What is my Stress Fracture?

Well, if you didn’t know, I have an almost complete stress fracture of the Fibula. What does that mean, Steph? Bear with me, this is more of a personal blog about my struggle with this stress fracture and a way for me to get the anxiety out and release some thoughts…

It means my leg is not broken, yet. It means with continued activity it will break, and then recover time would be extended further than if I hadn’t. The fibula is the smaller of the two long bones in you lower leg, and mostly non-weight bearing but helps take a load off of the tibia, the main weight bearing bone of your leg. Usually, the fracture will happen in the lower or upper part of the fibula, however, mine is basically in the middle…atypical for a stress fracture for a runner. Skipping most of the medical jargon and stuff, I am here wondering what happened. I went through my head countless reasons, but none make a whole lot of sense. So let me give you the basic timeline at least from when I found out.

I found out on July 9th, 2019, for an MRI I had done at 7:45pm the previous evening, July 8th. That day, I had already played 2 or 3 songs, not difficult for me, on our dance game with friends without any pain. My sports med doctors had called me directly and told me to be on crutches for 2 weeks, and the results from the MRI indicated swelling and edema around the fracture site, indicating the fracture was nearly completed and it was my body’s way of trying to protect itself. It was a hard pill to swallow, and emotionally, I had to hold it together, for the sake of my doctor on the phone, and the crew of friends who were visiting for a pokemon go ex raid (special kind of event you get invited to do to catch a special pokemon). There were all of a sudden so many steps I now had to take in my personal life to make immediate changes. I was overwhelmed, and since I had guests over, I could do nothing at the time. In retrospect, this might have been for the best since it prevented me from panicking.

Everything went through my head. How did this happen. Why did this happen. When would I be well again. I am going to miss our summer in Wisconsin this year, after it had been cold for so very long. We had only had summer a week or two when I got the call and I have been having a massively bad time adapting to my new climate in the upper midwest, and each passing season, it seems to get worse. I guess I’ll delve into that a bit.

When I moved to Wisconsin, winter of 2016, I found the cold to be novel. However, I immediately struggled to get outside with temperatures hovering around 0°F and snow everywhere all the time. I came from a place with cold and snow, but what I had to be outside in was not nearly warm enough, and after moving expenses and starting out married life with Rich, we had no money to invest in new clothes. The following winter, 2016/2017, was quite mild, and I was outside more often than before. But I thought this was what normal winter was, which I would be wrong about. I just lucked out. I took a break from running long after I PR’d my half marathon time and finished a late season 70.3 Ironman race (my first, Los Cabos, see here). I remember finally getting a winter coat good enough for the climate then at least and we decided to build a house (that wouldn’t be ready until August, a year after we purchased it) and my mind and life was occupied by that.

Fast forward to winter 2017/2018, post Ironman Wisconsin and Xterra Maui. I took more time off than ever, rather burned out from the training of both of those. I ran when I felt like it, 3-5 miles here and there, not getting monthly run miles past 30 miles/month. Then Andrea hits me up and says do Zion with me. I say ok. I figure I’ll train well enough. I struggled through it, but hit it hard in March and did my 2nd 50k (and coldest and wettest to date, it was awful weather) and long back to back weekends training myself as I got my coaching certificate earlier that year. I ended up doing the 100k in April, pretty well prepared with two months of mostly solid training. By this time I had more outerwear meant for Wisconsin, but it was another milder winter. Unknowing to me.

Again, fast forward to 2018/2019, my worst winter yet and the one I tried really hard to train through. Back in October 2018, I finished Cloudsplitter 100, but with a partially torn anterior tibialis tendon tear that took me down hard. I managed to get back up to marathon distance by December, and tried to hang onto some sort of base from that until February when I did Rocky Raccoon 100k. I fought hard to get in miles, but every time I would go out, everything would go wrong. I would deteriorate so quickly and get tired super fast to the point I would want to fall asleep on the trail. I got rashes and bumps on almost all my runs over 15 minutes outside below 40°F. I started bleeding from places I should not have been bleeding from and after every effort outside, I wound up falling asleep in front of our fireplace. It wouldn’t be until I rested that my body would feel normal again. I also noticed that my internal body temperature after running (taken less than 2 minutes after stopping) was below 94°F every time. That was rather scary. I was diagnosis with cold urticaria, and prescribed antihistamines for the winter months. I had to switch my training to be indoors and my training fell apart a little.

I managed to get in another 50k for my birthday, Terrapin Mountain, and it went as well as it could have given I did not have the mountain to properly train with in Wisconsin. I rested a bit, and continued to train along the mountains back in Virginia, preparing for the Blue Ridge Double Marathon in April. I rocked the double despite the weather. I wasn’t even sore from it. I had zero pain and did a few easy and light runs the following week. It was still pretty cold in Wisconsin this past year (2019) when I returned back after being in Virginia for a month, and my training lightened up a lot. I did a few 3-9 mile runs 2-3 times a week, but didn’t get in the speed work I had wanted for training for the halves I wanted to try and PR. I did one half at the beginning of May and at the end of May. In-between, I started doing weights, and really overdid it one day with legs, and did something to hurt my abdominal area, which showed in a 17 mile run I took super easy a week later. I rested another week, and did more light running. The last weekend in May was the Madtown half. I kept my effort even and was pretty successful considering I had no speed work in my agenda going into it. Still too cold for my muscle to really put power into strides.

