Archive for ‘Injury’

April 21, 2015

Musings on More

As evidenced by my posts the last few weeks, I went into the More/SHAPE/Fitness/Idontknowwhatelse Half Marathon on Sunday with mixed feelings.  It’s only been a little over a month since my huge PR at the NYC Half, and I raced a solid 4-miler in Central Park last weekend.  I’ve been ramping up the tri training over the last several weeks, though, and I’ve been cycling (no pun intended) between feeling like I’m on the verge of overtraining, backing off, panicking because I’m not training enough, ramping up, and repeating.  My big toe stopped squeaking this week, but now it hurts in a way that is somewhat reminiscent of the early stages of my stress fracture in the fall.  (I actually had an anxiety dream two nights before the half that all of my joints were squeaking like the Tin Man.)  Needless to say that when I toed the line on Sunday morning, it was with mixed emotions.

I scored a Wave 1 start for the race, and for the first time ever I actually lined up right at the tape.  That was mainly to get a view of Deena Kastor (squeeee!) RIGHT IN FRONT OF ME.  When the gun went off I attempted to hang with her for about 25 feet, and all I can say is that seeing an elite runner up close was both incredibly humbling and slightly terrifying.  In the thrill of chasing Deena I laid down a sub-7 first mile, which was probably not wise.  I tried to back it off a bit on the next couple, but running with the front pack was throwing me off and I kept finding myself speeding up.  It wasn’t long before the initial excitement wore off though, and I started feeling a bit flat.  My left quad was worryingly tight, and even though my toe wasn’t hurting much I was also fretting about worsening that injury.  To add to the fun, I could feel the early twinges of a side stitch forming, probably thanks to the breakneck speed at the start.

The course was just over two loops of Central Park, and I knew the key would be to keep my effort consistent between the uphills and downhills. I kept the pace in check for the first trip up the Harlem Hills and made up some time on the back side, but knew that pacing on round two would be tougher.  I had my first gel when I passed the starting line again, six miles in.  Almost immediately I felt the side stitch twinges solidify into a Side Stitch From Hell, a la the Baltimore Marathon.  This time I at least had more core strength on my side, though, and I found that if I kept my upper abs totally engaged and breathed very low in my belly that the pain was manageable.  I continued this way for about a mile and a half, breathing in for three steps and out for two, and eventually the cramp seemed to ease a bit.  For most of that time I fantasized about dropping out, calling my mom and the Caveboy and telling them I DNF’d.  Usually that kind of thinking would motivate and refocus me, but this time I just didn’t seem care that much.  I kept running, pretty much on pace, so I guess I did care, but I just could not find my mojo.  At some point the 1:45 pace group leader caught up with me, and I hung with her group until the next aid station, which they walked through.  They caught me again just before the second trip up the Harlem Hills, and and I was happy to tuck in and let them take care of pacing for a while.  About a mile later I heard the leader say something about the pace being off, and they sped up a bit.  They pulled away over the next mile, and while I kept them in sight, I never made a serious effort to catch them.

By that point my main concern was my left quad, which was still cranky.  I was hoping it wouldn’t cramp up with the downhill stretch through the bottom of the park, and knew I should be drinking more and taking in another gel.  I was still wary about the side stitch returning, but I finally decided it was worth the risk and took a gel around the 11 mile mark.  We still had a couple of rolling sections left, and the course was becoming increasingly crowded with the walkers that we were lapping.  I’m all for athletes of all abilities taking part in these events, and I’m a firm believer that the last person across the finish line has every bit as much right to the course as the first.  Participating in a road race demands a certain level of awareness, however.  Whether you’re running fast, slow, or walking, you’re part of an athletic competition.  Walking four-abreast and blocking the entire lane and forcing other runners into the grass or the bike lane IS NOT GOOD RACING ETIQUETTE.  I definitely paid for the clear sailing at the start with a lot of bobbing and weaving on the second lap when I was physically and mentally drained.  By the time we turned off at the 72nd Street cutoff to the finish line, I was pretty fried.  I managed to ramp up the pace to the low 7’s for the last 800m or so, picked off two runners in the chute, and ended up finishing in 1:45:33.  It was certainly a solid time, and one I would have been thrilled with last season.  I should be thrilled with it now.  It was just over 2 minutes slower than my PR last month, but the course was much more difficult and the day was at least 15 degrees warmer.  Given how generally flat I felt, it was a really solid performance.  I finished 44th in my age group and 280th/7,500ish overall, which is certainly respectable.  Still, I’m disappointed. I can’t tell if it’s just that I gave up a little bit mentally and stopped fighting for this one, or if it’s part of a bigger issue.  Last year I actually scheduled quality time with myself after key races to reflect how things were going and make any adjustments to my training going forward.  I haven’t done that this year, and I think it might be time.

