"Okay, same thing on the other side." I lifted my left off the ground and hopped in the same manner off my right foot. The pain was so severe and so deep it felt like that single jump would cause a huge impaction fracture down the length of my femur.
Dr. Getzin then had me lay supine on the exam table and performed a fulcrum test. This involved using his forearm as a point of resistance as I attempted to extend my hip and press my femur down toward the floor. The pain was significant, but not as bad as the hop test. After an x-ray ruled out anything obvious in the bone, and an ultrasound ruled out any soft tissue pathology, there was only one explanation left—a mid-shaft femoral stress fracture. I had been training for and looking forward to running the Eastern States 100 since January, and now, only one month before race day, I was faced with the reality that I'd have to forgo the race and take a DNS—Did Not Start.
***
First, a quick recap of how I think the stress fracture came about.
The first six months of 2017 had been going very well in terms of running and racing. After a brief bout with Achilles tendinosis at the end of 2016, I bounced back with a pretty solid run at the Cast A Shadow 6-Hour, followed by an "easy effort" marathon PR a few weeks later. After a busy month of running "B races" in April, a fast 50k in May, and an overall great training block, I nailed my PR at the Cayuga Trails 50 and felt that I'd recovered quickly afterward. Three weeks after Cayuga, I was feeling fresh enough to throw down for 40 miles at Many On The Genny. My right hip/upper leg was a little achy, but I was naive enough to think I could ignore it. The discomfort was noticeable but not really painful, and it didn't seem to slow me down at all during MOTG. The second half of that race really beat me up, and I think this was the icing on the over-racing cake.
Three days after MOTG is when the injury really made itself known. I thought I'd be okay for an easy effort run, as I usually am three days after a race of this effort, but an easy-paced five miles made my right upper leg really start to scream bloody murder. I took the next two days off, thinking I just needed some extra recovery time. Then, being the dumbass that I am, I went out as planned to the Finger Lakes National Forest to run the entire 16.5-mile Finger Lakes 50s loop and mark the course for the race the next morning. This was five days removed from MOTG. The pain returned after only 20 minutes. With the flags and all the walking, it took nearly four hours to complete the loop, even though I was merely adding flags to the ones already in place. I'd committed to this volunteer task months ago and didn't want to let the RD down, but in retrospect it was an awful idea. The following week, things felt worse after a few easy runs. This brought me to my July 11 appointment with Andy Getzin, a physician with Cayuga Medical Center Sports Medicine and Athletic Performance.
***
The plan after that first doctor's visit was to avoid running and all other high-impact activities, then return in two weeks to reevaluate. Since the x-rays were negative, it meant the stress fracture was in an early stage and its severity was to be determined. In fact, the only way to confirm the stress fracture was with an MRI, which I declined. Based on my symptoms, running history, and the imaging that was done, Dr. Getzin was quite confident in his diagnosis.
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| My right femur, and my first x-rays since becoming a licensed x-ray tech. |
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| For comparison, an advanced-stage or healed stress fracture in the right femoral shaft. Image taken from koreamed.org. |
A stress fracture is a series of very small cracks in a bone, and is most commonly found in athletes' weight-bearing bones as a result of overuse, ie. ultramarathoners running too many races. While each person and each injury is different, I know it's rare for one to fully heal in less than six to eight weeks. Ignoring or masking the pain from a stress fracture could eventually lead to a complete break in the bone. Even if mine somehow healed in four weeks, I'd have no time to get back into running before Eastern States on August 12.
The next two weeks were miserable, although the misery had started a week before the injury was even diagnosed. I continued exercising, mostly to keep my sanity, by paddleboarding, cycling, and strength training. The layoff from running, plus the void left by having to take a DNS, left me depressed and irritable. I'll admit I had trouble finding joy in anything else and whined to my wife about it way more than a grown man ever should. The date to drop from the ES100 start list, get a partial refund, and give my spot to someone on the waitlist, had already passed. My plan B was to ask about volunteering if things didn't turnaround quickly enough.
A few days before the follow-up appointment, I tried the hop test again at home, bracing for the worst. No pain at all. When I saw Dr. Getzin for the second time, he again had me do the hop test and fulcrum test, and everything was somehow pain free. He officially gave me the go-ahead to start Eastern States, as long as I would act responsibly and drop out if anything in the femur started hurting. I really wanted that belt buckle, but risking long-term damage to my body just wasn't worth it. Of course, I first had to start running again, without any pain. I also had to be realistic in my expectations for the race. My original goal of 26 to 27 hours wouldn't be possible. At this point, I was happy I'd even have a chance to run. I just wanted to finish the thing, even if it meant walking 21-minute miles for a 35:59 finish. It definitely paid off going to a doctor who is also a long-time endurance athlete. He understands the athlete's mindset and just how important a major goal can be, especially this far into the training cycle.
I took a few more days off from running, figuring the more rest the better, but also dreading the possibility of the pain returning. As long as I stayed off it, I'd cling to the hope of being able to run the race, but for all I knew those hopes would be dashed after jogging a single mile. Ignorance is bliss.
Later that week, I did an easy 5-mile run, followed two days later with an easy 6-miler. My legs felt stiff and the gait felt flat, but everything was pain free! The real test came 12 days out from race day, when I ran out to the Sugar Hill Fire Tower and back, totaling 19 miles. I also realized I had no trail shoes that would get me through 100 miles. I was able to get a pair of the Salomon Sense Ride at Finger Lakes Running & Triathlon Co. and try them out on this run. The pace was slow, even for a hot and humid afternoon, but nothing hurt and the shoes felt fine. I felt like a new man.
The final week leading up to the race was a family vacation to Old Forge, NY. Without the self-imposed pressure of trying to gain any fitness, I enjoyed the time off but also stayed active by swimming, paddleboarding, cycling, and some easy running. All I had to do was not hurt myself and I'd be good to go on race day.
I'm still kind of baffled how the injury went away so quickly. It obviously came on gradually as a result of putting more stress on the bone than it could handle. My patience throughout all of July was worth it, but a little more patience would have prevented the injury in the first place. During the Eastern States 100, every particle in my body except for my right femur was in complete agony. As I write this, two weeks later, it still seems to be healed 100 percent. The next few months will see repeated trips to the chiropractor and physical therapist to try to work things out so I'm less at risk for an injury like this.
I'm very thankful and fortunate to have had the opportunity to line up at Eastern States and destroy my body again en route to my third 100-mile finish. I wouldn't have made it to the start without Dr. Getzin's help and without Hayley's constant support and patience over the last nine months and during the injury.
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| The fire tower at Sugar Hill State Forest |
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| Early morning view from Bald Mtn, just outside Old Forge. |
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| Stand-up Paddleboarding on First Lake. |
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