To ITB or not to ITB

The world of English literature and running would be a very different place if William Shakespeare had written these- potentially immortal- words:

To ITB, or not ITB, that is the question:
Whether 'tis nobler in the legs to suffer
The hamstrings and Achilles of outrageous fortune,
Or to take massages against a Sea of troubles,
And by opposing end them: to die, to sleep
No more; and by a sleep, to say we end
The heart-ache, and the thousand natural shocks
That runners are heir to? 'Tis a consummation
Devoutly to be wished.

Of course Shakespeare did not write this, though there were moments in the last month or so where my self-pity certainly made me feel like quoting Hamlet. Usually I try to post a blog a month for my own benefit more than anyone else’s. In this case I wanted to wait a while, as late May to early June has been a particularly testing month for me. Since the completing the London Marathon I had felt a deep sense of fatigue, which I attributed to the fact that I ran a big personal best at that distance and after five months of good training was bound to feel a little tired. In retrospect I could have realised that something was wrong with my left leg, however I think it is always easier in hindsight to believe that I could have spotted the signs.

Throughout May I continued to see my physiotherapist in Bedford- three times over three weeks in fact- complaining of what felt like a hamstring twinge; as I began to re-enter into structured training for the Summer. I was told that there was minor knotting in the left hamstring, that I could do an easy run the following day and then return to training after that. This approach wasn’t yielding results and by the end of the fourth week of running, I did something that I hadn’t done yet in 2019, and that was stop at mile 10 of a 15 mile long run. Nothing was wrong, I felt strong if a little tired, besides the fact that my hamstring had seized up twice within the space of the few minutes. When I made the decision to stop and walk, a part of me knew it was the right thing to do; even if it felt incredibly frustrating and frankly strange to be doing it. Deep down something wasn’t right and I consoled myself that it had nothing to do with ‘chickening-out’ of the workout.

I contacted my coach to ask for a physiotherapist who could provide a second opinion on what was going on with my leg; as usual with popular physios, they tend to be booked up for at least a week. I rested and waited, being lulled into a false sense of security as my leg started to feel better. So it was a shock when the physio told me that I had three tears in my left hamstring, some historical and one made more recently. What then followed was one of the most painful physio sessions I have had to date, as I had to have my hamstring broken down again- due to me resting it for a week- so that I could then begin the healing process. I would be out for most of June from any sort of consistent running and that I would have to extensively strengthen my hamstring back up again.

After seeing the physio there was a sense of relief, shock and sadness. I had not been feeling quite right when I had returned to proper training, and it was good to know that the underlying feeling had been right and not some form of paranoia. I was shocked that I had managed to damage my hamstring so badly, in all honesty it had felt like a minor twinge, but it must have been hurting more than I realised. At least I know what to look out for next time. Sad because I wouldn’t be running properly for at least a month.

To compound matters, and following from my post in May, I had decided to set some ambitious goals: 1) to attempt to run a number of track races across the Summer, and 2) to enter a Winter marathon abroad. Prior to discovering how bad my hamstring injury was I had entered a 5,000m track race at the end of July in Milton Keynes and the Valencia marathon in December 2019. With the seriousness of my hamstring now apparent the 5k track race was now cancelled, along with two road 10ks, and Valencia would have to be reevaluated. I felt foolish for thinking that I could run two successful marathons in one year.

Once I had let the news sink in a bit more and began to start doing the rehabilitation works for my hamstring, I decided to note the reflections I made through my most serious injury to date. I hope they can be of some help to other people who are going through an injury, and are looking for a way of getting through it in a more constructive fashion:

1.       Whilst recovering from an injury the best way to be is in the present. There is little point in making concrete plans about what I am going to do once I recovered from my injury. Why bother risking further injury and delay to come back even a week earlier? Once I had accepted what had happened the best way was to work on a day-by-day basis with the rehabilitation work the physio had given me.

2.       This in turn means that I had to accept that my plans had to change. It is always easier when things are going well and I am running strong, to make predictions and book into races. It takes a lot more resilience and confidence to acknowledge, that I am going to have to drop out running some races to do better in the future.

3.       Usually related to points 1 and 2 above, is loss of confidence because of the injury and the fear that I will not be able to return to the same levels of running post-recovery. I have seen a lot of runners go through this, and there is no easy route out of this desert of bleakness. I have found that when I initially get injured I tend to oscillate between feeling sorry for myself and then being too hard on myself. My view on this is to be flexible in how I approach my recovery and running, not putting a fixed plan on how it will work, and working on the immediate results I am getting. To be clear this doesn’t make the situation any easier, though it could ease the frustration of going through an injury.

4.       Fear if what I will be missing out on in the future, e.g. the 5k track race, as well as the uncertainty of not getting back into training.  In this age of social media, it has the appropriate acronym of FOMO (fear of missing out); though I wouldn’t necessarily say that is what I felt. It’s more to do with feeling the need to have a plan in place, and making a steady progression towards the goal of running another good marathon.  It was frustrating to not be able to run on the track, however running won’t suddenly disappear overnight whilst I am injured. It is about remembering that there will always be another chance to run on the track.

5.       I also found that I had to constantly remind myself that running and the improvements we make in running are not linear developments. I have seen many runners go through a plateau for a number of years to suddenly have a big breakthrough race. It’s the same for injury, some moments you feel that you are ready to return to running and in other moments the injury makes you feel like you are back at square one.

6.       Probably the most obvious thing- to anyone reading this- is that I made sure I worked effectively with the physio in London. That was mainly figuring what caused the injury and the strength & conditioning work that will aid in the recovery. From getting deeper into the problem of my hamstring; I think I was carrying an historic tear during training (that I believed to be an ITB issue at the time), I then partly tore my hamstring during London 2019 and further tore the hamstring again when I started training again.

7.       The other thing that I have truly learnt whilst healing my hamstring is that I am not going to have one massive jump back into full-time running again, but it will be a gradual process. I have managed to find a certain sense of satisfaction in ticking off the small improvements that I am making in my rehabilitation exercises and strength work.

8.       I am currently reading a book called Running Free of Injuries: From Pain to Personal Best, which talks about runners having a choice about what they want to do when injured; either focus on what got them into this problem or look at solutions for solving the injury. I have tried to put this into practice over the last month.

Right now I am just grateful to be able to do the recovery exercises for my hamstring, and slowly start running again. As long as I can keep building on each run on a day-by-day basis then I can always take some measure of achievement from my running.

With the flights and accommodation booked for Valencia, one way or the other, I am going to this marathon in December. One thing is for sure I won’t be going down without a fight in this training cycle.