Qualifying for the Boston Marathon

Rachel, Well, the good news is you have a real ans...

2012-04-26T07:01:52.580-05:00

Rachel, Well, the good news is you have a real answer for why you felt the way you did. Also, the 'early stages' is good news--if you mind your healing process, you should be ready to run fairly quickly. 8 weeks is a pretty good rule of thumb for an uncomplicated tibial stress fracture. And, yes, you definitely have a great story! Hope you get to run Boston again with cooler weather and solid legs :) Thanks for writing back! -Alex

Hi Alex - MRI results should "Bone changes co...

2012-04-25T09:10:31.798-05:00

Hi Alex - MRI results should "Bone changes consistent with an early stage stress fracture." Whatever that means. Doctor said - no running at all until there is no pain at all. Total rest for a couple of weeks. Then non-impact exercise (assuming no pain), then - maybe in 8 weeks or whenever it feels 100% - I can try to run a little. I have a relay marathon to run on May 20, so I'll take it day by day to see how it feels until then. At least I got a good story out of it and an excuse for my super slow Boston time...I ran Boston with a "broken leg"!! In a heatwave. So, I got that goin' for me.... Thanks again for all of your advice. So very helpful.

Rachel, Congratulations! I'm so happy you fini...

2012-04-19T18:58:45.192-05:00

Rachel, Congratulations! I'm so happy you finished. And, wow, was it hot out there from what I read / heard! I hope your MRI comes back negative for a stress fracture. If it is indeed negative, I'd definitely give your body about two to three weeks of absolutely no running and still very light activity. I would hope by that point, your shins should have settled down a little bit, and you might be able to work in some very easy recovery cross-training towards the end of that time. By three weeks, you will want to 'work out' your usual 5-6 days per week, but you might want to just gradually replace some of that time or some of those days with running and wane out the other activity gradually. Example: By week 4 (assuming pain has really settled down), replace two days of cross-training with a short run, by week 5, try three days of short runs.
Let us all know how the MRI results go! Cheering for you, --Alex

Alex - Just wanted to report that I finished the B...

2012-04-19T09:00:51.659-05:00

Alex - Just wanted to report that I finished the Boston marathon. It was painful, slow and genenerally miserable (but I finished!!) and I don't recommend that anyone who has shin pain (of any sort) do it, but it is possible. I survived. However, I had another MRI yesterday to make sure the shin didn't fracture during the race. I should get my results tomorrow. I am pretty sure it is not broken, just inflammed. If not broken, how long should I rest it before I try to run again? I am signed up for a relay marathon on May 20 - my portion is just 5 miles - but I want to be sure to give the shin time to heal completely before I cause it to flare up again....
Thanks for your advice.
Rachel (from prior posts of April 3-5, 2012)

hi thanks for your quick response. yes the stress ...

2012-04-17T01:46:48.667-05:00

hi thanks for your quick response. yes the stress fracture was diganosed. via the bone scan in dec 2011. but didnt show on either of the mri's however, it did say stress fracture on the report of my bone scan. but yes you are right it should be well and truely healed by now

Kristy, I've read through your post a few time...

2012-04-16T22:51:51.216-05:00

Kristy,
I've read through your post a few times now, and I just feel your pain coming through, both the physical and emotional suffering that you've been through in the last year. I'm sorry it has taken such a toll on you, and that you've struggled so hard just to get some answers.
A few things stand out to me about your situation.
1). You never got a definitive diagnosis of a stress fracture or otherwise. Your first bone scan and MRI appear to be inconclusive. Your second MRI showed nothing.
2). You are not imagining your pain, and you've gone to excessive lengths to try to recover from it (not running, lengthy time in knee brace, crutches for 7 weeks). No one who loves running as much as you do would tolerate this without good reason!
3). If you did indeed have a stress fracture, this has healed by now.

There are a few things I'd do at this point, if I were you.
1). Collect your MRIs from both dates and take them for a second opinion. You aren't imagining your pain, and something is definitely wrong. You should get a confirmation on the stress fracture one way or the other. It will be helpful to know if this really was the root cause of all the pain.
2). Get out of the knee brace--at this point, this is not helping and is likely contributing to some atrophy or stiffening in the area.
3). Avoid any massage or 'work' that leaves the area bruised. It sounds like you may have had Graston or something like that.
4). Try some gentle active isolated stretching (not static) to get the area more loose over time. Do not push it.

