An Injured Athlete’s Mindset: A Bipolar Beauty and Beast

Photo by Andrew Mason obtained from Wikimedia Commons

“When we define ourselves by what we do and what we accomplish, we set ourselves up for a difficult moment when we can no longer do and accomplish what we used to.” – Jason Dorland

Take out 15-20 hrs of training/week. Turn down 2 coaches for lifting and running. Scratch the 1 race that I’ve been dreaming of for 8 months. Take away running, riding, lifting. And swimming, which my shoulders haven’t earned back yet. All of which have been taken away from me, completely out of my control. So after deducting all of that, what do you get? An athlete that’s been called to pursue other things but one that will always chase after the dream. That sounds pretty optimistic, right? Well, it took me almost 2 months to get to this place of mind.

I’d be lying if I said that I didn’t miss running every day. I’d be lying if I said that I didn’t itch to run and hear nothing but my breathing and footsteps. When I’m walking home without heavy bags on my back and in my hands, and the air is warm and welcoming to my skin, I reminisce how this, this is the perfect summer weather that I’ve always run in. When it’s raining and kind of humid, or when it’s 9pm and actually perfect for a run- I remember when those would be the exact times and conditions where I’d be running. Even when it’s been rainy, I reminisce the wet slogs out there. And I’d be lying if I said that I didn’t miss it.

Being injured sucks. It’s simple as that. Always has, always will. I’ve come to realize that this summer, is my summer of injury. It hasn’t been easy but I’ve realized the curse that comes with being a driven athlete. Through my story so far, I might be able to share some things to help give insight to those that know, treat and are the injured athletes.

MY STORY
My timeline begins from the fall of 2014. I had just finished my first sprint triathlon in early September. Things weren’t perfect heading into the race, as I spent most of my training in the pool and bike. I wished that I had done more brick workouts, and especially spent more time honing my running speed. School and work limited my training, so that was that. But worst of all, I came back from a family road trip and had this weird pain in my right shoulder in extension and external rotation. I got treatment for what I could, with a week or so left, was all taped up and didn’t feel the pain when I swam on race day. So that was all good besides maybe some nutrition issues that led me to wanting to puke my guts out right after I got out of the lake, and it didn’t stop until an hour after the race. My next goal was just to get healthy again, as I discovered that I had dynamic instability in both my shoulders, but worse in my right. From there, I looked to try to figure out what was the next race that I could do. I was hungry to return to focusing on running since I hadn’t gotten in much running in the summer, so I looked to Squamish 23K at the end of August 2015. It was a perfect challenge and I was excited.

Fall and spring semesters were incredibly heavy and I knew I wouldn’t truly be training for Squamish until spring exams were done. I only had time and energy to hit the gym, so that’s what I did, 2-3 times a week in both semesters. And I also began to work on improving my olympic lifts, getting help from a coach. I’ve always loved lifting weights, but I’ve always done it for the purpose of performances external to the gym. Everything I’ve done in the gym has always been geared towards becoming a better, stronger and faster runner. For the most part, I never lift or do core work just to do it. It’s always been done for the purpose of becoming a better athlete in my sport. So even though I could only hit the gym, I still had one goal in mind: feeling strong while racing Squamish 23K.

In the spring, even though I did revel in the fact that my shoulder stability was increasing and lifting PRs came steadily, what motivated me all the time, even during my studying, was my dream of being free in the summer and running. I dreamed of runs feeling easy, rhythmic and smooth. I dreamed and craved of ripping off 400m repeats and cranking out mile repeats. I dreamed of slogging on double days and getting winded from a hard long run. That’s what kept me motivated through assignments and exams. I was dreaming and waiting to feel like a runner again. And I waited for 8 months.

I thought this random foot pain, that I experienced when I started to run again, was a simple fix, like the other times I randomly had a localized niggle in my foot. I thought it’d be a done deal within a treatment, just like the other times. It appeared to be a more complicated issue, stemming from studying and writing papers for a couple of weeks without a physio appointment. I was all twisted, my left glute wasn’t firing as well as it needed to be, and it seemed like a simple loading issue that caused my foot pain. Unfortunately, as the pain subsided and problems were fixed, my walk runs still brought on burning fatigue in my left arch. And hearing about the permanent laxity or instability in my left hindfoot left me in despair and confusion. (I have a blog post in my drafts vault that addresses this in greater detail in relation to footwear and how I may have to retract my mission to transition into minimalism.)

