A few days later, she was diagnosed with a stress fracture in her left hip. While the injury didn鈥檛 require surgery, it鈥檚 forced Paulson to stop running 鈥� or even walking long distances 鈥� until it heals, preventing her from taking part in a pair of half-marathons for which she鈥檇 been training.
Paulson suspects she sustained the injury while working out with a marathon training group in late June. 鈥淭he workouts were more intense than I was used to, and I didn鈥檛 let my body heal after them,鈥� she says.
She ignored the pain she began feeling 鈥� which she attributed to a groin pull 鈥� and kept adding miles to her runs. 鈥淚t becomes addicting,鈥� she explains. 鈥淵ou want to keep going and do more and more. I got into that mode and wasn鈥檛 paying attention.鈥�
A tough time of year
Injuries like Paulson鈥檚 become increasingly common in the Chicago area come September, as runners increase their distances while in October. 鈥淧eople are getting into mileage that they鈥檙e unaccustomed to, especially first-time marathoners,鈥� says , a sports medicine physician at Midwest Orthopaedics at Rush and an assistant professor of orthopedics and family medicine at Rush University Medical Center. Blomgren has been part of the Chicago Marathon鈥檚 medical team since 2007 and also is team physician for the Chicago Fire and a co-team physician for the Chicago White Sox.
鈥淎 lot of people approaching these longer distances have some relative weakness or muscular imbalance that gets exploited in those longer runs,鈥� Blomgren explains. 鈥淲e start to see muscle form and running form break down, which leads to a lot of overuse injuries. They鈥檙e relying on secondary muscles to carry the work load and they鈥檙e not used to it.鈥�
鈥淢ost of the time it鈥檚 due to their technique,鈥� adds , a sports medicine physician at Midwest Orthopaedics at Rush who also has provided medical support at the Chicago Marathon and is a team physician for the White Sox. 鈥淚f their gait when they run isn鈥檛 perfect, they鈥檙e more prone to injury.鈥�
Blomgren and Bruene both stress that pain that continues during rest periods between runs is a warning sign, and runners who experience such pain should seek treatment. 鈥淚f the pain doesn鈥檛 get better after a few days and lingers even after rest, that would be when to be concerned,鈥� Blomgren says.
Stress a point
That kind of continuing pain may be a symptom of a stress fracture, a crack in the bone caused by repeated stress, such as long distance running. No wonder that stress fractures are most common in the lower legs and feet.
鈥淪ometimes, we鈥檒l see them in the shins, and people mistakenly think of them as shin splints, which actually is muscle tightness in the shin area that improves once you start running,鈥� Bruene observes.
鈥淭he stress fracture typically is going to cause a specific place to hurt, and on examination it will be very tender in that spot,鈥� Blomgren says. The usual treatment for stress fractures is six weeks of rest from running, sometimes with the fractured area immobilized in a brace or cast.
Of course, curtailing training for six weeks at this point means a runner won鈥檛 be able to participate in the Chicago Marathon, which can be a major disappointment. While runners may be tempted to continue training, as Paulson did, the doctors warn that they run the risk that the bone will continue to weaken and even actually break.
鈥淚t can get to the point that it鈥檚 a complete fracture, and even a large compound fracture that won鈥檛 heal with rest and will require surgery,鈥� Bruene says. 鈥淪omeone who goes through that could have avoided surgery if they鈥� had just stopped and seen a physician.鈥�
Taking a knee
Another affliction is so common to runners that it鈥檚 named for them. Runner鈥檚 knee is a condition in which the kneecap isn鈥檛 properly centered in a groove in the thigh bone in which slides up and down during leg motion. It鈥檚 accompanied by knee pain and stiffness around the kneecap during running, going up or down stairs, or sitting for a long time.
Like stress fractures, runner鈥檚 knee requires and will heal with rest. Runners should curtail their leg work until they can bend and straighten the knee painlessly and feel no pain when walking or jogging.
Outrunning your food
Some women runners may train so hard it results in a condition known as the female athlete triad, which results from a woman not eating enough food to supply the required by her level of exercise. The condition can occur in conjunction with an eating disorder, but also can be brought on by high levels of exercise alone.
The resulting drop in estrogen production can lead to , which in turn can result in stress fractures. The lessened estrogen levels also result in irregular menstrual cycles or ceased menstruation altogether.
鈥淚 have patients who are young college soccer players who think it鈥檚 normal,鈥� Bruene says. 鈥淚n fact, it鈥檚 a big red flag that someone鈥檚 training too much or not consuming enough calories. That can be the first sign before anybody has bone density issues.鈥�
Assuming eating disorders aren鈥檛 an issue, the solution is simply to eat more healthy calories. 鈥淔ood is fuel. Food is not your enemy,鈥� Bruene says.
Better in the long run
While seeking treatment may mean postponing that 26.2 mile achievement, it also can end up making someone better in the long run, literally. 鈥淲ith these patients, I spend the majority of my time counseling them about why the injury happened and how it happened and strategies to get them running safely so that it doesn鈥檛 happen again,鈥� Blomgren says.
鈥淪ometimes we do a gait analysis, and then a physical therapist works with the patient to correct the deficiencies in one area or another, how the foot is hitting the ground, how the knee is reacting, how the foot is reacting,鈥� Bruene adds.
Rachel Paulson has been seeing Blomgren every three weeks to evaluate the progress of her recovery from her injury. She hopes to be able to resume training in time to complete a half marathon at the beginning of spring.
When she does, she鈥檒l take a different approach: 鈥淚t鈥檒l be slow and steady,鈥� Paulson says.
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