My biggest concern right now is my toe and whether I’m headed for another stress fracture.  If so, it most likely points to female athlete triad syndrome and the possible need to rethink both my training schedule and nutrition.  There’s so much there to unpack that I am going to leave it for a separate post, but suffice it to say that the threat is weighing heavily on me.  It’s way too early in the season to be worrying about major injuries and overtraining.  My big-picture goal is getting to Boston in the next year or two.  That means prioritizing my overall fitness  and staying healthy so that I’m able to train consistently.  To that end, I’ve decided that for at least the next week or two, my fitness goals are as follows:

 

  • Get at least 7 hours of sleep every night.
  • Eat more calories than I think I’m burning each day.
  • Institute a biking boot camp and substitute biking for all run workouts until the toe shows signs of improvement.
  • Stretch every day.
March 13, 2015

I need a plan.

The New York Half is in two days and somehow I still have no game plan.  Despite the countless demi-marathons I’ve run over the years and having run the race last year, I just don’t have a  good feel for Sunday.  The fact that I’m returning from injury and have only been training for 5 weeks with limited mileage is the first question mark.  I’ve been hitting my paces on the intervals and tempos, but I do feel like my speed over distance suffered a bit with the time off for the stress fracture.  I’ve been putting in more training hours in the past few months than I ever have, but the bulk have been swimming, biking, and strength training.  Post-injury I’m still limiting my mileage only to the ‘quality runs,’ so my monthly totals are looking more like my weeklies were last year.   I feel like the change in training approach along with the added strength sessions has definitely made me leaner and given me more power in my legs, but the past few weeks have been almost like getting used to running in new body.

To top all of that off, I got hit with a cold this week, so my running didn’t so much taper as drop off a steep cliff.  I’ve been (for once) erring on the side of extra rest, so I did a short interval session Tuesday morning before the cold really set in, a brisk 3 miles Wednesday night in an attempt to shake the congestion loose, and another easy 3 on Thursday morning.  My last strength session was Monday and I’ve done no swimming or cycling this week.  I’m still feeling a little stuffy, but my five pronged defense of hot tea, Echinacea, vitamin C, bone broth, and frequent use of the neti pot seems to be working.

Still, the pacing question remains.  My last long run was an 8-miler, which I ran at 8:15 pace.  It felt quick, but not bad.  The half marathon A goal this season is sub 1:45, which basically means running 8 flats.  My gut tells me that’s probably a little too fast to sustain right now, but part of me wants to just go out like a Kenyan and let the chips fall where they may.  The course is fast—all the hills are in the first 5-6 miles through Central Park, and then it’s pretty much a gradual downhill to Battery Park.  That said, if I plan to negative split I’ll need to allow a little extra time for the terrain at the beginning and then really book it at sub-8 pace for the second half.  The Central Park hills aren’t that bad, but I know from experience that they can take their toll if you go out too fast.  My worry is that if I get caught up in the moment and take off at near 8’s through the park I’ll end up nursing a side stitch for the rest of the race.

So the real question is, how much can I actually handle right now? How fast is too fast in the park?  To add to the fun, thanks to my Garmin’s altoceloraphobia, last year I lost satellites for most of the stretch through Midtown, so I can’t really plan on reliable pacing once I hit the flat anyway.  In the end this race may be more of an exercise in just going with the flow.  Given the head cold and that it’s my first real race back since my injury, I think I’d be happy to run close to a PR (1:50:44), and then gun for 1:45 next month in the Women’s Half.  Still, the weather is looking pretty ideal—mid 40’s with some clouds, and I want to do my best and start the season on a high note.  This should be my first run in ages not done on tired legs, so maybe there’s still hope for some race day magic.