Nearly a month ago, I left a free and very brief injury assessment with a pedorthist at a complete loss. So much so that I went crying straight to my coach. (Not actually crying, but theoretically, pretty much.) This sudden pitfall left me to face my demons again. The same ones that tormented me in my grade 12 year of track when I struggled with a mysterious posterior knee issue for 6 months -until it turned into a full blown grade 2+ hamstring strain. 3 days before city finals.

Adding insult to injury (well, injury to injury), out of the blue, I flared up my ulnar nerve pretty bad from a harmless, routine workout at the gym. It was the worst flare up since my initial nerve entrapment 2 summers ago. This put riding on my road bike to work out of the question.

In this spiral of troubles, I learned that there are two faces in every injured athlete.

Note: Of course, I’m making sweeping generalizations about all athletes. But from my former track teammates that are still varsity athletes or former varsity athletes, I’ve seen this in them as well and I’ve discussed it with a couple of friends also currently injured.

THE BEAUTY
The injured athlete is a beauty that practitioners love. He or she will follow your instructions and do your prescribed exercises and stretches. We tell ourselves that if this is what we need to do to get ourselves back to doing what we crave and love, then we will do every single rep that you tell us to do. We will face the monotony that is rehab, but we will always get the work done.

I ask myself, “How bad do you want it?” And I’ll grab my theraband or what have you, and I will make sure that I don’t miss a day of rehab. Because each day is a day to get myself that much closer to running again. If you love your sport enough, you’ll be alone pool running in the dive tank or at the public pool with kids splashing and seniors swimming. (Interestingly enough, I’ve been accompanied by several injured track athletes in the pool this semester.) Every day is a chance for a comeback to erase the misgivings about your body.

The beauty tries to stay truthful, patient and optimistic. And tells him or herself that, they’re getting stronger each week and will soon return better than ever.

THE BEAST
Once an athlete realizes that he or she is out for more than 1-2 weeks, it’s a depressing blow to take. It requires time to digest and accept. I’m sure I could list out distinct phases, but the beginning will always be slight denial where you’ll come up with an arbitrary number of days or weeks that it’ll take before you’re back in your sport. The imaginary number comforts you. When things aren’t progressing as you wish they did, then things start to get iffy. It’s a dark cloud each day when you are constantly reminded by your body that you’re not healthy yet. The beast easily gets jealous as others are carefree and able to be active. The beast loathes that his or her body keeps failing.

Once time stretches even further and the injury is so complicated that it can’t really be defined into a number before you’re back, questions start. Questions appear to determine what you could’ve done to prevent this. Questions appear to determine why this happened. Questions appear to determine whether your body was meant for this sport or not. Questions appear to determine if this fight and push to return ASAP is even worth it anymore. It gets tiring each day to be so optimistic and to be checking your progress, only to be let down every time. Questions appear to determine if you should just -let go.

WHAT IT’S BEEN LIKE
Since it’s summer and I’m not in a full load of courses, I definitely have more time on my hands. So I notice that I actually have free time, which was supposed to be filled up by running. It wasn’t supposed to feel this way, because I was expecting time to become relevant to running, like back in highschool and in my first year of university on the track team. Each day would be dictated by running: easy day and strength, intervals or hills day, long run day or recovery day. How I ate, what I ate and when I ate would be dependent on each day of training and each workout. Take out that training and routine… and everything comes to a standstill. The strict routines and dependency on running becomes murky. Things that were so concrete and defined by running now weren’t.

In Chariots and Horses, Jason Dorland writes, “I was once part of a group of individuals that could do things that only a minute percentage of the world’s population could. Now, I’m just an average person with an average life.” This might be a pompous statement, but as a competitive athlete, you can’t help but have that mindset sometimes when your sport is taken away from you. When I first came to face this truth that I was struggling with… I realized that I felt unfulfilled. Days felt empty. I probably didn’t even feel truly happy. Most of the time, I felt mediocre that my summer didn’t start off like I had dreamed of. When I came to really evaluate when I could be running again and actually training for Squamish, I had to be mature and think. And I realized that, Squamish demanded too much and even if I lacked in aerobic capacity by race day, odds were, my foot would likely not be conditioned for 4+ hours on the trails. So, through a rough process of letting go and a change of heart… I made progress in a different way.

