Patellar Bone Bruise – What I’ve Learned

My training for Boston was going great.  More than great.  Amazing.  The winter months were brutal but didn’t deter me from getting my workouts and long runs done.  I ran on the treadmill more than ever, but made each run count and nailed my paces and mileage despite polar vortexes, icy trails and huge amounts of snow.  I raced a strong half marathon in March at RnR USA and was feeling so good about my fitness and mental strength.  It was all coming together – one day, one step at a time.

Rocking the Rock n Roll USA 13.1

And then, one cold Sunday morning 4 weeks before Boston, I decided to try out the ElliptiGo with my good friends Jeff and Maddie.  Usually on Sunday mornings I take a yoga class but thought why not switch up my cross training and bring it outside with some non-impact running on this super cool bike?!  I still think that in theory this wasn’t a bad idea, the ElliptiGo is an awesome form of cross-training for runners and I look forward to getting better at using it, but looking back it was a little short-sighted of me not to consider the risk I was taking.  I had never done it before and the feeling was totally new to me, and when I went to get off of it I fell into the pavement and banged my knee right into the asphalt.

I got up and assessed the situation – my knee hurt a little but it really wasn’t bad.  I got back on the ElliptiGo and we hit the trail for a few fun and, honestly, exhilarating miles.  We had a blast!

all of these pics were taken after my fall – it was so fun!

It wasn’t until a few hours later when I was home that I noticed my knee was pretty sore and stiff, especially walking down the stairs.  That week was rough.  It was supposed to be my peak mileage week and I ran a total of 31 miles (as opposed to well over 80), ALL of which hurt me — BADLY.  I saw two doctors who I really trust with my whole heart and they both diagnosed me with a patellar bone bruise. An acute injury to the bone, one that would take TIME to heal and a process that I really couldn’t rush.  It would take anywhere from a few weeks to a few months to feel normal again, and that uncertainty was rattling to me.  I really needed to take it one day at at time, to listen to my body and do all that I could do to help myself heal, while also preventing myself from getting another injury as a result of my form changing or muscles tightening or tendons getting grumpy around the kneecap (this was of more concern to me than the actual bruise itself was, to be honest).

As with any injury, recovering from a bone bruise takes time and the healing process is different for everyone and depends on a lot of factors.  A bone bruise is probably not the most common running injury, though I imagine this kind of thing could happen more frequently to trail runners who may fall on rocks and get pretty banged up.  I thought I would share what I’ve learned from my own experience with this injury though, just in case someone might find it helpful.

Running:  In the first few days following my fall, running HURT.  The pain was constant and didn’t seem to get worse as I ran faster or longer, but it did not subside at all.  Despite assurances from my doctors that it was “safe” to run, I hated it.  I was running in pain and in fear and after a few days of that I decided I needed to rest.  I did not run for the remainder of the week.  In retrospect I really think I should have pulled the brakes on my running right away – no matter what anyone advised me of.  If running through pain to you feels wrong then it probably is.  I think I probably slowed the healing process down a little by running through it.  I don’t think I made it worse, but I probably could have, had I continued to not listen to my body.  I gradually started running more and more as the pain lessened and I did not attempt to push my pace until it just naturally came back to me to do so.  It was more than three weeks before I was running my marathon pace again.

Pain Management: LOTS of icing, especially after a run.  I would typically massage the painful spots on my knee cap with ice cubes until they melted, or wrap an ice pack around my knee and elevate it.  I applied Arnica gel to it throughout the day.  After doing some research on anti-inflammatory supplements and foods, I started taking Vitamin D, Bilberry, Bromelain, Glucosamine with MSM (vegan), a vegan Omega (similar to fish oil but I am allergic to shellfish and eat a mostly vegan diet so found one I could take), Calcium and Vitamin C.  I also started taking Arnica homeopathically as well, a spray bottle I squirt into my mouth a few times a day.  I considered taking Aleve for inflammation but I really have mixed feelings about it.  I tried it for one run and I am not really sure how much it helped, and the worry that it might upset my stomach is pretty major for me since I already deal with GI issues.

