2010 was a rough year for me, as I was dealt some very serious injuries: bilateral inguinal hernias, obturator hernia, and a labral tear in my right hip. Ok, that’s a mouthful! This was the first time since 2003 I’ve had to take time off from running. I’ve trained through other things (like my fractured rib in ’07, torn calf in ’08), so for something to completely knock me out…. was a very big deal! I knew when it wasn’t getting better with conservative treatments, ~PT/ART/Massage/Chiro./Acupuncture, that something was seriously wrong. I’ll try to break it down on what I experienced and how I cameback.
Labral Tear in right hip joint
Looking back, I’ve had a few “moments” over the years where I’ve felt a “pull” in my right hip (flexor area) or had some sort of accident. Sometimes it would be sore, and my massage therapist would work on it, and it would feel better. I’ve also fallen down many times on my hips, whether while playing basketball, slipping on ice, or slipping in races (I slipped and fell on my right hip in a race in ’07). So I believe my hip issues may have been precipitating over several years, and all it took was some point for everything to “snap”. I specifically remember feeling a “pull” in my hip in fall ’09 and then again in Feb. ’09, when I tore my calf in a race, began dragging my leg, and then felt a pull in my hip. I dragged my leg for 5 miles before dropping out.
Assuming I had just pulled a muscle, I treated it as so (~getting massage, chiro., and acupuncture). I jogged easy for a few weeks. While my calf healed quickly, my hip did not. I began getting sharp/pinching pain in my groin (~feeling of pressure), and it became increasingly more difficult to lift my leg (~hip flexion). I went back to the doctor, got a bone scan, and it showed bilateral stress reactions on my pubic bones. The doctor said to take it easy. I continued jogging easy, and the sharp pain subsided.
Within a few weeks, I tried getting back to training and racing. I didn’t race too bad, but I couldn’t accelerate at all or use my “gear shift” at the end of races. It became extremely frustrating because I could start a race Ok, but at some point my hip/leg would shut down, like I’d lose control of it. Sometimes I felt like I was dragging my leg– it required a lot of “work” just to lift my leg. I had deep, dull pain in my hip with every step, sometimes sharp pains to my groin/down adductor area, and my leg felt unstable– sometimes it would get weak and give out. Conor said it looked like I was “churning butter” with my leg– it would swing all over the place. If I tried running beyond ~marathon pace for an extended period, at some point my leg would give out and shut down. I could do ~1K or mile repeats Ok, but anything beyond that, beyond MP, or trying to accelerate…. my leg would shut down. My massage therapist said I had less muscle mass on my right leg vs. left (right leg being the hip with the problems).
In April, still assuming it was a muscle problem (~my iliopsoas), I was getting extensive ART and massage treatments. That would make it feel better and improve my hip extention/flexion, but the positive effects were short-lived. I still had difficulties “shifting gears” at the end of races, as my leg would shut down. It felt like I was fighting my leg.
By May at the Indy Mini Marathon, I was at my worst. I had pain around my entire hip and in my lower back as well. It felt like I ran the race with 1 leg! My right leg felt like a “stump”…. like it would jar the ground, and there was no shock absorption/spring in the leg/hip. The last 4 miles felt like I was dragging my leg and couldn’t use it. I somehow managed to run sub 6:00 pace (1:18+), which I guess wasn’t bad considering it felt like I was running with 1 leg.
I went back to the doctor again, and they did an MR arthrogram. This is where they inject dye into the hip joint to illuminate it, and then they do an MRI. It’s a very specific test for determining whether there’s a labral tear (the cartilage in the hip joint). I need to point out here: I have specifically requested the discs of all my imaging and the paperwork findings as well. Here were the significant findings with the MR arthrogram:
Suspected small labral tear/separation at the superior aspect of the acetabular labrum
Chronic avulsion injury at the symphysis pubis, consistent with the general category of athletic pubalgia.
Ugh, bummer!!! Labral tears are serious, since the cartilage has little to no ability to heal itself. How did this develop– acute injury or chronic (bony or muscle impingement)? Is it inflammed (since labral tears can be present but not necessarily symptomatic)? However, of greater note: what’s causing the chronic avulsion injury to the symphysis pubis? This radiologist did not see any features on the MR arthrogram to suggest a CAM or pincer-type bony impingement.