January 30, 2015

Ups and Downs

It was that kind of week.

It was that kind of week.

You know those Time Warner Cable PSA’s that try to get kids interested in STEM subjects by relating them to sports?  I have a great idea for one:

“Running requires speed, strength, and endurance.  But did you know that it also requires basic arithmetic skills so that you don’t end up doing your tempo run 50 seconds per mile faster than you’re supposed to?  Well, it does.”

I’m still working on the ending.  I actually appreciate a good math error now and then, though.  (Not the Tacoma Narrows sort, but the more benign running-faster-than-I-thought-I-could kind.)  It was a good boost in what’s been an up and down couple of weeks.

Last Tuesday I did my first speed work since before the Brooklyn Marathon, and was thrilled to discover that I was able to keep up with my pre-injury interval paces without much trouble.  I banged out a solid 5-mile tempo run on Thursday and was still feeling some twinges in my foot, but by the weekend it was feeling almost back to normal.  On Friday I had my monthly strength session with my trainer, Kali, Destroyer of Worlds and Abs.  With all of the extra time spent not running for the past few months I had been putting in 2-3 strength sessions a week, and I was curious to see how I would fare this time.  My trainer is not easily impressed, though, and my hopes were not high.  After an hour of brutality, I finally earned a fist bump from her.  Go me.

Saturday I did an hour on the trainer bricked with a 4-mile run.  I had intended to go easy on the run, but I felt good and ended up running an 8:50ish pace.  I’ve been a little concerned that all the strength work might cost me some speed, but my core feels rock solid and I feel like I have much more power in my legs than before, so that’s all to the good.  Sunday was a 6-mile tempo on the treadmill bricked with a 30-minute swim, both of which felt great.  Monday I was back to strength training, as I’m determined to keep up the gains I’ve made.

Tuesday was supposed to be an interval run, which I would usually do on the treadmill.  Thanks to the Storm of the Century that Wasn’t, the gym was closed.  Brooklyn actually got about 7”, and I adore running in the snow, so happily set out with my Yak Trax.  I debated running to Prospect Park, which is really beautiful in the snow, but the 7-mile round trip seemed like a bit much.  In the end, I was happy I opted for a shorter run because my arch/big toe started hurting almost immediately.  There must have been something about the slight slippage that was intensifying whatever change there has been to my gait, and I ended up only doing 3 miles.  To make up for the missed speedwork, I did a 40-minute HIIT session on the trainer to round out the day.

Wednesday was a morning swim/ evening strength day, but I noticed when I was walking to a meeting for work that afternoon that I was rocking to the outside of my left foot to avoid putting weight on my big toe.  Not good.  I hoped it would be better for Thursday’s tempo run, but it was still tender that morning.  I vacillated, vacillated some more, and ended up deciding to swap Friday’s bike ride for the run.  I knew it was the smart thing to do—getting a secondary injury while coming back from the stress fracture is exactly what I’m trying to avoid.  I was still grumpy about it, though, and proceeded to try to set up my new Cat Eye Strada Smart before the trainer session so that I could start getting a sense of my power output.  This was all transpiring at 6 AM, mind you, so I was neither at my sharpest or most reasonable. I knew I didn’t realistically have time to get the bike computer set up, but I was still sulking about the run and resenting the whole situation.  I finally had to give up the set-up process at 7:10, which gave me exactly not enough time to get the full 40 minutes in and still get to work on time.  I also totally forgot that the Caveboy had a big thing at work that day until after he left and spent most of the ride feeling like a bad girlfriend.

That brings me to today and the miscalculated tempo run.  My foot was (thankfully) feeling better, and I was eager to get the tempo run in since I had missed running intervals this week.  I was supposed to be doing 4 miles at 8:10’s, but I obviously messed up somewhere because I set the treadmill to 8.2.  If you’re following along at home, that’s a 7:19 mile, which, for some perspective, is my mile repeat pace.  After the first mile I kind of knew something was up, but decided just to ride it out if I could.  I made it–probably with my heart rate higher than it should have been–but it was a huge confidence boost.  I did manage to finish getting the Strada set up on the bike last night (with the exception of calibrating the power output) so I’m looking forward to starting some more focused cycle training next week.  Until then, Go Pats!

