The 12 Weeks of Tibia Healing

     And on the 12 week of tibia healing my true love (me, myself and I?) gave to me...an MRI. Finally! Dr. Matt and Dr. Leo at Ohio Sports Chiropractic and Rehab suggested I get an MRI eight weeks post-stress fracture because healing was so delayed. I didn't want to drop the (very reasonable) $295 so I waited until I got through two failed attempts to return to light running before I caved and got the order. My main worry was that if I needed surgery, I'd better get on it and not delay any longer.
     I used Precision Diagnostic Imaging in Medina. They got me an appointment within one week of calling them and I only waited 15 minutes to be taken back for imaging. I wasn't prepared for the half hour to 40 minutes in the machine as all the images were being taken. Or for the intense magnetic tingling in my leg! The stress site even started hurting from the vibrating. They shipped the images off to a radiologist and Dr. Leo had the report by that evening.

Here are a few of the images:

Dark area is the stress site.

More contrast.

Cross section.

     Alright, the boring part is up next. I'm going to outline the 12 weeks of this injury in pretty close detail for those who have something similar going on and are scouring the Internet for anecdotal experiences. Just like I have for the last 12 weeks.

Week 1:
22.59 mile long run in 3 hours. This was a "time on feet" long run at an easy pace. At 10 miles my right leg collapsed. I thought it was strange but I didn't fall, didn't stop and ran 12 more miles on concrete.
Monday morning to Tuesday night - stepped out of bed and realized something was very wrong. Hurt to walk, pin-point pain, visible bruising, slight swelling, hot to the touch. Swam instead of ran. I didn't dare run. Aqua jogged and swam on Tuesday. By Tuesday night I knew it was a stress fracture. It was throbbing constantly by this point.
Wednesday - already had an appointment scheduled with Dr. Leo so I limped in and got the official diagnosis of tibial stress fracture. He tried the tuning fork test and I nearly jumped off the table. Also did cold laser treatment and Game Ready ice sleeve. It was really hurting by the end of this day and I only got through practice with borrowed crutches.
Thursday-Sunday - crutches Thursday and Friday as much as I could stand. Found out on Friday that biking was a no go. Awful pain Friday evening from the bike. In a boot starting Saturday. Pain levels diminished daily from the time I got in the boot.
Nutrition: Started on a strict supplement plan with 1700 mg of absorbable Calcium, 5200 IU of vitamin D, 1000 mcg of B-12 and 100 MCG of Vitamin K2. I also started tracking my caloric intake to make sure I did not pile on 10-15 pounds with the drastic drop in exercise. My body seemed to adjust seamlessly to the reduced training and within a couple of weeks I stopped worrying about gaining weight.

Week 2: 
Monday-Thursday -  leg continued to heal while in boot and the "big blur of swimming soreness" began. Suddenly jumping into thousands of yards of swimming a week is a shock to the upper body, especially with the form issues that I have. I attended practice on Thursday and committed to going back to practice every week to work on my technique with the coaches. Tried biking again Wednesday and again it hurt me.
Friday-Sunday -  More swimming, aqua jogging and core. I had my first 90 minute pool session on Sunday. After the workout I laid on the deck, aching and famished and feeling like I couldn't even make the short way back to home without calories. I logged 8000y of freestyle this week and 7.5 hours of cardio total. I struggled with energy levels at the end of this week and that trend would continue. Swimming is hard!

Week 3: 
Monday - first experience on the alter g. Five miles in 37 minutes. I kept it at 40% for this session but severely suppinated the entire run. I was afraid to run and tense. Double workout at the pool in the evening. First full day out of the boot, round 1.
Tuesday-Wednesday - monster swimming yardage. Felt like I needed to keep the boot on so I did. This was the first week that I felt like healing stalled. I think the main factor was refusing to compromise on exercise minutes as I was transitioning out of the boot.
Thursday - on the alter g again. More pain at 40% than on Monday but I was off Ibuprofin for the first time. The boot started causing ankle issues and I worked hard to transition out of it.
Friday-Sunday - Went back in the boot Friday to get through work and practice and the meet on Saturday. On Sunday I biked next to Amanda for 12 miles while she did her long run and at one point I turned sharply to avoid running into her on a turn and fell of the bike onto my shin. It didn't break and I was encouraged by this. By this point I walked around on egg shells afraid that at any moment my tibia might snap.

