I contemplated quite a bit about how to begin this blog post. Speaking about injuries can be a sensitive subject for many runners, myself included. So, I decided to set for a long run a few weekends ago, and let my thoughts come to me organically. I was running along a beautiful river, here in Colorado, and noticed the movement of the river water, and how different animals were either fighting against the current, or freely flowing with it. As the miles went by, I noticed that some portions of the river had rapids, while other areas were stagnant and calm. Some places were teeming with wildlife, while others were barren. I started thinking that this was such an excellent metaphor for returning to running from injury. At times it seems the recovery process is flowing along like planned, calm and productive, then you hit a rapid, or a setback. Some days you find yourself also wanting to swim upstream and fight against the current, while other days you just want to give up and be carried away downstream.
On some runs, you may also find yourself completely alone. You are in a different place in your running journey than your friends who have not had an injury to overcome, and the path seems so barren and lonely. But, when you make the conscious effort to keep going, despite wanting to give up, you find that you practice gratitude and gain some perspective on how far you have come. Just as a river that keeps flowing forward, you too will experience various things along the way
, that build your strength, character, and resilience.
Although I do not take pride in saying this, most runners at some point in their running journey will experience the devastating process of coping with an injury. Despite doing all of the “right things,” sometimes injuries are inevitable. Overtime, the accumulated wear and tear that running has on the body, outweighs the body’s ability to heal and recover, and injuries manifest. Today I would like to share with you, my own personal story of severe injury and how I was able overcame it, return to running and thrive.
I have been a distance runner for close to 13 years now, and have experienced some minor injuries throughout my running journey. None, however, have compared to the severity of my most recent one. In 2019, I found myself training especially hard for the California International Marathon (CIM), in hopes of not only qualifying for the Boston Marathon, but to actually run enough to get under that qualifying time and get in. For those of you that are not aware, simply qualifying for this prestigious race, does not ensure you have a spot at the start line. With the popularity of the Boston Marathon, and the amount of runners, like myself, who have only dreamed of running fast enough get to the start line, there is a lot of competition for those coveted spots saved for only the fastest in the field.
For the past 3 years, I have qualified for the Boston Marathon, but not by enough to earn that spot at the start line. In 2018, I missed the cut-off for the 2020 Boston Marathon by 23 seconds, fueling my motivation to work extra- hard in 2019 to run a much faster time, and ensure I earned that spot in the 2021 Boston Marathon.
Three months before CIM in 2019, I started noticing a weird and painful sensation in my pubic bone and pelvic area. On my runs I kept having this internal dialogue with myself, “What in the world is this sensation? This feels like there is a force or a tiny being, in the middle of my pubic bone, ripping my pelvis apart… this can’t be good.” Having gained so much fitness throughout this training cycle, I pressed on despite the discomfort. I made a point to do things that were in my control like: following my anti-inflammatory nutrition protocols, and resting and recovering diligently. I decided to make the choice to push through to CIM in December, get my goal, then take a much needed rest.
Now, I must interject here and say I am not advocating for pushing through injuries to do further damage to your body. I was under the care of a Dr. and PT(Physical Therapist), that told me that if I could handle the pain, it would be ok to push through for a few short months to my race, and then take that much needed time off. So, I did just that, and achieved my goal at CIM, running close to 14 minutes under my needed Boston Marathon time. I knew I was definitely fast enough to ensure my spot at the 2021 race and now it was time to REST.
After taking 6 weeks completely off from running, I decided that the day had come to start back to easy running on the treadmill. But, lo and behold, that familiar and nagging pain in my pelvis was back. I went back to my Dr. to get some imaging done to see exactly what was responsible for this excruciating pain. My MRI showed something called, “osteitis pubis.” What in the world is this weird-sounding diagnosis? It sounds almost inappropriate to say out loud! Osteitis pubis is a fancy way of saying that there is inflammation in the pubic bone. It can be cause by numerous things, but in my case the adductor attachment points onto my pubic bone were the culprit. No wonder I was in so much pain!
