[Disclaimers: (1) this is long. It took me a few months to work through writing it. Apparently I had a shit ton of processing to do. (2) Oh yeah, there is some swearing in here. Part of the processing. (3) Thanks to all of the family/friends/health professionals who have helped me during this experience. You guys are the best. XOXO, Dani]

A hip story in progress

“Definitely no running for three months.” I remember going into tunnel-vision, shocked, while the doctor nonchalantly broke this news. Even though the pain had been steadily increasing over the previous month to the point where I couldn’t sleep at night, I had been certain that I was mentally weak and a hypochondriac. I had gone to the doctor to confirm that. I had even downplayed my symptoms, just in case he told me nothing was actually wrong with me. But the diagnosis that day was tendinopathy (read: chronic tendonitis; tendon injury that has stopped healing) of one of the quad muscles (rectus femoris) at the attachment at the front of my hip. As the ultrasound ran over my skin and I heard “tendinopathy”, I was both relieved and embarrassed. That didn’t sound bad at all. So I couldn’t believe it when he casually told me that I couldn’t run for three months. I remember calling my sister (a med student), desperate for her to tell me he was wrong, that it wouldn’t take that long.

But most of all, I remember calling Alex immediately afterward, and through my tears admitting one of my deepest fears: “I’m scared of the person I will be without running.”

That was December 17, 2018. Two months before that, Alex and I toed the line at Blue Sky Trail Marathon on October 20. We had signed up for the event when we returned from our backpacking honeymoon in September, excited to participate in a trail running event where we could literally see our house from the start line. We hadn’t trained specifically for Blue Sky, but our base fitness was fairly high going into it. Post-wedding, we felt like we suddenly had time to tick some objectives off of our list: running around Horsetooth Reservoir from our front door, jiking Four Pass Loop and Halo Ridge...we were dialed. I couldn’t believe how strong I felt, alternating running and hiking up Towers, cruising the first 9 hilliest miles with ease. But when we were passing the Blue Sky trailhead on our way out to do the southern namesake portion of the course, a weakness and pain came on relatively quickly in my left hip flexor. I told Alex I needed to walk for a bit, so we let the foot off the gas, ate some food, and I tried to walk it off, as I have so many naggles. Alex asked, “do you just want to stop? We’re right here...we could just stop here.” But I was absolutely terrified of DNF’ing. (DNF=did not finish.) Knowing myself and my brain, I knew that if I stopped, I would question and obsess over it for some indefinite amount of time. I would lie awake at 3 AM, brushing tears away, googling “are you a real runner if you quit a race” or “when should you DNF” or “are you too weak to be an ultrarunner.” I saw it all flash before my eyes, so real...no way was I stopping. Plus, the rolling singletrack was too tempting to run, and we were setting such a good pace, so I gritted my teeth and figured it would go away eventually. Eighteen miles later, by the finish, it had gotten significantly worse. I couldn’t lift my leg, and downhill running had become even more challenging than the up. Still, we finished just over 5 hours, with me in the top 20 females. It was the best I had “raced” since Imogene in 2011. No stomach issues, no cramping, no nerves...just this weird, pulled hip flexor.

I had to take a break for a week. I couldn’t lift my leg to even put my shoe on, much less run. But over that week, I felt more and more insane, so eventually I figured I should try to run on it. My first day back, I ran 6 from the office at lunch, trying to swing my left leg forward like a rag doll. I was (stupidly) stoked. “See, you’re fine. You can run,” I told myself.

The fake-it-til-ya-make-it face during a third lap of November turns in RMNP.

Over the next 6 weeks, I oscillated between trying to run, trying to ski, trying to ice and take my turmeric, trying to be tough, trying not to say anything, going to PT...and then freaking out that “it still isn’t getting better”, being in a significant amount of pain, telling myself aloud that I was making it all up in my head, cancelling PT appointments. We had been dreaming about running R2R2R over our first Thanksgiving as a married couple, and it was slowly breaking me knowing that I shouldn’t do it, and knowing that I had to tell Alex I couldn’t do it. “I could probably do it if I hiked the whole thing, but I really want to run it,” I finally told him. We made the call 3 days before we were going to leave.

