"You Shouldn't Break a Bone Running 100 Miles" and Other Things I Believed

On the screen in front of him, my orthopedist examined the Grade 4 stress fracture that split across my lesser trochanter and the extensive surrounding edema. He turned to me with a quizzical look and said “I mean, you shouldn’t break a bone running 100 miles unless there was some kind of underlying issue.”

I’m not a doctor, but generally, I would agree. I’ve run plenty of 24-hour+ races and never ended up with a stress fracture from one of them (even when I was in the depths of my eating disorder).

But what I hadn’t told him yet is I *had* vague hip pain for several weeks before Cascade Crest. The moment the tiniest bit of it started (July 4th, to be exact) I backed off and shut it down. It felt vaguely familiar to hip issues I’ve dealt with on and off for years (where multiple MRIs showed nothing except a torn up labrum that’s been with me forever), and I didn’t want to go back down that road. So I told my coach at the first niggle, and shut it down. My past has made me hyperviligant around potential injury, and this one was no exception, even with my “A” race looming.

In the 2 weeks before the race, I did a handful of runs and rested otherwise. Sure, I’d go in stupidly tapered, but I still wanted to make sure it wasn’t anything more serious than a terrible case of the taper tantrums, given my injury history.

So I made a deal with myself that I’d run the race, but ONLY if I had an MRI that was clean - no bone edema, no stress reaction, nothing of alarm where I could potentially do more damage running 100 miles on it. A week before the race, my MRI came back clean as a whistle. Bones looked great, everything looked exactly as expected (other than the partially torn hamstring, torn labrum, and a litany of things I already knew existed).

Phew.

I guess it was just taper tantrums - the issue with hyperviligance is that sometimes you create issues that aren’t there, and I guess this was one of them. “A” race, here we come.

So even though it was still a bit bothersome up until the race, I decided to give it a go - if my hip started to hurt at any point during the race, I’d shut it down and take the DNF. At this point in my life, I know it’s not worth pushing through that, but I did feel confident knowing that my bones were good.

And I had a spectacular race - the first 100 miler where I felt like I could actually RACE, not just SURVIVE. I was freakin’ stoked. No hip pain after it warmed up in the first few miles (in fact it was my opposite foot that hurt the most throughout). Whoop whoop taper tantrums be damned!!

The end of the race was in sight when coming down the last descent at mile 99, a wave of lightning bolts when down my right leg that left my breathless.

“Fuck fuck fuck fuck” I told my pacer Becca, stopping in my tracks. I hobbled a bit, and tried to run it off. I mean, shit happens at the end of a 100 miler, I’ve raced enough long races to know that things will implode. I had three miles to go (silly 102 mile hundred miler). I walk/jog/hobbled it in, knowing that finishing was really the only option. To be honest, the thought that it was a stress fracture didn’t even cross my mind at the time, even when my poor dad had to help carry me into the house post-race since I couldn’t put any weight on my leg.

Post-race, thinking ice may help my “hip flexor”

Because as that doctor said, with a clean MRI before a race, you shouldn’t break a bone during a 100 miler. And I told myself that as I hobbled around post-race and in the 2 weeks after. I told myself that as I decided to bike a few days of RAGBRAI. I told myself it felt like a hip flexor - I couldn’t lift my leg well. It felt like all things I had experienced before that *weren’t* bone. I could go up and down stairs without pain (though I couldn’t walk without a limp). I told myself, if it was bone, going down stairs would be terrible. Gotta be labrum/hip joint, and maybe it was time to finally seek out surgical options.

Because yes - you shouldn’t break a bone during a 100 miler with a clean MRI before hand.

Except I apparently didn’t have a clean MRI.

The ortho then pulled up my pre-race MRI: “hmmmm…yeah I don’t know why the radiologist didn’t pick up on this bone edema right there,” he said, pointing at my lesser trochanter. “It’s faint, VERY faint, but yeah - you had the beginnings of a stress reaction before the race.”

I ran a 100 miler on grade 0 stress reaction, which then developed into a Grade 4 “EFF YOU” stress fracture by mile 99. Yup, that would do it.

