Injury Recovery, From the Perspective of Mauricio Elizondo

Let’s face it. Getting hurt sucks. It is even worse when you are training for something, and the injury affects it enough that you missed your goal. It happens to all of us, including myself, who deals with people’s injuries for a living. I want to share my experience with a significant injury that I recently suffered, so you can get some ideas of what to do when you have an injury and suddenly your plans change. My mindset as a PT is to have patients focus on what they CAN do, instead of what they CANNOT to help them physically and mentally get through a tough injury. 

I was training to run a marathon in under 3 hours for about 4 months and had 2 months to go for my race (I was going to run by myself, don’t enjoy big races as it is difficult to control your own pace in those). I was feeling great, and my pace was on target. However, my shoes were starting to wear off so much that I needed to get a new pair. I did not obey my advice, which is to NOT change shoes in the middle of a training program. I run with Hoka’s Clifton 7 shoes, and I should have ordered the same model but instead, I ordered the Clifton 8 model. There are a few differences between them, which include a 2 oz weight difference (the new model being lighter), the material around the big toe being stiffer in the new model, and the Clifton 8 being narrower even with the wide version that I like. 

I got a new pair on 3/20 and went for a run on 3/21. At the beginning of the run, there were no differences but when I got to mile 3, my left front shin started to hurt. Wasn’t a “running” pain, it was a sharp grabbing pain. As soon as I felt that I stopped because it was just getting worse. I immediately thought to myself that it was the new shoes, as nothing else changed (pace, treadmill, heart rate, etc.). I rested the rest of the day, following my advice, iced it, and compressed it overnight to assess the damage the next day (which is when you see how severe the injury is unless there is some obvious swelling initially or trauma). My initial thought was an acute inflammation of my tendon sheet of the anterior leg tendons. With some rest, compression, and cryotherapy treatment, I would be good to go in a couple of days. 

The next day, my shin was swollen, and it was difficult to walk. Specifically, absorbing the weight when walking. I knew something was damaged and it wasn’t going to be a couple of days type of recovery. I was upset and frustrated, as I knew it was my fault for doing things I wasn’t supposed to (yes, I do them too!). Like many of us, I had to go to work (I was working at a tennis tournament in Miami) so resting all day wasn’t an option. So, what CAN I do? 

Here is lesson #1: Minimize damage and seek help. If swelling is present in any body part that you think you hurt, some tissue is damaged, and you need to find out what it is because it affects the prognosis of your recovery. A tendon doesn’t heal the same as a bone, and a bone doesn’t heal the same as a ligament. They all have different healing times and strategies for healing. Also, if there is the damage already in the tissue, you MUST minimize further damage to it. So, what did I do? I couldn’t skip work and it hurt to walk. I didn’t have crutches or a walking boot available, which would have been an option and preferably the best option. What I did have was a compression sleeve and supportive shoes which helped the pain. If it helps the pain, it is minimizing damage. Once I was at work, I got an Ultrasound scan to see how my tendons looked as I was suspecting they were the issue. My Tibialis anterior tendon sheet (a layer protecting the front tendon in your shin) was severely inflamed, but I also noted some increasing signaling in my shin bone, which is a sign of a possible stress fracture. At that time, it was hard to tell which one was giving me the most pain, but because I went for help early, we came up with a plan to exactly determine what my problem was. No, it wasn’t an MRI or more expensive imaging, it was treatment based. I took a course of anti-inflammatories for 4-5 days and if my pain didn’t improve with the medicine and rest, then I had a stress reaction or fracture. 

After 5 days, my pain wasn’t better. Therefore, it was safe to assume that I had a stress reaction or fracture (which I would confirm later with a repeated ultrasound). An acute inflammation in the tendon would have responded by 5 days with anti-inflammatories and rest but since it didn’t, I had to treat my injury as a stress fracture (worst case scenario) and that implied not running for 6 weeks because that is the time it takes the bone to heal. Going back to my lesson #1, if I wouldn’t go for help like many people would, I would have tried running earlier than 6 weeks and could have potentially prolonged the recovery process by not knowing exactly what was going on. I can’t stress it enough; tissues have different healing times, and we need to respect those by making sure what the exact problem is. 

So, did I do nothing for 6 weeks? Of course not! I would have gone insane, and that is mentally not healthy either. Like I tell my patients (I did follow my advice here), this is Lesson #2: you should do what you CAN do, and there will always be something you CAN do. Weight-bearing and walking were difficult and painful for the first two weeks, so I focused on doing upper-body lifts at the gym and peloton rides for cardio. Once weight bearing was easy by weeks 3-4, I incorporated the elliptical for cardio and some non-plyometric LB lifting. By week 5-6, when I was completely pain-free, I started adding some plyometric activities (jumping) to be ready to run again at week 6. This progression is essential to do before you go back into the activity you got hurt doing. It would have been much different if I would just rest for 6 weeks and gone straight back into running. I would have had an increased risk of having another injury because of not proper conditioning before being back to my activity. 

In a conclusion, being hurt doesn’t necessarily mean you are inactive. Seek help quickly, don’t wait until it has gotten worse, or you got re-injured to sick help as it may be too late. Always seek what you CAN do but have guidance with those decisions as each injury is different. 

Hope this helps you in any way! As always, we are happy to help and guide you at PSP during the injury process. Any questions or comments, please email us at info@performancesportphysio.com or even better, call us at 727-826-7142.