It turns out that having your significant other and best friend as your running, skiing, and climbing partner can have a downside. Alex and I just had never really experienced it before; 95% of our relationship and time in the mountains together had been all the “good” stuff. Sure, we’d get in arguments about avalanche conditions, gear placements and climbing anchors, which line to ski, probability of thunderstorms, etc. But most of the time, we just got to do what we both love most with the person we love most. The bond we’ve built over time through those experiences is legit crazy. I don’t know many other couples that operate this way, but you know ‘em when you see ‘em. People wonder “don’t you get sick of each other?” But it’s like this positive feedback loop….like a hungry bear, where the more you feed it, the bigger and stronger it gets, but the hungrier it gets too.

The hard part is when you can’t feed the bear. The guilt we both felt, even early on in this experience, was, for lack of a better phrase, “super duper shitty.” I cried. Alex cried. I apologized for not being more honest. Alex apologized for not listening to me. We cried some more. We made plans for “when” my hip would be better. I felt terrible for being a pent-up asshole. Alex tried re-creating with other friends, but just didn’t enjoy it because he wanted me there. I worried that the “only reason we’re together is because we’re running/skiing/climbing partners” (knowing that’s not true) and Alex constantly reminded me that (of course) that’s not true (although it is an important part of our relationship). It sucks. Luckily, the joys mentioned in the previous paragraph exceed the shittiness 100-fold, but it doesn’t mean the parts that suck don’t suck.

Sometimes I wondered if it wouldn’t be easier to be alone so I wouldn’t feel the guilt of holding Alex back. But deep down I knew how lucky I was to have someone to hug me when I was sad, tell me they were there for me no matter what, love me even when I wanted to push everything away. That’s something running could never give me.

[Back to the story.] After that initial appointment with the sports med doc, he thought I should get an MRI, just to rule out a labral tear and/or femoral neck stress fracture. I spent two weeks on crutches and a month of going back and forth with insurance and doctors, and then finally got an MRI in late January (after also getting an x-ray)...and everything came back normal...even though I was still in a significant amount of pain (which was incredibly confusing). I got a second and third opinion on my xray and MRI, but nothing felt right.

My PT Priya was amazing and spent session after session with me (even a 2.5 hour long session with two other PTs), trying to figure out what was going on with me and find a way to get my body to heal. At the end of January, she referred me to a fourth doctor (Dr. Tim Mazzola) in Boulder, but I couldn’t get an appointment until the end of April. At the end of February, she also had me start seeing one of her colleagues at Rebound, Brad Ott, who she felt like could maybe help me better. Brad noted that my pelvic alignment was totally off (“did you ever fall down?”), and he started working with me to correct that ASAP so my tendons could actually heal themselves.

The “three month” window (mid December through mid February) the first doctor had told me about had come and and gone, with no significant improvements in functionality or pain. I tried going back on crutches again. I tried to get excited about something non-outdoor-activity related like baking (donuts were my favorite part) or getting better at the uke or taking online programming courses, but it wasn’t enough to fill the hole. I obsessed that I was doing something wrong that was inhibiting my healing. I freaked out when finally my body fat started to climb and there was nothing I could do. I tried keto for four hours then decided that was dumb for my mental health. I ate ungodly amounts of protein. I dreaded leaving the house because every time I saw someone else running, I would cry tears of jealousy and regret and sadness...and guilt and self-loathing (for feeling the previous three emotions). I avoided contact with coworkers in my office so I didn’t have to answer the incessant “are you feeling better yet?” question. I was tired of hearing how I “was missing an incredible ski season.” I felt guilty that Alex didn’t want to recreate with other people, and instead stayed home with me. I felt exhausted and unmotivated and defeated for several months, with only Alex literally pulling me out of bed as my way for getting up in the morning. I thought maybe I had some kind of vitamin deficiency only to go to get bloodwork done and be told that I was depressed. I cried after most PT sessions...tears of gratitude and relief, but also deep shame of my body that I felt so disconnected from and that I couldn’t seem to fix. I avoided looking at myself in the mirror and as I did my tests at PT, I couldn’t stand seeing my weak thigh try to lift itself, and was terrified someone would notice how “fat” I was getting.

