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Sometimes injuries happen no matter how careful we are. In the last 5 years of working with athletes I've found that even if you follow all the golden rules and progress training slowly, injuries may still happen. It might be that an athlete has an underlying instability or weakness which finally becomes apparent (and will become apparent no matter what they do), or it might be a freak accident. This was the case with my injury this last summer of 2022. While on a meaningless shakeout run 48 hours ahead of the Spartan North American Championships I somehow managed to land awkwardly on the rounded edge of a newly paved road. My foot completely folded and a sharp pain shot up my leg. Like most rolled ankles, the pain usually subsides within a few minutes and you can continue running. I checked out my ankle and it was completely fine and painless (weird, but something I credit to my weekly ankle strengthening work). I did have a strange, pinpoint pain under my foot. I immediately ended the session and went back to the hotel. By 3am my foot was discolored, swollen, and I could no longer structurally support any weight on it. A few x-rays later that morning revealed 2 broken bones (cuboid and 5th metatarsal) and I was strongly urged not to race in 24 hours as a simple 6 week recovery would surely turn into surgery and upwards of 6 months off. I followed the medical advice of these healthcare professionals and was actually able to safely race twice, 8 weeks after the injury (with medical clearance from an orthopedic surgeon, of course). I'd like to share how I navigated training with a healing, broken foot, and was able to race so soon after the injury, in the event that any of you reading this are currently injured. *NOTE: this blog does not serve as medical advice and is intended for informational purposes only. You should always consult a healthcare professional before beginning any training regiment*
Weeks 1-3 following injury
Week 1: the first week was spent in an airboot when moving around, and otherwise I tried to stay off my foot whenever possible. There wasn't much training that was done this first week as I just wanted to let the swelling in my foot subside (and I honestly wasn't really even wanting to train at this point). Within a week of the injury I was back home where I got more x-rays, consulted with more Doctors (who recommended at least 4-6 weeks without running), and got a referral to an orthopedic specialist.
Weeks 2-3: as of week #2 I I was able to start some sort of "training" again. Knowing that my recovery could be as short as 4-6 weeks, there was still a possibility that I could race in October, so my goal was to try and find a safe way to maintain cardiovascular fitness as well as lower body strength while being smart to not aggravate my injury. Remember: we need to think about our long term racing career, not just a short term goal. I didn't want to sacrifice racing for the next 10 years just to get 1 more race done.
Week #2 training: cardio was done entirely on a spin bike. I was able to transcribe my run workouts onto the bike for equivalent duration and effort (remember: running heart rates don't correspond to cycling heart rates). If my run was supposed to be 8x1:00 @ XX:XX with/ 1:00 recovery, I did the exact same thing on the bike, but cranked the resistance as high as possible in order to really target my legs. Upper body strength was unchanged save for having to be very carful with any hanging movements (pullups, chinups). Lower body exercises presented the biggest challenge as I still was not cleared to load my foot with weight. The only 2 exercises I could do were leg curls and hamstring extensions.
By week #3 I had consulted with a specialist, did more x-rays, and was advised I was ready to start slowly loading my foot (walking) without an airboot. I was also advised that I should not run for another 3 weeks (6 weeks total). In my opinion, this is where athletes need to be careful and check their ego (and not progress too quickly)...see the reminder about long term vs short term goals above. Week #3-6 training: I first focused on being able to walk properly again without any compensation. At the same time I started to gently load my foot in workouts starting with bodyweight squats. Once I could walk normally and do bodyweight squats without discomfort or compensating, I was able to progress to squats with gradually heavier weights. As for cardio, intervals were still done on the bike, however by week #3.5-4 I was able to once again walk properly, so I started experimenting with incline walking/hiking on the NordicTrack Incline Treadmill.
By the final 2 weeks my foot had healed to a point where I was able to simulate race-day by spending up to 3 hours at a time power hiking at steep inclines on the NordicTrack. Although I couldn't run, I figured I could at least train similar heart rate zones to running (I was able to get my heart rate into Zone 3 at sub-running speeds) in a race specific manner. I couldn't run, but I was able to accumulate significant elevation/vert, around 26,000-27,000 feet (7924m-8229m) per week.
Week #6-8: by 6 weeks I again had more x-rays done which revealed my foot was completely healed! I was given clearance by the Orthopic Surgeon to being running again and even race (keeping in mind that I was accepting the risk of rolling my foot and re-fracturing the same bones). Again, I started gently, running only 1km (0.61 miles) at a time for the first week, after which I started increasing distance (5km, 8km, 10km, 15km) if my foot responded well.
Racing after injury: things to consider
While I was lucky to regain health and race so quickly after injury, I certainly didn't come back in pre-injury shape, regardless of the fact that I was still doing 12+ hours of aerobic work while injured. Here are some things to consider:
-Loss of impact resistance: one of the first things I noticed was that my lower body had lost resistance to the impacts of running. I did a hard, 10km run, and when I finished my legs were cramping as if I had just done downhill mountain intervals (and even when I do those intervals, they never cramped like this!)
-Loss of strength in the affected area: it took several more weeks (even 1 month or more) for my foot to regain its strength. Until that point it simply felt like I had a weakness on push-off while running (i.e: running didn't feel natural on that foot and felt awkward). There wasn't any pain, but it did feel like I wasn't getting the most out of every stride.
-Loss of endurance: I noticed on race day that I had about 2km worth of effort at my pre-injury abilities, after which I would hit a wall and found myself holding on for the remaining 3-8km (Sprint and Super).
-There is no replacement for running. This is something I knew prior, but let it serve as a reminder for those mortals (like myself), that you cannot take extensive time off running and expect to return in top run-shape, no matter what you do. Yes, other forms of cardiovascular training (rowing, cycling, etc) will help to maintain fitness, but they are not at all the same biomechanical movement patterns and shouldn't serve as a long term replacement (unless absolutely necessary) if you're trying to become a better runner. In fact, it has taken around 3-4 months for me to feel like certain aspects of my cardiovascular fitness have returned to pre-injury levels (ex: uphill running).
Although it became clear very quickly in those races that I was not in race shape, I was still grateful to be able to finish the season racing. During those races I quickly realized what kind of fitness I had to work with and simply tried to give 100% of whatever I had in me on that day (and hopefully not finish last!). There are other athletes who are not as lucky to bounce back so quickly who are injured much longer, so it's all a matter of perspective! If you're injured at the moment, try and keep positive, take training one day at a time, and remember to think long term: don't compromise your long term racing career for short term satisfaction...and if you are going to take risks (like I did racing so soon), make sure you consult with a healthcare professional so you can make the most informed decision!
Need help navigating injury or planning your training after an injury? Send us an email: outlawocr@gmail.com