Pain is a really interesting thing. As an endurance athlete, my high pain tolerance is something I pride myself in. Running a marathon is painful, but I’m not sure anything will ever compete with 500 meter repeats on the erg in college. That shit sucked.

And then there’s varying degrees of pain. When you go to the doctor with an aliment, they’ll generally ask you to rate your level of pain on a scale of 1 to 10.

Well, fun fact: when you’ve got chronic pain, they’ll also ask about your mood levels. How pissed off are you today because of your pain? Are you depressed? How limited is your life right now? Are you suicidal? Can you perform your job? What about your daily activities? Please choose the smiley face that applies to your current mental status.

Chronic pain.

Chronic pain is interesting, too. It’s this nagging presence in your body…something is not right, but you learn to live with it. You learn what it’s like to roll out of bed in the morning and feel it. You know what stretches make it [temporarily] feel good, and which positions make you feel like you belong in a geriatric hospital. From an emotional level, some days are better than others. Some days you want to guzzle an entire bottle of wine and hysterically cry over a bag of Doritos. Other days, you’re optimistic, and can see a light at the end of the tunnel.

I finished the Philly Marathon in 2016 and knew I needed a break because of my hamstring (which I later learned was actually my back). But what I didn’t know was just how long that break would end up being.

18 months.

It seems like I’m tempting fate by saying this, but: 18 months later, I am pain free. And in an attempt to keep this post as straight forward as possible, I want to briefly go into detail of my injury process. Please remember that I am not a medical professional; if you’re in pain and don’t know why, keep asking questions (Jason would be so proud right now). Do your research (and not Dr. Google research either…), consult opinions of PTs, remember that your MRI is NOT always the best representation of what’s going on, and above all – understand how the human body works. The more knowledge and understanding you have of your own body, the more you can decipher what’s really going on.

December, 2016 – March 2017: hamstring tendinosis
Initially, I thought my hamstring was very seriously injured. Symptoms included:

—Pain shooting down the back of both legs, but mostly targeted right under my butt. The pain never traveled below the knees.
—Some light pain in my back, but nothing to really write home about.
—Very limited flexibility.

My pelvic MRI showed inflammation at the attachments of both hamstrings, but oddly, moreso in the leg that didn’t hurt so much. (Again: MRIs are not always helpful for soft tissue injuries). My doctor + PT diagnosed me with hamstring tendinosis. I started up a 3x/week strength training program, designed by him, with a massive focus on eccentrics and all hamstring rehab accessory work.

Somewhere in February-ish, the pain down the back of my left leg seemed to dissipate. I assumed the strength training was working.

April 2017: hamstring PRP
Initially, I was seeing an orthopedic doctor for my injury. I’ve worked with her before, so I liked and trusted her. I inquired about a PRP injection, and she agreed that we could give it a try. My insurance did not cover it, and I coughed up the money. Sigh.

They drew enough blood to inject PRP in 3 locations around my ischial tuberosity. Going into the injections, I was terrified, and had heard it was going to be one of the most painful experiences of my life. It was, in fact, not so bad.

Post-injection, I was instructed to remain on crutches for 3 days, then resume very light activities, like walking and very low level PT exercises. I was told i could try a run 2 weeks after the injection. My first tester was a shakeout at the Boston Marathon. 

The Boston Marathon
The weekend of the Boston Marathon 2017 was a turning point in the injury. The shakeout was…fine…but after spending the weekend sleeping on a floor and walking miles and miles around the city of Boston, I woke up the day after the marathon and could barely move. And, sure, the pain was shooting down my leg. But what really startled me was how the pain was radiating in my back. Symptoms included:

—Shooting pain down the back of one leg.
—Radiating pain specifically in my back – the area was around my L4 all the way down to S1, and even over in my SIJ.
—Incapable of bending over and standing for anything longer than 5 minutes. Lying down was the only comfortable position.