Exercises and Physical Therapy:  For the first week following my fall, I was pretty much resting the knee and avoiding any activity that hurt.  I got on an elliptical at the end of the first week, pain free.  It was boring but I was happy to be moving without discomfort!  I stuck to my regular routine of core work and Pilates all week though, and modified the exercises that hurt me (shoulder bridges and certain lunges – basically anything that stretched the muscles that inserted at the top of the patella).  After a week or two though once I was beginning to feel better I did these exercises carefully at the guidance of my physical therapist – I needed to retrain the quad muscles to lengthen properly and these exercises were great for that.

Medical Attention:  I went to see my chiropractor, Dr. Wong, right away the day after the injury and have seen him once a week since.  In addition to his excellent chiropractic care, he has done laser treatments, stim, Graston and ART and has helped me with correcting the imbalances that showed up in my body as a result of the injury.  He examined my knee and made sure the injury was not more serious – all ligaments and tendons in tact.  I also saw my physical therapist, Rich.  He confirmed the same diagnosis as Wong and has helped with mobility and strengthening exercises as well as releasing some of the super-tight muscles around the kneecap with dry needling technique.  Rich also taught me to massage the tendon above my kneecap with a cross-frictional technique for 3-5 minutes before I run.  I think that has been really helpful.

Emotional/Mental State:  An acute injury really knocks you down – literally and figuratively.  I felt like I was on top of the world with my running and then in an instant I was trying to climb up out of a major slump physically and emotionally.  The thing is though, I believe that everything happens for a reason and that our biggest struggles are truly our greatest opportunities for growth and strengthening.  My injury has been no fun on a lot of levels, but at the same time I think it has been an essential part of my story and it is building me up in so many ways.  I have learned how to trust my body in new ways, and I have discovered a determination and strength in my heart that is so unwavering and comforting.  I feel like this experience is making me a stronger runner overall and is also going to enable me help others who I know love, teach and coach.  The road to recovery is a bit of a roller coaster ride emotionally and that is all part of the process.  There will be downs and ups, just like there are in running and like there are in LIFE.  You just have to hang on, listen to your heart and to your body, and BELIEVE that you will get better.  Because you will.

I leave for Boston tomorrow and I am so excited to run on Monday.  With each day I can literally feel myself healing and getting stronger.  I will lace up my shoes on Monday morning, proudly pin my bib to my shirt and run with my HEART.  I feel pretty sure that my legs will come along with me for the ride now!

Have you ever had a patellar bone bruise or a bone bruise of any kind?  Do you have anything to share or add about your experience with the healing process?

Are you running Boston on Monday or will you be there?  My bib number is 9465 and I’m in Wave 2, Corral 1.  You can track me by texting 9465 to 345678!  

onward and upward – Boston!

Wow!  It’s time.  I leave for Boston on Friday!!  To say I am excited is an understatement.  To say I am looking forward to it sounds silly — I am so much more than “looking forward” to it.  I am over the moon – so so so happy and incredibly grateful – to head up north for this amazing experience and truly wonderful race.  To hug my friends and loved ones, to run with them and laugh with them and I’m sure cry with them, to be a part of this overwhelmingly amazing event and the massive movement of healing and strength and celebration that it will be.

Words just don’t do any of what I am feeling even a teeny tiny amount of justice.  It is BIG.  Just so BIG.  I feel so lucky!

The last few weeks have been so busy.  Good busy, but wow SO busy.  I have been completely immersed in my Pilates teacher training.  I love love love it, and am really excited about it, but the training itself and the work that goes along with it is A LOT of work, and balancing the practice and study along with parenting, teaching, coaching and running and just being a human has been quite an adjustment for me.  I am learning though and I have it down, most days!

mermaid stretch – a favorite, but a tricky one for me to teach!

