Diary of an Injury: Four Months Later

You may think it is funny that I am writing about an injury four months out.  What sort of milestone is four months, anyway?  Well, it’s less scary than six — which is what, in good faith, I would have to call this if I was writing a couple of weeks from now.

Because the first time I felt pain associated with this injury was on December 3, 2013.

I tried to self treat, which may or may not have made it worse.  But in any event, by the time I arrived for my first physical therapy session (more than one month later, and just about four months before today) I was in a greatly weakened state.  I was helpless.  I was afraid.  And I was beginning to think that I would never get better.  That my days as a runner were over entirely.  And I experienced a horrific loss of my sense of self.  For a short while, anyway.

At those first few sessions, I could do almost nothing.  Arching my back was considered an “exercise.”  And you can just imagine what that could do to the mind of a girl who had run her first marathon just two months earlier, finishing proud and strong.

So where am I now?  Well, I’m not so sure.  But here’s the general run-down:

My injuries include but are not limited to:  inflammation of my right quadratus lumborum, left piriformis and (lately) gluteus medius on both sides.

My treatment has included twice weekly physical therapy sessions, which are currently on hiatus as I eagerly await approval of additional sessions from my insurance company.  My last session was last Thursday, and in that session I performed a good lot of exercises, and received no manual palpation of my trigger points – which I usually do – by my physical therapist.

My physical therapist beats the hell out of me and I love it.  Because it makes me feel like I am using my body the way it is intended.  Because it makes me feel strong.  Because it makes me less afraid of how much I can take.  Because he tells me I have a “game face”.  Because he has become a friend and a mentor, too.  Because the workouts keep getting harder and harder which means that I am improving at every turn.  Even on the bad days, I am headed somewhere better.

I started running again on March 6, 2014, on a treadmill at a hotel gym in Chicago.  I attempted .5 miles that first run, and my longest run since totaled over 7 miles (about two-and-a-half weeks ago); though I suffered a flare-up shortly after and have been running up to 4.5 miles at a time since then. My weekly mileage has averaged at about 15 miles per week for the past month and I hope to gradually step that up and hit 25 miles per week (my usual between-training-cycles mileage) by late June.

I haven’t done any speed work though my pace has greatly improved.  Low 8’s come naturally and I can usually muster something in the 7:2x, 7:3x range by around mile 3 (or later) of a run.  Every time I have wanted to do a speed workout, I’ve had some flare up or something else has made me opt for an easy run instead.

Flare ups are caused by wearing high heels, sitting for prolonged periods (as I write this, I am taking periodic standing breaks every few minutes), descending flights of stairs and – oddly – running slowly.  The days of 9 minute mile slogs are over.  My body feels better when it moves faster.  There are other causes, I’m sure, but these are the ones that I have consistently noted.  I am fairly certain that getting inadequate sleep (and thus not allowing my body to properly recover) has been another trigger.

There are good weeks and bad weeks and okay weeks and they seem to flow in just that order.  So just when I am reveling in the joy of feeling like I can start training again, I have a setback and am in agony for a week before I have another week where I slowly but steadily feel like I am getting back to a good place.

Races are something that I can’t stop thinking about.  On my good weeks, I obsess over race calendars and fantasize about crossing the finish line of a November marathon.  Philly and Brooklyn top the list of those that interest me.  But on my bad weeks and okay weeks, I am brought back down to reality.  When I entered training for the NYC Marathon last July, I was already logging 28 or more miles per week comfortably, racing regularly and feeling strong and injury free.  I am nowhere near that place right now.  I am still dealing with discomfort associated with my injuries, I haven’t raced in more than six months and I haven’t been training (and by “training” I mean doing proper speed work and logging 25+ weekly miles) consistently.

The only race that I currently have on my calendar is a 5k in Coney Island that my husband and I signed up for on the day before my birthday.  I go back and forth about whether to sign up for more.  Running shorter distances like the 5k or 10k are really enticing to me right now because I know that I can handle the distance and it would just take a month or so of consistent training to go for some sort of a target time.  So that seems practical and realistic.  But after throwing $200 plus in race fees in the garbage this year for DNS’ed races, I am apprehensive to throw more money into the pot.  I really want to feel good and strong for a while before I start making the commitment to race again.

My apprehension about racing is much more than just about the money, or just about the fact that I am still healing.  It has to do with two more things, as well.  The first is that I have to admit that I have struggled with some anxiety going in to my more recent races.  In 2013, I was so hyper-focused on specific times that I didn’t even know how to enjoy myself racing.  The night before and morning of were fraught with fears of whether I would be able to meet some arbitrary goal that I had set for myself.  And it has been nice to be able to let go of some of those fears for a while.  I want to hold off on racing seriously until I feel more confident in myself and in my body and in my ability to achieve the goals that I set for myself.  I need to learn how to be proud of my efforts, no matter what.  And that just isn’t me.  I beat myself up.  The second reason is, just that:  I beat myself up.  I set a goal and I will be damned if I don’t meet it.  I don’t feel pain until it is too late, because I am so committed to finishing that 20 miler, or getting that 10k done in sub-50.  So screw everything else, ’cause I’m gonna hurl my body at that finish line if it’s the last thing I do.  And yes, that is probably how I got injured.

Swimming is something that I started doing to keep my sanity during the period of time when I was unable to run.  It has turned in to another passion of mine, and I really look forward to my time in the pool.  There have been some side effects emanating from that though; such as some hip soreness after especially long swims (about an hour of breaststroke).

Soreness scares the hell out of me.  I am working very hard on this whole “listen to your body” thing.  But when it tells me it’s sore, I fear it is telling me that it is injured.  And that just isn’t something that I want to hear.  I am learning to be patient.  To lay off when I feel sore, and assess again the next morning or the next time I attempt the same activity.  The gluteus medius thing is making me nervous.  I am sure it is all associated, and so I am just trying to incorporate more “total rest” days in to my routine, taking one every fourth day.

My exercise routine is slowly, but surely, becoming more consistent.  In general, I do physical therapy exercises (including core and lower body strength training) twice weekly, a second strength session (consisting of upper body and some additional core exercises) twice weekly, I run 3-4 times weekly and swim 2-3 times weekly.  I am working on building an eight-day training plan, which right now looks something like this:

Day 1 – strength (PT & lower body); easy run (20-30 mins)

Day 2 – strength (upper body & core); swim or row then run easy (optional 40 mins)

Day 3 – run (speed training)

Day 4 – rest

Day 5 – strength (PT & lower body); tempo run (30 minutes)

Day 6 – strength (upper body & core); swim or row then run easy (optional 40 minutes)

Day 7 – long run (start at 5 miles, adding one mile every week)

Day 8 – rest

But it is really just a work in progress, and needs to be flexible and forgiving.  Also, I really need some more input from my physical therapist and wouldn’t necessarily recommend this training plan to anyone else.  So if you are dealing with an injury of your own (or not) consult with your own specialists before building a plan that works for you.  This is just one that might work for me.

Getting back to where I was before is something that I no longer think about.  I know that there will be a point when I will have healed completely, and this injury will fade into a distant memory of the past.  But I don’t think that I will ever “get back to where I was before” because I am working with a very different body these days.  I’ve dropped weight and built strength and train in an entirely different way.  I will heal, I will improve and I will be an even better runner than I was before – and maybe better even that I had ever imagined – but getting better doesn’t mean getting back to where I used to be.

I know and accept that healing means that I will end up in a place that is very different.

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