Week 4:
 Log entry on why I stress fractured:
"Saucony Zealot 3s - too wide and loose, movement all over the place every run, re-tying them half way through but didn't fix it. Probably led to...
Achillies tendonitis - both left and right but worse in the left...limped the first 5 minutes of nearly every run in July and August. For sure compensated during this entire training cycle.
Swift rise in volume and intensity in August - averaged 45 miles a week in July, more like 75 in August. So stupid in hindsight but I pushed Becki's mileage and paces way over the top. I was determined to perform well at Akron. I'll never make this mistake again. Marathon training needs a three month buildup.
Concrete training - pretty sure I'll never run on concrete again.

Fixes: I threw away my Zealot 3s and bought Brooks Ghost 10s. When I start running again it will be on grass. I may never go back to 7 days a week of running but I'll play that by ear."

Monday-Friday - I bought the week on the alter g, which is a great deal but it was a mistake on my part. I didn't need the temptation of unlimited running placed in my lap. I logged 25 miles on the alter g on Monday, Wednesday, Thursday and Friday and did double workouts in the pool.
Saturday - I finally gave in and got an x-ray after being in pain all Friday night and Saturday morning. The image showed a possible stress injury on the distal tibia with a linear line of calcification, signalling healing. Massive weekly exercise totals of: 8 hours 35 minutes of cardio, 2000y of aqua jogging, 8,900y of swimming, 25 miles on the alter g.

Week 5:
Monday-Tuesday - started incorporating more low impact with biking and walking. None of it was completely pain free. The only thing that was pain free was swimming. 
Wednesday - alter g again and I got impatient with the ease of the workout and went way too fast. 6 miles at a 6:40 average. Frustrated that I had to keep it at 45 percent still.
Thursday-Sunday - More low impact incorporating, including rock climbing on Friday night and a long, fast bike on Saturday. I was feeling so good by Sunday that I jogged around the course at my kid's cross country meet. This was the beginning of the serious set backs. Running on it was not wise. 

Week 6:
 Monday-Thursday - I paid for my indulgent jogs with pain for most of the week. Despite this, I hiked on Tuesday, jogged at 100% on the alter g on Thursday and hiked the Buckeye Trail loop in Peninsula. By Thursday night at the conference meet my shin was throbbing but I had no choice but to walk at least three more miles on it getting around the course.
Friday-Sunday - hit 100 minutes in the pool for the first time! Epic levels of exhaustion were setting in with all the pool hours. Despite warning signs from my shin I jogged more on Saturday to get back to my house on time after a hike and then figure skated for the first time in 12 years for 1.5 hours. I had to sit and do nothing Saturday night because I couldn't put weight on it at all. As I got to the six week mark I started feeling discouraged. I think part of the reason I was pushing the activity level was because I couldn't mentally face more weeks of incessant cross training.

Week 7:
Monday-Tuesday - a full hour on the elliptical on Monday then an attempt at a run/walk on Tuesday that left me hobbled. I took the rest of the week off cardio to get my head on straight and get the pain under control. By Sunday I was mostly pain-free and ready to face another week of intense cross training.

Week 8:
Monday-Thursday - No more messing around with hiking or walking or test jogs. I would say I started behaving like a proper stress fracture patient starting this week. Pool on Monday, stationary bike on Tuesday (that hurt my shin), pool on Wednesday, swim practice Thursday. The last of my running fitness started to fade this week and I wasn't sad to feel it go. I started embracing swimming and the fact that I was mastering another sport.
Friday-Sunday - Swam again on Friday. Out of nowhere, my shin started hurting on Saturday. I swam again on Sunday after the pain went away but I ruled out running for the coming week.
Weekly totals: 11,100y of freestyle, 2600y of aquajogging, 14.4 miles of stationary bike, 7 hours, 20 minutes of cardio

