My Boston Build

Making the start line through injury or injuries…

I started training for Boston 18 weeks out. My base was around 30-35 miles/week when I started training. I had just completed a 12 mile trail run in the mountains. During this run, I twisted my left ankle. It wasn’t a bad roll, I could keep running and it didn’t bother me. However, later that day we attended a concert and I was standing on it for hours. I noticed it felt a little off. I continued to run through the next few weeks and that foot continued to feel weird. It would never hurt on the run, but later in the day I would have aches in the arch, on the top of the foot, near the ball of my foot, etc. At this same time, my right knee starts hurting out of nowhere. I take a full 7 days off of running. I start incorporating swimming for cross training because the bike did not seem like a good idea with my foot hurting. I see a podiatrist about my foot and his assumption is that it was plantar fasciitis mostly affecting the arch of my foot. I had PF when I was 25 and my foot felt NOTHING like PF, but I listen. He puts me on a medrol (steroid) dose pack for 7 days to decrease inflammation after we had already tried high dose ibuprofen for about 10 days. Although this helped slightly, I think it did more harm than good. I resume running and my knee feels ok, but the foot is still not 100%. This is mid January at this point and I had just finished a 5 mile run and noticed a spot in my ball of my foot between my first and second metatarsal. It started off really mild but as the day progressed it continued to get worse. It hurt to bear weight to the point I’m thinking “is this a stress fracture?”. I go to an ortho urgent care in town who obviously can’t find anything on X-ray (I’ve had an x-ray of this foot 3 times at this point). He wants to put me in a boot and shut me down for a week even though I had literally just taken 7 days off of running but OK. I tried to wear the boot that day and it makes the pain excruciatingly worse. At this point, I’m a mess. My mind is at its worse, thinking great I finally got my shot to run in Boston and now I’m injured. I spend that weekend extremely upset. Monday morning, I schedule another podiatrist appointment and somehow get in that week. He comes into the office, does not even lay hands on my foot, and says “oh you’re still having pain, ill order an MRI”. Which ok, FINALLY, but also where is your beside manner and this is a completely different issue that I’ve been having, maybe you want to look at my foot? I call the radiology office later that day to schedule the appointment; I don’t have time to wait for them to contact me. I get in with a cancellation appointment that Saturday. MRI comes back on Monday, negative for any anomalies. Now you’re probably wondering what does my foot feel like at this point? When I first get up in the morning, its at its worse, kinda like stepping on a pebble. But as I start to walk around for the day it tends to lessen to the point that I don’t even notice it. I tried running 1 mile, no pain. “Weird, what is this?”. The cycle continues feel it in the morning, feel it bending my toes in dorsiflexion, walk around, pain goes away. I start to run a little bit more, pain doesn’t get any worse. I take a rest day, foot feels the same as it does on a day I run. So in my head, I think running isn’t making it any worse. The podiatrist office finally calls back with the MRI results (even though I have viewed them myself and know I am safe to continue running) and he wants to put me in a boot. ABSOLUTELY not. I tell them how I can walk/run without pain but they want to shut me down and put me in something that could cause more pain/throw off my back. No way, I am finished with that office.

I start incorporating running again slowly. This is the beginning of February and I’m running 10-15 miles/week with a marathon in 2 months. I’ve been averaging about 5-6 miles on a run. I do a 7 mile run, things are ok. The next week I do a 10 mile run, things are ok. I start thinking okay, maybe things are going to be ok. Mind you, I still have this foot pain every morning getting up that dissipates with movement. I run the Wilmington half marathon at the end of February. I paced half of it with an athlete and then run a progression for the second half. While doing it I feel great, post run I noticed my right knee hurting again along with my hamstring feeling really tight. I’ve never had hamstring issues before running. I’m in the mountains for a few days post race, running more elevation. Knee keeps hurting about 2-3 pain level. “Ugh great, more time off”. My high hamstring has loosened up and is not bothering me.