Then of course a few weeks ago I fell and bruised my kneecap when I took a spill off the ElliptiGo.  It wasn’t a bruise that you could see – actually there was never any discoloration and it really didn’t even look swollen – but the bruise was much deeper than that and in the bone itself.  This caused some of my quad muscles and tendons around the knee to be not-so-happy and made me feel pretty uncomfortable and unsure of myself on the run.  I have taken my recovery very seriously and had to be extremely patient in order to allow myself to heal.  It has been hard at times, running through pain I was unsure of at first, then taking time off from running altogether for several days, then running at a lower intensity (both mileage-wise and pace-wise) and also adding in time for icing and strengthening exercises and more foam rolling, etc.

dry needling

I have been doing physical therapy for it and also seeing my chiropractor regularly over the last few weeks.  Every week I have felt a little better but not ALL better and I have tried to trust the process and let go of any worries about how I might feel when April 21st rolls around.  It’s sort of been an emotional roller coaster of having good days and less-than-good days.  This last week though I finally felt like I turned a corner – I am feeling so much more like myself!  The worry is lifting off my shoulders and my focus is on BOSTON and being ALL IN for that whole experience, whatever that means as far as running goes is not even close to being the most important thing to me right now.  I do have a great feeling about it though, a really really great feeling.

This morning I went for a run with my buddies Maddie and Meghan and practiced what I think will be my goal race pace (somewhere in the neighborhood of 7:00/mile).  It came to me effortlessly, feeling more like the “me” before falling, and I finished with a HAPPY heart.  We chatted the whole way and the topic of conversation pretty much the entire time was BOSTON.  Maddie and Meghan are two of my favorite people in the whole wide world and they are both running Boston for the first time!  I can’t believe how lucky we are to all be going together.  Stepping into this amazing dream TOGETHER!!  There is so much to celebrate I don’t even really know how to put it into words.

we are going to BOSTON!

Boston is about so much more than running 26.2 miles.  Well, every marathon is about so much more than running 26.2 miles in my opinion, of course… but there is without a doubt something extra magical and special about THIS race.  And this year, after what happened last year, is going to be even more amazing than I can possibly imagine.  I’m ready to rise up to it, to embrace it, to open myself up to it, to share it, and to cherish and treasure every second of it.  I feel SO blessed, so lifted up!, and I will run with my heart as fast and as strong as it will carry me on Monday.  Onward and upward, Boston, HERE WE COME!!!!

a bump in the road – bruised knee

This past week was a Jess-is-going-crazy-in-the-head kind of week.  Some (my husband, in particular) might argue that all weeks are aptly described that way.  But we won’t dwell on that because it’s all relative and I like my kind of crazy most of the time (and so does he, I think!).  This last week though was not the fun kind of crazy.  It was the worried, creating awful scenarios in your mind when you have no control, on the edge of depressed kind of crazy.  The kind of crazy that really makes you crazy, I guess.

You see, Boston training was going awesome and then last Sunday after my recovery run I went for a ride on the ElliptiGo for the first time.  My good friend Jeff just started working for them and I was really excited to try it out.  A piece of equipment designed to prolong the years of a runner, to help the injured runner stay in shape while running without impact outside on the trails.  Sound like the perfect cross training for a marathoner, right?  I mean, how cool is that!?  I will tell you – very honestly – that I think it is INCREDIBLY cool and loads of fun.  I will also tell you – very honestly – that I am a klutz of the uber-degree, and that if anyone is capable of achieving the irony of injuring herself on a piece of equipment that was partially created to help people who are rehabbing from injury, it would be yours truly.

Jeff gave us detailed instructions and showed us all the bells and whistles (it is really very simple!) and made sure we were comfortable before going for a ride on the trail.  It was a new feeling for me and took a tiny bit of getting used to at first.  We practiced in the parking lot for a little while and the first time I went to stop and get off of it I fell and crashed into the asphalt, banging my kneecap right into the pavement.  I feel like it happened in slow-motion I was barely moving!  It hurt, but not too bad and I really didn’t think much of it at all.  I seemed to quickly get the hang of it after that and we went out onto the trail for a ride and had a blast.