Week 9:
Monday - first run at 70% on the alter g. I only did three miles with a new approach to limit my introduction to low impact. No hour-long sessions! Leg was stinging and tingly that night but not painful. I took the kids to the pool and refused to set my right leg down as I leaned against the edge of the pool, not because of pain but because of the stinging. Also swam 1900y. That's nothing these days!
Tuesday-Sunday - lifted heavy on Tuesday and biked long on Wednesday, which led to some pain the rest of the week. I found that lifting before swimming killed me and the weight bearing was too much. Shin hurt all day Thursday and I started feeling resigned to it. But it got worse by Friday morning after a sleepless night of throbbing. I cancelled my alter g appointment and put the boot back on. I was pain-free in the boot by Sunday. I started working on my butterfly stroke and got excited about swimming all over again.
Weekly totals: 10,950y of freestyle, 2000y of aqua jogging, 3 miles on alter g, 14.5 miles on stationary bike, 7 hours 30 minutes of cardio

Week 10:
 Monday-Sunday - started practicing starts out of the blocks and began pushing off the wall with both legs to prepare for a swim meet later in the month. This produced very little pain, much to my relief. I also started doing intervals with aqua jogging. My attitude is not good towards these. I reached 1:45 in the pool for the first time but all these hours in the pool began to take a toll on my skin. I developed a chlorine sensitivity by the end of this week. On Sunday night I hived up and couldn't get it to go down. The boot also started hurting me by the end of the week.
Weekly totals: 12,750y of swimming, 2,635y of aqua jogging, 6 hours, 55 minutes of cardio

Week 11:
Monday - first run at 100% on the alter g! Three miles at 8:00 pace. I had no issues with this run or from it later in the day. If only I had been satisfied with this for the week! Dr. Leo tried the tuning fork test and there was only slight tenderness on the site. He did find that the bone felt "spongy" on the site. Of course I swam that night. There's no doubt about it, I am a compulsive exerciser.
Tuesday-Friday - Swim practice on Tuesday left me in hives over 80 percent of my body and I knew I couldn't go back for a few days. So I jogged 1 mile on Tuesday and finished on the elliptical. The elliptical hurt my shin. But I jogged two more miles on Thursday and stubbornly hiked 5 miles on Friday to mark the BBA50k course. I was in agony by Friday night. Unable to put weight on my right leg. I sat around my house and willed myself not to take Ibuprofin because it restricts bone growth.
Saturday-Sunday - on crutches for most of these two days. Level of pain was an intermittent 5-6, at least a 3 all the time. I had to work a lot and got by at the store with crutches.

Week 12:
Monday - back to the pool and my skin and shin dealt with it! Only using one crutch as needed.
Tuesday - pilates and boxing but keeping cardio to 45 minutes or less.
Wednesday - 45 minutes in the pool. Shin has fresh bruising from running last week.
Thursday - off
Friday - my first swim meet with the Medina Masters Swim Club. Let the personal best chasing begin!
Saturday - off
Sunday - tried to get to an hour in the pool but energy levels tanked by 50 minutes. Dragged myself home to get some calories and a nap.

Week 13:
Monday - 1 hour of pilates that kicked my ass. First pain-free day!
Tuesday - most difficult swim practice so far. 3200y, including my first completed IM (individual medley: fly, back, breast, free), 50y sprints off the blocks. Day 2 pain free.
Wednesday - MRI!!! Did another hour of pilates that hurt my shin. Are you sure it's just a stress reaction?

Official diagnosis.

A few added notes for those going through the same thing: if it hurts, don't do it. Just say no to pushing through a low impact activity that is hurting even when you have cardio minutes to log. Turn around, go home and find a zero impact activity that doesn't hurt.
Don't worry about gaining weight. Your body will adjust to the new activities. I started this injury at 107 pounds and I am currently 107 pounds! After the first few weeks of worrying, I realized I was not going to gain weight and quit counting calories.
Don't give up on the supplements. The absorption rate is low but you're still getting extra calcium and vitamin D by taking them.
Find another low or zero impact sport that you can develop a passion for and enjoy. For me it is swimming but other options would be yoga, boxing (support one leg) and pilates.

Trunculent tibia stress fracture recovery: a typical week of cross-training and strength-training

  

God, I hate the boot. And Chacos.

