The Anatomy of a Running Injury

I am writing this for both the reader and myself to reflect on an injury that put me out of commission and halted my running streak. I want to stress that runners have to listen to their bodies and look at taking time off when needed. I demonstrate that using something like Training Peaks may or may not tell you when you are near an injury, and it is still better to listen to your body and STOP before it gets even worse. I will walk you through the work up to my injury, some screenshots from my Training Peaks, and how long it has taken me to get back to 100%. I also managed to keep running for 683 days before being sidelined by the injury, which I will explain further. If you want to see what my injuries were, you can click here.

The Medical Tent

I will start my journey to injury in the medical tent in Honolulu, Hawaii. Not that this was the root of my injury, but I want to illustrate how I sometimes think I know more, even if I have done something twenty-plus times. During the Honolulu marathon, I was convinced I could get through the race on Water + Gels. Who would have thought that I needed more salt? My TrainingPeaks stats showed a Fitness level of 173 CTL and 184 ATL for Fatigue, and my form was 55 TSB. All these numbers show that I was pretty well-rested. I want to comment that I was successful with a 10×800 Yasso workout two weeks before this race. I felt good, and I should have completed the race on target.

My 2022 “A” Race

My A Race for 2022 was the Mt Charleston Marathon. I got a PR for this race in 2020 and was hoping for a PR + BQ. I took a couple of weeks off my regular running schedule and then was ready to start some intense training. I didn’t account for the caveat of going from Hawaii to Minnesota in December. For some background, injury has plagued me for 8 out of the last ten years of spring training. I knew that training hard in the winter eventually led me to injury. Another reference back to me “thinking I know better.”

TrainingPeaks Numbers Briefly Explained

Before diving into my timeline, I want to briefly explain the three main numbers I will highlight in this article. TrainingPeaks also give you a PMC or Performance Management Chart. These numbers and the chart help coaches and athletes with their training. I will illustrate how important it is not to rely only on these numbers. I recently found out that a coach can get an automatic email of comments from a workout. If you are using TrainingPeaks, I highly recommend using the comments and perceived effort sections to give you coach feedback but also let you look back to see how you were doing during that time frame.

Fitness (CTL)

There is a simple formula to calculate the CTL. It is

CTLtoday = CTLyesterday + (TSStoday - CTLyesterday)(1/CTL time constant)

At the peak of running my, CTL should be around 160. We can see this from the chart here. According to TrainingPeaks, I am more in line for an Ultra than a Marathon. (Or maybe I should have tapered more?)

Chronic Training Load (Fitness) combines duration and intensity to provide a value of how much an athlete has trained historically. TrainingPeaks calculates CTL, by default, as the exponentially weighted average of daily TSS for the past 42 days (7 weeks). Note that, in effect, CTL represents the training an athlete has done in the past three months, given the nature of exponentially weighted averages. 

Fatigue (ATL)

The formula for Fatigue is

ATLtoday = ATLyesterday + (TSStoday - ATLyesterday)(1/ATL time constant)

Acute Training Load (Fatigue) combines duration and intensity to provide a value of how much an athlete has recently trained. TrainingPeaks calculates ATL, by default, as the exponentially weighted average of daily TSS for the past seven days. Note that, in effect, ATL represents the training an athlete has done in the past two weeks, given the nature of exponentially weighted averages. 

Finally, we have the form (which I admit that I don’t completely understand)

Form (TSB)

Training Stress Balance (Form) represents the difference in the balance of training stress. TSB provides a measure of how much an athlete trained recently (ATL) compared with how much an athlete trained historically (ATL). TrainingPeaks calculates TSB by subtracting yesterday’s Fatigue from yesterday’s Fitness. Form (TSB) = Yesterday’s Fitness (CTL) – Yesterday’s Fatigue (ATL). TSB is not a predictor of performance but a measure of how adapted an athlete is to their training load. 

Form (TSB) = Yesterday's Fitness (CTL) - Yesterday's Fatigue (ATL)

As I mentioned earlier, these all go into the PMC or Performance Management Chart. You can use this to plan your workouts and make sure you are not getting too tired.

Back on Topic

Now that I have some of the background out of the way, I will get back to the topic on hand—my injury and what lead up to it. I will zoom into the time I know I overdid it and did not back off enough to rest and recover. I want to learn from writing this and hopefully educate others so they won’t fall into the same training trap.

Feb 5th, 2022, was a cold icy day. I Start at 9F (It Felt like -7f). The ice on the roads was relentless and worse, the sidewalks were not plowed, so I would run from smooth to single-track-like trails with very uneven surfaces. The worst part was when you came across a dusting of snow, and you didn’t know if there was ice or solid pavement underneath. What this means is you run entirely different than expected. You take tiny steps (Like an Icelandic horse). This puts a lot of stress on the glutes. I made it through the run, but in the end, I felt like I had finished a marathon. I was that tired.