I immediately emailed my ortho doc and said, “I think we’ve made a terrible mistake…my injury is in my back and not in my hamstring.” She immediately referred me to a spine specialist. 

May 2017: Sacral Stress Fracture
I walked into the spine doc’s office, and he had my January pelvic MRI pulled up on his computer screen. He asked me to point to where my pain was on my back, so I showed him. He spun around, pointed to my MRI and said, “yeah, of course you’re still in pain there. You’ve got a stress reaction in your sacrum. It’s been there since the winter. You just need to let it heal.” 

I’m sorry, what? 

As I stared at him in disbelief, he continued to use the words “fracture” and “reaction” interchangeably, and in a very blazé manner. He then started laughing because he couldn’t believe that no one had told me that I had this issue.

I returned home from the spine doctor and immediately emailed my orthopedic doc, and informed her of the new diagnosis. She responded by telling me she HAD seen the bone swelling on the original MRI, but it was, “something that is seen relatively commonly in athletes/runners such as you,” and she justified her decision for targeting the hamstring in our rehab efforts because she believed it would help most in my scenario.

Ugh.

July, 2017: Diagnostic Sacroiliac Injection
Spine doc suggested getting a SIJ injection to confirm or refute that the pain was coming from my sacrum. If the pain went away with the lidocaine, we would know that the sacrum was, in fact, the issue. If it didn’t, we’d have to investigate somewhere else.

I was nervous AF going into this injection, so I opted to get a sedative. Being on a table for 20 minutes with a massive needle being inserted into your back? No thanks. The drugs were awesome and the procedure was quick. I walked away with a completely numb back – healed! 

Not.

The numbing agent was awesome. At least it confirmed that my major issue was, in fact, my back. But after about a month, the pain creeped back. Fuck. 

I returned to the spine doc and told him that the SIJ shots were…fine…but definitely not the be all end all answer to my problems. I felt empty and devastated. What was wrong? What could this be? He reminded me that my discs were fine: “your MRI was pristine!” as I started to hysterically cry in his office. In response to my tears, he said, “well I hope these are tears of joy…no need to come back to me unless you’d like a spinal fusion!”

He left the office and instructed a nurse to escort me out. A few days later, he suggested I consult with a woman named Yetsa Tuakli – a physiatrist. 

August 14, 2017 – Dr. Tuakli

Physiatrist = Physical medicine and rehabilitation (PM&R), also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities (wikipedia) 

I had heard about Dr. Tuakli from my original orthopedic doc. She had a great reputation and had done a TON of studies with pain management via injection therapy. I felt optimistic going into my appointment with her. And, even better…she was a track & field athlete!! She had narrowly missed competing in Rio in the 2016 Olympics in the long jump for Ghana. Damn.

The moment Dr. Tuakli walked into the room, I knew it was going to be a different experience. Her energy was infectious and her interaction with me was unlike anything I had with any other doctor. When I spoke with her about my symptoms, she listened; I was no longer the crazy patient who had phantom pain. Dr. Tuakli believed me and actually worked with me to figure out what was wrong. She spent well over the “normal” time I’ve ever spent with a doctor, and every time before she’d leave the room, she’d patiently ask, “ok, Mary, did I answer all of your questions for today?” And, fun fact I later learned: I was her very first patient out of med school. 🙂

If it wasn’t for Dr. Tuakli’s patience and intelligence, I would not be where I am today – healthy and running again.

September 12, 2017: Facet Joint Injections
Her initial hypothesis was that my issue was related to my facet joints. She thought they were compressing a nerve, causing the pain down the back of my leg.

facetjoints2_250-BB.jpg

Image from spineuniverse.com

So in September, 3 injections were administered into L3 through S1 on the right side, and 2 injections to L4 through S1 on the left. Unlike the SIJ injections, they were received without any sort of sedation…which was fucking brutal. The procedure was quick, but I almost passed out on the table. Then as I was walking to my car, I threw up in the parking lot and had to lie down in the car before deciding to finally drive home. It was my fault: I was stupid – I jumped off the procedure table before I was really ready. Just me trying to be a superhero (get a grip, Mary).