If you can confirm the stress fracture, there are many reasons you might still have pain, even after it has healed. When your body goes through the process of healing a fracture, the inflammation through remodeling process will affect all surrounding tissues. Tendons, muscles, etc. can get adhesions and scar tissue, which can cause a great deal of pain and stiffness. You can break this cycle, though it will come a little bit at a time.

There is another condition that occurred to me based on what you described, although it is rare--it can occur after nerve damage / post injury. You might want to read a little about it: Reflex Sympathetic Dystrophy. It's unlikely this is what you are experiencing, but something that one of the other runners who commented above ended up with as a diagnosis after her stress fracture and extended period of agonizing pain long after the bone had healed.

I can feel how devastating all of this has been on you. I've love to dialogue with you a bit more in depth. Please feel free to write to me at fongrrl at gmail dot com.

Wishing you the best, --Alex

hi i was wondering if you could suggest some adivs...

2012-04-16T03:03:02.052-05:00

hi i was wondering if you could suggest some adivse for me. last may 2011 i ran a half marathon and got 2nd was fine afterwards but went for my ususal run a couple of days later and i couldnt walk all of a sudden. went to my physio who said it could be a lateral miniscus tear or strain but wasnt sure. i had my honeymoon planned in a months time so we suggestd we will see how it is after that and if no better will get an mri. came back no better so got referral for mri, which took 2 months to get. during this whole time i wore a knee brace and did alot of walking no real running and physio contiuned to work on my knee, quite vigouriosuly at time (even made me bruise alo) got mri which was 5 months after injury which showed nothing, but ortho decided to give me a cortisone shot for the hell of it i guess. after the shot i was in immense pain and went back to him numerous times. got worse and worse then the cortione actually caused some fat loss and loss of pigmentation where it was injection (although they say this shouldnt casue pain) in the end pain was so bad wasnt able to walk again even though i had been doing so before hand, although was advised to get rid of my knee brace which i wore 24/7 before the shot. so maybe that had something to do with it. anyway they decided to send me for bone scan and another mri, bone scan was 7 months after injury and suggested it was a stress fracture of the lateral lip of the lateral tibial plateau. so crutchers were given to me finally and was on them for around 7 weeks. got 2nd mri, showed nothing again. got off crutchers and no better really still am not pain free to even walk yet let alone run, my lifestyle has completly changed, all i wanted to do was run again now all i want to do is have a day without pain. it nearly a year since injury and now a sports med specialiset says it might be nuropathic (is. my injury healed but my brain still thinks it is there) and wants me to take some medication to help with neuropathic pathways of the brain, im not so sure but am at my wits end. i just want to walk. it really affecting my work, health and relationship. have you ever heard of stress fracture going on this long? or could it be a prob with the nerve? i also wonder if i hadnt had the cortione it may have been a different story and may be gone by nows. hope you can help. thanks

Rachel, Thanks for writing back and sharing your s...

2012-04-05T08:59:52.174-05:00

Rachel, Thanks for writing back and sharing your story! Tell me how Boston goes :) --Alex

Thank you so much! Just returned from doctor visi...

2012-04-04T12:18:12.109-05:00

Thank you so much! Just returned from doctor visit #2. He said I could have a second MRI "if I wanted it," (which I thought was odd) but since the last one was negative and the symptoms are the same (not a lot worse), he suspects it is still periostitis (i.e. "just" shin splints). He agreed that my description of the pain is text book stress fracture, but he was pretty confident the MRI would have revealed a break. His advice? No running until Boston. Pool train to keep fitness. Go to the start line. Run until there is pain. When/if it hurts - stop. If I finish, great. If not, I got there and I tried, but I won't be injured when it is over. So - I am sadly expecting the slowest Boston time ever, but I am looking forward to the experience. Thanks a ton. Your blog is incredibly helpful.

Rachel, You are in a tough spot and I completely u...