January 20, 2015

Reunited and it Feels so Good

Graph1

This was my first entry in my running log since November. Apparently it stretches the bar graph to fill the space available.

 

I had my first date with the treadmill this morning since before Thanksgiving, and it was glorious.  I had 6×800’s at 3:43 pace scheduled, and I really had no idea whether I’d be able to handle it, both from a cardio standpoint as well as the questionable structural integrity of my foot.  I ended up cutting it to 5 repeats instead of 6, as I decided not to exceed 4 miles including the warm up and down, but it felt great.  I can feel the injury twinge a bit while I’m running, but my foot didn’t feel at all sore afterward, so I’m assuming I’m still in the safe zone and not setting back my recovery.  I’m still a bit wary, though, as my foot strike seems a bit altered now (another reason for cutting the workout a bit short).  I’ve always pronated more on my left side, and I suspect that may have been the cause of the injury in the first place.  Now I seem to be pushing off my big toe more than the lesser ones, and I’m curious if the avoidance of pain may actually serve to correct my stride.  Any slight alteration in gait changes biomechanics and alters the stress put on joints, muscles, and soft tissue, though, and I’ve learned the hard way to be ginger as my body adapts.  More than once I’ve caused a more major injury by compensating for a minor one, and I definitely don’t need to compound this one.

But back to the intervals.  It was amazing!  The cardio felt fine the whole way through, and I definitely could have banged out the last repeat without any trouble.  It was satisfyingly tiring in the way only a good speed workout is, and I felt properly worn out and hungry for the first time in weeks.  I found myself wondering what the runners’ equivalent of smoking a cigarette after is… 

It's looking slightly better.

It’s looking slightly better.

January 19, 2015

Making Progress

Stress Fracture Update

The big news this week is that I ran… twice!  The first one was supposed to be just a mile, but turned into two, and the second was supposed to be 3.5 and ended up being 2.5 due to freezing rain, but still, I ran!  My foot felt a bit sore for about the first mile or so of each, and again towards the end of both runs, but overall there seemed to be no increased soreness or swelling afterward.  I did notice that my arch felt a bit tight a few hours after, and I think I will probably need to be a bit more diligent about stretching and using the foam roller as I ease back into running.  I’ve been keeping up with the strength, biking, and swimming this week as well, and weirdly, I think I can actually feel my body starting to adapt to the new training.  Everything stays the same for days or weeks, and then suddenly the hand weights that felt heavy last week seem to be lighter, or something will just click mid-swim.  Last week I looked in the mirror and thought that it seemed odd that my arms didn’t really look any different after a month of swimming and weight training, and then two days later I looked like I had taken up a blacksmithing hobby.  (I actually did a little in college and have some lovely candlesticks to show for it…)

Anyway, I’m trying hard to come up with a training plan for the next several weeks that will challenge me without risking reinjury.  My successful runs this weekend gave me enough confidence to sign up for a 4-mile race a month from now, and I’ve decided to try using a slightly modified FIRST plan to train.  I’ll actually be doing the cross-training this time, which should fold nicely into my tri plans, and if all goes well, a fast 4-miler will set me up for faster distance work this spring.  I still need to lay out my full race calendar for the year, but I want to hold off a few more weeks to see what kind of running volume I’m able to handle before I start committing to the spring races that I really want to do.  In related news, I got the email on Thursday for my guaranteed entry to the NYC Marathon, and $227 later I am officially in!  Long Run Buddy is as well, and I’m very excited to have a training partner for the full distance of my long runs this fall.

When do I get to call myself a Triathlete?

Even though I’m holding off on committing to any major (running) races for a few more weeks, I did sign up for two sprint-tri’s in May and June, and suddenly that whole endeavor is getting much more real.  My swim classes started last Tuesday, and I’m so, SO glad I enrolled.  The class is geared to novice (but not absolute beginner) swimmers and is focused on the basics of technique and efficiency.  I’ve always seen myself as a weak swimmer and was nervous that I should have signed up for the beginner class, but I seem to be at least at the average skill level in the group.  A few of my classmates have done the NYC Tri before, so I feel a bit more confident that I’ll be able to get through the swim in the allotted time, not to mention survive a dip in the Hudson.  There are also several veteran runners/first-time triathletes in the class who are signed up for the NYC race, and it will be great to get to know a few other newbies as well.  Last week’s session focused mainly on breathing technique, and in addition to working side lying kicking and one arm drills, our coach referred us to this video, created by sea mammal Michael Phelps’ coach, Bob Bowman.  His explanation is very clear and after a very focused half hour in the pool this weekend I actually did start to feel the bow wave on my head.