A few hours later I was at home and noticed that my knee felt sore and stiff at the point of impact.  There was no swelling or discoloration at all, but it just didn’t feel right.  I began icing it and put some arnica on it and emailed Dr. Wong to ask for his advice.  The next morning I decided not to run and went to see Dr. Wong.  He thoroughly examined my knee and leg, did some Active Release Therapy and Graston (ow) and told me that it was a bruise to the knee cap and I should be ok to continue with my training.  He advised me to ice it frequently and to warm it up a bit before running.  I was relieved that it wasn’t more serious.

On Tuesday morning I went for a 13 mile run with my friend Meghan and it HURT.  The whole way.  It didn’t get worse as I ran but it didn’t loosen up either.  On Wednesday I went to the gym to run on the treadmill – 12 painful miles, every single step.  I was worried.  I emailed Dr. Wong and he again assured me it was okay to run through the pain I was feeling, that it was normal to feel stiff and sore … which was a relief but also didn’t make the pain go away of course.

Thursday morning I woke up to run and got on the treadmill and the pain persisted.  After 3.5 miles I stopped.  I was done hurting.

I started to reassess everything in my head and made a decision that I would not be running for a few days.

I don’t run through this kind of pain.  I never even have pain like this!  Running is supposed to feel good and make me happy, instead it is hurting and I feel anxious, helpless and sad.  I noticed I was getting a blister on my left foot too, which probably meant I was altering my stride because of the pain — which could lead to other problems of course.  Something just was NOT right.  I knew I was risking losing fitness for Boston by taking time off from running.  But I also knew that I would rather risk losing fitness than risk hurting myself in a more serious way and not be able to run Boston at all.  That was not something I was willing to risk.

That afternoon I got a second opinion just to be safe and was assured once again that my kneecap is bruised and that it is not more serious than that.  Rest would work wonders.  My body will heal itself if I give it a chance to do that.

I decided I would take recovery as seriously as I take all other aspects of my training – I have been icing diligently and resting my knee as much as humanly possible for a mom of three young kids.

Reminding myself to trust in the healing process, to follow my heart and listen to my body.

I have not been running.

Saturday morning was tough because I was coaching and couldn’t be out on the trail running with our runners and coaches.  Sunday was tough because I was not running the half marathon I had signed up for, which I had planned to run at Boston goal pace as part of a 22 miler.  That was a bummer of a choice, but it was without a doubt the right one.

trail side in blue jeans

Yesterday morning I got up and went to the gym and found some pieces of equipment that I could get a workout on without hurting my knee at all.  It felt so good to move and not hurt, and gave me confidence that I am doing the right thing and that everything is not only going to be okay but it is going to be awesome.  It wasn’t running, but it really lifted my spirits.

Yesterday afternoon I couldn’t believe how much better my knee was feeling.  I was tempted to run on it but decided not to.  I went back to the gym again this morning and did the elliptical for an hour with my amazing friend Dora who is tapering for her 50 miler.  We chatted and laughed and it was really a great way to spend a Monday morning.

i get by with a little help from my friends

Later this morning I went to Abby’s running club before school.  She and I were on the trail together and we walked/ran about 2 miles.  I was curious and nervous about how my knee would feel.  It felt absolutely fine.  I came home and iced it after that and was all smiles, practically floating.  Grateful.  So glad that I didn’t continue to push through my pain last week.  I am going back to the doctor twice this week and am planning to be very careful, to keep icing it and to really continue to listen to my body.

The big picture is always the most important thing to me and I do not want to be in pain in Boston, or really, ever.   Not injury pain.  I am okay with feeling the pain and discomfort of exhaustion or being out of breath or having muscle soreness from a hard workout or pushing my limits to fatigue … but injury pain that persists – noooo way.

Oftentimes doing the hard thing is the right thing.  One day at a time, we make choices.  My choice today is to do all I can to get to Boston feeling healthy and happy, even if that means not running when my heart wants to run so badly.  I’ve got three weeks.  My head’s up, and I’m so excited to celebrate in Boston.

4 weeks

Boston is 4 weeks from today.  4 weeks.

I can’t believe it.