2012-04-03T19:36:47.338-05:00

Rachel, You are in a tough spot and I completely understand how you feel. It's such a huge accomplishment to qualify for Boston (Congratulations!) And heart-breaking to think you might not be able to run it. A couple of things for you:
1). Your first MRI was negative for a stress fracture. This is the tool of choice, so unless it was missed, you probably have a different issue. Did the MRI reveal anything? Your pain indicates a real issue, and I would hope that the MRI should show something.
2). You might have tendonitis (the pain for this can be pretty severe).
3). You might have a stress fracture anyway, regardless of your earlier MRI.
If I were in your shoes, I'd be doing my best to get another MRI so that you have the best information possible. An X-ray is likely insufficient.
If you do have a stress fracture, you, I would recommend passing on Boston. (Looks like you have already come to that conclusion.)
If you don't have a stress fracture, you may be able to manage the symptoms (at the cost of making them worse later) and tough it out through Boston. You will probably want to re-set your expectations on what your goals are for the race, and tone your effort down a bit. But, celebrate what your effort has brought you! I'm happy to help you think through this a bit more as you have additional information. Feel free to email me directly at fongrrl at gmail dot com.
Best wishes, and I sure hope you can get to Boston this month! --Alex

I qualified for the Boston Marathon and have been ...

2012-04-03T10:05:53.382-05:00

I qualified for the Boston Marathon and have been looking forward to running it FOREVER. Mid-way through training, I started having shin pain - localized and shooting - so I thought it was a stress fracture. An MRI did not reveal a stress fracture, so I kept running. I received treatment from a chiropractor, eliminated short runs in favor of pool running, but kept the long runs. Ran 21 miles this weekend and now can barely walk, the pain in my shin is so bad. Same spot. I have an appt. with a doctor on Wed. (10 days before Boston). If he says I still don't have a stress fracture, should I run? If he confirms a stress fracture, I'll cancel my trip to Boston, but if it is not a stress fracture, I am inclined to give it a try. I have wanted to run Boston my whole life and may never qualify again. To be this close and give up b/c of an injury (esp. if the doctor says it is "just" a shin splint) just makes me sick. On the other hand, the pain after my long runs is terrible and I fear making a bad situation worse just because I am pig-headed and didn't listen to my body....Help, please. I don't know what to do....

I want to bookmark the page so I can return here f...

2012-04-02T01:35:03.536-05:00

I want to bookmark the page so I can return here from you that you have done a fantastic job.

Anonymous, Thanks for reading my blog and leaving ...

2012-03-29T22:12:11.620-05:00

Anonymous, Thanks for reading my blog and leaving me a message! I ran six days a week leading into this race. Although some weeks were higher, I ran mostly in the 55-65 mpw range. Congrats on your New York marathon! I'm looking forward to running INGNYC Marathon this year :) Best wishes on qualifying for Boston. You can do it! --Alex

Thanks for sharing your experience. I found it re...

2012-03-28T09:46:53.904-05:00

Thanks for sharing your experience. I found it really helpful (and motivating)! How many days a week did you run? And what was your weekly mileage? I ran the NY marathon this past Nov in 4:04 and want to get my time down to 3:40 in order to qualify for Boston.

I would like to thank for the efforts you’ve put i...

2011-12-23T05:28:49.594-06:00

I would like to thank for the efforts you’ve put in writing this blog.

Justine, Sorry to hear about your metatarsal stres...

2011-12-08T21:40:41.260-06:00

Justine, Sorry to hear about your metatarsal stress fracture :(. The good news is, being a smaller bone, it should heal relatively fast if treated well. Aqua jogging is a great cross training with cardio benefit that you should be able to do now. However, with only four months to train for a marathon, I'd take a look to see if you can find one a couple of months later as a compromise. This will give you adequate time to heal, and not rush you back to running if you're foot is not ready. You probably don't need to take twelve weeks off-but everyone heals differently. Best case, you could take the sixty minute walk test in five to six weeks and see how you do. Best wishes for a speedy healing! --Alex

Thank you so much for posting this! I was just dia...

2011-12-07T20:29:36.527-06:00

Thank you so much for posting this! I was just diagnosed with a metatarsal stress fracture and was just told that I can not run for 12 weeks and I can't do any sort of cardio activity for two! I was just about to start training for my third marathon coming up in March. Shall I even try to pursue this? I was reading about aqua jogging from your previous posts, could this be an alternative training method?

Thank you so much for the advice! It really puts m...

2011-12-05T19:33:18.219-06:00

Thank you so much for the advice! It really puts my mind at ease knowing the pain might just be inflammation. But I am continuing to take it easy. Thanks!

Megan, Thanks so much for writing. I'm sorry ...