It didn’t help that when sharing any of this, I would occasionally get the response of “maybe it’s just in your head?” Or “maybe your body was hurting for a long time so now it can’t shut off the pain signals.” Or “maybe you should just push through it.” Literally, confirmation from the world outside my brain that maybe I really was making it up. Maybe I was weak. Maybe I should have tried harder to push through it. But then I knew that wasn’t right. Deep down in my heart, past my brain, I knew something was wrong, and the reason it was still messed up was because of my brain. Because I had listened to the voices in my head.

There were some good moments too. I worked on a training program to swim a mile (arms-only, with pull buoy) and got more confident in the pool. I still got in monthly ski turns with Alex. I did get better and more confident with baking (especially donuts). I learned some new songs on the uke. I felt sure that I actually loved running/skiing/climbing, and that my passion of moving outside was my own, not something I had been conditioned to love as a kid. I learned that I don’t want to get fat-adapted by dieting. I accepted that it made sense that I was atrophying, because DUHHHHHHH. I learned to truly believe that Alex and my relationship wasn’t solely based on being recreating partners, and that I hadn’t tricked him into loving me with my mad tele skills and route-planning. I realized that I could still find joy in celebrating OTHER people’s love of running by supporting them in reaching their own goals.

I got FUCKING MOTIVATED and started doing everything I could to make myself better. I read into the power of the mind for healing, and started visualizing golden strands rebuilding in my hip, making it strong and stable. I took more vitamins. I ate more protein. I religiously did my PT every single morning at Whetstone, and tried to be as honest as possible during my appointments with Brad. I drank shit tons of water, and got myself a (SICK) used mountain bike (Judy 3.0). I swam a mile with only my arms, and wore my running shoes all the time. I foam rolled (not too much!) and listened to my body. I started seeing Ginna Ellis (Boulder Acusport) for acupuncture, and at my first appointment, she asked me a bunch of questions, including “did you ever fall down?” There was that question again, which I’d been asked by several other doctors and PTs. “Nope!” I answered confidently (and then she stuck me with a ton of glorious needles). That night when I got home I told Alex, “Man, everyone keeps asking me if I ‘ever fell down’...but I didn’t, right? I can’t remember falling….” Alex shook his head at me, “Dude, how do you not remember. You took the hardest fall I’ve ever seen you take on Day 1 of the backpacking trip. Remember? Right on your face, with the fully loaded pack?” Whoops. I mentioned it to Ginna at my next appointment, and then didn’t think much else of it.

Finally, in early April, things seemed to have turned a corner. Brad had crushed it. My hip wasn’t achy all the time. I was sleeping better, testing better at PT. One Friday morning, Brad told me he thought I was ready to try a small run test over the weekend. As Alex and I drove away, I was quiet and shaky. I couldn’t believe I could try to run. I was so excited but so nervous. I didn’t feel 100%, and because the injury had been caused (or at least exacerbated) by me running and skiing when I wasn’t 100%, I was scared to try again. But also: unbelievably excited. That Saturday morning, I took some tentative jogging strides and immediately felt my spirits lift. My hip didn’t feel 100%-- BUT...it happened. My heart was STOKED. My appointment with the doctor in Boulder was approaching the following week, and I wasn’t sure that I should go. But then again, I wasn’t 100%, and I had gone 5 months without running. “Worst thing that happens,” I told myself, “is that he tells you you’re fine and a hypochondriac.”