This week I hope to start structured training for the 4-miler and settle into a workable training schedule that incorporates multiple swim, bike, run, and strength workouts each week.  I will be doing two-a-days several times a week, but I’m hoping that scheduling more short and varied sessions will keep me healthy while still building fitness and strength.  I’m trying to alternate days so that I minimize doing the same activity back-to-back, but I still have to work out the kinks.  I’m incorporating a lot more strength training that I did last season, and I hope that will help me prepare for a heavier training load and avoid injury.

Here’s the plan this week:

Monday

Weight training – JM No More Trouble Zones

 

Tuesday 

AM

Running – Intervals

6×800 @ 3:38*

RI 90 sec

PM

Swim class

 

Wednesday

AM

Swim – 30 min

PM

Strength – JM Ripped in 30 Week 2

 

Thursday

AM

Running – Tempo

2 mi @ 8:04*

1 mi easy

2 mi @ 8:04*

PM

Optional 30 min bike

 

Friday

AM

Strength – 1 hr with Trainer

 

Saturday

AM

3 mi easy

PM

30 min swim

 

Sunday

AM

Brick:

Cycle

10 min easy

10 min tempo

10 min easy

5 min hard

5 min easy

Long Run – 7 mi @ 8:34* (If all goes well this week)

 

*I should note that these paces are pegged to my last marathon and I have no idea if I’ll be able to handle the speed after 6 weeks off.

January 9, 2015

Recalibrating

This was a big year in running for me—I set new PR’s at every distance I raced, finally ran a marathon, and then ran another one.  The thing that I am most proud of, though, was learning how to really work hard at my training.  I’ve never been one to skip workouts, but this year I tried to bring focus and purpose to every run.  The hard days were really hard, and easy runs became opportunities to work on form and efficiency, rather than just zone-out sessions.  More than anything else, though, I learned that the voice in my head telling me I was too tired and I couldn’t do it was usually just that—my head being tired.  I’m still working on it, but I got much, much better at ignoring that voice, pulling up my big girl tights, and pushing through.

I’m now dealing with the other side of that coin, however, which was misreading the signs that I was overdoing it on the bike.  Although I felt some discomfort, the pain never felt remotely like what I recognized as an injury—I just thought I was putting in some tough workouts.  As runners, we rely on our ability to listen to our bodies and differentiate between the discomfort of a hard workout and the pain that indicates an impending injury.  My mistake was assuming that my ability to discern that line extended to a new sport in which I had little experience.  The fact that cycling (and swimming, too) is not weight-bearing means that the threshold for and severity of discomfort are entirely different, and I failed to calibrate for that.

For the past two weeks I’ve been slowly returning to something that resembles an actual training schedule, albeit without the running.  In contrast to my usual approach, I’m going mostly by feel and making it up a week at a time.  I’m realizing that switching from running to tackling the other triathlon disciplines is a bit like driving in the snow.  I know exactly how the car handles under normal conditions, and while that’s useful information, I still need to go easy on the gas pedal and leave lots of extra braking distance.  My general zeal for new athletic endeavors combined with marathon-level endurance have proved to be a dangerous combination, so I’m trying to recalibrate a bit.  To that end, I’m mixing up my workouts so that I’m not doing the same activity on consecutive days, and still incorporating lots of strength training.  For biking since the injury, my approach so far has been to stop before I feel like I’ve really had enough.   I seem to be finding my groove with the swim workouts—I actually got (temporarily) thrown out of the slow lane by the lifeguard and upgraded to the medium lane last weekend.  My classes start next week, so I’m expecting that will lend a bit more structure to my pool workouts as well.  This is how week 1 of Operation: Recovery has looked:

Tuesday

30 Minute Swim:

Warmup
4 x 25m
Drill:
4 x 25m Catchup
4 x 25m Kick
4 x 25m Fist
Cooldown
Easy 25m resting as needed for remainder of 30 minutes