(To be clear, if the pre-race MRI had noted that edema, in no way would I ever had started the race. I don’t mess with bone, and I’ve been pretty lucky to catch bone stress injuries pretty early with that approach. I’ve been proud of how healthy I’ve been the past few years. It would have sucked to miss out on my race, but it maybe would have required a few weeks off, and I could pivot to a fall 100 miler instead.)

But I made a mistake by running that race, one that I didn’t know I was making until it was too late and the damage had been done. And I’m trying to give myself grace for that: grace that I was doing the best I could with the info that I had at the time. I don’t regret running that race, because I didn’t know any better. Because it’s not like I was pushing through pain that was blaring at me for the entire 100 miles. I thought I was actually listening to my body.

I thought I could trust MRIs, and that I shouldn’t trust the injury hyperviligance in my head.

That trust was a costly one, and I’ve spent the last few weeks moving through those repercussions. 6ish weeks on crutches, at least 3 months before I return to run, the chance that I may still need to end up having it surgically pinned if it doesn’t heal well. The distant but looming nerve-wracking and emotionally taxing ups-and-downs of the return to run. The utter loss of fitness, and the loss of what I love to do. Internalizing that people are likely judging me, thinking that “oh yes, she *must* have gone back into her eating disorder, she must be relapsing since she had ANOTHER stress fracture.” The doctors who side-eye you and don’t believe you. The fact that I’m now so internally shaken I’m questioning myself. The feeling that maybe I should just give up running.

But by far the worst part of this is feeling like I need to explain this to everyone else. To pull up my labs I had done pre-race and point them out to everyone and say “here look at all my levels I am HEALTHY PLEASE BELIEVE ME.”

If I dig deep, though, am I trying to convince others or am I trying to convince myself?

I’ve had plenty of stress fractures where I knew underfueling was the culprit. But I’m also learning that sometimes, stress fractures can be just dumb luck, some poor decisions, and a confluence of events. Such as:

• False reliance on a clean MRI meaning everything is ok (and a missed reading at a crucial time)

• a right hip joint that has already had many issues - torn labrum, impingement. My ortho told me that instability in a hip will put you at higher risk for stress fractures in that area (the load has to go somewhere!)

• Ignoring my gut feeling that something was off before the race, and telling myself that since the MRI was clean, the pain while running was all in my head (oh you taper tantrums!)

• making a terrible decision in ignoring my body telling me to not ride my bike 250 miles across Iowa post-race, but pushing through that for personal reasons that were ill-advised in hindsight. I’m sure the bone was broken by that point, but it clearly didn’t help, and likely made it worse.

Could I let myself believe that maybe this stress fracture was just a confluence of shitty timing, poor decisions, and dumb luck? Or does it feel more comfortable to me to hop on board the merry-go-round of self-flagellation and get angry at myself for all the damage I’ve done to my body through the eating disorder? Or internalize how others questioning me have made me question myself?

I’m trying to remind myself that I made some good decisions along the way as well:

• shutting it down in the first place and insisting on a pre-race MRI when everyone advised against it, telling me it was my hypervigilance

• insisting on a second MRI post-RAGBRAI, even when medical professionals told me it was classic presentation of labrum/hip joint.

• questioning the first ortho who read my MRI and told me it was femoral shaft. I’m no radiologist but I’m pretty sure I can tell when something is shaft vs neck. I sought out second and third opinions who confirmed that it was, in fact, intertrochanteric/neck. This is important because these fractures are much more high risk that femoral shafts, and I need to be careful. Had I blindly relied on the first ortho and his advice, things may have ended up very poorly.

The standard MRI garb that many runners know all too well.

At the end of the day, I’m still looking into the reasons why I started to get that bone edema pre-race in the first place - I have a litany of tests lined up (blood tests, hormone levels, DXA scan), to make sure things haven’t turned for the worst. I’m doubling-down in focusing on nutrition and making sure I don’t ever go into even the slightest caloric deficit (three cheers for still eating the same amount during this time of injury as I was during training!)

Let’s be honest: the causes aren’t one or the other, it’s a mix of all of the above. And I can shake my head knowing the stupid string of events that led me here, and also have it serve to be a wake-up call that I still need to be super vigilant about my bones. Like so many things in life, it’s never so black and white, so I’m taking responsibility for all those decisions, and learning from them.

Still, not quite sure I’ll ever be able to trust an MRI again.