2020 recap, part III: Big-time Injuries

I'm no stranger to injuries, but in 2020 they have played a more significant role than usual. This is a not-so-brief synopsis of the year in injuries.

Here's what I learned about myself in 2020: I require very little social interaction; I can spend 20 hours every day in the same room and be OK with it; baseball without fans is weird but still essential to my happiness; my kids are loud and hilarious and cute and terribly annoying in large doses; my body can tell me when it needs some time off, and I should really listen to it. It's that last point that I'd like to dive into in this post. 

One of the most interesting opportunities presented by 2020 was the freedom to train without an objective or even a plan. For much of the year, there were no races anywhere to be found. This afforded me some much appreciated flexibility in my training. If I was thinking of a running workout but my work schedule didn't allow it, I'd just do something else instead and worry about the workout another day. If I felt a twinge in my foot, I'd take an extra day off, no second thoughts. After all, there was very little to gain from pushing myself relative to what I'd lose (namely, my sanity) from overdoing it and getting injured or sick. I followed this laissez-faire training approach for several months and really loved the mental break it provided. 

Then, one day, for no reason other than a need for some variety, I flipped the script. Why not use this weird year as a way to test a few limits? Now, let me be clear about something: my limits are as modest as they come. By testing them, I wasn't planning to suddenly start running 100 miles in a week; 40 miles in a week would even be a stretch. Rather, I wanted to start cutting out non-running days and push through any niggling little injuries to see if I could overcome them without taking time off. If it worked, I'd be able to establish a new running baseline. If it didn't, I'd at least get a better understanding of those nebulous limits. 

So, what happened? As you might guess from the title of this post, my limits are now crystal clear. Sometime in June, I started feeling a general ache around my left knee. I'd felt a pain like this many times in the past -- it was something I used to associate with heavy training loads (mostly in college), but it never became more than an annoyance. It seemed like the perfect injury to train through to see what would happen. I did this for eight weeks. It was always sort of there. That it wasn't getting any worse was a good sign, right? While I was on vacation in Maine, however, it began to deteriorate. I didn't have my bike with me, so I stubbornly ran on it anyway. The final run was an 8-miler right before we drove home. It hurt terribly on the drive and was extremely painful to walk on, especially up and down stairs, for several weeks afterward. 

Now I know -- this kind of pain requires a little time off. Since I didn't give it a little time, I had to give it a lot. 50 days, to be exact. When I finally started up again, it was with a cautious progression, starting at 1 minute, and increasing by a minute or so with each run. It took another 100 days to run an hour. All told, that's almost half of the year spent injured or recovering from this injury. 

It got me thinking - how many other times had I had an injury of this duration or longer, and what were those recoveries like? It turned out this was the tenth such injury in my running career. As you can see in the chart below, most of these were in the 11 years from 2003 through 2013, when I had not yet made the mental adjustment to my post-collegiate running reality. 

In the past 18 years, these ten injuries have resulted in 1076 days off running (nearly three years) and required another 950 days to ramp back up to "normal" training, which I arbitrarily define as being able to run for an hour. The total impact of these injuries, then, is 2026 days, or 5.6 years (31% of the last 18 years). This number only accounts for these "major" injuries. There have been dozens of other injuries, as well, that were less "injurious" to my running. For instance, only one of the 50+ ankle sprains shows up on the list.

"Major" running injuries and the time spent off and recovering from each.

To further make this point. I'm currently dealing with an undiagnosed issue with my right knee that doesn't show up on this list but has cost me roughly six weeks cumulatively over its ten or so recurrences in the past three years. This one worries me because of how different it is from anything I've experienced before. Most running injuries, as you probably know, start off small. You might notice it after a run or the next morning and think nothing of it. Gradually, after trying to ignore it, it grows into something more worrisome. If you ignore it long enough, as I did with the left knee, it gets to the point that you need to take some time off to fix it. The other type of running injury is an acute trauma (e.g., an ankle sprain) with a fairly obvious origin and diagnosis.

In the case of my right knee, neither of these categories fits it. This one spontaneously starts with an unprovoked sharp pain in the midst of an otherwise typical run. The pain is so bad that I literally cannot take another step. Most of the time this has happened, the pains abates completely after a few days off. In many cases, I've raced within a week of the "injury" without any adverse reaction. As a result, I wasn't too worried about this...until now. This injury had happened a couple of times a year until 2020. This year, it's happened four times - in March, May, July, and December. You might say, 'Hey, you went five straight months this year without any single episode.' Well, person I'm pretending to talk to, those were the five months I was either not running or ramping back up from the other injury (see above), so it does seem like this thing is happening with increasing frequency. Also, it doesn't seem to be rapidly improving, as it had in the past. I'm worried, to say the last, but still hopeful it won't be the next entry in the "major injury" chart. 

Here's to never discovering my running limits again!

Appendix: Timeline and notes on this current right knee pain

9/17/17 - This was first time I recall the sharp knee pain, though I don't specifically mention it in my Strava post. Took two weeks off from running then slowly returned.

7/23/18 - After a track workout, I wrote, "had strange pain in front of knee on cool down that I couldn’t run through." Took three days off from running and was better within a week. Raced Run4Kerri 8 days after the knee started to hurt.

9/3/18 - Had a recurrence sometime this week, but I never mentioned it in a Strava post, nor did it really affect my running.

5/18/19 - Had planned a run on the bike path to the beach in Narragansett to meet the family, but then... "Random sharp patellar tendon pain early, mostly gone by end, really sore after." I ran through this because I needed to get to the beach, but it wasn't a smart move. Took three days off from running, then resumed with a couple of easy runs before being able to do a big run in the mountains a week later.

9/14/19 - Developed knee pain that I described as patellar tendinitis. It very well might have been; I don't quite remember. I took four days off and then jumped directly into two races with a patella brace on. It flared up a few weeks later but then finally dissipated.

3/21/20 - Went for a road run around URI until "some out-of-the-blue knee pain triggered a route change mid-way. " In this case, I smartly adjusted my plans and immediately returned home. However, the next day I stupidly ran 10 miles on the roads because I wanted to take advantage of the nice weather. This set me back, and I essentially took a week off after that. Once I returned again, all was well.

5/24/20 - The day after a longish run and hill workout, I ended up with the knee issue again. "Right knee pain in same spot as usual. Couldn’t make it more than a mile." Took a couple of days off, then was able to run a virtual track 5K a week later. 

7/23/20 - While in Maine, the day after an interval workout, I had to stop my run after just 2 minutes, with the simple description "right knee hurts." I was able to run just two days later without any issues.

12/1/20 - After a nice trail run, as I was running up the final hill back home, the knee pain started with its usual suddenness. "My “good” knee suddenly started hurting at the end. It got so bad, I had to walk home." This time, I paid close attention to how and where I felt the pain. It seemed to start just above my kneecap before creeping down and around it and settling in on the outside edge. Took three days off and was at it again.

12/19/20 - While waiting for Santa to arrive on our street, I decided to keep the dog entertained by sprinting with him up and down the road. In the middle of one of our laps, I saw Santa's truck turn on to the street. I picked up the pace a little, and as I was slowing back down my knee just kind of "went." I knew it immediately. And, sure enough, the next day, I was only able to make it a minute before it hurt too much to continue. After a day off, I tried to ski but that also caused too much pain. I tried again to run on 12/27, made it two minutes, and then had too much pain. And that's where I am today.