Ignorance is not always bliss :-(

Some people will say "it's only running", but in fact, it is often actually so much more than that. Worse things can happen, but when a hobby and complications thereof can affect your physical and mental health in both the present and the future, it's a topic that should be addressed.

It might seem like I'm jumping on the recent bandwagon of personal stories, but I do think it's a good thing that more and more people are being open and honest with issues they face, and so if telling my story helps even one other person from going through the same thing, then it's worth recounting it.

Discovering the world through running!

I first started running 10 years ago, initially as a way of getting to know the local area, and meeting people/making friends when I moved here. I found that I loved it, being outdoors, the social side, getting fit etc and then coincidentally I found that I wasn't bad at it (well, distance running that is - "running" at school was all about short, fast stuff and I was {and still am} appalling at that). I've had my fair share of injuries over the years, such as tendonitis and plantar fasciitis, but these past 12 months have been a big different.

Hindsight is a great thing, but even so, I can't quite remember when I first noticed that there was a problem.

The marathon in Cyprus

At the beginning of the year, training had gone really well and I felt in great shape. In March, I travelled out to Cyprus to run a marathon with hopes of running in the low 2:40s, hopefully not far away from my PB. Unfortunately race was rather hotter than anyone had predicted, which affected all of the runners as we slowed down during the course of the event and many dropped out, so I was rather disappointed in my time.

I was then invited out to run the Kraków marathon at the end of April and despite being pushed over on the cobbles of the startline, I managed a much better time (despite rain, puddles and cold this time). A week later I ran an ultra.....by accident. I was going to accompany my parents when they ran the Wings for Life World Run in Poznán but they decided they'd rather I just ran my own pace and them theirs.....and I ran further than I thought I could despite having just done the marathon.

I'm not sure that's a happy face at the
 end of the Wings For Life World Run

I had a lump on my shin which swelled slightly when I ran, and I could feel a bit of pain in it with the first couple of miles of a run, but it then settled down and I was pain-free. I wasn't sure what was causing it so rested up for a couple of weeks after the trip to Poland and then went to see a physio. He looked with an ultrasound and couldn't see any periosteal reaction so reassured me that it was very unlikely to be a stress reaction/fracture and hence to return to running.

The World Trail Champs

The 100K in China

Fast forward to November and I'd run the World Trail Champs, 100K on concrete at altitude in China, and another marathon....but the lump was still there. I went to see my GP who also thought a stress fracture was unlikely due to the lack of pain and the presence of swelling which increased with exercise, but he agreed to refer me for an Xray and an Ultrasound (we thought that maybe there was a herniation of soft tissue through the fascia or something). He also signed my medical form and I headed off to Oman for a 6 day race across the desert....which was pain-free (well in my shin anyway...the infected blisters on my toes were another matter!!).

On returning from Oman, I had several voicemails letting me know that "surprisingly" the Xray had shown an anterior tibial stress fracture (the ultrasound was "normal").  I asked for a copy to be sent to Will, a friend in Carlisle who is an orthopaedic consultant with an interest in sports injuries and he nicely described it as "the black line of death". The problem was that you usually rest a stress fracture until it no longer hurts to walk/to do usual daily activities and then gradually return to running....but mine didn't hurt to do any of these, so Will suggested cutting back on my running and then rexraying in a month (the local xray department weren't very happy to do this, but luckily I have some useful medical friends).

Enjoying topping up my Vitamin D levels

Ice cream = extra calcium

I did cut back...right back for me...just the occasional 3-4mile easy run but a month later there was no change on xray so I cut back further (and hated it). I then headed over to see my relatives in Australia and although I initially did a few runs, I then stopped running and just walked, cycled and went to some non impact gym classes with my cousin (eg pilates). I hoped that a couple of months over there being in the sun (and so topping up my vitamin D levels) and eating ice cream (extra calcium) would mean I came back fully healed and raring to go.

Cycling in the Australian sun

I think that going to Australia was probably the best thing I could have done (even if the trip hadn't already been planned months beforehand) as it is at times like this that you really need the most support and often get the least - I'm not saying that people are "fairweather" friends and only keep in touch whilst you are actively running and racing (though clearly some are), but just that some are (usually unconsciously) a bit self-absorbed so don't think to ask how you're coping without doing one of the things that you love doing most (and that normally keeps you sane), whilst some are so used to bigging up their own niggles that they actually don't really understand/believe in an actual injury, no matter how serious it is.

On my return to the UK, my leg felt no different to me, and there was still a lump on my shin, but I "thought" it was smaller than it had been....but it's very hard to judge such a subjective thing so I went for a further xray. I was absolutely gutted to see no difference from the original films. I couldn't understand how I'd run on it for 6 months without any deterioration (but then again it didn't settle either), yet resting it for the most past of 6 months had not led to any healing (and I really had cut back.... from around 300 miles a month to about 8-10!!).

December (right) and March (left) - spot the difference...

I spoke to an endocrinologist with an interest in bone density and REDS (relative energy deficiency in sport) as this was the only thing I could come up with as a possible problem. I felt almost "angry" that my leg wasn't healing and frustrated that it had happened to me - I am not underweight, having a normal BMI, I love eating (and I really do love both ice cream and cheese) and don't restrict my diet at all, I do weight bearing exercise, and I take vitamin D supplements. The only things that count against me are that I have never liked milk so avoided it (except for no my cereal) through childhood, though I now add it to my scrambled eggs and porridge as well as having it on cereal, and that I have been amenorrhoeic for the last 6 years (and no cause has been found for this - normal hormones so not the early menopause I'd though, and a normal BMI).

She suggested blood tests - mainly normal except for a low white cell count (I would say that the WCC can become slightly suppressed with hard training...but I'm not exactly doing much of that now) and a low T3 (one of the thyroid hormones, though the rest are normal...which possibly suggest an energy availability issue) and a DEXA (bone density scan).

My FRAX score - risk of fracture

I had the DEXA scan last week and we could see that it showed osteopenia (the stage between normal bone density and osteoporosis), worse in the spine than the hip. I was devastated and sat and wept in the carpark before pulling myself together and returning to work. That might seem like an overreaction to some people.....but it's not "just running". Sure, it means that I doubt whether I'll ever be able to run at a high level again, but more worrying is the long term health impact. I have seen patients with osteopenia and osteoporosis who end up with minimal impact fractures and so have to avoid certain activities, and others in constant pain from multiple fractures, such as wedge fractures of their spines.

The NOGG guidance

I cannot thank my friends enough who came to my aid last week when I needed the support......hugs, messages, "care packages", meals, wine, chat and just company....you are all legends! As for me, at least I now know a bit more about what I am dealing with and so can try to work out where to go and what to do next......and hopefully this will not only benefit me, but also any patients, friends, colleagues and runners who have similar problems as my experience will enable me to advise them in a more knowledgeable way (eg since going through this I have discovered that giving hormones to those with premenopausal amenorrhoea is actually detrimental to their bone mineral density rather than beneficial as has been thought for years).......onwards and upwards......