     I'm heading into week 9 of no running on dry land due to a tibial stress fracture that I sustained at the end of August due to averaging 45 miles a week in July and 80 per week in August. This is the longest I've gone without running since I was 13 years old. It's not fun but I don't have a choice in the matter. My throbbing leg wouldn't get through a mile on dry land at this point. So I make do and log hours of cross training/strength training and a few miles on the alter g at Ohio Sports Chiropractic and Rehab in Northfield. Below is a typical week including my strength training. In the next couple of weeks I plan on moving into weight lifting for the first time in my life. I'm looking up videos now to see what I'm doing so wrong that I can't even squat the bar. When it comes to body weight strength training I'm an old pro and I'll continue with that along with weights. Tomorrow I'm braving the "upstairs weight room." My only experience with this weight room at the rec is the rare occasion that I run on the upstairs track when it is frigid and storming out. I run by it over and over again while oddly shaped, top-heavy men lift more that what looks comfortable and then jog very slowly around the track when they're done. I'm not going to become a meathead any time soon, I promise. I want to log insane amounts of miles next year (building slowly this time!) so I need my hamstrings and glutes to cooperate.

Monday - cross training interval session totaling 60-75 minutes. Pt, core, upper body, 5-10 minutes of boxing, myrtl drill, shin prevents.
Example from today, October 30th, 2017:
a.m. - Treatment at Ohio Sports Chiropractic and Rehab. Leg swing series from myrtl drill, 3 miles on the alter g @ 70 percent body weight in 23:30 (7:50 pace), foam rolling on right calf. Rest of myrtl drill, shin prevent series (duck walk, knock knees walk, tip toes, heel walk, walking lunge with twist, high kicks, back kicks).
p.m. - 40 minutes total in the pool for 1900y total, interval session freestyle. 8 minutes of boxing (warmup)
Core/upper body strength session:

• 100 butterfly crunches
• 30 side crunches each side
• 30 oblique crunches each side
• 50 "dead bugs" pt move
• pilates 100s
•  30 roll up situps
• yoga stretch break
• 5 minute plank series (high, side, high, side, forearm) 
• 3-7 fingertip pullups
• 20 pushups 
• 5-10 headstand crunches
• 10 single leg deadlifts with dynamic knee raise
• 20 body weight squats
• 20 dumbbell curl and raise
• 20 dumbbell reverse flyes
• Full static stretch, mostly yoga moves

Tuesday - easy cross training 90 minutes in the pool, half freestyle (2500y) and half aqua jogging.
Pt, core, upper body, 5-10 minutes of boxing, myrtl drill, shin prevents.

Wednesday - interval cross training in the pool or on the bike for a total of 90 minutes. Pt, core, upper body, 5-10 minutes of boxing, myrtl drill, shin prevents.

Thursday - swim practice! 3000y of frantically trying to keep up with swimmers much more accomplished than I am under the watchful eyes of two strict coaches. I love it! Light core because I'm too sore to do anything else. I pretty much lay on my floor and do half-hearted crunches.
Example from last Thursday: Medina Master Swim Club practice: 2x300 wu, 100 kick, 100 swim, 25 scull, 25 swim, 4x150, 100 kickboard, 50 pull, 2x500 (300, 100, 100), 3x200 broken, 200 cd

Friday - 3-4 miles on the alter g at Ohio Sports Chiro and easy cross training in the pool for 60-75 minutes. Pt, core, upper body, 5-10 minutes of boxing, myrtl drill, shin prevents.

Saturday - off. I usually recover from swim practice on this day. I'm sore for at least 24 hours after every practice. Swimming is hard work!

Sunday - 100 minutes in the pool baby! I usually get well over 3000y of half freestyle and half aqua jogging. Pt, core, upper body, 5-10 minutes of boxing, myrtl drill, shin prevents. Eat a lot and get ready to do it all over again next week.

Athens Ohio Marathon: train for an 8k, race a marathon?

Athens Ohio Marathon http://www.athensohiomarathon.com/
Sunday, April 9th, 2017
Goal: pace with Todd, race for the win in later miles
Result: 3:07:00 for first female, 1:32:14/1:35:46