For the next 10 months I underwent numerous conservative treatments. One in particular might have been the most painful procedure I have ever had done in my life. The procedure is called PRP (Platelet-rich plasma) injections. This involves taking numerous vials of your own blood, collecting the plasma (the thick, viscous portion) then injecting it into the injured site to encourage your body’s inflammatory response to that area, to promote healing. I had 3 large syringes of plasma, slowly injected into my private areas, a process I would not wish on anybody, but the natural healing aspect of it seemed very worth it to me. So, this is why people think runners are crazy, right?
Upon researching osteitis pubis, and some other athletes that have recovered from this injury, I discovered that the elite runner, Laura Thweatt, had her own debilitating experience with this same injury. I reached out to her for guidance, she is a fellow Colorado resident, and she gave me the name of a local strength coach, that helped her through her injury process. I immediately called Kevin Purvis, at KP Performance, for help.
I worked for 10 months with Kevin, as well receiving conservative treatments for this injury such as prolotherapy, shockwave therapy, active release techniques, and dry needling. Basically, everything that can be done to help with this injury, I did all of it. I saw some slight improvements, but after nearly a year of putting in hard work to heal and get stronger, I was still experiencing that same pain while trying to get back to running. That’s when I decided to listen to my gut instinct, telling me that this might be something more serious, and no amount of conservative treatments could help relieve me of my pain. For me, running is much more than a form of exercise or a way to be competitive. It is just as beneficial for my mental health and wellbeing as it is for my physical health, so seeking answers to how to go about returning to running pain-free was my main goal at this point.
After more extensive research, I discovered the Vincera Institute in Philadelphia, where some of the nation’s (and the world’s) leading surgeons in core and pelvic injuries, practice. With the support of my amazing husband and one of my best friends, I flew up to Philadelphia to see if I could get some answers. After some incredible scanning done at this institute, they found what I was dreading: a severe injury only surgery could repair.
While reviewing the imaging with the doctor was shocked I was even able to run a marathon with the type of injuries I had. I was mortified and shocked at the same time too. To put it simply, both adductors on each side of my body were tearing off of my pubic bone, and my rectus abdominus (ab muscles) was 1/3rd torn off my pubic bone. Surgery was scheduled for the next day. At that moment all of the feelings from the past year that I had been experiencing, bubbled to the surface of my being: Guilt of not knowing the extent of my injuries and putting my body through this trauma, fear of having this surgery, and relief of finally getting a diagnosis.
After the surgery, I followed a protocol designed by the PT from Vincera Institute, to ensure I was recovering appropriately, and was cleared to begin run-walking again at week 7. With a smart “return to running plan.” I was back to fully running in about 8 weeks. In conjunction with the PT protocol, following Kevin’s strength and mobility protocols, I have also been working with an incredible trainer, Jen Lopez at Vital Strength and Fitness, to get my body strong again to handle the impacts of running. Currently I am training for the Boston Marathon in October of this year, and am pain-free, injury-free and beyond grateful for this laborious and painful journey that I have been on since 2019.
My intentions behind sharing my story, is not to promote running through injury, or to be applauded for overcoming something hard and painful. My hope is for my story to be relatable, to emphasize how amazing the human body is, and its capability to heal when given the proper nutrients, and in my case after receiving the proper medical attention. My experience is a great example of how wonderful the medical field is in helping people to recover, but also the importance of consistently choosing to nourish your body with the proper nutrients to support healing. So this is what I would like to share next.
Although, my injury did require surgery and I am beyond grateful for the talented surgeon that helped me reattach my muscles (Shoutout to Dr. Meyers!), I know that my body was also capable of returning to running after such an intensive surgery, as promptly as I did, because of the nutritional choices that I make on a daily basis. Consistently nourishing myself with whole, nutrient-dense foods, while avoiding certain ones that promote inflammation in the body, I prepared my body for the traumas of the surgery itself, and for the healing and recovery process afterward.