 

Wednesday

AM: Strength training – Jillian Michaels’ No More Trouble Zones

PM: 30 min moderate biking

 

Thursday

35 Minute Swim:

Warmup

4 x 25m

Ladder 
25m, 2 X 50m, 2 X 75m, 2 X 50m, 25m
Cooldown
Easy 25m resting as needed for remainder of 35 minutes

 

Friday

AM: 45 min moderate biking

PM: 15 min strength training – Nike’s Strength for Runners

 

Saturday

45 min swim:

Warmup 
4 x 25m
Drill 
2 x 25m Right Arm
2 x 25m Left Arm
2 x 25m Kick
2 x 25m Scull
Endurance
2 x 50m
Cooldown 
Easy 25m resting as needed for remainder of 45 minutes.

 

Sunday

AM: Strength training – Jillian Michaels’ No More Trouble Spots

PM:1 hour moderate biking

December 31, 2014

Getting Stronger

I’m not really one for year-in-review appraisals or New Year’s resolutions.  In general, I associate New Year’s with two weeks of noobs crowding the gym.  (Newbies please note: if you are walking on a treadmill, the automatic cool-down period at the end is not for you.  Do not walk in slow motion for five minutes while others are waiting, only to hop off and resume a brisk pace to the locker room. Seriously.)

In light of my recent injury, though, I can’t help being a bit more reflective than usual this year.  I had easily the best training year of my life.  I learned how to set challenging goals and not to let myself off the hook for them.  I learned to train hard and successfully.  Injury aside, I think also I learned how hard I can push myself, and it’s harder than I thought.  As a friend said recently, “You have to cross the line now and then to figure out where it actually is.”  The stress fracture, too, has been instructive.  I’ve been reminded that I’m not Superwoman and no matter how good of shape I’m in, I still need to be gentle with myself.  I enjoyed running this year more fully than I ever have, and I’m now even more acutely aware how precious every step is.  I have realized these past few weeks how much running has become part of my identity, and how it’s become a measuring stick for how may day, or week, or life is going.

My foot continues to improve, albeit slower than I would like.  Interestingly, it seems to plateau for several days at a time, and then overnight will suddenly feel markedly better.  The injury first became apparent just after Thanksgiving, but I’m pretty sure that walking four miles on it at the Jingle Bell Jog and the pain that ensued after probably set things back a bit.  That would put me at somewhere around week three of the healing process, which means the bone callus should be forming now.   There is a distinct bump at the site of the injury now and the area is definitely less tender now, so that’s all to go the good.

Swimming really has been the silver lining to all of this, as I may have actually set myself up to drown in the Hudson next summer had I not been absolutely forced to focus on the swim.  I’m far worse at it than I expected, and I never would have dedicated this much time to it if running or biking were at all possible.  I don’t enjoy swimming yet, but I’ve been working hard, and after watching several YouTube videos to study up on technique I’ve definitely been able to make some headway.  Last week I realized that I was “swimming flat,” meaning that my hips were staying parallel to the bottom of the pool while my upper body rotated.  I finally got the reach-and-roll rhythm going and suddenly instead of flapping around, I felt like I was actually gliding through the water.  Make no mistake, I’m still terrible, but I can now reliably overtake some of the oldest women in the slow lane.  At any rate, my swim classes start in two weeks, and I am perhaps unreasonably optimistic that they will help tremendously.

Part of my current frustration with swimming is that I am not good enough to get a really hard, satisfying workout in.  I’ve also been strength training, though, and I am finding an appreciation for pushing through a really hard set that I’ve never had before.  I tend to rush through lifting, so I do best with a trainer or video to guide me on form and pace.  It’s been difficult to find really challenging workout videos that don’t require a lot of high impact cardio intervals, but so far I’m most impressed with Jillian Michaels’ No More Trouble Zones.  I can do most of the workout without modifications and the sets move fast enough to provide a good cardio component as well.  I really do feel like I will come through this injury stronger physically, and maybe mentally as well.

Cheers,

ModC

December 22, 2014

Taking the Stress Out of Stress Fractures

Beyond the Pounding Model

If I can take any comfort in this injury, it’s that there are concrete steps I can take to support the healing process.  Unlike a lot of the tweaky soft tissue injuries I’ve had in the past, this is a clear diagnosis with a clear progression of recovery.  I take some satisfaction in knowing what processes should be occurring when, and how I can possibly help them along.