The following weekend, I did a bunch of boot camp style workouts, but nothing long. Most things were intense though. I had done more weight lifting 2 days beforehand too, including legs again. When I flew out to Colorado, I was massively dehydrated. I admit, I am very bad about hydrating, but some of this was not preventable in this case due to travel mishaps…I was basically late for everything preventing me from getting water on the other side of security, and a flight too short for the airline to have water on board, and my next flight boarding on the other side of a large airport before I landed.

When I ran between those two flights, I could already tell my legs were swelling, as I could feel my heart beat pounding against the tight walls of my legs. It wasn’t quite painful yet, but I could tell I was in trouble. I did not have time for water, as I was the last person to board that flight even with running across the airport. I immediately pushed the button for service and they didn’t come to me until the flight was taking off. I finally got some water…even if it was a tiny cup. By the time I landed in Colorado, my legs were shiny and full of fluid and very puffy, but hard as rocks. I could feel my heart beat inside them even while sitting. I tried to do my leg exercises on the plane, but being in the middle seat with an obese person sitting next to me and using some of my own seat (I will save you my rant on that), I had absolutely no room. I went to sleep that night and got up early to go run.

Usually when this happens to my legs, and yes I have tried compression on planes, and several brands (I am supposed to be called about a personalized medical pair, but its been two weeks now—they call YOU), I just work out, go for a run typically, and after about 20 minutes, I start experiencing a LOT of leg pain and pulsing feeling like my muscles are tearing apart, and if I can push through that, the swelling will diminish and I’m back to normal and can run normally after that. I have done this a few times before, every time with the same feeling and same result. This time felt a bit different. This time it felt like my muscles were being pulled apart more so than before, and were bleeding inside. I was with my friend Scott, doing a life in the day sort of thing and doing all the workouts. I mentioned I needed to stop, trying to massage my legs and let blood flow through them. I remember my right leg hurt a bunch and I was close to limping. My left leg was also in bad shape but not as bad. Since it was only a little under 3 miles, I don’t think it got the fluid out of my legs. Maybe it was the altitude, lack of oxygen, maybe it was the dehydration. There were so many things going on right at that time.

I did a few more workouts that morning before heading to a local gym where I foam rolled my right leg out. It was about 60% better after, but I then noticed my left leg was still in the same shape. My priority though was my right leg and I kept tending to it. Some rest that night, and I woke up with some residual swelling, but not nearly as bad as it had been the day prior. My legs were still super tight across the skin and muscles, but they were starting to jiggle again (for lack of a better word). I took a step out of bed and my left leg hurt, and hurt to touch. My pain overall still was not absent from the swelling and the feeling of my muscles being ripped the day before (I don’t think they tore, but that’s debatable, I’m just describing a feeling for the sake of this blog). I continued to workout and run. The beginning of runs would feel horrible and I would limp on my left side. But the longer I went and warmed up, the better it got. This was the case for every run afterwards, and was up until I got the MRI.

I decided to then do the FKT I had planned a few days after getting back from Colorado. 40 miles along the Military Ridge State Trail, solo. I started out in some pain, but it went away with the miles. I felt pretty good at the end in fact. The next morning I was only a little sore and the pain in my left leg was present, but not as it had been the previous weekend. I had scheduled a doctors appointment with my primary care office about the swelling by this point. I was worried about deep vein thrombosis, or DVT, a very real and scary danger involving leg swelling that can potentially kill you if there is a pulmonary embolism (PE). I was able to get a scan of my veins and an x-ray done to rule them out. Results came back negative. I was able to get an x-ray scheduled and done after S’mores 24, 53 more miles on the leg. I had played a soccer game the week before, and some of the push offs from the left leg felt real bad. I decided to rest it at that point. The x-ray came back with a small thing that triggered something from the tech and told them to investigate. At this point I had been referred to a sports medicine doctor for their opinion. This is now late June and I had been active this whole time being told by 3 doctors so far “let pain be your guide”. I did this, but apparently this ended up being for the worst. I got in to see her in July. She said she doubted it was a stress fracture because of its location and my history I had given with my training of when the pain started. I did fail the hop test, as I did not even want to “hop” on one foot knowing it would hurt. I didn’t know what this meant at the time.

During this period of time, I had two professional massages, and they commented how tight it was and it felt like a knot to them. It did hurt when they massaged it and it was not better when I left. But it also wasn’t worse.

By the time the MRI was scheduled, insurance caught up, it was July 8th, and when asked by the lab tech where my pain was, I could no longer find it. I guessed since I knew it had turned into a spot of pain as the pain from the left calf subsided over the weeks. So from May 30th until July 9th, I was fairly to extremely active on the leg in question, only stopping a majority of activity after June 26th when I was told to just bike and not run. When I got the call about the results, biking was no longer an option.