So, let’s talk more about these beneficial nutritional protocols that I follow!
In order to speak about the foods that help decrease chronic inflammation in the body, let’s first discuss what inflammation is and how it slows the healing process and increases the risk for injuries.
What is inflammation?
- Inflammation is a natural bodily process that is needed in order for the body to function optimally and properly
- It is the biological response of the immune system to act as a defense mechanism to aid in proper blood flow and nutrient delivery to affected areas
- It is needed for healing and repair, eliminating pathogens from the body
We need inflammation for our bodies to work optimally, to heal, grow stronger, and recover. Inflammation is NOT the bad guy! The goal is not to eradicate inflammation completely, but to prevent it from becoming excessive and chronic. Chronic inflammation is prolonged, consistent and very damaging to the body. Chronic inflammation can interfere with the body’s healing processes, and slow down recovery leading to injuries, OR prolonging injuries from recovering.
What kinds of foods can lead to chronic inflammation?
- High sugar, high fat (poor-quality fats), highly processed foods, and alcohol
- High trans fat foods and high omega-6 fatty acid content: vegetable oils: margarine, corn, soybean, safflower, canola
These highly inflammatory foods can lead to chronic inflammation and cellular damage. Not ideal for optimal recovery and healing.
Can nutrient deficiencies cause chronic inflammation?
Nutrient deficiencies are far too common, especially within the running community. It is a great idea to get routine bloodwork performed to see what deficiencies may be present, and work with a certified nutritionist to discover a variety of foods that may help support these deficiencies. Some examples of nutrients you may be deficient in are:
- Magnesium (Mg) deficiency: ~50%- 75% of the population is deficient in Mg.
- Mg deficiency promotes chronic inflammation.
- Mg depletion in the body promotes monocytes (white blood cells) to release more pro-inflammatory cytokines -NOT good for healing and/or recovery
- Vitamin D deficiency: 1 billion people worldwide are deficient
- Low Vitamin D levels are associate with an increase in inflammatory cytokines.
- Vitamin D is essential for strong bones. As runners we definitely need strong bones to withstand the impact from our sport. A deficiency in Vitamin D, could lead to an increased risk for stress fractures! The dreaded stress fractures that every runner fears, can very much be linked to a poor diet coupled with chronic, systemic inflammation.
- Imbalance of Omega 6 fatty acids (FA’s) to Omega 3 fatty acids: Omega-6FA’s are essential in the body for healing and inflammatory response
- Omega-3FA (EPA/DHA) are essential for quickly resolving acute inflammatory responses
- If Omega 6’s are consumed in excess: can cause chronic inflammation leading to disease, immune dysfunction, and obesity
- It is important to keep a balanced Omega-6:Omega-3 ratio to avoid chronic inflammation
- Optimal balance is 1:1 ratio
Bloodwork and Testing
Obtaining bloodwork and bone density screens (DEXA) to rule out nutrient deficiencies is something I encourage runners to do. Finding out any deficiencies and areas of improvement in the diet, along with addressing a potential need for supplementation, is very valuable information that can keep injuries at bay, and support the healing process from injuries.
Some of the nutrients and hormones to test for in routine bloodwork are (and not limited to):
- Full Iron panel
- Vitamin D
- B12 (especially if vegan or vegetarian)
- Omega 3
- Cortisol levels
- Hormone levels, thyroid levels
- Red Blood Cell Count
- DEXA scan for bone density
Addressing deficiencies and areas of improvement within a runner’s diet, are important first steps to establish a foundation to start building on, to create a strong and healthy body. After this foundation is set, a personalized nutrition plan may be created to address these deficiencies, and either decrease the risk for injuries, or help promote the process of healing from injury.
What Macronutrients and supplementation supports recovery and healing from injuries, and what foods should I avoid/limit?
