Motivation
It really cannot be overstated how much I despised running for the first 28 years of my life. Gym was my least favorite class in elementary school because of the warm-up laps. In seventh grade, I was miserable during the entire cross country unit. In eighth grade, I walked the mile, dreaming of the time in high school when gym was no longer mandatory. Four trips around the perimeter of the fields at Ridgeview Middle School took me at least 16 minutes, much to the irritation of my classmates.
My disproportionately large chest had always made running uncomfortable and embarrassing. I associated running with side stitches, gasping for breath, cold-induced ear aches, and the monotony of slowly traveling a distance that could be spanned so much quicker via car. There was no doubt about it: I hated running with a passion I now reserve for truffles. The cognitive dissonance set in when I realized there was no such thing as an indifferent runner: everyone who willingly participated in the sport was practically a raving lunatic about the virtues of running. (I must admit that the idea of torching hundreds of calories at a time was also alluring.)
Getting Started - the Couch to 5K Program
In my early 20s, I made a few short-lived attempts at becoming a runner. It didn't stick, and I had plenty of excuses handy as to why running wasn't right for me, my favorite being that I just didn't have the knees for it. Several testimonials for the Couch to 5K program convinced me to give running another shot in the spring of 2008. Your cardiovascular system, muscles, and joints need to become acclimated to running to avoid fatigue, frustration, and injuries. The Couch to 5K program eases your body into running (though it isn't necessarily easy). Each workout involves alternating back and forth between running and walking, with the length of your running intervals and ratio of running to walking increasing each week.
On my very first day, Shawn and I headed to a nearby paved bike and running path and alternated runs of 60 seconds with walks of 90 seconds. Shawn was the timekeeper. I cherished those walking periods. The runs were a different story. I waited as long as I could to gasp "How....much....more?" Sometimes we only had a few seconds remaining in our run, but usually the answer was discouraging.
Progress
Make no mistake, running was absolutely miserable. You probably won't actually start to enjoy running until you're good at it. The incremental gains I made (however small) as I progressed through the program were a huge motivator for sticking with it. Every time I looked ahead to the next week's plan, I couldn't comprehend running the extra time. ("There's no way I can run for three minutes at a stretch!") Amazingly, I added to the amount of time that I could run continuously until I could go 8 minutes, then 12, then 20. In only a few months I could knock out five miles - something I never dreamed of being able to do.
Once I no longer felt like dying from exhaustion, achy joints, and lack of breath, a funny thing happened: I fell in love with running. It became the top priority in my life. I started passing on a second cocktail in order to get a run in (at 10 in the evening!). When traveling, suitcase space normally reserved for extra wardrobe options went instead to my Nikes and a sports bra. My choice in apartments when I moved to NYC was strongly influenced by proximity to good running routes. Running was my saving grace during my near-divorce, and my two marathons are the accomplishments I am most proud of. I am now one of those running nuts I used to be so perplexed by.
My advice for beginning runners:
- Run outside, not on a treadmill.
- Do not be worried about your speed - that will come later. At first, just be concerned with how long or how far you can run.
- Try not to stop unless you think you're doing serious damage. No one ever died from a stitch in their side.
- Break down your run into more manageable chunks. Just worry about making it to the next block instead of thinking about the entirety of your remaining run. Get used to playing mental games like this while running!
- We are self-centered by nature, but trust me: not everyone is looking at you.
Injury
In February '10, I finished the Austin marathon without walking once, in 4 hours and 32 minutes. Three months later, I finished the Providence marathon in 4 hours and 9 minutes.
I was running 50 miles a week and plotting my next marathons (I had registered for Chicago in fall '10 and was considering Las Vegas and Miami in the winter) when I felt a sudden pain on the right side of my groin in the middle of a routine run.
My Symptoms
My groin hurt that first day, but it wasn't unbearable enough that I couldn't finish my run (another 4 miles). I decided to try running the next day, but after only a quarter of a mile, I knew something was terribly wrong and turned around for home. I was in pretty extreme pain those next few days. Do you remember the feeling of accidentally slamming your crotch into the top bar of your bike frame? Simple movements like walking, going up and down stairs, and stepping off a curb elicited that same sensation. Running was obviously out of the question. Even more perplexing, the pain was at its sharpest when I bent at the waist and lifted a leg.