In the blink of an eye, this winter has somehow zoomed by, even with the most miserably cold temperatures and seemingly never-ending amount of snow storms and polar vortexes that have come our way, one after the other.  I am so happy that spring is knocking on our door, finally!  That we are seeing glimpses of the season really contemplating the possibility of sticking around for a while and saying “see ya later!” to Old Man Winter.

I will not miss him whatsoever.  I kind of want to give him a big old kick in the butt as he leaves.

This training cycle has been extra-special to me for lots of reasons, one of which because it’s taken more guts to get out the door for my runs.  It’s taken more commitment and more ooomph to rise up to the tough workouts than it does for me to get out there in the summer and fall months.  I’m a warm weather girl at heart.  Winter is not my favorite time of year, by any stretch.  I believe I would be very happy with maybe a week-long winter.  Just one week of beautiful, gorgeous, sparkly snow.  Then it could melt as quickly as it came and I would be fine with that.  I don’t think such a climate exists in this world, but it would be pretty much perfect in my mind.  The rest of the year I would take the other three seasons happily.

We have survived and even thrived.  Thank goodness for treadmills on those icy, single-digit degree days and for lots of moisture-wicking layers and hand warmers for those dark cold mornings on the trails.  Thank goodness for my friends, more than anything, because they have been with me through it all.

The birds are starting to sing again and the trail is peppered with runners, bikers and families.  Without a doubt I am starting to feel an extra pep in my step, and I will carry that lightness and gratitude with me all the way to Boylston Street.

4 weeks.

Rock n Roll USA Half Marathon 2014

My goals for the Rock n Roll USA half marathon this Saturday were the following ~

  • Break 1:28. 
  • Run the hills SMART, not hard.
  • TRUST myself.
  • BE BOLD.

I was pretty nervous about the time goal for a few reasons.  A 6:40-6:45 average pace over 13.1 miles intimidated me – that’s not much slower than my tempo pace and the most consecutive tempo miles I’ve done in a training run this cycle has been 6.  Also, I was not planning to taper for this race at all (I ran 81 miles last week, including the race, and was in the high 70s the week before), so I knew I wouldn’t be heading into it with “fresh” legs.  I didn’t really want to set a “limit” on what I was capable of, yet I also wanted to have something to reach for.

With all that said though, I was still going to GO for it and give it the best I had in me, because the other goals I had for the race were ultimately a ton more important to me than the time on the clock.

Race morning came and my plan was to run the first mile or two easy, which I was thinking would be right around a 6:50ish pace.  By Mile 3 I wanted to be holding my goal race pace, locked in at 6:40-6:45 through Mile 10, with the understanding that Mile 7 would be slower because I was aware of the long monster hill in that mile and I wanted to maintain an even effort up it so I wasn’t winded at the top.  Then from Mile 11 on I would push myself and put it all out on the line, running as fast as I could to the finish.  I figured if I could execute the race like that I would be in pretty great shape to accomplish all of my goals.

Sometimes we surprise ourselves though.

As soon as the race started I knew things were going to go differently than I had planned.  I just had no idea how differently.  I was running with ease and strength and felt so present in the moment, so in my element, so in love with this sport and with the energy of race day.  I looked at my watch early on and saw that the pace was faster than I expected, but it didn’t shake me at all.  I was trusting myself, trusting my body.  This was where I was meant to be.

I took the hills in stride and maintained an even, constant effort up them as well as down them, including the huge one at the start of Mile 7 (last year that hill had me nearly throwing up when I reached the top, this year I dominated it – THAT was a good feeling!).

Around Mile 6 I felt my tummy cramp a little bit but this is not a feeling that is new to me.  I told myself it would pass and thankfully it did.  I was planning to eat the gel I brought with me right around Mile 6 or 7, but because of my tummy I decided it would be a bad idea and I really didn’t feel like I needed the extra energy anyway.  My tummy talked to me again at some point during miles 8 and 10, but both times the feeling went away and I was glad I didn’t stop for a false alarm.  I kept running strong.