WHERE I’M HEADED
Abbey D’agostino, one of my role models, said in her Flotrack interview, “[when you’re injured] you really learn what your motivation is when you’re like, sucking it up by yourself in the pool… if your running is all have you and it’s not going well, it’s going to be so much harder to recover and come back stronger.” I first had to keep telling my running coach that I wouldn’t be able to join him yet. And I had to keep pushing back my imaginary return date. Then I had to turn down my lifting coach for the summer. Then I ultimately had to tell the race director that I could no longer race. Finally, I had to see what I have beyond running.

It wasn’t easy, but it’s taken tremendous pressure off me, not having to rush my return to training. In the last month, I’ve made substantial strength gains in my feet as I’ve been doing my strength work on both feet. It’s taken weeks of consistency and drive to embrace the monotony and lack of excitement to work on foot intrinsics. But I’ve always made sure that I’ve done my rehab, to the point of blistering and burning off skin from my toes when doing barefoot strides on the hot turf in the sun.

Thankfully, things seem to be coming together this week. My ulnar nerve has finally calmed down that I’m quite sure that after yesterday’s acupuncture treatment, I’m good to go. I’ll be quite careful and won’t ride until I have a solid week free of symptoms. Maybe even 2 weeks if I’m paranoid. And, most importantly, I’ll be getting my orthotics on Saturday. If that doesn’t prove to solve my issue… then I’ll have to re-evaluate and start from scratch. But I won’t fret for now until I see what happens.

CLOSING REMARKS
As I was reading another runner’s blog, I suddenly remembered a Dr. Seuss book that my coach gave me at the conclusion of my grade 12 track season, continuing the tradition where the coaches give all captains a gift.

wpid-wp-1435285662077.jpeg One of the things that my coach wrote inside was, “If all else fails, consult the book; it will guide you to happy and healthy.”And in the book, Dr. Seuss says, “Your brain and heart will guide you all that you do.”

I don’t know that I have any answers or great tips to give. But as athletes, we’re a different breed with different demons to deal with. One coworker of mine commented on how she sees this all the time. And people say, “If I can just do another Ironman. Just one more race. Then. I’ll be happy.” It’s that need of achievement to feel fulfilled. But she said if that’s what we think will make us happy, and we can’t make the decision to be happy in this very moment, then there’s something wrong. It’s a mind boggling dilemma. At least for me right now, it’s not even about racing anymore. I just want to be able to go on runs, to feel like a runner again. I love running and my heart says that I’m not ready to give it up.

Just like Abbey D elegantly says, I’m a person of faith. I’m pretty sure that this time of physical misfortunes has meant to be a wake up call and lesson for me. But despite that, I know that the lesson isn’t for me to necessarily give up on my dream of running and tackling 80km+ weeks. I’m just an athlete that’s been called to pursue other things but one that will always chase after the dream. Once a runner, always a runner. #trialsofmilesmilesoftrials

MTSS or Stress Fracture? Does it Really Matter?

Deshea_Townsend_treated

Photo by Steel City Hobbies obtained from Wikimedia Commons

It feels so good to be able to progress from a red to green theraband and from couch surfing (+some suuuper easy stationary bike) to pool running last Monday. When I tried to actually swim a couple of strokes, my foot let me know that it wasn’t a good idea. But I was incredibly stoked about being able to pool run on Monday. I was also able to start walking barefoot with next to no pain (just going downstairs sparked some pain spontaneously) last weekend. Fast forward to this weekend, I am so thankful to have been able to attempt a 10x1min run/walk (with walking warm up). My left foot was a bit sore from riding to work with cycling shoes for the first time on Saturday in a couple of weeks. So after 8.5 minutes, I called it quits. BUT, I was able to get past the muscle guarding and fear, as I worked into my 5th rep and really felt like I was running smoothly again. I’m surely not out of the woods yet, but if it’s anything like my limited shuttle run workouts coming off my Lgr2+ hamstring strain, I think I’ll be back soon. (Fingers crossed.)