Where to go from here? The doctor advised me to stop running and rest for 2 weeks. Then, I began running again…. and my hip felt even worse! Felt like my leg was collapsing, inner groin pain/pinching/pressure, and like the femoral head was grinding/jarring in the hip joint. My doctor decided to give me a little bit of cortisone in the hip joint to see if it provided any relief– for diagnostic purposes. Because the cortisone shot was isolated to the hip joint, they could determine whether the labral tear is truly inflammed, or if the problem is outside the hip joint. Sure enough, I felt relief, just with walking. I waited 2 days before I started running again.
Wow, when I started running again! It was like all the mechanical problems and deep hip pain went away. My leg didn’t feel like it was going to collapse under me, and I couldn’t feel my hip jarring with each step. I ran for a month, and in the meantime…. visited a hip specialist in Indianapolis (Dr. Lintner). He recommended a hernia specialist in Indianapolis (Larry Stevens), and suggested I see the very best labral tear surgeon, Dr. Philippon in Vail, CO. At this time, I thought my only option was surgery for my labral tear. I knew this might be a lengthy road, so I was very aggressive and persistent, sending the Vail clinic all my paperwork, imaging, etc..
I should also add that I seeked out several opinions about my MR arthrogram. My local physician consulted with a radiologist in California (who apparently wrote the textbook used by radiologists). He thought the labral tear was significant enough to cause problems. However, he said the “chronic avulsion” injury is very common in female runners, likely because of the shape of our hips and the muscular stresses imposed on the area. I also sent the images to a relative who’s a Radiologist, and he consulted with another Orthopedic Radiologist. They weren’t concerned about the labral tear, noting they’ve seen worse in football and hockey players. However, my relative thought it looked like my hip is rotated/twisted forward/medially (see x-rays below).
The people in Vail requested an Anterior view and Cross table lateral view X-rays of my hip, to determine if I have a bony impingement. The images are below:
I was consulting with Dr. Philippon’s Physician Assistant. In his opinion he didn’t think my labral tear was bad, nor did I have a bony impingement. However, after consulting with Dr. Philippon, he said I do have a CAM impingement. I researched what a CAM impingement is, which is basically a mis-shapened femoral head that “rubs” the cartilage in the socket. Looking at other people’s x-ray images…. no way does my femoral head look like that!
Although I was approved as a surgical candidate with Dr. Philippon, with the wishy-washiness of opinions (which included Dr. Philippon’s expert opinion), I couldn’t take the risk of undergoing the highly invasive and traumatic $40,000+ surgery, having my “femoral head shaved”, and risking whether I’d ever be able to train and race the marathon at the same level again. As my local physician suggested, I should try a conservative approach of getting back to running and see if I could successfully comeback.
I was also reassured to try this approach by Strength and Conditioning guru, Michael Boyle, and one of my runner friends, who also had the cortisone shot for a labral tear 10 years ago, rested, and successfully cameback…. no problems 10 years later. As Michael stated, 97% of the population will develop a labral tear, and most won’t know it or be symptomatic. As long as there’s no pain and no bony impingement, you can successfully live with a labral tear. If you have a bony impingement, it’s a far more complicated situation on whether to get surgery or if you can live with it. Knowing my tear was small and no longer inflammed, I decided to try and comeback without surgery.
Although my deep hip pain and mechanical issues from the labral tear had gone away following the cortisone shot, I still had persistent abdominal pain and a feeling of pressure/pinching in my groin. It was mostly a throbbing and sometimes sharp ache in my abdomen, a few inches below and to the right of my belly button. Sometimes I felt it on the left side too. This pain was especially bad after sitting, driving for long periods, and having the seat belt across my abdomen. Also, I had some pain on and above my pubic bones. The pain was especially bad when I would try to accelerate in races, as this area would tighten up/pull and I couldn’t “go”.
I should also mention I had a lot of GI issues for a few years, which I thought was a normal part of running. I would sometimes develop sidestitches that were so severe it was like someone twisting a knife around my lower abdomen. This happened to me when I ran my 2:38 PR at Twin Cities, where I had an excruciating sidestitch for 1/2 the race. Looking back now, I believe a lot of it was tied to what all was wrong down there.
