT RUN!”

As I have every reason to be given my previous medical treatments, I am still concerned that the surgeon’s timeline may be too good to be true.  I fear the treatment of my stress fracture has been like eating at one of the formula-based Mexican restaurants where the #5 is always a two-enchilada combination – it’s been simplified to a plan that is used on almost every patient.  I really want to believe my injury is as straight forward as taking six weeks off.  Going to see medical provider after medical provider like a doctor-shopping, pain medication addict, I have felt like an old woman who is so desperate to regain her youth that she would try and pay for any “miracle” drug or treatment.  Medical providers have made broken promises, and I have paid for and followed orders (and lost money and muscle mass).  I would much rather write a post about trying a new practice that helped me recover more quickly, and I know that other people have tried some of the same treatments that I did and had great results – For example, a cocktail waitress at the Charleston wedding a few weeks ago was telling me about how well laser worked for a friend.  But like the Almost Famous quote, I have to be “honest and unmerciful.”  And I believe all my leg has really needed is just rest from running (cross-training allowed).

So, in conclusion of this extremely long writing that resembles a chapter in a book more so than a blog post, I am hoping to start running again in three weeks pending an additional x-ray.  In addition to slowly building my miles (no more “I feel great!” three weeks in and aggressively jumping my mileage again like an idiot), I am focusing on more strength training.  In addition to rehabbing my tiny little right calf, I am focusing on the tibialis posterior (or posterior tibialis – I can’t figure it out!) because I believe this muscle – especially when tightened – played a significant role in my current injuries including my plantar fasciitis (which I haven’t even mentioned) and in my old “ankle sprain” injury from the fall.  I will also work on my glutes (which the therapist thought were weak but the chiropractor said were fine) and my hip flexors (the chiropractor said the right one was not firing).  Lastly, I will continue to take calcium supplements.  Maybe it had nothing to do with my injuries, but I did stop taking my daily multi-vitamin back in the winter after being instructed at my yearly physical that supplements were not necessary.  I didn’t lie at the beginning of my post when I said there were a lot of opinions involved.  At least my strengthening exercises and vitamins are like ice baths – maybe they aren’t necessary and won’t help, but there’s definitely no harm in trying.

3 Weeks till Running (Hopefully!)

This Week’s Beer Choice: Ballast Point Sculpin IPA (San Diego, CA) at Pint Central (Charlotte, NC)