Unfortunately, somehow, my brain hadn’t examined ALL of the worst case scenarios. “Well, first things first, you do have a labral tear,” Dr Mazzola told me that sunny April morning in his Boulder office. “But I’m also not convinced that that’s what you’re dealing with.” I couldn’t believe it. After all of that, I had indeed fucked up my labrum at some point. “Did you ever fall down?” he asked me, and I told him triumphantly that YES I had fallen down, but it was back at the end of last August. “Interesting,” he replied.

I can’t remember exactly how long the appointment was, but it was the best doctor’s appointment I’ve ever had in my life. Up until that point, I really felt like my PTs were the only ones who had seemed to care about figuring out what was going on and how to get me better. This doctor obviously cared. He went through a long series of physical tests. He found the same thing Brad had found, with my hips tilted forward and my left slightly more forward than my right. After running through tests and beginning to look at things with the ultrasound, he had found that my SI joint ligaments were damaged and unlocking in oppositional directions, my glute medius still was exhibiting tendinopathy, and my rec fem was looking GOOD (which was surprising, since I was still having some pain in the front of my hip). He tested my psoas, which he said wasn’t firing at all. “Maybe you have a back injury...let’s look at it with the ultrasound…” he mused as I flipped onto my stomach. “A back injury?” I asked. “Yeah, sometimes when you have a back injury, your nervous system can shut down function to certain areas,” the other doctor in the room told me. “Oh man,” Mazzola said, running over my spine with the ultrasound. “Well, avulsion fracture of L1 vertebra.” Dr. Mazzola then “tested” his theory by numbing my back, then re-testing my iliopsoas. Boom. Worked totally fine. Medical miracle.

Sure enough, it had all (likely) started with that fall on our backpacking trip, and then had progressed to being tendinitis (and then tendinopathy) of my rectus femoris and glute medius, SI ligament strains, and a labral tear because half of my hip flexors had stopped working, and meanwhile I was putting in 50-60 mile weeks of running when we got back from our honeymoon and didn’t stop, despite pain and weakness and sleepless nights, until mid-December.

This is what relief+frustration looks like.

I was shocked. I walked out in a daze, PRP* paperwork in my hand. PRP injections of the glute medius, both SI joints, and my L1-L3 fascia were his recommendation. Start taking collagen and some vitamins. Something like that. I got in the car and broke down. It was an incredible relief to know that I hadn’t made things up in my head...and also pretty devastating. I should note that I had been feeling pain in my SI joint since December, but I had been initially told that it was “referred pain,” and because I figured it wasn’t real and also because I didn’t want to sound complain-y to my PTs, I had never said much about it (so silly, in retrospect). I called Alex, emailed Brad and my sister, and compulsively googled “avulsion fracture” over and over again. Fed up with myself, I packed up my stuff, emailed my supervisor that I would not be working the rest of the day, and drove up to the Sunshine Canyon trailhead, defiant tears rolling down my cheeks. I ran a mile from the car on glorious singletrack before I made myself turn around. My lungs burned and my legs were weak, but I felt so incredibly free in those few minutes. I suddenly realized that things were going to have to change moving forward. I couldn’t fight it any more. I needed to listen to my gut. Trust myself. Be even more patient than I had ever been, and start from scratch, try the PRP, do the PT, and wait another few months to start trying to run again. I knew that’s what I needed to do for myself if I wanted to continue putting in long days and efforts in the mountains.

The complicating factor in all of this was the fact we had decided to move to Reno, NV. Initially our plan had been to move on July 1, but with the realization that the recovery from the PRP would take a while, Alex and I both agreed that it would be better if I stuck with Brad who had gotten me this far in the recovery process even without any PRP. We changed our plans to move on August 1 instead, and luckily I got in for PRP on May 17.

