Tuesday, September 2, 2014

August 2014: How I got injured doing everything you're supposed to do

Before we left for Nicaragua, I’d begun feeling pain in my right fifth metatarsal (i.e., baby toe), and I was hoping that taking some time off for fieldwork would be all I needed to recover.  I only ran once the 11 days we were out of the country, but I did walk as much as 25 kilometers in the forest each day.  By the end of the trip, my toe didn’t really feel any better.

I tried to jump back into things as soon as we were back home but struggled with exhaustion, the lingering effects of 100+ chigger/sandfly bites, and a caloric deficit from lack of decent eating options while we were away.  The metatarsal pain became more noticeable, particularly when I ran on trails in my relatively new Altra Lone Peaks (0mm drop), which is what I did most often.  I wondered if there was something about the Altra toe box that was pressing on my foot and causing the problem.  To manage it, I switched to my Sketchers Go Run Ultra, a cushiony 4mm drop road shoe that our runner friend chrism42k recommended.  These shoes are what helped me recover from my stress fracture/tendon injury, and what got me through the Estes Park Marathon.  At this point, however, they are falling apart.  The tread is almost worn through on the mid foot, which is where I strike in these shoes.  Plus, they are good on the roads, but not good for trails—and trails are what I need to be training on, considering that the Bear Chase 50 miler looms in the not so distant future.

I iced, stretched, and got by.  On Friday, August 22nd, it was William’s first day of kindergarten, and I planned on going out for a 20 mile trail run after dropping him off at school.

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I was fine until one of the other moms started crying.  Then it was rough going for a while.  There was nothing else to do but leave for my run.

My foot was hurting from the get-go— not enough to make me stop, but enough to notice.  After 15 miles on a rocky, rooty trail that is a challenge for me, I decided to do the last 5 miles on the dirt path bordering the Spring Creek bike trail.  Easy.

Mile 18 and everything was fine.  One minute I was running, and the next minute, there was a blinding pain in my skull.  I was on the ground, but I had no idea how I’d gotten there.  I hadn’t felt myself trip, there had been no sensation of falling, no time to right myself in midair.  Just, *bam* and I was down.  

I picked myself up and felt totally out of it.  I wondered why there was blood on the trail.  God, my head hurt.  I looked behind me and there was a tiny tree root sticking maybe and inch above the dirt.  I must have tripped on it, but how?  It had happened so fast.  I saw a drop of blood splat onto the trail and realized that it coming from me.  I used my phone as a mirror and was surprised to see myself looking like this:

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The wind was knocked out of me, but I started walking.  This had happened at a very fortunate place:  there was a bathroom at the tennis courts about a half a mile away.  The front of me was covered with dirt and there was more blood coming from several scrapes on the back of my right hand, my right hip, left elbow, and left knee.  My brain felt jarred.  I wondered how hard you had to hit your head to have a concussion.  

I made it to the bathroom and washed myself up.  Now less than two miles from home.  I didn’t notice any pain in my little toe anymore.  I thought, how strangely fortunate it was that I’d hit my head instead of injuring my legs—this way, getting myself home would not be a problem.  

I arrived at our house shortly after Rob returned from collecting Will from school.  Will was having a snack at the kitchen table but stopped short and grew very solemn when he saw me.  “Oh no, mommy,” he said.  “You have bleed on your head."

I felt completely wrecked.  It was hard to tell how much of that was a result of simply having run 20 miles, and how much of it pertained to the fall.  My head hurt so bad, especially at the point of impact near my eyebrow.  It occurred to me that this unfortunate head-trail interaction might lend some additional evidence to the endurance running hypothesis of human evolution.  My fall might partially explain the mystery of why our endurance-running ancestors had protruding brow ridges (i.e., supraorbital torus)—  to help buffer their brains from injury when they fell while chasing down antelope on the trail.  We’ll never know.

Erectus Image from:  http://newswatch.nationalgeographic.com/2013/11/24/know-your-hominid-skulls/


At some point during my state of possible concussion, I apparently agreed to let Rob go buy a cargo bike:

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We attended the Fort Collins Peach Festival, where Rob got 7th place overall in the 5K and won a probably-not-vegan peach pie (which we gave to our college student neighbors).

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We also went to Denver to catch the last of the USA Pro Cycling Challenge, which was Jen’s Voigt’s final race before retirement.


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By the end of the weekend, my head didn’t hurt anymore, but I could no longer ignore the persistent pain in my right metatarsal, which had nothing to do with the fall.  It didn’t take too long searching Google and my old anatomy textbooks to figure out that the pain was coming from the insertion point of the peroneus brevis tendon on the fifth metatarsal.  The cause of this kind of injury?  Forefoot striking.  


This is crazy.

Ever since Born to Run was published in 2009, “minimalist” running has been all the rage, and forefoot striking is thought of as a panacea that will prevent injury. Before Born to Run, we all over-pronated in our clunky 12mm drop shoes, we struck the pavement with our heels, and we suffered chronic injuries: plantar faciitis, chrondromalacia, iliotibial tract syndrome.  The way avoid all these things is to run barefoot (or in low heel to toe drop shoes, 0-4mm) so that you land on the balls of your feet as nature intended, and to leave behind the concrete jungle of sidewalks in favor of more forgiving surfaces, such as dirt and trails.  

So here I was, doing all of that.  In the past 5 years I’ve run mostly in 4mm drop shoes, but in late July, I switched to Altras— 0mm drops.  My gait has actually been pretty weird throughout this whole time—for years, you can tell from the wear patterns on my shoes that I was forefoot or midfoot striking with my left foot, but still heel striking with my right.  With this switch to the Altras, though, I think came an unconscious switch to forefoot striking in my right foot.  And a concurrent injury to my right peroneus brevis, which was strained too much with the sudden gait change.

I did some ice massage (seriously, this helps) and KT-taped for peroneus brevis, a method that actually forces your foot into pronation (maybe not as evil as we once believed) and takes the pressure/impact off your lateral metatarsal.  I also put the the inserts that my Skechers came with back into the shoe, converting it from 4mm to 8mm drop.  And then I ran.  It worked like a charm.  No pain more, so to speak, in my foot.

Now, to continue healing from the fall, keep other injuries at bay, figure out what shoes I’m going to wear for Bear Chase 50, and somehow ramp up my mileage enough that I’m able to run the race.

156.22 miles in August.  969.62 year to date.  I’m across between optimistic and terrified of the 50 miler I signed up for in September.

Thanks for reading.

August 2014


Unknown said...

oh lissie, please just sit down on the couch and eat chocolate!!! no more bleed pictures!!! love and hugs, auntie

Anonymous said...

I agree with auntie!!!!! My feets! Hurt just reading about all,the horrendous things we do to cause our feet to HURT!!! So!?what happens when YOUR feet wear. out?? Maybe the old folks of generations past. Had the right. Idea wearing the hideous orthopedic shoes!!! sigh!! AND my head throbs just thinking about your fall!! maybe YOU passed OUT?? And it wasn't a tree root in your path after all!!! Wear your helmet , and knee guards and Gloves ! And always. Be sure To NOT injure your PHONE!!! I shall try not to worry! Sigh. Luv and hugs mama

amypfan said...

This entire post is horrifying to me. Love you.