I was referred to hernia and laproscopic specialist in Indianapolis, Larry Stevens. Larry felt my abdomen, had me cough, and do a crunch. He could feel a “pulse”, a weird palpable spot, right where I had the pain. He felt it on both sides. He said this indicated I had indirect inguinal hernias on both sides, which is a tear or weakness in the inguinal canal. The inguinal canal runs along the panty line of the hip. I did NOT have a big bulge, as most assume when they think of a hernia. Also, none of this was visible on the MR arthrogram, which was focused more deeply on my hip joint. He also said he’s been seeing more women runners with this condition for some reason. He was able to schedule me for laproscopic hernia surgery the following week (yeaaa!).
The laproscopic surgery entailed 3 small incisions, 1/2-1 inch long. I was put under general anesthesia. He used mesh and tacks to repair the hernias, kind of like patching up a tire. The tissue would grow over it. To his (and my) surprise– the hernias were far worse than expected! I had 5 hernias total– I had both indirect and direct hernias on both sides (4), along with a very rare obturator hernia in my groin. I had basically torn the entire inguinal canal! He had to put mesh and tacks over my whole abdomen.
He said I had enlarged inguinal canals, which is more common in men– this is how I’m developmentally built, so I had a pre-disposition to herniation. Also from researching it, obturator hernias are more common in thin women– since there’s less fat and more space around a thin woman’s pelvis, there’s greater possibility for herniation in the obturator canal. It’s likely this hernia was pinching the obturator nerve down my leg, hence why I’d lose control of my leg when I tried to accelerate.
Finally, that pain in my lower abdomen and groin was gone…. but I still had to recover from the trauma of surgery! I only took the 2 required anti-inflammatories for 5 days, knowing I’d heal faster without them. Bloating, constipation, and trying to get out of bed were the toughest things to deal with. After a week, I began walking…. and boy was that rough! I cried cause it hurt so bad, and I couldn’t even imagine running! I continued to walk every day, and then twice a day, for 5 weeks (probably 4-8 miles per day of walking).
I should first point out that we thought the problem all along was with my iliopsoas, adductors, and relating muscles around the hip/abdomen/back. I exhaustively received treatments with massage, ART, chiropractic care, and acupuncture. While all these things provided pain relief and helped improve my range of motion, the deep hip pain and abdominal pain persisted, which is when I began visiting doctors and getting imaging. I now know the muscles around my hips were being overused to stabilize my hip/abdomen/back because of the hernias/labral tear.
I did physical therapy pre- and post-hernia surgery with Brian Schuetter at St. Vincent’s Sports Medicine in Indianapolis. He’s a fellow runner and was ‘great’! I did PT for 4 months (2 months before surgery and 2 months after). I believe this helped A LOT.
I learned I had a lot of tightness in my upper right chest– I had fractured a rib back in ’07, so I had likely compensated for it, which meant a crazy right arm swing and significant rotation in my torso. With the oddities in my hips…. along with this “quirk” in my torso…. it’s easy to see how the “levee broke”. I had to work extensively on “opening up” the right side of my chest so my momentum was going forward rather than twisting.
I also had to work on my hip range of motion and mobility, both hip flexion and extension and also adduction and abduction. Hip extension continues to be a limitation for me, but I’ve learned to accept my anatomy for what it is. Especially, I had to work on stretching my hip adductors (inner groin) and strengthening my hip abductors (lateral hip). As female runners, we tend to overuse and develop overly strong adductors because of both the shape of our pelvis and also overpronation. You can see this in most females– the leg/knee collapsing medially during the running cycle. However, since we’re not moving laterally, we develop weak hip abductors, which further compounds the leg “collapsing” medially. My PT program involved several months of doing an exercise where I’d prop my leg on a chair, hang over, and lean for a few minutes into my inner thigh to stretch the adductors. Then, to strengthen my hip abductors I’d do “band walks”, which is lateral walking with a rubber resistance band around your ankles– this BURNS and is very difficult! I progressed to a stronger band.
I did a ton of different bridging and plank exercises, rotational and functional control exercises, spine and abdominal mobility, along with “rolling patterns” to work on gaining correct neuromuscular firing patterns. I had to learn how to disconnect my torso from my lower body so it’s just my legs lifting and going through the running cycle (rather than compensating by twisting my torso and overusing my hip flexors).
I had also lost a lot of strength and coordination in my right leg– I did lots of single-leg jump roping, lateral jumping exercises, and single leg balancing exercises. I’ve spent the past year and a half continuing to work on this, and I’ve come a long ways!