As soon as I began to suspect that I had a stress fracture, I started researching the condition, its causes, and the healing process.  It’s actually quite interesting, and not as simple as the repeated pounding model that most of us imagine it to be.  Stress fractures are certainly correlated with repetitive stress, however, studies have shown that the mechanism is far more complex.  Repetitive loading causes a slight distortion in the bone, which in turn leads to decreased blood flow and oxygen to the area, particularly during long workouts.  Muscle fatigue can magnify these effects as the soft tissues become less able to resist the stresses applied.

The lack of oxygen seems to then trigger the bone’s rebuilding cycle to begin.  The normal cycle of tissue breakdown and rebuilding ultimately results in stronger bones, however the early stages of the process actually significantly weaken the structure.  As microscopic damage occurs, osteoclast cells are sent to the area to absorb the compromised bone.  In fact, osteoclasts actually cut tunnels within the existing bone structure along the lines of stress.  (How cool is that?)  Once the damaged tissue is cleared away, osteoblast cells come in and begin to deposit new bone within the matrix.  It takes 10-20 days for the newly placed bone to mature, however, and it is during this time that the injured area is most vulnerable.  If the cycle progresses normally, in about three weeks the bone is stronger and effectively reinforced along the direction of stress.  If too much stress is placed on the bone during the remodeling process, however, the repair process will be interrupted, and/or damage will outpace the body’s ability to repair it.   The microscopic fissures begin to merge, and a crack forms in the bone.

At this point, the injury becomes painful and activity must be reduced.  As the bone begins to heal, a soft bone callus forms around the injured area.  While the initial fracture is often not visible on x-rays, the bone callus will appear as a ghosted area.  After about a month, the callus will begin to harden and the injury is markedly less painful.  The bone is still not at full strength, however, and returning to full activity at this point can result in a recurrence of the fracture.  The callus can also put pressure on adjacent bones and tissues causing a change in gait and/or pain and numbness in the area.  After 8 weeks, if all goes well, the bone should be returning to full strength and normal activities can be slowly resumed.

Nutrition for Healing

For the stress fracture to heal, further stress on the bone must be limited.  And while the time frame needed for the new bone to mature cannot effectively be accelerated, the rebuilding process can be supported by supplying the required minerals and nutrients, along with plenty of rest.  It’s worth noting here that NSAIDs block one of the inflammatory markers that stimulate osteoblasts, and taking them will slow the healing process.  Curcumin and ginger reduce inflammation without disrupting the development of new bone, however.  Studies have also shown that supplementing with additional vitamins and minerals can aid healing and reduce complications:

Vitamin C & E  – anti-oxidant properties help counteract the release of free radicals that occurs during a fracture

Vitamin D – aids in the absorption of calcium

Magnesium – also needed for calcium absorption, and often deficient in runners as it can be lost through sweat

Calcium – bone is nearly 70% calcium phosphate, so adequate supplies are critical to fracture healing

In addition to the supplements above, I’ve also been adding a tablespoon of gelatin to my coffee every morning.  There’s a batch of bone broth going in the crock pot, and I’m keeping my protein intake a bit higher than I normally would when I’m not running as well.  (Despite runners’ tendency to not want to gain weight while they are sidelined, this is NOT the time to restrict calories.)  Getting adequate rest and sleep is, of course, critically important, and that is made slightly easier by the fact that I’m not running at 6 AM every morning.

It’s hard sitting still with my foot up, it’s hard to resist the urge to put the regular pedals back on my bike and work up a good sweat, and it’s really hard to not run.  I’m getting in some good strength training and am starting to see results in the pool as well.  There is certainly a silver lining to be appreciated, but no matter what, getting injured sucks.  I’m trying to remind myself that after a year of hard training I really do need some rest.  My foot may be the most acute issue, but I will certainly benefit from a little down time and switching up the routine.  I’m probably not losing as much fitness as I imagine, and even if I am, I’ll get it back.  I did it once already, and it’s easier to regain fitness than to build it up from scratch.  If all else fails, I’m thinking of developing a bone broth-based cocktail.

~ModC