It is important to remember that fueling yourself when you are injured, is just as crucial as fueling yourself during training. Your body needs the calories and nutrients to heal, to build back stronger and ready for the impact of running again. I want to make it clear, just because you may not be running at the moment, or expending as much energy, under-fueling during this temporary time away from running, will make your healing slower and may potentially make the process of returning to running longer. You should not feel like you have to earn your food, or you are not deserving of as many calories, because you are not able to run as much are you are used to. Now is the time to load up on a wide variety of foods to keep inflammation under control and to support the healing process. Remember the body is designed to heal when given the proper nutrients and the right environment!
Here is the nutritional protocol I used to prepare my body prior and post-surgery, and for my own healing process. It is really not much different than how I eat when I am in training.
- Eating organic, whole foods, vegetables: increasing intake of dark colored fruits and vegetables (anthocyanins), good-quality protein, and healthy fats. I increase my intake of foods that boost glutathione (antioxidant) production: broccoli sprouts, cruciferous veggies, garlic and avocado
- Eating healthy fats and oils: avocado, seeds, nuts, unrefined oils: extra virgin olive oil, avocado oil, ghee, also increases absorption of fat-soluble vitamins (A, D, E, and K)
- Eating adequate protein promotes tissue repair, conserves muscle, and is involved in nutrient transport and wound healing. Make sure you are not skimping on protein intake! Aim for 20-25% of daily calories in protein.
Sources: Grass fed beef, wild-caught salmon, eggs, pasture-raised chicken/turkey, lamb, seafood, beans, bone broth, quinoa, collagen supplementation (taken with at least 50mg Vit C)
- Increase intake of Vitamin C, Vitamin A, Vitamin D+ K2, beta carotene, Vitamin B complex, Vitamin E, polyphenols, Zinc, Magnesium, Selenium, Sulphur- rich foods
Sources: berries, swiss chard, kale, spinach, arugula, squash, brussels sprouts, broccoli, cauliflower, nuts and seeds, grass-fed beef, wild-caught salmon, seafood, turmeric, eggs, onions,avocado, garlic, fermented foods, oils: extra virgin olive oil, avocado oil, ghee
- Cooking more with potent-anti-inflammatory foods and spices: onion, garlic, turmeric, ginger, cinnamon (Tip: add later in the cooking process to ensure heat does not destroy benefits)
- Supplements and brands I use: Fish oil/Omega 3 fatty acid/DHA/EPA (I like the Nordic Naturals brand/ 200-4,000mg/day) If you require surgery, discontinue use of these 1-2 weeks prior because of blood thinning effect), probiotics (look for large number and diversity, I use the Klaire labs brand), Magnesium glycinate (400-800mg/day), collagen (Vital Proteins brand)
- Foods to avoid/limit that promote inflammation:
- High sugar foods and highly processed foods like candy, packaged goods, sodas
- Highly inflammatory oils: canola, corn, soybean, cottonseed, peanut, safflower, sunflower, rapeseed, grapeseed
- Any foods you have a known sensitivity to or allergy. If you do not know if you have such sensitivities, it is a good idea to explore that option with a certified nutritionist to eliminate any foods that may be keeping your body in a chronic state of inflammation.
Learning to nourish yourself for healing and recovery is crucial in ensuring your body stays strong and healthy, and that you get back to running injury-free. Just as everyone’s recovery from injury process is individual, so is a person’s nutrient requirements. I think we can all agree that being injured is not a state that runners want to be in for very long. We can also agree that nutrition during this time is very important, but so is remaining mentally healthy, and experiencing injuries not only take a toll on the body, but they can drastically affect the health of the mind.
Through my personal injury journey, I have come across some excellent tips and resources that have helped me combat the emotional struggles that come with injuries and I would like to share these with you. The mind and the body are very much connected so, whatever your thoughts and feelings are they will either negatively or positively impact your body. Something to keep in mind during this journey.
How to approach the mental aspect of injuries?