I was compliant-to-a-t with my physical therapy! I highly recommend working with a physical therapist– it was great being able to work on my weaknesses and see progress like I see with running. When I went for my follow-up post-surgery, they were highly impressed with everything I could do. My mobility and strength in my lower abdomen was excellent. I finally got the green light to start back running!
Starting with walking and progressing to running
A week following hernia surgery, I went for my first walk, ~30 min…. and it was painful and awkward! I cried…. a lot. I wondered how I would ever run again, considering how much walking hurt. I was emotionally wrecked after the first walk, so I waited a few days before I tried it again. Each walk got better! I kept walking 30 min-1 hour a day, and I progressed up to doing 2 walks a day (6-8 miles/day of walking). I figured if I walked twice a day, it would eventually make it easier getting back to running twice a day. I walked on bike paths and trails– rolling terrain.
I was cleared by the doctor after 5 weeks (late Aug.) to start back running. Him and the nurse were very impressed with everything I could do, compared to most patients– I credit the PT and walking. I started running 5 min. the first day…. and walking the rest of the time. It felt ‘amazing’ to run! I almost couldn’t believe I was running, given my emotional distress with walking a month before! I kept up my two-a-day walking routine. I did 10 min. of running the next day, then 15 min., 20 min., and so on. I was never exceptionally sore– I credit the walking (~being weight bearing) for easing my transition back to running. However, with my “new hips”, it felt like I had to relearn how to run. I definitely had some muscle/body quirks and saw a few health professionals to help me get over this hump.
I didn’t start tracking my training until after 3 weeks, when I felt I was training enough to start recording it. I kept up the twice a day walk-run routine until mid-October, when I was finally back to full running twice a day. I also got up over 100 mpw by mid-Oct. (yes, happened pretty quickly, and my body felt better running more too). In Oct., I started adding in strides and some light heart rate based progression runs– man, I was out of shape and slow! My first real workout (late Oct.) followed by my first race, were terrible (personal worst type terrible)!!! My husband Conor reassured me the next race would be much better…. and it was (2 min. faster for 10K!).
My friend Janet’s husband, Jay, contacted me in early Nov. about running Dallas White Rock in Dec.. I told him no way because I was out of shape. Well, after that second 10K and my first long run with progression pacing (2 weeks before Dallas), I took a leap a faith and signed up for Dallas!
A leap of faith in Dallas
I arrived in Dallas with this feeling I was meant to be there and that I might win my first marathon. Lo and behold, I get there and two African ladies signed up at the last minute! Oh boy, I was nervous! I was having dinner with the Robinsons the night before (elite coordinators), and Vanessa told me, “I think you can win!” She said it with conviction and a sparkle in her eye! She had total faith in me, and it made me believe it was going to happen.
The next day we toe the line, and I had this, “OMG” feeling… I’m about to run a marathon…. What am I doing here…. I can’t believe I was walking for fitness a only a few weeks ago! I hadn’t felt that nervous since my debut! We took off, and the pace was so slow and uncomfortable, and the two Africans were sitting on me. I wasn’t feeling great at all, and wondered when the Africans were going to take off. By 8 miles, I was pissed cause we were still running slow and the Africans were still sitting on me -20m back. Once the HMers turned off and I was alone, I took off and dropped the pace.
I finally started to feel good, and by 11 miles when we started to go around the lake, I could no longer see the Africans. I was completely alone and in the zone. I felt like I was out for a Sunday long run with progression pacing! I was feeling pretty good… until I hit the top of the second Dolly Parton hill around mile 21. I felt my legs collapse underneath me! I took a gel and within a mile I got my second wind. Those last few miles I told myself to run it like a 5K and took 1 mile at a time. I came across…. I’d won!!!!! 2:42, only 4 min. off my PR! It wasn’t until they put me on TV when I realized what I’d done (see video ).
Winning my first marathon…. esp. after what I went through…. was the highlight of my career (as I type this, I’m teary eyed!). It meant a lot to me. Little did I know it was the beginning of a ridiculously awesome next year!
I hope by sharing my story, it’s helpful to those who might be struggling with hernias and/or a labral tear. I also hope it provides inspiration that you can successfully comeback (esp. if you’re a high performing athlete). I also wanted to share my story to show that labral tear surgery isn’t always necessary…. a conservative and patient approach could save you from the highly traumatic (and costly!) surgery! Also, a labral tear may not be the main problem (as I found out with the hernias). Be persistent… Get lots of opinions… Keep all your records and imaging…and do your research!
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