Overtraining, Stress Fracture and Recovery
There’s a reason my blog entries slowed to crawl (came to a grinding halt) last winter. It’s because after the Millinocket Marathon in December 2017 the symptoms of overtraining that started back in September accelerated and left me literally, neck-deep in water. I knew my immune system was taking a hit after the Fundy Circuit 50k when I spent a month fighting off a nasty MRSA infection that colonized a patch of upper arm chaffing and spread out from there like a true believer in manifest destiny. I had to take antibiotics (my first in 18 years) and though it killed the MRSA it weakened my gut and thus my resistance to the seasonal sniffles. I also developed a skin itch that seemed auto-immunish and was keeping me up at night. I spent a lot of October, November and December feeling un-enthusiastic and run-down.
The hard part about being tired and run-down is that it becomes a vicious cycle. When one is too tired to shop for and prepare fresh food, needs cold medicine to get through work, drinks coffee to perk up and eats ice cream to self-soothe . . . one only tends to feel even more tired and run-down. You can only put-off nourishment and recovery for so long before your body starts shouting at you to “do something different!”
In my case the shouting started just a week after I wrote my last blog post back in February. I was on a family vacation in the Bahamas and enjoying early morning runs on the sandy roads around the island. But my left ankle was acting up. Because I am me, I had brought a small travel foam roller with me and I tried using that to roll out my peroneus muscles along the outside of my shin. The way my left hip sticks out from dysplasia puts a good amount of stress on my entire left lateral line, from the TFL and ITB down to my outer knee, calf and foot. I try to manage it by keeping my hip and butt muscles strong but I’ve had issues in the past including torn ligaments, stress fractures and cysts.
This outer ankle pain felt slightly different then just a tight tendon and instead of responding to the foam roller by relaxing, the tendons seemed to react by getting really pissed off! Ok fine, I won’t roll, I’ll just go for some gentle trots.
The weekend we got back from that trip I went on a big hilly run and by the last mile the pain had a real burn to it, enough to slow me to a walk. The next day my twin brother was visiting and we’d been planning to do a training run together. I decided since it would be flat and slow I’d be fine. We ran 8 miles and by the end the pain was agonizing. I didn’t know it then but that would be my last run for eight weeks.
No one needed to tell me I couldn’t run, the pain was bad enough that I knew something was really wrong and just the thought of running made me queasy. My first line of medical support is chiropractor Sarah Lucey who not only patches me up but diplomatically accepts my rugged body use without openly calling it abuse. I hoped she could tell me if I’d broken my ankle or torn a tendon. She tried the old tuning fork trick and nothing happened, no sharp pain. Then she gently squeezed behind my fibula and I screeched and just about jumped off the table with pain.
The next step was an x-ray. I was grateful that I happened to see a doctor who also runs and was willing to take my injury seriously. It was winter and running and xc skiing are key parts of my mental-health plan and I was already getting very anxious. She wrote me a referral to an orthopod in Bangor and had my x-rays sent up to him. But she also warned me that stress fractures often don’t show up on the x-ray for at least two weeks after the injury as it takes that long for the rebuilding bone to reveal itself.
While I waited for my appointment with the orthopedic guy I started researching alternative work-out plans. I am not the kind of person that sees an injury as an excuse to sit on my ass. Not because I am virtuous but because both my brain and body need the movement. I don’t talk (or write) much about it but I’ve spent my life managing my mood and let’s just say there is a dark side and I’ve been there.
As I mentioned in my previous post I hired coach Lindsay Simpson from The Run Formula to write me a training plan for the Vermont 100. Ironically the plan she wrote started exactly one week before my ankle started hurting. But the bright side was that I also had access to the Run Formula forum where I could ask coach Beth Schutt questions. I peppered her with several variations of “what do I do now!!?”. The answer was “pool running”. (I did try indoor biking but it hurt too much).
Having access to real runners and coaches when you are injured is really helpful. I still trolled about the interwebs gleaning a self-diagnosis and treatment plans but the reassurance of my coach regarding my training was invaluable.
First, the pool running. I needed a foam buoyancy belt to keep me upright. I didn’t find any locally so I ordered one online (I used the “AquaJogger Active Water Exercise Buoyancy Belt”) and it arrived the very next day. Off I went to the Ellsworth YMCA to try it out. I couldn’t just swim outright because the pressure of kicking horizontally was quite painful on my ankle while running vertically (in the deep end so as not to touch down) didn’t hurt at all.
I found aqua jogging to be tolerable, especially with a good Latin dance mix on my waterproof iPod. I also wore a low-end waterproof Polar heart rate monitor which doesn’t record data but was useful in keeping me moving fast enough. In theory your heart rate in the water is about 10% slower than on land because the water pressure makes your circulation more efficient. So for most of my water-jogs I was aiming for 115-135bpm and 160-180 strides per minute.
My online research resulted in some dietary changes too. This was not my first stress fracture. Over the last twenty years I have also broken my foot bones, the base of my femur, and a wrist bone. My maternal grandmother died of osteoporosis and though I have never suffered from the Female Athlete Triad my bone density could use a little help. I started taking Jarrow Formula’s Bone Up (calcium supplement) BioSil silica and collagen and CBD oil which has been shown to help bone building after a fracture. Certain acidifying foods are said to inhibit building bone mass so I cut out dairy, coffee and most sugar for two months. I don’t drink soda but carbonic acid is another known bone-leacher.
My recovery the timeline went like this:
Week 1: Seek medical advice
Weeks 2-6: Replace all land running workouts with pool running.
Weeks 4-8: Added two 1hr indoor cycling sessions per week (pain-free).
Week 6: Confirmation with orthopod that I had stress fractured my fibula. His advice – do whatever you want as long as it’s pain free and no, you probably won’t be able to run that 50k trail race in a couple weeks.
End of Week 6: Ran 1 hour on an elliptical machine and walked 2 hours on a treadmill at full tilt to keep heart rate up at a 15min/mile pace.
Week 7: Re-introduced land walking 1-4 miles at a time, 20 min/mi pace.
Week 8: Started land running again! But not ready to run Traprock 50k that weekend. Instead spent school vacation with the girls and hiked for several days with a backpack 5-10 miles on the Appalachian Trail. Dull aching pain at night but nothing sharp.
Week 11: Back to regular land training but at a slower pace.
Week 12: Ran 20 miles at the Riverlands 100 relay. It hurt a lot. My pace was slow and even so I was totally exhausted by the finish. But my ankle felt ok and I was back out on trails!!
This is a video of my first celebratory trail run this spring:
Over all I ended up spending 35 hours aqua jogging and only a week inside on machines (I loathe running inside). I was able to run the 50 mile North Face Endurance Challenge Trail race in Wachusett, MA on June 9th, twelve weeks after the original injury. It was indeed a challenging race but I was happy with how I ran it. With over 10,000 feet of elevation gain, several steep boulder fields and very technical single track I had to hustle to beat the time cut-offs and I was the last woman to finish under the 14-hour cut-off (14hrs 3mins). It was excellent preparation for the Vermont 100 and I could see why Lindsay had suggested it as my 50-mile training race.
I spent the next month hill training and by the time the Vermont 100 came around I felt totally ready. I’m not going to write a detailed race report here because the race was almost entirely uneventful in the best kind of way. It was hot and humid and I made some errors in nutrition that left me puking between miles 40-60. But the best part of this race was that I felt reasonably good and even for the last 10 miles I was able to run despite all the climbing and descending. I’ve wanted to do this race for a few years and it was satisfying to fulfill that goal.