The next day I had an easy run. (1 mile). I remember feeling ok. At the time, I was not putting all my comments in TP. (Now I do because looking back is very valuable)

On the following Monday, I had a speed workout scheduled. I remember asking a friend, “Are the downtown trails clear?” He thought they would be. I set out on a 10-mile speed workout.

  1. Warm up2.00 mi @ 113 bpm
    Zone 1: Recovery
  2. Ramp up in 6 steps
    1. 1.00 mi @ 120 bpm
      Zone 2: Aerobic
    2. 1.00 mi @ 123 bpm
      Zone 2: Aerobic
    3. 1.00 mi @ 126 bpm
      Zone 2: Aerobic
    4. 1.00 mi @ 129 bpm
      Zone 2: Aerobic
    5. 1.00 mi @ 132 bpm
      Zone 2: Aerobic
    6. 1.00 mi @ 135 bpm
      Zone 3: Tempo
  3. Cool Down2.00 mi @ 113 bpm
    Zone 1: Recovery

I did nail this run, but I was hurting.

The next day I had a 6-mile easy run scheduled. Which I did, and I do remember being in such pain. I decided to do just easy 1-mile runs until I recovered. I did one-mile runs until one day, I was on the treadmill, trying to hold myself up because my glute hurt so bad. That was day 683 of my run streak. I had run three marathons, one Ultra Marathon, and one Half Ironman.

Glutes

I equate this as completely changing the way I run and adding distance and load in one month. This was not a sharp pain as this article from Runners World talks about. The injury was more like working out with sore muscles day after day and then adding more to it. My PT characterized it as an over-use injury. I should have slowed down on all my long runs. In addition, I should not have done any outdoor speed work. Since I get injured nearly every spring, I have made a mental note not to do speed work in the winter ever again. (Unless my winter is somewhere warm). I feel great running in the cold, and I can push myself. But my muscles never really warm-up, and I never have the chance to run on ice 12 months a year (Nor will I ever!)

Complications

Because I ran for two weeks after recognizing my glute injury, I developed some odd pains in other parts of my legs. Specifically, I ran with a limp, and after my glutes healed, I developed some significant IT Band issues. Both legs had tight IT bands. This culminated with a couple of painful nights trying to sleep as every time I straightened my left leg, I could hear a big “Snap.” I started doing daily Yoga and stretching as much as possible. I also tried to remember to roll. I say “tried” because as soon as I think I feel better, I stop doing what made me feel better, and that seems to be not long enough.

Hawaii heals

We headed out to Hawaii for a couple of weeks in May 2022, and I went with the belief that the islands heal all injuries. I was continuing my daily Yoga and rolling my IT Band. The IT Band showed up as knee pain, and after a week, I was feeling nearly 100%. I stopped rolling and stretching like an idiot, and I can remember starting a run (on a downhill) and reversing everything I had achieved in a matter of 3 seconds. The moral to this story is that you need to continue the therapy that is prescribed to cure your ailment, even after you think you are healed.

Couch Stretches

When I got back from Hawaii, I saw my doctor again, and he prescribed a couch stretch at least five times a day. Wow! this worked,

Five times a day (About 2 minutes a session), I stretch my left quad, and after a couple of days, I am feeling great.

Of course, what do I do? I forget to do it and start the cycle over again. So, at the time of publishing this post, I have restarted my couch stretches and my rolling, and I am feeling pretty darn good.

Please keep up with any therapy you are given! This part is important, even if you start to feel better.

The COVID Twist

When I returned from Hawaii, I felt like I had some summer Minnesota allergies. I had one day where I felt a little ill (Like a fever), but I took a decongestant and some Advil, and I was able to work and run. I ran the Grandma Half Marathon and felt some chest congestion towards the end of the race. I also noticed that my heart rate was elevated the entire race. I had attributed this to Clairton-D but stopped taking it on the Wednesday before the race. I was still coughing on the Monday following, and my wife said I should take a COVID test. Sure enough, I was positive.

What I am doing in to the future

The future looks bright, and as I enter the second half of my fifth decade, I hope to get one more marathon PR. The main lessons I have learned coming out of this experience are:

  1. I am not doing speed work in the winter
  2. I am going to work on stretching consistently
  3. My run volume means nothing if I am injured
  4. Cross-train
  5. Spend more time in healing Hawaii

Brent W. Peterson

Commerce running, talking geek

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