2011-12-04T06:02:33.203-06:00

Megan,

Thanks so much for writing. I'm sorry to hear about your sacral stress fracture. Generally speaking, this stress fracture would have healed within the three month time frame, especially given that you allowed sufficient time for the bone callous to form and harden before you began picking up activity. One area that you should be thinking about is your diet and hormone levels. Are you eating enough calcium rich foods, getting lots of Vitamin D and protein? Is your weight adequate? Those are the kinds of things that could interfere with expected healing times. Meanwhile, the aqua jogging alone three months out shouldn't re-fracture your injury. However, there may still be a lot of inflammation. In my experience, the pain with the stress fractures only seems to settle "in the fracture area" when healing is pretty well under way, and the prominent pain experienced is one of soft tissue around the fracture. So, you may be experiencing some initial soreness or trauma to the soft tissue and or scar tissue around the re-modeled bone. It seems you are doing well with the slow running and the biking. At this early stage (only a few months out), it's safe to use pain as your guide. Go ahead and back off the things that do seem to cause you pain and continue doing things that don't cause pain during (and especially after--up to 24 hours after). You might try less vigorous aqua jogging and or plain swimming (great aerobic capacity builder). In short, it's highly unlikely you've re-injured yourself this far out if all things are equal (no calcium or vitamin D deficiency, etc.) with what you've done. But--trust the pain as your guide. It is the most important diagnostic tool you have without getting an MRI every day :) Meanwhile, you are certainly due for a "recheck" if you can go back to your doctor and get a follow-up bone scan or MRI to confirm healing progress. Best wishes to you, and congratulations on staying fit despite this set back! --Alex

Inspirational post! I am a high school cross count...

2011-12-03T09:41:12.190-06:00

Inspirational post! I am a high school cross country and track runner and was diagnosed with a sacral stress fracture 3 months ago after running 40 mile weeks. I rested completely for 2 weeks in which the pain subsided quite a bit. I have been biking on a spinner bike (usually 6 days a week, 3 days of which were intense) for the next 2 months. I only experienced mild pain sporadically throughout these 2 months. Since my recovery was going well I thought it would be ok to mix it up and start water jogging. Since I had been training intensely on the bike, I thought it would be ok to do an intense workout the first day of water jogging. Immediately after the water-jogging workout and still 2 days later, a nagging pain has returned to the sacral area. I have started up running again very slowly which has not caused any pain. I knew that after an injury, I should take up running again very slowly, but I was not sure if it was the same for activities such as water-jogging in which there is no impact. I'm worried that I have interrupted the healing process and injured my sacrum again. Could water-jogging cause this? Thanks.

P90X, Thanks for the visit and the kind words. It ...

2011-10-18T12:21:59.505-05:00

P90X, Thanks for the visit and the kind words. It has been two years.. and so much water under the bridge. I'm glad you brought this post back to my attention, as I'd forgotten about this moment and probably needed to be reminded :). Not mere serendipity I don't think. Best, --AG

Sorry - posting a bit late I't's tr...

2011-10-17T14:35:27.480-05:00

Sorry - posting a bit late
I't's true. In your photos you actually don't look that annihilated (which is what I would look like). And a very respectable time.
~ Toby

Hi Alex, one more quick comment. Yesterday, I ac...

2011-10-10T20:48:07.141-05:00

Hi Alex, one more quick comment. Yesterday, I accomplished something I never thought possible in July of this year. (Post SF diagnosis). I ran my first half marathon. Well, ran-walked it. I did the Jeff Galloway method, run 5 minutes, walk 1 minute. My finish was 2:17 - I was simply happy to be there. Lesson learned in May, I am now taking time OFF to allow myself to RECOVER! Lisa

The Chicago Marathon was a BLAST! I kept in mind t...

2011-10-10T15:33:39.663-05:00

The Chicago Marathon was a BLAST! I kept in mind that finishing was the most important goal since I was healing and not running at my full potential. I am really proud of the accomplishment and am looking forward to a 15K in November to end the season before January training starts for my goal marathon.My 11 year-old is now thinking of doing a 5K. Thanks again for all of your support:)

Shawna, Anything sub-4 is an awesome goal :) Sound...

2011-10-09T17:07:33.550-05:00

Shawna, Anything sub-4 is an awesome goal :) Sounds like a good short term and long term plan ;). I'm looking for the "right" goal for myself for 2012. I met my 2011 goal (qualifying for New York guaranteed starting position) in April. The January race is just something to get me going (5K or 10K), and maybe run with my twins. Dying to hear how Chicago went for you! Hope you are enjoying a good rest now :) --AG