- Unfortunately, a very common thought emerges in the mind of an injured runner: “Will I gain weight while I am not able to run as much?” To be honest, this thought crossed my own mind when I was recovering after my surgery and gaining fitness back. So, I cannot say that this should not be something we think about. Runners are validated in feeling this way, but I will say that this is the time to really focus on repairing any broken relationships with food you may possess, or any negative thoughts you may tell yourself surrounding how you eat. Consciously moving away from weight and numbers, and whatever control those may have over you is not an easy thing to do, but this is the time to practice that, and it will benefit you long after you’ve recovered from injury.
- This is the time to focus on truly listening to your body and recognizing its cues. Maybe your injury was a result of under-fueling and ignoring your body’s hunger cues? Or, maybe you over-trained and did not listen to your body when it needed rest? This is the time to begin listening to what your body is telling you it needs in the moment, and focusing not on weight or numbers, but on ensuring you are getting the proper nutrition you need to heal your body on a daily basis. Your weight will naturally go back to where you feel your healthiest, once you return to running. And the goal is to not impede your recovery in any way during this process. Remember stress and anxiety create a highly inflammatory environment in your body and stalls healing!
- Remember: Food, sleep, hydration, and anything you do for recover is not a want but a need. Prioritize them.
- Acknowledge that there is a lot of change going on in your life while injured. You are used to routine and training. It provides certainty, structure, and motivation to achieve goals. I get it, I went from being the fittest I have ever been in my life, and running my fastest marathon, to needing surgery and starting back from square one. It is not easy. In fact, going through the injury process is a form of trauma and grief, and it can feel like your identity may be a bit lost. Now is the time to reflect inward and look for other ways to find meaning in your life apart from running. Who are you apart from running? What can you do for self-care? What are some hobbies you like outside of running that you can spend more time doing now in this healing process? How can you help others during this time, when you may normally be too busy due to training? Once you are back to running you may find that forming these internal values, will benefit you in your training, by keeping a healthy perspective and balance in your life.
- Injuries can be a very lonely place. Especially when you may be used to seeing your friends in running groups, or spending your weekends running with them and grabbing coffee and brunch after. When you form that community with other runners, I can assure you that you will find that you are not in the minority when it comes to going through injuries. You are not alone. Now is the time to seek support from your friends that have been in your position. The natural tendency is to retreat inward, but I encourage you to remain open to being social and doing other activities with friends during this time away from running. Try not to compare your current situation to where you have been in training before. Live in the moment, because that is the place that will best serve you. It is also not beneficial to compare your personal journey with anyone else’s. Practice grace and gratitude.
- Something that really helped me to cope through my injury, was to read and research about it. That led me to the Vincera Institute where I received my surgery, but also to various support groups for injured athletes and runners on social media, where I felt supported and encouraged through the tough times.
- I also spent this time reading about the sports psychology side of returning to sport after injury and how to understand and deal with all of the emotions that come with it. This has been very beneficial in understanding this process and a lot of the information I am sharing with you have come from these various sources.
Resources for Support
I highly recommend the books:
Rebound: Train your mind to bounce back stronger from sports injuries by Carrie Jackson Cheadle and Cindy Kuzma
The Comeback Quotient by Matt Fitzgerald
The podcast: The Injured Athletes Club (The authors of Rebound)
Social media group on Facebook and Instagram: The Injured Athletes Club
As you go through your own personal running journeys, I hope you find joy in the process and recognize that like life and like the river I spoke of in the introduction, there will be lots of ups and lots of downs, and times of serenity followed by turbulence. When you are returning to running from injury, give yourself grace, practice gratitude for your body’s ability to heal, and have patience. Focus on the things you have in your control which are your nutrition, following your running recovery plan, and your mindset.
Thank you for letting me share my story. You are not alone. Keep putting one pain-free step in front of the other, mile by mile, and you will be back to achieving your goals maybe sooner than you think.
“It has been said that time heals all wounds. The truth is that time does not heal anything. It merely passes. It is what we do during the passing of time that helps or hinders the healing process.” – Jay Marshall
Kaydee Gregg, N.T.M.
Nutrition Therapist Master