This round of shots was immensely helpful. Obviously the lidocaine was a dream – I felt nothing in my back for a good hour or two after the injections. But what was even better was that they resolved almost 100% of the sciatic pain I was experiencing. HEALED!

Kind of.

After the initial drugs from the shots wore off, I started getting an intense aching/burning sensation in my hip socket — the front of the hip, my groin, over my pubic bone (almost like period cramps), the circumference around the hip. The pain worsened with activity and nothing seemed to make it feel better. So while the sciatic pain seemed to feel better…this hip pain was a new thing. WTF.

I explained the issue via email to Dr. Tuakli, insisting I get a hip MRI because I was convinced I had a labral tear. I was in pain…and I was sassy…and looking back at my email to her, I regret being so aggressively adamant that I was right and she was wrong.

As always, she was patient and wrote a well-thought response to my hostile email…but ultimately refused to prescribe me a hip MRI and told me I needed something called a caudal injection. This injection was to be injected into my tailbone, with the intention of the medicine traveling up my spinal cord, diffusing anti-inflammatories along the way, thereby calming down the discs from L5-S1 to even potentially L3-L4.

November 20, 2017 – Epidural
FINE. Fine. I will get another fucking back injection. I didn’t think she was right, but I humored her, and got the injection. It was sans sedation and there was no barfing. Success! 

Kind of.

There was a snafu with this injection: Dr. Tuakli had prescribed a caudal injection…but she wasn’t the doctor who administered it. So instead of a caudal, the doctor who gave the injection administered an epidural, which went straight into the disc (I believe at L5-S1). While effective in quelling pinpoint inflammation, it wasn’t what I needed.

When Dr. Tuakli realized what had happened, she decided to take matters into her own hands. She told me if/when this shot wore off, she’d give me the caudal the way she learned in school, and the way she prefers doing it. I was comforted knowing I still had another option, and I trusted her judgment.

Ultimately: the epidural was fine and it did help the hip pain (and any remaining sciatic pain)…but didn’t really help longterm. The shot lasted about 1-1/2 months, and I felt it totally wearing off in January.

March 22, 2018 – Caudal Injection
At this point, needles into my back ain’t no thang…but I wasn’t necessarily thrilled about a large needle going into my tailbone. Regardless – I was ready for this to happen.

The process was SUPER easy, and I received it with no sedation again. Yes, my pants were half down as I lied on my stomach and yes, my bare ass was exposed to a room of 4-5 people..but WHATEVER…just get me out of pain.

First was the numbing medicine, then dye, then the medication. When it was over, Dr. Tuakli was very pleased with herself, and showed me the x-ray of how the medicine successfully defused itself uniformly throughout my lower pelvic region. She explained that with many patients, the medicine will drift to one side of the spine or the other…but with my injection, it was perfectly placed and the medicine went exactly where it needed to go. YES.

Immediately post-injection, things were VERY different from the others. With the other back injections, the lidocaine into the spine completely numbed the area for a few hours immediately following each procedure. But with the caudal, the lidocaine went into my tailbone – a region that wasn’t in pain – so I didn’t walk away from this injection feeling on top of the world. I walked away feeling exactly the same as I did when I entered (plus/minus some humiliation points for the bum exposure.)

To be completely honest: I had zero expectations about this injection. As my 8th back injection of the year, I thought I had nothing left to lose. Maybe it would help…maybe it wouldn’t. Whatever, so over it.

Two weeks later
Exactly two weeks after the injection, things started to turn around. While the caudal injection didn’t necessarily help pinpoint back soreness…it helped any and all residual nerve pain I had been experiencing down my leg…in my hip…etc. Being able to control the nerve pain was a complete gamechanger. I can live with a sore back from time to time. Nerve pain was debilitating.