     On a whim last fall I decided to enter the 2017 Athens Ohio Marathon with training partner, Todd Smith, and new running buddy Jon. Their goal was to Boston qualify for 2018. Todd needed a 3:07 and Jon needed a 3:02. The plan was to train for a sub 18:00 track 5k up until February and then transition into marathon training while maintaining track workouts for speed.   
     My plans changed when I hurt my back in late December and had to take the first two weeks of January off to rest it. Then I had two weeks of just over 30 miles where I found that I had lost nearly all of my speed. I wasn't even able to hold 6:20 pace for 1000 meter repeats. This was a problem because I was hoping to be on the Team Ohio "A" team for the Bank of America Chicago Shamrock Shuffle 8k and I needed some speed for that. Becki assured me that it would all come back and to let the workouts do their job. Sure enough, my workouts started getting faster and I was able to hit my 8k goal pace of 6:00 for several of them. Knowing that I also had a marathon looming, I tried to get to 20 miles in my long runs but my back wouldn't let me. My longest run was 18 miles in a 7:30 average with a marathon paced workout with my teammate, Amanda, worked into it. The trip to Chicago and racing with my team was an epic time and I'm looking forward to doing it again. I ended up just a few seconds out of my "A" goal of breaking 30:00 but it was technically the fastest race I have ever done in my life so I tried to be happy with that effort.
     Before I headed down to Athens to race with Todd and Jon I made the mistake of plugging in my 8k for a marathon prediction. I got 2:54. Without marathon training that wasn't possible, even on a flat course, and I tried not to let that number stick in my mind. I really believe I can run a marathon somewhere in the low to mid 2:50s but there's a lot of work for me to do before that happens. I went into this marathon with the mindset to stick with Todd and survive 26.2. If I made it to the later miles feeling good, I would try to win.
     I had a track fundraiser to go to Saturday night but I was in bed by 9:30 p.m. and had everything set out for our 2:30 a.m. wake up call. I took the kids down with me and we had an afternoon of activities planned for after the race. They were troopers with waking up so early and driving three hours down to southeast Ohio. We arrived just after 6 a.m. We searched out the porta potties, much to the kid's disgust, and I showed them the finish line with instructions to start watching for me at 10:50 a.m. (8 a.m. start). I had my oatmeal and coffee in the car and made sure I had fresh body glide on everything, arm warmers on, watch connected, gel flask filled and shoelaces tightened and double knotted. "I can't believe I'm doing this," I told the kids before I headed out to meet Todd and Jon at the start. They just nodded in agreement over their netflix and snacks (thanks Ohio University guest WiFi!).

Before the start. Lots of pre-dawn Thursday morning miles shared with these guys! Photo credit: Rachel Smith

     I met up with Todd (and Rachel and Ethan) and Jon at the starting line to get a light 10 minute warmup in. The weather was perfect for the start at 42 degrees, light wind and sunny. Our warmup included some of the famous Athens hills. I normally like hills but I was glad I wasn't running a marathon on them that morning! The course follows the Hockhocking-Adena Bikeway for most of the race and is pancake flat. I was hoping this would help me have a decent race despite my lack of marathon training.

