My Experience with Stress Reaction

Short story: I've been off for a while recovering from a stress reaction and metatarsalgia in my foot.  And I'm back.

Long story for those who are interested in the tale of my cranky bone: read on.

The human body is an amazing thing.  I have patients often comment, "I don't understand why I'm in pain?"  I reply with a wry smile, "you should be asking why you aren't in more pain."

We beat ourselves up every day.  We assume poor posture at our desks.  We use poor body mechanics to lift that load of groceries out of the trunk.  We overtrain or ignore the warnings our body gives us that are hinting at injury.  And sometimes there is just that perfect storm that is unpredictable and therefore unavoidable that sidelines us for a while.

Running injury is often not just one thing.  It's a bunch of little things that add up to be a big thing over time.

This fall I dealt with my first show stopping injury.  I first experienced pain in my forefoot in early July, but it wasn't until Nov 23 that I finally completely stopped running and on Nov 28 I had the MRI that confirmed a stress reaction, suspected stress fracture and diffuse bone marrow edema in my second proximal phalanx. I did not take the news well and and was frankly pissed off that the show stopping pain in my foot was coming from a tiny little bone in my TOE! I am back to running now, have resumed my daily dose of endorphins,  and can finally blog about it.

What is a stress reaction?  I have been telling people I have a stress fracture because it's easier than going through this long diatribe.  Stress fractures and stress reactions are both repetitive stress injuries of bone.  A stress fracture usually appears on a bone scan or MRI as a definitive fracture line, whereas if you catch it early enough, a stress reaction is described as it was in my case as "some linear transverse low signal" in the bone.  Combined with the bone marrow edema (swelling in the middle of the bone), this put me in the stress reaction category.  Regardless of what you call it, my bone was pissed off.  And I was too.  A stress fracture is the most feared injury among runners because the only treatment is total rest, and it often requires weeks off from running.  A stress reaction may only require a few weeks and I was consoled by the fact that maybe, just maybe, I would have an accelerated recovery.

Didn't you know you had a broken foot?  Well, no I didn't at first. Ultra runners always have pain somewhere and foot pain is common.  My right foot is a little messed up from a gymnastics injury when I was a teen and it's often a little sore.  My injury wasn't one that happened suddenly while on a run one day.  It developed over a period of several months during which time the pain would come on after running and then go away with lower mileage or rest.  It started with numbness and tingling in my forefoot and pain under the ball of the foot which are symptoms of metatarsalgia, which is all I thought I had at the time.  As a way to cope with and understand this injury, I have been trying to work out the WHY in this equation.  The answer is that there is no simple reason why which is why it got to the point it did in the first place.

My higher mileage weeks with lots of hill training working on mid-forefoot strike in minimal and possibly worn out shoes in July started me off although I can honestly say I am not a high mileage runner overall and I don't blame this on overtraining.  Then racing the Fat Dog 70 with its 13,000' of elevation didn't help.  As fall came I was forced onto the roads more due to family constraints.  At this point my foot was really getting sore so I started replacing some runs with spinning and stopped doing hills.  Late fall is when I do speed work.  That, combined with the fact that the graston I have been having on my hamstring was working so well,  resulted in my top end interval pace dropping by 2:00/mile in less than a month. All that push off on the roads was the final straw.  Up until this point I never had ANY PAIN while running.  Running was the only time I was totally pain free.  This is not a justification, but important to note the power of endorphins and how endurance athletes can train and compete when they shouldn't.  I was in kick ass shape but it wasn't relevant at this point because finally that last week I couldn't walk without a limp and my foot was throbbing and waking me up at night.  I work on my feet all day long which hurt more than anything - I could barely work more less run.

