Today the site of the injury is sensitive to the touch again — but just barely.  And it feels more sensitive along the bone than it does on the bone.  Thus it is possible that what I’m feeling is just scar tissue breaking up.  I’m not sure.  I’m not sure what I’m going to do.  I guess I’ll probably wait another week before running on it again.  I’m afraid that it won’t feel any different even then but that’s just my pessimism about this whole situation shining through.  I know that stress fractures take 6-8 weeks before you can run on them.  Even then they aren’t healed.  And 6-8 weeks is generally the minimum time.  I’m probably just not ready yet.  It sucks but crying about it isn’t going to make it heal any faster.

The good news that I have to report is that my 60+ mile ride this weekend was pretty good!  I rode alone from my home to the Musselman Half Iron Triathlon.  The route was hilly but I still managed to average about 15.5.mph.  For most any cyclist that is pretty slow but for me, for my bike, and for the route, it’s not half bad.  Plus I wasn’t trying to go fast.  At the beginning of the ride I avoided putting forth much effort because I didn’t want to suffer in the late miles.  Mentally I treated it just like a long run.

Along the ride I met two guys from Holland that were biking from Boston to LA!  Between those guys and all of the atheltes at the Half Iron I should have been motivated.  Instead I felt sad that I wasn’t participating (neglect for a moment the fact that I can’t swim and I’m horrible on the bike and that I can’t currently run without pain).

Did the injury sap my motivation?  Probably, at least to some extent.  Maybe I’m just tired from poor sleep patterns lately.

According to my calendar and the way my leg feels I could start running any day I want.  But…I don’t want to.

I’m not seeking sympathy.  I’m not reaching out for help.  I’m just documenting this so that later I can look back and see what was going on as opposed to believe my false and incomplete memories.

ps: The title of this post is dumb because it actually means “Why are you Motivation?”

In 1 week I will try to run again.  If it doesn’t feel right I will take an additional week off.

And what is it about humans and making things worse?  I’ve been quite knowingly doing things that aren’t good for me but doing them anyhow.  For example I haven’t been eating right.  Eating comfort foods is a common way to deal with stress.  I’ve been doing that.  I haven’t been getting enough sleep.  I’ve skipped some bike rides or cut them shorter than I should.  I seem to be intentionally sabotaging myself.  It’s easy to explain comfort foods — they give you pleasure.  But the other behaviors don’t really give you pleasure or very little.  Perhaps I’m trying to make matters worse so that I can hit “rock bottom?”  The funny part is that none of this is serious!  I’ll recover from my injury.  I’m making a mountain out of a mole hill.  Missing running isn’t serious, not really, but it feels like it is.  Maybe someone with a real problem can come by and smack me.

I also put the aircast back on.  After one day of not wearing it my ankle felt strange, possibly painful just walking on it.  I don’t know what to think about that.

I’ve been looking into the possibility of using an Exogen ultrasound bone stimulator.  I don’t have enough information at this point and I’m afraid this might be snake oil too.  The last thing I want to do is have insurance pay for another useless treatment.  As I type this I think I might not bother with the bone stimulator.  For one thing you need a prescription.  For another plenty of people heal just fine without one.  I’m not a pro athlete.  My livelihood doesn’t depend on running.  My sanity might but my family won’t starve because I can’t run.  I need more information.

I just did a quick search on pubmed.com (one seriously awesome site for searching medical research texts) and found some interesting hits (with full text!).  One study, which doesn’t seem to be a study since I don’t see a control group mentioned, has a positive outlook on LIPUS (low intensity pulsed ultra sound) in accelerating the healing of bone fractures.  Another study, which appears at first glance to be well executed (double-blind, randomized, used a placebo device in the control group) found no statistical difference out of a group of around 100 patients.  This sounds like the aircast all over again.

If it sounds too good to be true it probably is… but not always.  I think in this case it’s too good to be true.  I’ll stick with the tried and true method to return to running.

I expected that the most likely outcome of the MRI would be the confirmation of a stress fracture.  About equally weighted I thought the MRI might give no information.  I also thought there was an outside chance, very small, that something else was going on.  I had silly fears of seeing a tumor on the MRI results.

The simplest answer is generally the correct one.  The results showed evidence of a stress fracture or at least bone injury.  Right at my ankle bone marrow edema is clearly visible.  Bone marrow edema means that fluid has collected in the bone marrow.  This is a reaction the body has when presented with bone trauma.  The radiologist and the doctor agreed that this is evidence of a stress fracture.  When you look at my history there’s no doubt that some bone injury has occurred.

After the confirmation of the stress fracture, which was suspected all along, the doctor left me with very little information.  He couldn’t explain why his treatment (the aircast) didn’t work as he had expected.  He said that my case is very atypical.  I think, to him, there are two parts of my case that are atypical.  First that I could hop pain free and second that I didn’t respond well to the aircast leg brace system.  I can think of a few explanations.  As for the hopping it could (possibly) be due to the location of the injury though I think that is unlikely.  More likely the injury isn’t as severe as is typically seen and I was probably well along the healing process by the time I saw him.  As for the aircast not working I think the most likely explanation is that the aircast doesn’t really assist in the healing.  This contradicts what this doctor has witnessed but corresponds with all other data I’ve seen.  The 3 week recovery time for a stress fracture seems so fantastical to me that the claim must be questioned.  I do not think that there is enough data to support that claim.  I certainly didn’t recover after three weeks and I was dilligent about wearing the aircast.  I actually kept the aircast in my bathroom overnight so I could put it on as soon as I stepped out of the shower.  The only time I didn’t wear it was when sleeping and showering.  I even wore sneakers around the house because it seemed to provide more support than wearing it alone.  I will likely continue to wear the aircast as I do not suspect it is hurting anything.  I might be helping — just not as much as sometimes is claimed.

The doctor didn’t really give me any guidelines.  Perhaps he thought I knew everything I needed to know.  Pretty much the only guidelines I was given was “plan on primarily cross training for the next 2 months.”   I think that I do know the proper way to recover as I have researched this extensively.

My recover plan is essentially the following.  First I will not run at all for 4 weeks.  I will then attempt a very short run consisting of about 100 meters of running at a time for about 1 mile.  If that does not go well I will take an additional week off.  If it goes well I will increase the running distance for the next run.  Based on the experiences of other runners I suspect that I should be back to 40-50 miles per week relatively quickly.  I’m thinking about 3 months from now.

And so I rest, bike, weight train, and continue to learn to swim…and feel extreme envy when I see anyone running.

For the last two weeks I’ve been treating this as a tibial stress fracture and have diligently worn the aircast leg brace.   With that brace I should have been running unrestricted in 3 weeks.  Unfortunately I feel like I haven’t made any progress.  I am pretty confident that I would be in extreme pain if I ran for just 1 mile.

Both the doctor and I are confused.  He took x-rays yesterday and they showed nothing out of the ordinary.  X-rays rarely show anything for a stress fracture until they have started to heal.  Even then many x-rays don’t show the fracture.  So the doctor ordered an MRI.  I was lucky enough to get the MRI done last night.  I won’t know the results until Monday afternoon.  The technician wasn’t allowed to show me the images.  He claimed it was illegal.

My hope in a quick recovery is almost gone.  I am 99% certain I won’t participate in a Fall marathon this year.