Part of the reason it took so long was 1) insurance, and 2) progression of doctors trying to figure out what the pain was. I will say this though, I do not thing it was the increase in activity AFTER my days in Colorado in early June which would explain why it’s so severe (I had a huge increase in mileage and activity post Colorado including the 40 and 50 miler only two weeks apart), but it probably most certainly made it worse, despite my pain decreasing over this period of time, only being irritated during soccer games and the beginning of runs. My gut says that it started that weekend in Colorado, and because of the swelling I had.

The only mechanism that explains where it is, and don’t quote me because this is all new information and might be that my anatomy is bad, is a muscle pulling at the bone until it fractures. The purpose of the fibula is supporting muscles of the lower leg and ankle stability. I never turned my ankle, at least not within the last year. Ankle feels fine and has been fine. A trigger for a fracture is also weak calf muscles, I’m fairly confident my 16” calf is not weak and is well supported. My body was not fatigued either so it’s not like the fibula had to take any addition weight on. Unless it was too much weight when I did weights the few times leading up to the Colorado trip.

Could it have started during Cloudsplitter? I had major swelling post race, but my pain was limited to my torn tendon on my right (but who knows what 80+ miles compensating on my left leg to make up for the injured right leg would do?), and anterior shin pain on both legs evenly. I haven’t experienced any leg pain since Cloudsplitter. Not after Rocky, not after Blue Ridge. I felt so good physically going into May and my mileage dropped a lot then, so I wasn’t spiking in mileage or effort.

Whether it was cumulative or sudden, I don’t think I will ever know. I know that MRI’s don’t lie, and yes I felt pretty good physically when I went in for the MRI July 8th, hardly any pain I could even hunt down. It blows my mind that I am one step away from a broken leg. I’m glad I mostly started resting 12 days before the MRI, although I biked a few times (no pain at ALL), went for a hike and a few short walks (around half a mile) without pain, and played some dance games without pain as well. As I sit here, I have absolutely no pain left at all. Of course, I have been on crutches, so maybe that has changed? I feel baffled by the fact that I have that much internal swelling and I can’t feel anything.

I friend suggested that maybe my muscles are so strong that they are supporting my bone enough that I can’t feel it. I would believe that easily. I also remember I took a nice salt bath (also trying to figure out if that would help the pain go away) earlier in mid June, and letting my leg move in the water and feeling the site of pain back then. Since then, I have been cleared to swim as I wish, and have been. Yesterday, as of this blog, I swam with my legs, and felt nothing. I assume I was feeling the swelling from the fracture, and not the actual fracture since there aren’t nerve endings in bone.

Regardless, I have started to seek my own help, and asked for a therapist, 1) to help deal with this life changing event (going from very active, to hardly active at all for the sake of healing) and coping with the associated depression resulting from not doing anything and trying not to blame myself, and 2) how in the world will I deal with another winter, when I was not able to fully experience and enjoy summer in the best ways I know how? This makes me sad writing it out. I started writing this very blog post to help me cope and get my thoughts out instead of making countless social media posts that go nowhere but probably annoy people and think I’m complaining for the sake of complaining. However, there is quite a waiting list to be seen. I am trying not to get discouraged by this.

There is also quite a long wait for physical therapy of which my insurance does not want to cover (although they covered it for the torn tendon earlier in the year, it took from early November to early January to be seen). So I need to start educating myself on how to recover properly in case I am truly declined from PT. I found a useful medical journal article that details the study of recovery for patients who are active runners recovering from a tibia fracture. Although the tibia is the weight bearing bone in the leg, the recovery for that is much longer and involved, so I figure if I follow that protocol as described therein, then that should be a good enough plan for a fibial injury.

Where do I go from here? I of course have bailed out of Badger 100, which was supposed to be my 2nd 100, and I had goals of going sub 24 hours. I instead will be volunteering and doing my best to bring my best to those out there. August 7th is the date to look to right now, which is when I can start weight bearing again. I was told to wait for 6 weeks before running is attempted. Six weeks is August 21st.

It will be touch and go from week 4 on in my honest opinion. I oftentimes forget I am really broken, and walk away without my crutches like a normal person. I’m babying and limping on purpose, even though I do not have to. I am trying to be super careful. I have upped my calcium and Vitamin D intake to normal daily recommended values at least just in case that was a cause. I do wonder after recovering for a few weeks when I can put in effort like as in stairclimbing and other activities to build endurance and muscle. I still have so many questions, many that cannot be answered. I am still talking to doctors about my leg swelling, and will know more the more flights I take, but part of me doesn’t want to cause it on purpose just to show the doctors how bad it is.

Looking ahead, Cloudsplitter may be off the menu in any capacity, but I’m going to take it day by day, and build as strong of a body as I can with what I can do so I can jump back into training safely. If an ultra is off the table, then I have a few long distance triathlons that I can train for that happen in the winter (given they don’t sell out). I know I am hitting swimming hard, and can already do a half ironman swim under the time cut-off. Next step in recovery is biking, since it is not as weight bearing as running. Building these up and keeping my base cardio is important to me. Whether than ends in a triathlon, an ultra, or nothing at all and getting good enough to beast the Georgia Death Race for my birthday in March, I’m going to come back.