I was still convinced it was a metatarsalgia, and was self treating with footwear (nothing felt good but barefoot was impossible), met pads (made it worse due to all the swelling), acupuncture (helped), laser (helped), ice baths (bandaid help) and ultrasound (made it worse).  The day I did the ultrasound and felt an immediate stabbing pain, my heart sank.  Ultrasound only hurts when the bone is stressed and it hurts as it absorbs more of the sound waves than soft tissue. I walked right downstairs and made an appointment with my sports med doctor for a week later.  I had a bad feeling that I was about to be wearing one of those horrid cast boots and that I wasn't going to be running for quite some time.

Sure enough, my doc (who also runs with me and knows it takes a LOT to stop me from running), listened to my history, took one look at my swollen foot, ordered the boot and an MRI, and told me we were treating it as a stress fracture until proven otherwise. I was actually ready and grateful for the boot because I was just in that much pain.  I didn't care what it took at this point.  I just needed to get better as fast as possible.

I was fortunate to receive the MRI 5 days later confirming my diagnosis.  My doctor confirmed that I stay the course and in the boot.  Her only other advice was "100% pain-free activity," knowing that I was going to stay active no matter what.  So I wore my boot faithfully for 2 weeks.  I only took it off to drive, spin and do pool running.  For driving and spinning I wore a graphite plate in my shoe and did not stand up on the pedals while spinning. Pool running initially hurt, so a friend who also had dealt with a metatarsal stress fracture suggested I wear shoes in the pool.  Brilliant! So I wore an old pair of Merrell Pace Glove shoes and it worked great. It's not like I was going to be running in them anymore.

I was devastated to have confirmation that it was not just soft tissue, but I was confounded that a small bone in my TOE was giving me so much pain.  Not a metatarsal in my foot as we had thought. My toe. Who gets a stress reaction in their TOE!?  I'm not a pointe ballerina.  Then I looked down at my foot and saw the missing toenail on that toe. I am used to losing my big toe nails each season, but never the 2nd toe.  Hmmm.  All that downhill running that I love at Fat Dog where my toes were jamming into my shoes likely didn't help either.

It was a long 2 weeks (but thankfully not 6) of hobbling around at work, lots of spinning interval workouts, strength training, and a few pool running sessions up to 90 min.  I ended up doing more spinning as it was just more convenient.  At the end of the 2 weeks my foot didn't hurt anymore in the boot and it was time to take it off.  I started back with 5 whole minutes of walking on the treadmill and then would get back on the bike for the rest of my workout.  Over the next 10 days I worked up to 60 min of walking and then started integrating running back into my walks.  It was slow, tedious, and frustrating, but I was so happy to just have no pain anymore and be back to running even a few footsteps.  I gratefully kept each test I was giving myself.

I was so excited to run my first 10 mile training run on New Years day with my buddy Scott.  It felt GREAT!  My foot is happily cushioned in my new Altra Neoshell Lone Peak 3.0 trail shoes which have lots of room for my toes and a stiffer outsole to protect my forefoot. It will be a long time before I try to go back to more minimal shoes, but that's fine with me.  I'm running on frozen ground and snow right now.

Scott and I - my big smile says it ALL!

It was exactly 6 weeks from Nov 23 to the day I ran my first 4 miles without any walk segments.  I'll take it.  Most things heal in 6 weeks - soft tissue, tendons, even bone.  Very few injuries last forever.  I really saw the evidence of that and the benefit of following doctors orders to a T.

Going through this injury has NOT been easy.  As sore as my foot was it was much harder on my mind than my body.  My husband told me right at the beginning (when I really didn't want to hear it), "maybe you'll learn something valuable from this that will make you a better runner, physio and coach."  I glared at him.  But he was right.  I have learned quite a bit about injury psychology, the addictive nature of endurance sports, and cross training while not able to run.  This requires its own dedicated blog post coming soon.

I can now talk to my patients from personal experience, have vowed more than ever to train smart, and hope that my experience will help me coach my athletes more intelligently.

On the topic of coaching and teaching, check out my new website www.bouncestrong.com!

Here's to ReBounding Strong!