A few days later, she was diagnosed with a stress fracture in her left hip. While the injury didn’t require surgery, it’s forced Paulson to stop running — or even walking long distances — until it heals, preventing her from taking part in a pair of half-marathons for which she’d been training.
Paulson suspects she sustained the injury while working out with a marathon training group in late June. “The workouts were more intense than I was used to, and I didn’t let my body heal after them,” she says.
She ignored the pain she began feeling — which she attributed to a groin pull — and kept adding miles to her runs. “It becomes addicting,” she explains. “You want to keep going and do more and more. I got into that mode and wasn’t paying attention.”
A tough time of year
Injuries like Paulson’s become increasingly common in the Chicago area come September, as runners increase their distances while training for the Chicago Marathon in October. “People are getting into mileage that they’re unaccustomed to, especially first-time marathoners,” says Josh Blomgren, DO, 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’s medical team since 2007 and also is team physician for the Chicago Fire and a co-team physician for the Chicago White Sox.
“A lot of people approaching these longer distances have some relative weakness or muscular imbalance that gets exploited in those longer runs,” Blomgren explains. “We start to see muscle form and running form break down, which leads to a lot of overuse injuries. They’re relying on secondary muscles to carry the work load and they’re not used to it.”
“Most of the time it’s due to their technique,” adds Julia Bruene, MD, 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. “If their gait when they run isn’t perfect, they’re more prone to injury.”
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. “If the pain doesn’t get better after a few days and lingers even after rest, that would be when to be concerned,” 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.
“Sometimes, we’ll 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,” Bruene observes.
“The stress fracture typically is going to cause a specific place to hurt, and on examination it will be very tender in that spot,” 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’t 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.
“It can get to the point that it’s a complete fracture, and even a large compound fracture that won’t heal with rest and will require surgery,” Bruene says. “Someone who goes through that could have avoided surgery if they’ had just stopped and seen a physician.”
Taking a knee
Another affliction is so common to runners that it’s named for them. Runner’s knee is a condition in which the kneecap isn’t properly centered in a groove in the thigh bone in which slides up and down during leg motion. It’s 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’s 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 reduced bone density, which in turn can result in stress fractures. The lessened estrogen levels also result in irregular menstrual cycles or ceased menstruation altogether.
“I have patients who are young college soccer players who think it’s normal,” Bruene says. “In fact, it’s a big red flag that someone’s training too much or not consuming enough calories. That can be the first sign before anybody has bone density issues.”
Assuming eating disorders aren’t an issue, the solution is simply to eat more healthy calories. “Food is fuel. Food is not your enemy,” 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. “With 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’t happen again,” Blomgren says.
“Sometimes 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,” 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’ll take a different approach: “It’ll be slow and steady,” Paulson says.
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