But while pool running for 30 minutes on Monday, I thought about what I learned at the running injuries course, as mentioned in my previous blog post. JF had talked about whether it was truly important to differentiate between MTSS (medial tibial stress syndrome) and a tibial stress fracture. If symptoms were the same, ie. same sort of stage in the injury, why would he need to send his patient for a bone scan, wasting money and increasing radiation sort of exposure, if his treatment would be identical regardless of the diagnosis? Most patients and competitive athletes might want to know anyway, just so they have something concrete that they can google and hopefully have a timeline for return to activity. However, I think JF has a point.

I for sure don’t have a stress fracture or MTSS. It’s likely just dysfunctional foot alignment and weakness in the structures. And my newest theory is that it’s glute amnesia, which was already sort of affecting my left glute in relation to my right shoulder dynamic instability near the end of my triathlon training last summer. The hours spent writing papers and then right into studying for finals might have just made it worse. And when I walked and ran especially, too much load and torque was put onto my left foot. But anyways, it kind of almost felt as if I had a stress fracture while I was pool running. It’s been about 4 weeks with this injury that came out of no where in the tail end of my finals before I even started to run, which obviously exacerbated it. Only last weekend was I been have to walk barefoot without much pain, after my fifth metatarsal was adjusted by the locum chiropractor I was working with. And my rehab has been kind of similar, as if I had a stress fracture, in trying to return to running.

I really wanted to try a walk run workout today to get my foot stimulated. This way, as JF really stressed, my foot can begin to adapt to the stress and the structures in my foot can receive stimulus to promote healing and strengthening. Similarly, as I mentioned, it’s probably why 2nd hamstring strain (also grade 2+ but opposite leg and ~6 months apart) recovered much faster than my 1st strain. I started a shuttle run protocol as soon as I could (as per the SFU varsity physiotherapist) and I recovered much, much faster even though when I initially started, I felt like I was running through maple syrup. My muscles weren’t firing as well as usual, so I felt like I was stuck in slow mo and my ROM (range of motion) was very limited. I felt insanely awkward like I wasn’t accomplishing much, but my body was very much fatigued after each workout. Thus the shuttle runs helped stimulate my hamstring to heal and got me back to running form quicker than when I didn’t do much of anything after my 1st strain.

Currently, even though my physiotherapist and I haven’t been able to pinpoint the exact “mechanism”  that led to this injury, what’s clear is that my left glute isn’t firing well in proportion to other muscles. And, the instability (and weakness) in my left foot is still present. So I’ve been patient and religiously working on my foot strength, proprioception and now glute strength. Nothing exciting, just trying to get my motor control and feet strength back.

It’s really all about getting back to the basics, especially after being affected by an injury for this long. I decided to test out my eccentric heel drops last week, and found that my left calf had ridiculously weak motor control that was nearly half of the control in my right calf. I’ve already been doing this for less than 7 days and today I could tell that the asymmetry has decreased. I’ve also been training a 2xMVA (motor vehicle accident) client at the gym for over 8 months now. Although her core and leg strength have gone up considerably, her neck and shoulder issues have been flaring up again the last while. As she is very aware of her own body, even she suggested to go back to basics. We’ve been working on a lot of scapular clocks lately for proprioception and motor control.

During the time that I was rehabbing my shoulder(s) (left was also a bit unstable), I was initially limited to glenohumeral centering and scapular control. I did this supine, then standing with therabands. -Next to people attempting to deadlift with good form, and with weight that was less than my warm up. I then came up with this phrase to help keep me patient and motivated: “Regress to Reinforce, Progress to Propel.” Following any injury, it’s wise to recheck your foundation. Is that transverse abdominis firing as it should? What about the big trouble maker, glutes? My good friend and former coworker, who is an RMT and fellow kinesiology student, came up with another good one in parallel: “Simple to Stabilize, Complex to Challenge. – Christin Sadler.

So I think no matter what injury you suffer from and no matter what the “true diagnosis” is, whether it’s MTSS vs. stress fracture, you have to start from the bottom and make sure that the foundation is there before you progress. This will lead to a more steady return to activity and less chance of re-injury. With that being said, no matter how long it takes, single leg box jumps, I’m comin’ for you!