I schedule an appointment with a pain management clinic in town that does shockwave therapy for my knee and to ask him about my foot. The doctor can’t believe it when he hears about the podiatrist not only putting me on a steroid, but also that he wanted to put me in a boot. He reviews my MRI and concludes that it could either be sesamoiditis or a compressed nerve. Given the location and the symptoms that are not consistent with sesamoiditis, he concludes on a compressed nerve. I get two rounds of focused extracorpeal shockwave therapy on my foot and my right knee spaced 1 week apart. After the first round on my foot and knee it was markedly better, after the second round, no pain. This was the first week of March at this point, Boston is 6 weeks away. At this point, I think I just want to run. I don’t care about my time, I don’t care about doing workouts, I don’t care about anything but toeing the line I’ve worked so hard towards.

From here, I am able to consistently run until the race. I average right around 30-35 miles in the weeks leading up to Boston with 40 miles in a 7 day span as my peak. You may be thinking, great she was able to come back pain free. Wrong. Through those last 6 weeks, I had issues with my shin hurting (only for a few days) along with my high hamstring coming back. I had been seeing a PT throughout training. We tried dry needling my high hamstring/glute and cupping. I tried massage therapy. Nothing really worked. Back to the pain management clinic I go with 2 weeks to go. They give me 2 rounds of shockwave therapy again spaced 1 week apart, the last one 5 days before the race. Talk about cutting it close but I was willing to do anything to make the miles more comfortable. The pain wasn’t terrible, I could run easy without pain, but anytime I tried to pick up the pace it would hurt. Running long also caused it to tighten up like crazy. We debated was this piriformis syndrome or high hamstring. Still at this point I think it may be a combination of both. The shockwave helped immensely. After the first round, I was able to run hard again. Second round, it felt even better. I was able to do one last workout before Boston that included marathon pace miles. I left for Boston thinking, ok maybe this will go better than expected…. Stay tune for the full Boston recap.

Now lessons learned from this training cycle:

First off, I would not have been so persistent with getting through this if the pain had been severe. All of my pain was mild to moderate. Nothing hurt me while running and if it did I backed off immediately (this was typically only my knee I felt running). I know most likely these aches were from trying to increase mileage and at times intensity and my body was not always on board. I listened to my body daily. I adjusted runs daily. I had several weeks where I envisioned running more or doing more harder effort workouts and I just scratched them and ran easy. I spent the majority of this training cycle running at my easy pace which on my vdot is 8:30-9:30. Typically I feel most comfortable 9:00-9:30. Don’t be afraid to just run easy. Sure you might not be at your peak fitness and you might not set a PR, but if your goal is to run the race, dial it back and just be content with comfortable miles.

Find a PT and a doctor that listens to you. The PT I worked with through training along with the doctor at the pain management clinic were super professional while also understanding of an athlete’s needs and dreams. If you don’t have someone that is on board with you and isn’t listening to you, RUN AWAY. Seriously, what if I listened to that doctor that wanted to put me in a boot for absolutely no reason other than he didn’t know what was wrong with my foot and clearly didn’t want to take the time to figure it out. Also think twice, before someone puts you on a steroid or offers a steroid injection. Steroid injections do have the potential to weaken tendons and oral steroids can increase risk of stress fractures.

Consider getting a gait analysis. I got one done a few weeks before Boston and learned that I have a slight anterior tilt which is likely putting more strain on my high hamstring. I also learned that I am landing heavy on my left side and have an imbalance between my left and right glutes/leg. This off season I am dedicating to strength training and fixing this imbalance.

Cross train. When my miles were at my lowest, I was strength training 4-5 times per week along with swimming in place of runs. I continued to strength train 2-3 times per week (one upper, one lower, one full body) until the taper when I cut back on strength. I continued to swim on average 2 days a week until just before race day.

Rest. I took more rest days this training cycle than I have in my entire life. I listened to my body and when it said stop, I did. That being said get your sleep too, aim for 7-9 hours/night.

Eat. I upped my protein to typically around 120-140g/day along with increasing my carbohydrate intake. This is way more than I ever used to eat but it makes a huge difference not only in terms of recovery, but also balancing training. Although I was not running as high of mileage as usual, I was still exercising 8+ hours/week. This equates to a hard training plate if you train by athlete’s plates. That means half of you plate should be carbohydrate, quarter protein, quarter color (vegetable).

Lastly, don’t be afraid to adjust. If I had not adjusted, I wouldn’t have made it to Boston and fulfilled my dream running goal. Training plans are just that; they are plans, but they are not set in stone. A few missed runs doesn’t equate to a bad race.