It took two long weeks before my practice's sports medicine doctor could see me. During those two weeks of waiting, I woke up in the middle of the night drenched in sweat, I bawled, I combed the internet for a diagnosis, I went through the motions of living, but for all intents and purposes, I was a zombie.
Diagnosis
I was thrilled when the sports medicine doctor diagnosed me with a pulled groin (technically, a "strained adductor"), because my internet research led me to conclude that the injury I didn't want was a pelvic stress fracture. He arrived at his diagnosis because I didn't feel extreme pain when I hopped up and down on one leg. I was to commence intensive physical therapy, check back in after two more weeks, and then get the go-ahead to start running again. At thrice-weekly PT, I learned stretching and strengthening exercises, my "rotated pelvis" was adjusted, and I received ultrasound and ice therapy.
But I really didn't get any better.
I still felt a deep reverberation every time I stepped off a curb, and putting my pants on or shaving a leg caused a strange pain. It felt like bone, muscle, and nerve pain all rolled into one. The discomfort of a strained adductor was not supposed to linger the way mine was. Still in denial, I was hoping that at my reassessment with my sports medicine doctor I would be cleared to run. I would have happily run through the pain, as long as I wasn't doing damage! The only injury that would be catastrophic to run on was a stress fracture, and that possibility had been eliminated, so surely I'd get a green light to run. Still, an inkling of doubt (not to mention pain) kept me from attempting to run too soon.
At my follow-up, my doctor decided it was time for an MRI. I had barely gotten dressed and out of Radiology when he called me with the news: I had two stress fractures of my inferior pubic ramus (one on each side). He had never even thought to suspect it, because it is such a rare injury. The only cure was rest. Physical therapy should be ceased (especially the ultrasound therapy, which can do further damage to a fracture), I should avoid being on my feet, and weight-bearing exercise like the elliptical was a no-go. I could do the exercise bike or run in a pool as long as I didn't feel pain. He'd see me in another 8 weeks (12 weeks from my initial injury) to reassess.
Anecdotal evidence on the internet shows that this is almost always the way a pubic ramus stress fracture is diagnosed. (My friend Lindsay's story is eerily similar to mine.) It's deemed a groin strain, the patient embarks on expensive physical therapy, and then an MRI eventually proves the injury is much more insidious than a pulled muscle. I have not come across one instance of someone with a pubic ramus fracture being diagnosed correctly from the get-go.
Causes
For the year leading up to my fracture, I had amenorrhea (no periods), probably due to imbalanced hormones caused by high-mileage running. I didn't know it at the time, but this imbalance of hormones made me more susceptible to fractures, as if I were a post-menopausal woman. (A bone density DEXA scan taken five months after initial injury showed my bone density is now normal.) A fall and a change in running shoes to Vibram FiveFingers could also have been contributing factors. (In my friend's case, there was no one defining moment or cause she has been able to single out as the cause of her pubic ramus stress fracture.)
Resources
- Straddle Pelvic Stress Fracture in a Female Marathon Runner: A Case Report (article)
- Stress fractures of the pubic ramus. A report of twelve cases (article)
- Frayed Laces (blog)
- My blog posts about my injury can be found here; posts about running in general are here.
Recovery & Updates
Hindsight is 20/20, and I wish I had taken it easier during my recovery period. Living in NYC means you can rack up miles simply walking back and forth to subway stops, which is precisely what I did. I have no doubt that if I had used crutches, I would have healed faster. I lifted weights (upper-body only), rode the stationary bicycle, and attempted to run in a pool once. At the 12-week point, my sports medicine doctor cleared me to start running very short distances again, despite lingering pain. He did not order any follow-up tests, so gun shy from lack of proof I was healed, I waited a week before embarking on treadmill running (5 minutes every other day). After a few weeks, I moved my running regimen outside, where I ran 10 minutes every other day, then 15 minutes every other day, and so on.
I worked my way up to 40 minutes of outside running every other day, but in December of '10 (6 months post-injury), I was certain I had re-injured myself. However, an x-ray showed I was completely fine.
Through the spring of '11, approaching the one-year anniversary of my injury, I ran between four and six miles every other day. I attempted a few longer runs (up to 12 miles), but decided to back down on distance. Starting in the summer of '11 (one year post-injury), I began running 5 days a week for six miles at a time. I've had no aggravation of my past injury. When training for the Toronto Marathon in May 2012, I kept my weekly mileage between 35 and 40 miles per week to avoid reaching my injury threshold.
