Lessons Learned from a Year-Long Injury Battle

At the beginning of 2023, I was a month out from my first marathon in 3 years and first postpartum marathon…. and I started having knee pain. I did a 21 mile long run and could barely walk without pain the next day. With no traumatic event, I assumed it was runner’s knee, and technically it was. I’d been lucky in my 14 years of running thus far to have never been injured, but figured I still had a lot of weakness postpartum that was causing my knee to be out of alignment and putting me in pain. Runner’s knee usually clears up in 4-6 weeks with proper care and reduction in running. Of course, every case is different.

The onslaught of injury

After self-diagnosis, I pulled out of the marathon and took myself to physical therapy. We worked on strength and I was able to keep running about 15-20 miles/week while keeping the pain manageable. Then I broke my toe chasing Quentin around 😕. I took 6 weeks off running and focused on strength, physical therapy, cycling and elliptical work. During that time, I had no knee pain, so I was pretty disappointed when I started running again and had pain almost immediately. My physical therapist assured me that runner’s knee can come and go, so we had to keep the focus on getting stronger.

I remained hopeful and had another marathon on the books. This was my last year to use my 2020 registration from CIM, so I figured that starting to run in April would give me plenty of time to build back up (the marathon was in December). I took all time goals and expectations out of it and just wanted to complete the race and remain injury free.

My coach took a very conservative approach to my build up over the summer. I started with a run/walk when my toe healed up and focused on time based runs for much of the summer. I was feeling sluggish and very out of shape. It felt harder to run during this time than it did coming back postpartum. While I thought it was strange, I gave myself grace and stayed committed. I would later find out my ferritin and vitamin D were in the tank and it wasn’t just me. My knee pain was slight during this time and never got worse with my runs, which felt like we were on the right injury recovery path. I even got to race! My first and last race of 2023 was a local 5K in August.

Then, 3 weeks later, I got a stress fracture. I was out for my long run before Labor Day and my foot started aching out of nowhere. I didn’t step off a curb or trip and there was nothing that could point me to what could be wrong. Similar to my knee, no traumatic injury. I was about 2 miles from home and 6ish miles into my run. I stopped, took off my shoe, rubbed my foot, and then tried to keep going. Still hurt. I stopped again, stretched my foot and tried to keep going. I thought, “I can probably make it two miles, but what if this is something really bad.” I’ve never had a stress fracture, and this was painful. I felt like a wimp, but knew I would regret pushing through the pain if it meant not running again. Little did I know, it already meant not running for a very long time.

Stress fracture and third injury of the year!

I called my husband to pick me up and I went to urgent care for an x-ray. A stress fracture doesn’t show up on x-ray for quite some time so they saw nothing and sent me on my way. We had a camping trip booked for the long Labor Day weekend and I didn’t want to ruin it or stay home, so we went to a medical supply store that afternoon and picked up a walking boot. By this time, my foot was very sore and swelling a bit. The boot instantly made it feel better and we went on our camping trip. I was sore the entire weekend away and any time I took the boot off, my foot hurt 10 times worse.

I was at a loss of who I should see for this injury. A podiatrist? An orthopedic doctor? I scheduled with both and luckily, my physical therapist got me into an orthopedic foot specialist within a few days. He x-rayed my foot again and was able to see a stress reaction. He ordered an MRI so we could know more and gave me a better walking boot that allowed for more ankle mobility. The MRI confirmed a stress fracture, but because I caught it early and didn’t keep running on it, I saved myself about 4 weeks in the boot and it had already started healing. I had to be in the boot for 8 weeks and my marathon was off the table, but a small win in there based on my decision to stop running right away when my foot hurt.

I’d come to the conclusion that 2023 wasn’t my year and I needed to accept that. I joined a gym with a pool and started aquajogging and doing pilates in addition to any physical therapy exercises and strength work I could do. A few weeks into wearing my boot, my knee pain was the worst it had ever been. I couldn’t understand how not running would cause me so much pain in my knee. At this point, I’d had some sort of knee pain for almost 10 months. I went to the same orthopedic practice where my foot doctor was and saw a knee ortho to get an MRI.

It gave me more clarity and answers: plica syndrome and a meniscus tear. My meniscus tear had no symptoms and wasn’t causing me pain, but the plica syndrome gave the answer I needed. Despite all of my strength work, reduced high impact activity, and physical therapy which are the conservative treatment for plica syndrome, I couldn’t make it go away on my own and would need surgery. Plica syndrome removal recovery is about 2-4 days on crutches. But it seemed silly to have arthroscopic surgery and not fix my meniscus tear as well. The tear was in a part of the meniscus that received adequate blood flow, so if the tear could be repaired it would heal well and allow me to get a longer life out of my knee. The recovery time was 6 weeks non weightbearing and at minimum 3 months of no running (likely more).

Surgery and recovery

I moved forward and scheduled surgery. I had already lost running and wanted to give myself hope that I could run forever if I fixed these things. After I scheduled the surgery, I started having pain in my other (my left and good) knee. I couldn’t believe this was happening to me. My ortho assured me it was likely due to compensations from all of the issues I’d had on my right side (my broken toe, knee and stress fracture were all on the right side), but he ordered an MRI anyways. It showed mucoid degeneration which means my meniscus is degrading and could lead to a tear, but I didn’t have pain in that area. It also showed some tendinitis, but he assured me it would likely sort itself out after I recovered from my current surgery and got more balance within my body. He offered up a PRP injection to help calm the area down. Since you need to rest for about 4 weeks after a PRP injection to give it time to do it’s magic, it made sense to do it when I had surgery because I’d be off my feet for the most part for 6 weeks.

Waiting to head into surgery!

