About a month out from Texas I noticed some pain in the groin/hip flexor region on my right side (it was my left side that I had surgery on last year). I honestly wasn't extremely worried about it and figured I likely strained something. I went to PT right away and was working on being as proactive as possible. Since the discomfort had been going away after about a half mile I continued to train for my last two peak weeks. I even had an awesome 23mi (3 hr) run 2 weeks out from Texas. My fitness was great and despite the injury I had remained confident I could still have a great race. A couple days (and a couple runs) after that 3 hr run, the pain in my hip became worse and was no longer easing off during the run. I took a week off running, figuring I wouldn't run until the race if necessary since I was still confident in my build up and fitness. I wasn't really showing major signs of a stress fracture or labral tear and we chalked it up to some misalignment, compensation and inflammation issues. I was scheduled to leave for IMTX on Wed May 11. On Tues May 10 I tried a short run (10 min) at PT. I stepped off the treadmill and my PT asked how it felt. Not good, I answered. It had been extremely difficult to get through a 10 min run, and while I could probably get through the marathon, at what cost? Plus it would probably be the most miserable marathon of my life. However, I was still hanging on to a thread of possibility that I could race. I had worked so hard in my build up to IMTX, I was in the best shape I think I've ever been in for an IM. I was so close.
I left PT a bit tearful with plans to come back later that day to try one last ditch effort to correct my misalignment and see if it made a difference. I have to give my PT a huge thank you for doing everything in his power to see if we could figure it out before I was scheduled to leave. I called coach Tara on the way home and we quickly made the decision that I wouldn't race. I knew it was the right decision, but I still needed her to talk me through it. I needed someone that knew the ins and outs of the work I had put in to tell me it would be ok. Very dramatic I know.
Post decision I talked to my PT about going to an orthopedist to get an MRI done. Then I took my pups out for froyo and started planning some fun things to do that weekend that would take my mind off not racing. I saw a different ortho from last year, and initially talked to his PA. The PA was thinking tendonitis but wanted to rule out a stress fracture. After everything I dealt with last year I was grateful for him ordering an arthrogram (would show stress fracture, labral tear, tendonitis etc etc) just in case. I wasn't showing any symptoms of a labral tear, but I am of course paranoid of all things hip injury related.
I had a really fun weekend despite the change in plans. I went out with some awesome ladies. Brian and I had a nice evening playing mini golf and eating huge desserts. I went for a fun long ride (bakery stop included) with some great guys. We went kayaking with some good friends. Lastly we had a fun evening at the beach and dinner with some rock climbing friends.
I had my arthrogram and was nervous about how familiar this whole thing has been relative to last year. The radiologist very kindly called me personally early the next day to let me know the results himself. He told me he could see a small labral tear and a stress reaction. My heart sank (I even exclaimed noooooooooooooo on the phone). Last year I had had a large labral tear and a stress fracture. He quickly followed up by saying that when he does hip/shoulder arthrograms on athletes, most of the time there are small labral tears but since I was asymptomatic it was likely nothing to worry about (phew). He then told me that the stress reaction (swelling in the bone) was early (no fracture yet) so would not require as much time to heal as a fracture would. I silently realized that if I had run IMTX it would have likely developed into a fracture.
I saw the ortho that afternoon, and honestly seconds after he walked through the door I was not a fan. This was my first time meeting with him and immediately after walking through the door he said you're too skinny, you don't eat enough. Now my friends are well aware how much I eat since I usually finish their meals at dinners out... He then proceeded to be very condescending and even said that I probably wouldn't be able to do well at Lake Placid with this short break from running (clearly he doesn't know me very well). All I really wanted to know was when I could run again, and he indicated 6 weeks from my last run which would put me at June 15, not horrible. I would still be able to swim, pool run, bike, elliptical to my hearts content as long as their was no pain/discomfort. The one thing he did mention that was useful information was that I should talk to an obgyn about possible low estrogen.
I figured hey, if the doctor was insisting I was too skinny then that is just an excuse to eat some spaghetti and meatballs and ice cream!
Here is where this may be too much information, but hopefully might be helpful for other female athletes. It is somewhat well known that female athletes are at a higher risk for things like stress fractures and anemia. The increased risk for stress fractures has been linked to vitamin D deficiencies and also low estrogen. Estrogen likes body fat, so since endurance athletes are often very lean, estrogen can become low. Estrogen also helps to protect the bones. I had skipped a few cycles and had been somewhat irregular. I hadn't been worried about it too much since it happens to female endurance athletes all the time. Last year in addition to the labral tear that I had surgery to repair I had also had a stress fracture. Initially I had assumed it was solely due to the instability in my hip joint from the tear. However, I had gotten off birth control early last year because I really just didn't like being on it. It was starting to click. The birth control could have been providing me with the estrogen needed to preserve my bone health. Possibly related (but maybe not), osteoporosis runs in my family (both my mom and maternal grandmother). I went to the obgyn and had some blood work done. My estradiol was a bit low (normal is 50, mine was 37), and my vitamin D was borderline normal. The obgyn put me back on birth control to increase the estrogen to protect me bones and encouraged me to continue to take Vitamin D and calcium.
I am really sad to miss a couple races that had been on my schedule (IM Texas and Eagleman 70.3), but am confident that I will be ok for the rest of the season. Even without running, I feel like I've been able to do some pretty solid training. I have two weeks left until I can start running again and my hip is actually feeling really good. I feel like I could run now, but a friend in the medical field said when it feels good, give it two more weeks. That puts me right at June 15 so I'm feeling good about the recovery. I am getting pretty over pool running, but sometimes we have to do things we aren't super excited about to get where we want to go.
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