Monday, May 18, 2009

On Being Injured

If you are a runner, you are going to deal with being injured. I hope that you are very durable, or at least a fast healer, so that your need to cope with running-related injuries is minor. But, trust me, if you are in this for the long term you are going to get hurt. Like I am right now.

Left hip, back side, probably gluteus medius. It’s inflamed, and in spasm. Therefore it irritates my sciatic nerve, so I get the occasional shooting pain down my left hamstring and ITB. Running more than a couple of steps is painful. Sigh.

As an endurance sport, running is essentially a long series of physical stresses followed by periods of recovery. In order to be a runner, you will be testing your body’s capacity to adapt to your workouts and races. That repetitive process, whether played out over minutes, hours, days, weeks, or years, will eventually lead to a break down, or two, or three or more. It is inevitable.

In her seminal 1969 book “On Death and Dying", Elisabeth Kubler-Ross first introduced the now-famous concept of the five distinct stages of grief. At first she intended to apply these stages to those with terminal illness, but she later postulated that the very same coping model applied to anyone suffering a loss that was felt deeply on a personal level. I can’t imagine a better definition of how we runners react to injury.

Stage One: Denial.
You think that the pains you feel couldn’t possibly indicate an injury; after all, this can’t be happening to you. You run, you recover, you do it over and over, so this just can’t be an injury, and it will just go away if you ignore it. You keep running.

Stage Two: Anger.
Of course, the pain intensifies, to the point where you can’t ignore it any longer. You think (and maybe even shout out loud, enraged), “Why me?” At this point your fellow runners and loved ones find it difficult to deal with you. You simmer and seethe; words of encouragement sound as if they are mocking you, and anyone who is running is subject to your resentment, envy, and displaced rage. Of course, you keep running, with gritted teeth and an edge to your attitude.

Stage Three: Bargaining.
Whether you are religious or not, you begin to negotiate your case with a higher power, muttering things like, “Please, just let me get through the next race, then I promise I’ll take some time off and I’ll start stretching regularly and eating right and everything else I should have been doing.” At this point you also start impulsively improving other habits, in the desperate hope that doing right by your body in other ways will magically heal the running-related injury. You make sure to brush twice a day, you eat better, you remember to take your vitamins, and you get to bed earlier. Eventually, you try taking one day off from running, as if you can trade just one workout for a clean bill of health. But, of course, you go right back and you keep running.

Stage Four: Depression.
The pain of the injury has now compromised your ability to run. You take one day off, then two, then suddenly a week has gone by and you haven’t logged a single mile. You stay in bed a little longer in the morning, thinking “That’s it, I’m finished, I’ll never run again.” You find yourself lingering in the ice cream section at the grocery store. Your running shoes are now tossed into the back of the closet; you can’t stand to see them. The latest issue of your favorite running magazine arrives, and you toss it into the recycling bin without even opening the cover. Nothing can cheer you up. You’ve stopped running and you think you don’t care.

Stage Five: Acceptance.
Finally, one day, you look at yourself in the mirror, and you admit, “It’s true, I’m injured.” You feel slightly ashamed at having taken all this time before admitting to the obvious … again! You also start to listen to your family and friends, who have known all along that you probably just needed some rest, or maybe a visit or two to your physician/chiropractor/acupuncturist. While you don’t quite see light at the end of the tunnel, at least you admit that you are in the tunnel. And you stop despairing, and start making the adjustments necessary to get back on your feet. After all, you haven’t lost your identity, you’re just injured. That’s right, JUST injured. You know you need to be patient, and you finally begin the healing process.

Ironically, I’ve been through this more times than I care to count, and yet I fall victim to the same pattern almost every time. You could take my running log, page back through it, and discern the stages as I plodded through them over and over again. Take this latest injury, for example. It was over eight weeks ago that I first wrote “left hip tight and sore”. Did I change anything? Nope. That’s stage one. Then you see the tone of the log entries change, and the stray comment appears such as “damn hip still sore, WTF?” Yep, stage two. Then there are some embarrassingly sincere comments like “need to stretch more” and “taking anti-inflammatories”, and (rolling my eyes as I type this), “just need to get through the 50k at Bear Mountain”. Right … stage three. Of course, I managed to get through the 50k race, despite limping along the entire way. Immediately thereafter I stopped running entirely. Sure, I got on my bike and did some half-hearted pedaling last week, but I also “overslept” a couple of times and missed the bike workout completely. My wife tried to be sympathetic, but I was moping around and detaching. Tsk, tsk, stage four. Then, at the end of last week, I finally faced the music and just admitted that I’m hurt. I also began to recall in more detail the time two years ago when I had a very similar injury in my right hip. I eventually overcame that one, and my right side is completely fine now. Given the right amount rest and easy stretching, I’ll get the left side back in shape someday too. Made it to stage five.

Kubler-Ross emphasized that not only is there nothing wrong with going through these phases, but in fact it is necessary, on a psychological level, to move through them as part of the normal process of coping with loss. She also pointed out that not everyone experiences all of the stages, and not everyone goes through them in the very same order, but to my estimation they remain an elegant and resonant way to describe a very common experience.

May you never be injured. But, if you should fall victim to the rigors of our running lifestyle, try not to beat yourself up too badly for being, well, human.

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