How to Fracture Your Pelvis and Qualify for Boston – All in Six Months (PART ONE)
Posted Dec 05 2012 10:46am
If you’ve been reading this blog at all over the past year, you might recall the turbulent emotional rollercoaster that was my 2012 running calendar. I had an aggressive and optimistic race schedule planned out from April to November 2012, including dreams of PR’s, capped off with running the NYC Marathon in November. The year started successfully with a PR at the Cherry Blossom 10-Miler, but was brought to an abrupt halt with two (count it) TWO pelvis stress fractures in April. Although the year ended better than I could have imagined, the effort involved in making this possible was much more than I had prepared for. During my injury, I spent an abnormal amount of time on google, frantically searching for similar symptoms, magic solutions, and recovery stories from others who had come back from similar injuries. I remember promising to myself that if I ever made it to the starting line of a marathon in 2012, I would summarize how one can, in fact, recover from a stress fracture – if they’re willing to put in the work.
But let’s back waaay up and start at the very beginning:
PART ONE: How to Give Yourself a Double Pelvic Stress Fracture
Only now, six months after I gave myself these injuries am I able to reflect upon what factors likely contributed to them.
(Before I begin, Disclaimer: I am obviously not a doctor – any opinions here are solely my speculation as a seasoned distance runner. If you stumbled upon this site while frantically researching your own injury, please consult your doctor before taking my amateur advice.)
Wikipedia defines a stress fracture as “one type of incomplete fracture in bones. It is caused by "unusual or repeated stress" and also heavy continuous weight on the ankle or leg.”
I ran the Cherry Blossom 10-miler in D.C. in early April and had a great race resulting in a PR. I felt strong, and recovered fairly quickly after the race. I decided to continue my training straight through to the Broad Street Run in early May. One morning, mid-April, I finished a breezy 10-miler over the Ben Franklin bridge. Later that day, I remember complaining to Joe, “the bone in my pelvis hurts a little. Like, right on my pelvic bone.” But then it went away.
The next day or so, I started feeling very tight in my groin. I started stretching my groin like crazy. Over-stretching. On “cold” muscles.
Which resulted in a groin pull. I was limping. It was terrible.
But I thought that was it. No big deal. So I pulled a muscle. I can recover from this in a week or so. At this point, I had to pull out of Broad Street, thinking I just had a pulled groin (I could barely walk, never mind race!) But decided a week or two off would do the trick and I could come back for a 4th of July race.
A week or so later, the groin pain subsided so I decided to try running. BIG mistake. With one step, I had sharp, nauseating pain throughout my torso and almost threw up on the Schuylkill River Trail.
I finally went to the doctor. After the X-Ray didn’t show much (I almost punched the X-Ray tech when he said, “you probably just have tendonitis or something”), it was time for an MRI. Which showed the following:
1) Stress fractures of the left inferior pubic ramus and left superior ramus/acetabular
2) Pubic symphisis stress osseous response (muscles around are all inflamed - maybe this explains the groin pull?)
3) Surrounding bone marrow edema
Oh, is that all? I finally swallowed my pride and knew it was time to get serious and lay off the running for 12 weeks. Of course, this was after a week of denial, pouting, and complete frustration as I knew I was about to face an entire summer on the elliptical. (Stay tuned for PART TWO!)
In retrospect, after months of considering my training and what I was doing wrong, I believe the following contributed to my injuries:
1) Lack of Strength Training: The only strength training I was doing at this point consisted of bicep curls with a 10lb weight and abs twice a week. The Theory of Constraints (aka “Weakest Link” theory) says that every system, no matter how well it performs, has at least one constraint that limits its performance – and it will break at this constraint. Even though other parts of my body were strong, there were some vital areas that lacked attention and were on the brink of failure: hips, pelvis, etc.
2) Lack of Stretching: I stretched maybe five minutes after each run. If I felt like it. Every runner knows this is a no-no, but sometimes after running for an hour or two, I was ready for a shower and a burger.
3) Weight/Low Body Fat: This is huge and took me awhile to completely understand and accept. I believe one of the main reasons I hurt myself was because I was a little underweight. At 5’4” and weighing 123 lbs, I thought my weight was right in line for a healthy, athletic female. Even after learning I had low body fat and started eating at least 30% of my calories from healthy fats, I still hovered around this 125 lb range. During the 3 months I took off, I continued cross training (PART TWO!) but I gained a few pounds, and maintained a weight around 128-130 while training this fall. I feel like these extra pounds helped me recover and withstand the training. I felt stronger, like my bones and muscles could tolerate more. Although a weight of low 120’s may be considered normal for my height, I now think my frame requires a little more weight and body fat to sustain the activity I want to be able to handle. After all, I’d much rather be strong and able to run a marathon rather than be skinny.
4) Calcium Deficiency: This likely goes hand-in-hand with the Weight/Body Fat issue. As soon as I was diagnosed with my double SFX, my doctor had me start taking 1500 mg of calcium a day (taken at 3 increments of 500 mg per day – your body can only absorb 500 mg at a time). I don’t eat much dairy at all, besides greek yogurt or froyo. I only drink almond milk, and most cheeses bother my stomach. So I’m sure I was deficient in calcium, obviously required for strong, healthy bones.
5) Minimalist Shoes: This was also another tough one to swallow, because I was am as big of a fan of the minimalist movement as the next guy. I do still believe that excessive cushion doesn’t correlate with our natural ability as humans to run, and can result in chronic injuries such as runner’s knee, etc. I am a loyal fan of Chris McDougall and will continue to let fellow runners borrow my copy of Born to Run. However I think there’s a balance. Over the past 2 years I had slowly transitioned from my cushiony Adidas down to Nike Frees down to New Balance Minimus and ultimately down to Altra Eve’s – which essentially have zero drop and are comparable to Vibrams, but without the individual toes. I loved the Altra’s while running in them – I believe they are the reason I overcame chronic tendonitis in both knees and they also helped me to race faster. But I can’t ignore that the complete lack of cushion and shock protection might have put unnecessary stress on my body – causing it to break at its weakest link. Again, these are just speculations. But, I moved back up to the NB Minimus, still an excellent minimalist shoe while Marathon training this fall.
So, I basically think a combination of these factors is what ultimately caused The Worst Injury Ever.
Coming up next:PART TWO: How to Recover from a Double Pelvic Stress Fracture and Qualify for Boston – All in Six Months!
Q: Did you ever learn anything from a serious running injury? What is the best running advice ever given to you?