Okay - we have a plan. Surgery is late November after Thanksgiving. When I head in, my doctor tells me I will wake up to a brace, which means he could repair it, or a bandage which means he had to take out my meniscus. When I woke up and saw the brace, I cried happy tears!!!! Repair was successful. He also told me my plica was significant and he understood why I couldn’t ever get rid of my pain. It felt extremely validating to know I’d made the best decision because I wasn’t sure up until that point.

The hard part of recovery was about to begin. I’ve never done so little with my body for so long. My mom stayed with us for a few weeks to help with Quentin, but I started my recovery exercises right away to get movement and range of motion in my knee. I’m now almost 8 weeks post op, walking, biking, swimming, and still working on range of motion. The most painful point in my knee is my plica removal. Because my knee was straight for so long to heal my meniscus, I have a lot of scar tissue on the inside of my anterior knee where the plica was removed. I have a lot of work to do to get this cleared and get full ROM back, but I get to start again and I’m hopeful. My right knee is still achy from time to time, but my PT encouraged me to give my body time to be more balanced and stronger to see if it goes away.

Coming out of PT about 3-4 weeks post-op!

Most recent PT session at 7.5 weeks post-op!

So what did I learn from this?

I want to share this to help anyone who’s struggled with constant injury and setback or, if you do experience something like that in the future. I wouldn’t wish this on anyone, but there are things I wish I’d done differently and new insights I gained about myself in this process.

The importance of seeking multiple opinions

My initial self-diagnosis and taking myself to physical therapy were steps in the right direction, but after taking 6 weeks off high impact work with my broken toe and the pain coming back (this put me at 12 weeks post initial knee pain), I should’ve gotten an evaluation from a physician and imaging done. If you don’t have a traumatic injury (i.e. I didn’t slam my knee onto the ground) it can feel like this is overkill, but you do not deserve to live with unexplained pain that is keeping you from doing what you love especially if you’ve been consistently putting in the prescribed work. Oftentimes, we assume medical professionals,including physical therapists, know everything but they are human just like us. They know what they know, so seeking multiple opinions is important.

You shouldn’t be in physical therapy forever

Physical therapists are wonderful, and I always have one on call if something comes up and I need some help with aches or pains. But if you’re in physical therapy for the same injury for a very long time, then you need to seek additional help and expertise. Physical therapists cannot see inside your body, then can only take what you’re telling them from a pain perspective or what yor physician has advised. My physical therapist agreed with my self-diagnosis of runner’s knee, but as a very committed athlete who did my exercises religiously for almost 10 months, I wish he had referred me out after a few months since I was still having pain and unable to get back to normal training. My pain decreased during that time, but I also wasn’t running as much as I wanted to because I was still in pain.

Patience and persistence

Dealing with multiple injuries and setbacks requires both patience and persistence. I was committed to addressing the issues at hand, including a conservative marathon buildup and ongoing physical therapy. Despite the challenges, I’ve continued to pursue a solution for my injuries and work towards recovery. This entire experience has forced me to commit to my overarching goal with running - whether I ever hit a PR again, I want to be able to run forever. This chapter will continue to help me as I continue the long build back from surgery. I will never take a single run for granted.

You are your biggest advocate

You are the one who knows your body best. For months, I thought I wasn’t working hard enough in PT or on getting stronger even though I spent almost the same amount of time on those things that I did when I was running 50 miles per week. I was working hard, but what I was doing wasn’t working. I thought I was good at advocating for myself, but I wish I had asked more questions, not so much about what else I could be doing to get stronger, but who I should see or what my options were if my pain wasn’t going away. Navigating the healthcare system is challenging and figuring out what type of doctor you need to see for a specific injury. Taking things into my own hands finally, seeing an orthopedic doctor, and advocating for advanced imaging allowed for a clearer understanding of my underlying issues and the reason why my pain wasn’t going away. This reinforces the importance of actively participating in your healthcare decisions, seeking the necessary diagnostic tools, and making informed choices for your recovery.

Nutrition matters all the time

Looking back at my bloodwork from InsideTracker, I didn’t notice a trend of my Ferritin and Vitamin D dropping over the course of months. I had been hyperfocused on my high iron without realizing these other markers were putting me at risk for a stress fracture. I also thought that since my running volume was low, my risk for bone related injuries was lower and was very surprised I had a fracture. I was still lifting heavy in the gym, but it just goes to show your body recognizes stress and it needs to be adequately fueled to tackle your goals. Whether you’re working at the capacity you want to be or not, be sure that your nutrition and bloodwork is lining up to be able to perform and recover.

Sometimes, surgery is the answer and that’s okay

Orthopedic doctors will provide an option for surgery because ultimately, that’s all they can do for you after a consult and MRI - move forward with surgery or prescribe you PT. You’ll hear tons of people say that you should avoid surgery at all costs and put this fear in you of going through it. When my doctor suggested surgery, I was terrified. I’d never had surgery in my life and the most traumatic thing that I’d ever undergone was childbirth. I feared being put under and scared myself reading all the complications of surgery that are rare, but can happen. No risk, no reward. If I’d spent 10+ months putting in the effort to make a conservative recovery with physical therapy and no running, then the only answer left for me was surgery or to give up running. I had to give myself a shot and am grateful I did. I have hope now. I still have fear of knee pain and am hyperaware of any aches which is a side effect of being injured for so long, but I know this was the best choice for me. If this is your option to feel better, it’s okay to take it.

If you’ve been in an injury cycle, please don’t lose hope. Keep working hard, searching for answers, and finding a way. You will be so glad you didn’t give up on yourself even if it gets harder as you go on.

As always, thanks for being here while I continue to chase my dreams!

J