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Injuries and Treatment

So You’re Injured…Now What?

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Nine weeks ago, as I awkwardly crutched out of the doctor’s office, I thought a lot about luck. I took 40,000 steps on a long run a few days before, and one of those was steps was supremely unlucky. The trail gave way, along with my ankle. An MRI laid out the details: a rare talus impaction fracture (the talus is part of the ankle hinge near the top of the foot) and a strong case of the “What ifs?”

What if I went to margarita night and cut my long run short? What if I chose a trail that didn’t have the crumbly consistency of a chocolate chip cookie? What if I made an offering to Paean, the physician for the gods in Greek mythology? At the very least, that last one probably would have cut down on my medical school studying.

Fast forward nine weeks and my talus impaction fracture seems to be healed (knock on wood). More importantly, it gave me perspective on dealing with serious injuries that will help me as a coach, runner and soon-to-be doctor. My takeaway: if you gave me the power to go back in time, I wouldn’t change a thing. Well, maybe I would have gone to margarita night, but that is more of a general principle.

My takeaway: if you gave me the power to go back in time, I wouldn’t change a thing. Well, maybe I would have gone to margarita night, but that is more of a general principle.

The prospect of a long-term injury forced me to zoom out, strengthening my empathy, relationships and self-acceptance. On top of that, I had a lot of time to think about why I dedicate so much of myself to trail running.

For me, it comes from a love of the simple act of trail running. It has nothing to do with making it to the next race, and the next race and the next race. That seems obvious, but sometimes it takes a pause to reflect (whether from an injury or anything else) to find your truth. And that’s just what I learned—your lessons may be completely different.

There’s a saying that comedy is tragedy plus time. I would never wish injury on anyone, but perhaps injury plus time is just an opportunity to learn more about yourself and develop some comedic stories along the way.

You don’t want the injury process to take too much time, though. The story doesn’t need to feel like it’s written by George R.R. Martin.

While time off can provide perspective, you get to a point where you have learned enough lessons and are ready to get back to the trails. These suggestions can hopefully go a long way in curing a case of the “What ifs,” getting you back sooner and happier.

Advocate for yourself as a patient (kindly)

Doctors can be busy people. Some doctors see up to 30 patients a day and have as little as 10 minutes per patient. Like trail runners, doctors can take missteps, too. Outside of Dr. Paean, medical professionals are not infallible. If there’s a diagnosis or timeline for recovery that doesn’t seem right to you, kindly ask questions and seek to understand the rationale. If it still doesn’t make sense, schedule a second opinion.

Given that medicine can be chaotic and appointments can take a long time to schedule, it’s often beneficial to express your enthusiasm for running. Whether you are a professional or recreational runner, doctors love patients who are motivated to recover. Even expressing your love of running to the receptionist scheduling your appointment can mean the difference between having to wait four weeks and four days to get an MRI scheduled.

If you’re going to research your own symptoms, be wary of Dr. Google, who is only board-certified in the field of OH MY GOD EVERY INJURY MEANS YOU ARE DONE FOREVER. Running message boards almost always have runners who never run again after suffering from IT (iliotibial) band issues, plantar fasciitis, talus fractures and hangnails. Conversely, what Google paints as a quad strain could actually be a femoral stress fracture. It’s good to do research, but be mindful of the perspective you are getting.

If it’s going to be a long haul, take some dedicated time fully off

Hard training is objectively hard on the body. Studies have shown that the endocrine system and the immune system can be compromised during periods of intense training. It’s not surprising that many top runners take dedicated periods of time off each year. Often, that time off precedes a breakthrough.

Shalane Flanagan took 10 weeks off from running starting February of 2017 for a stress fracture before winning the 2017 New York City Marathon. Des Linden took time off from structured training in 2017 before winning the 2018 Boston Marathon. And most pros take an offseason where they don’t do much of anything.

Cross training is great, but give your body some time to decompress first. Usually, a week or two is plenty, though everyone is different. Studies indicate you won’t lose much fitness. Consider using the time off to get blood work to see if there are any underlying deficiencies that you can address while at rest.

An unplanned break can be tough to swallow. I’ve found that the first three days of a running break are the hardest as the body grapples with a change in routine and the brain deals with all the pent-up energy, like a puppy doing crate training to learn not to go to the bathroom in the house.

But with time, dedicated rest always seems to get better. New routines form and eventually the brain learns not to pee on itself.

Develop a cross training and physical therapy plan

Sit down with a coach, physical therapist or doctor and sketch out your cross-training plan once you’ve determined how much dedicated time you want off. Taking control of the time off can turn a passive struggle into an active training opportunity that will make you stronger when you return.

Anecdotally, I’ve seen athletes have success with high-RPM bike intervals (95-110 RPMs), which may prepare the body for the neuromuscular demands of running. A typical 3-day block would be:

Day 1: 10 min easy (95-100 rpm), 10-20 x 1 min fast (110 rpm)/1 min easy, 10 min easy

Day 2: 10 min easy, 1/2/3/4/3/2/1 min fast with 1 min easy between each, 10 min easy

Day 3: 30-60 min easy or rest

Depending on the injury, it can be helpful to layer in progressively more weight-bearing activities from there, progressing to the elliptical, the stair mill, Alter-Gravity Treadmill and finally to barefoot jogging on grass. Let pain be your guide—if you feel anything in the injury site, try a new activity (for most running injuries, swimming with a pull buoy between your legs is okay). And remember, physical therapy and correcting imbalances always has priority over hard aerobic training.

Running is not always dreamy in the return

During my recovery, I would fall asleep and have visions of myself prancing gracefully like a mountain goat covered in glitter (a mountain unicorn!). My first run back, however, was not mountaincorn-approved. Despite all my cross training, I felt horrible.

Don’t get discouraged by your first runs back. Often, fitness is lurking, it’s just running economy that is lacking. If you are patient with your return-to-run plan, things will gradually improve as your body adapts to the musculoskeletal stress of running impact and the neuromuscular demands of the running stride.

When will you be ready to return? That is highly dependent on the individual, so make sure your doctor approves of running before taking those first awkward-baby-gazelle steps. Even after getting the doctor approval, keep your runs extra short for 7-10 days and stop immediately if there is pain (some pain can be normal, but it’s better to come back 99 percent too slowly than one percent too fast).

Running is just one part of your identity, not your whole identity

A few weeks before my injury, I jokingly asked my husband, “What do you think non-runners do with so much extra time?” Ironically, I answered my own question a few weeks later: they do awesome things.

Even when running is temporarily on hold, life has so many incredible things to offer. Go snuggle with a doggo, catch a sunrise or read a bestseller. If you are addicted to the dopamine hit from running, you can get dopamine in other ways too—invest more time into relationships, go out of your way to do nice things for others or crank up the rock ‘n’ roll.

When you do get back to running, you can have a deeper portfolio of things that make you happy. You might find out what lots of runners discover: the worst injuries can actually be the luckiest breaks.

—Megan Roche coaches runners of all abilities through her coaching service, Some Work, All Play. She graduates from Stanford Medical School in June.

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