Just before the start. Photo credit: Athens Ohio Marathon

Miles 1-9: 6:46, 6:59, 6:59, 6:57, 6:56, 6:59, 6:50, 6:58, 6:54
     We almost missed the start because we were taking the pic above and I didn't have time to get my watch connected. So my watch splits were a little off. The above mile splits are off Todd's watch. I ran with Todd nice and relaxed for the first 6 miles. This pace felt so, so easy compared to previous marathons where I've tried to maintain under 6:50 pace. Todd had to keep reminding me to slow down because I kept wanting to drop to a 6:40 pace. There were two women running ahead of us and I assumed they were in the half because we were the first three females in both the half and full. I took a sip of my Cliff gel flask right before every aid station and a few sips of water and Gatorade at each station. My stomach did not like the Cliff gels but I forced it in anyway. I started feeling legit nauseous by mile 10. Mind over matter, I told myself I wasn't allowed to throw up until the finish. My arm-warmers were getting hot and I had to take my watch off to get them off. I wasn't able to finagle that watch back on my wrist and I stopped looking at it. When we finally reached the half marathon turn around I realized that the two women ahead of me did not turn around. Cue panic. The winning times from previous years were nowhere near 3:00 and they were on pace for a very low 3:00. I thought the girl ahead of me might be overreaching a bit based on body language. I put my head down and decided to catch her by mile 10. I still feel guilty for dragging Todd through that quicker 9th mile but I had gone hunting and there was no turning back.
Miles 10-18: 6:51, 6:55, 6:55, 6:53, 6:59 no data
     I caught the second female right as I passed the 10 mile sign and immediately zoned in on the next woman. She was more than a minute ahead and looked like she was running smoothly. From this point until I caught her all I did was look ahead and watch the gap shrink. I was pissed with every aid station because I had to grab fuel and disrupt my focus. I was running with a male runner at this point who ended up staying with me until about 22 miles. We didn't talk very much as I wasn't in the mood but we did pace together pretty well. Rachel and Ethan were cheering at about 15 miles and I dropped off my arm-warmers and watch. I was so thankful for that. Starting at 16 miles I began to feel the lack of marathon training. My feet ached, my IT started tightening up, my glutes felt like were going to cramp up at any moment and I had to focus on not letting my form fall apart. But the gap kept shrinking and at 18 miles I passed into first. "Good job," I grunted at her, unable to even turn my head. "Good job," she grunted back and I moved ahead at my steady 7:00ish pace.
Miles 19-finish: no data but I ran a 1:35:46 second half
     The guy on the bike followed me as I took the lead and this led to an entertaining last 8 miles full of walkie-talkie relayed information about who was in the lead, what checkpoint they were at, who was dropping out and who was looking strong, complete with bib numbers and names and a bunch of walkie-talkie jargon that I didn't understand until I noticed patterns. I listened every time it went off off but I didn't turn my head to either side unless I needed to sight out someone at an aid station to ask for water. I stopped taking nutrition after I passed into first and only had a few sips of water in the last 8 miles. I was too nauseous to take in any more Cliff gel and there were a few points where I considered stopping just to have a quick puke to get it over with. "No walking!" I mentally shouted to myself. I made it a goal to not walk for the first time in a marathon. I've walked a lot in my previous ones. I caught Jon right around mile 19 and he ran with me and the other male runner for the next two miles before gradually falling back. He still managed a strong finish in 3:09.

    Thanks to the walkie-talkie I knew I was far ahead of the second female by this point. Starting at 22 miles I told myself, "you can jog 4.2 miles, no problem, just jog." Starting at 23 miles I was done. That finish line needed to be there but I had 3.2 miles to go. When I got into the 24th mile I started looking ahead to landmarks to make it to before I stopped and laid down on the side of the path for a nap. Speaking of this path, it was never going to end. And I couldn't see another marathoner ahead of me. The only runners were a few half marathon stragglers. At the last aid station I splashed water on my face to get rid of the sleepy feeling that was taking me over and launched into the final two miles. People tend to talk about breaking through mental barriers at this point in a marathon but I say fuck. that. My body was trashed. No mental games were going to help me out at this point. What I needed was to stop running. I was already 7 miles past my longest run in 6 months and my body was in revolt. I made it to about mile 25.5 before I walked. I asked the guy on the bike how far I had to go and he said about half a mile. That seemed impossibly far but I started jogging again. At this point a guy blew by me, practically sprinting his last mile. Once I got in sight of the track I saw Rachel on the side of the path and decided that I didn't want her to see me walk so I would keep jogging to the finish. She offered to take my gel flask and I dropped it on the side of the path. Honestly, she was amazing for helping out with these things! As I rounded the turn of the track I saw that I was still in the 3:06s. I couldn't muster the kick I needed to make it under the clock in 3:06 but I didn't really care. I was so glad I could stop running that I laid down on the track on the other side of the mat, fully intending to take a nap. The race director made me get up and directed me to medical. Why does everyone always think I need medical attention and not a nap, or at least a few minutes to lay down?

Well, I don't look good. Photo credit: Athens Ohio Marathon

     The kids greeted me on the other side of the fence with flowers they had picked, a reporter asked me a few questions about the race for the Athens Messenger, Jon finished, I got a massage, Todd finished and before I knew it a half hour had passed and I still hadn't taken in any nutrition. By the time I started trying to drink and eat my body was in a full-on electrolyte imbalance and I was dehydrated. The rest of the day, and really the past few days have not been pleasant with struggling to get in good nutrition. Taking Todd's advice the next time and having a Gatorade to chug at the finish. If I puke it up, that's fine, I'll drink another one, but I have to make sure I take in nutrition after I race.

Ultra-runner Michael Owen won for the men in 2:38. Photo credit: Athens Ohio Marathon