Miles 1-10:
6:31, 6:30, 6:29, 6:14, 6:22, 6:25, 6:57 (hill), 6:23, 6:25, 6:20

When I came through Mile 10 it was time to be BOLD – time to pick up my pace and race the last 3.1 miles to the finish.  I knew I had it in me and I felt this amazing sense of energy – I was so ready to rock it.

Mile 11: 6:13

Mile 12 was more of the same.  There was one woman left in front of me that I could see.  I passed her with ease early on in Mile 12 and was running with a pack of guys at that point.  It was a really cool feeling.

I looked at my watch as I approached the 12 mile marker and saw that I was clocking a 6:08 pace and it felt amazing.  I was so excited and determined!  I only had a little more than a mile to go and I was going to race it all out.

I was being BOLD.

And then, all of a sudden, I felt my tummy talk to me again.  I told myself it would go away just like it had earlier on in the race…but I was wrong.  I was in trouble and came to a screeching halt on a neighborhood street of Capitol Hill and was all of a sudden walking, trying to calm my GI system down.  It wasn’t working.  I literally was looking around for places to pull over – checking out parked cars to see if maybe I could hide behind one (ridiculous thought), alleyway streets – looking for any place I could go to the bathroom.  There were no porta-potties and there wouldn’t be until the Finish which was still over a mile away.  I crossed the 12th mile in 6:30, so I really hadn’t lost much time at that point.

I quickly considered my options, nervously walking as fast as I could because any time I tried to run I was pretty sure I would go to the bathroom in my pants and THAT was most definitely NOT an option I would consider.  I hate writing this by the way.  It is hugely embarrassing but it’s really real so I am just telling it like it was — awful!  I decided my choices were as follows:

(1) Just walk, and hope my system would calm down.  Be happy with how I raced up until this point.  It was still a great race after all!

(2) Find a place to go to the bathroom – take care of it – and run hard!  Don’t let it stop me.

I really wasn’t okay with option 1, as long as I could find a place for option 2.  There were cops and spectators lining the streets because we were in a neighborhood and the turnoff split for half/full marathoners was coming up.  I saw an alleyway blocked by three cones.  I am sure what I did was completely horrible and illegal and disgusting … but I ran down the alley and ducked in by the side of a brick building and went to the bathroom.  And now I am telling the world about it!  Oh my gosh.  Go me.  Such a lady.  Ugh.

Anyway, I took care of it and ran back down the alley out onto the course and raced my heart out from there. I distinctly heard a man yell to me “YOU GO GIRL!” as I race passed people.  I laughed to myself as I thought “thanks, I just did, and I feel SO much better!”  I figured no sense in dwelling, let’s just move on and finish what I started.

Mile 13 was a 6:56 including my stop.  I over-ran the course by more than a quarter mile, thanks in large part to my detour, and my last .38 was at an average pace of 5:51.  I crossed the Finish with a time of 1:26:25.  According to my watch, with the extra mileage, my average pace was a 6:28.  This was 7 minutes faster than I ran this same race last year, and a PR in the half marathon distance by a little more than 3 minutes.

I found out later that I was 1st in my age group and the 11th overall female out of more than 10,000 women running the half that day.  All of this really did, and still does, astound me.

I was really happy with how I raced this, and with how I handled and overcame my issues towards the end … even if I am horribly embarrassed by what I had to do to deal with it.  I accomplished every one of my goals for this race, and surprised myself a lot.  GI issues are no fun and I have dealt with them a ton – not just in my running but in my daily life – and I am still working to improve on this.  Figuring out my food allergies and making changes to when and what I eat before running and especially racing has helped me a lot, but I obviously have not gotten it all figured out yet and that’s okay.  I will keep trying and I won’t give up.  I am certain now that I should avoid dairy completely the week before my races, and probably just avoid it altogether even though I’m not allergic to it.  It messes with me!

Boston is exactly 5 weeks from today and I’m feeling strong and hopeful about the journey ahead.  I am finding myself dreaming bigger and feeling bolder lately.

In my heart, I know that anything is possible.