When I explained this “overall better” sensation to Dr. Tuakli, she actually informed me that many people who receive caduals report the same thing, which is super interesting. I just overall felt BETTER. Not 100%…but so much better.

Neural Plasticity and Pain
I started this blog post discussing the effect that pain has on us. And people with chronic pain know how disabling it can be. I will forever empathize with anyone dealing with a chronic injury because I know what it was like. My pain made me depressed…it made me irritable…I’d get in stupid arguments with Gabe…I’d randomly start crying at the gym…it was horrible.

So one of the biggest things I did towards the end of this saga was this: I redefined my relationship with pain. I learned that pain didn’t mean I was going to fall over and die tomorrow; instead, pain was my body’s way of telling me I might have pushed a little too hard on one particular day. It didn’t mean I was “starting over” with my healing. It just meant I needed to take a little step back.

When I actually started to believe that pain wasn’t so scary…I began to heal. 

I also stopped testing my injury. You know when you have an injury and you keep testing/poking/prodding it to see if it’s still hurt? Yeah. That. I stopped that. Completely. Cold turkey. Nada.

After reading Jay Dicharry’s book Running Rewired, I realized that every time I was testing my injury, I was remapping pain signals to my brain; the only way I’d get out of pain was to stop testing my body every.single.day.

I needed to reteach my brain that my injury was no longer something it needed to be on high alert from; I needed to rewire my system. So I stopped provoking pain and I started to believe that I WAS HEALING…and honestly, this was HUGE in my recovery.

Sleep and Pilates
Finally – I can’t undervalue how important sleep was in all of this healing process. And less stress. Somewhere along the way, I also had the realization that my sympathetic nervous system was in overdrive from lack of sleep and extreme stress from…LIFE. So I started getting more shuteye and also making intentional moves to back away from my computer/phone and spend more time with Gabe and Wilson.

The final piece of this entire recovery puzzle for me has been core work, pilates, and strength. I understood that while the injections helped with the internal swelling, I was still severely lacking in strength. At my last appointment, Dr. Tuakli told me, “you need to do pilates pretty much every day for the rest of your life.” So in the winter, I started practicing pilates – at first 3-4x/week – and now I’m down to about 2. I absolutely LOVE pilates and I have not felt this strong in a very long time.

Running and…what now?!
I threw out timelines about “coming back” to running a LONG time ago. I truly had accepted that I would never run anything longer than a 5k ever again. Those who can’t – teach/coach…right?

I started walk/running in July of 2017 while obviously still undergoing tests and injections. My runs were fine…nothing to write home about. It wasn’t until a few weeks after receiving the caudal injection in March that I really believed I might be able to someday be painfree. I am now 5 months out from the injection, and I feel very confident in the direction things are moving.

Dr. Tuakli had told me that my return-from-injury strategy needed to be double the  amount that a “normal” recovery might be. This made complete sense to me, and it’s also been VERY true in terms of how I’ve returned to running from this injury.

I feel like I actually started accumulating consecutive days of running in January, so this is what the past few months have looked like:

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IMG_2634       IMG_2639        IMG_2638

This is the slowest I’ve ever come back from injury, and I have my best friend, Rochelle, to thank for writing my program and keeping me reeled in for the past 7 months. The process has definitely been slow and not entirely painless. Many runs have been like this: I’d do a run/workout…I’d irritate my back…I’d recover for a day and get plenty of sleep…the pain would completely subside within 24 hours…I’d try the SAME exact mileage or workout speed/distance a week later, but this time, no pain whatsoever. Wash, rinse, repeat.

So it’s almost been as if my body acclimates to the new stress before really moving forward. I’ve explained this process to my PT and he thinks it’s just my body’s way of adapting, which is logical.

So I’m confidently looking ahead in a way I never have before. I’m ready to write a new page, and learn from this experience. I promise to never take running for granted, and to always keep things in perspective. This running thing – we really are lucky to have it in our lives. It might have broken my heart for the past 2 years…but I’m ready to give it another chance this year. ❤️