So there I was finally, laying on the table in the doctor’s office, with Dr. Mazzola re-injecting my platelets back into me, one hand on the ultrasound, one hand on the needle, both eyes on the monitor, with Joe the scribe playing Hips Don’t Lie in the background. Alex was there too, documenting and providing moral support. When all was said and done, I crutched out, SI belt firmly around my hips, barely able to bend at the waist from all of the swelling, but happy. As Alex and I drove north back to Fort Collins, I had a moment that felt like a flashback-- I had a mental movie play that was like the last 8 months in fast-reverse, ending with me falling flat on my face in Spiller Canyon. Maybe it was just a moment of light-headedness from the procedure, but it felt to me like my brain was ready to start helping my body heal the right way this time.

The ensuing weeks and months since that day have been a continued effort to enjoy the process. We watched literally all of Game of Thrones in the span of a few weeks. It didn’t take long to get off the crutches. At my first PT appointment one week out from PRP, I was still extremely swollen and feeling unstable, and Brad cautiously tried doing some testing on my alignment. I was in the SI belt for a month. My strength gradually returned, better than it had been pre-PRP. I volunteered at Dirty 30 (which I had run last year) and realized that I’m not a fake ultrarunner. (WTF is up with this brain of mine.) I accepted that not running for months doesn’t mean you aren’t a runner. I battled back thoughts that I wouldn’t be taken seriously by doctors or PTs if I wasn’t fit (read: thin), because I realized nobody ever treated me otherwise.

Right now, I’m exactly 10 weeks to the day out from the PRP procedure. Some days are easier and better than others, but overall I think I’m steadily improving. The achiness is still there, but not as intense or constant as it was for months. At my most recent followup appointment with Dr. Mazzola, he reassured me that things were healing, and that the pain would be the last thing to resolve. I’m hopeful that I’ll be able to start a very slow return-to-running program again in a few weeks. Mentally, I’m feeling like I’ve been tested, and that I’m doing it. I’m getting through it. This experience is giving me a new confidence in myself that I didn’t have before. In my intuition. In my sisu (yay for being ¼ Fin). In my ability to get through day-to-day life without skiing, running, or climbing. In my partnership with Alex. In my trust that the end of the tunnel is there, even if I can’t see it. I know now that you can be a fighter and have acceptance at the same time. I have a new compassion for myself, which has been uncomfortable but simultaneously stabilizing. I also have a DEEP compassion for others who live with chronic pain, illness, injury, depression, anxiety...for being human. It’s ok to not be ok. We can’t always say words that will magically fix things for others. Listening is an incredible gift that you can give. We can’t make negative thoughts go away, but we can choose to take away their power by recognizing them for what they are: just thoughts, not reality. Feelings aren’t black and white-- you can feel good, bad, happy, sad, angry, relieved, whatever, all at the same time. Life doesn’t always/ever go to plan, and I’m learning to be ok with that.

When I was running a lot, I would repeat “be fierce, feel brave” over and over to myself while pushing through the pain cave. I’ve been pushing through a different kind of pain cave, and while that mantra still feels relevant, I have a new one I’ve been trying out: “confidence, resilience, and faith” (thanks to AJW).

Confidence that I’m doing the right things for my recovery.

Resilience through pain, doubt, and fear.

Faith that it will get better.

[If you read this far, I owe you a beer and/or a donut.]

*PRP: Platelet rich plasma. “PRP injections are prepared by taking anywhere from one to a few tubes of your own blood and running it through a centrifuge to concentrate the platelets. These activated platelets are then injected directly into your injured or diseased body tissue. This releases growth factors that stimulate and increase the number of reparative cells your body produces.” https://www.hss.edu/condition-list_prp-injections.asp

A few articles that I found helpful:

-Several posts on this woman’s blog (here’s one): http://www.therunnersplate.com/2017/06/01/getting-back-in-the-groove/

-https://uprighthealth.com/hip-labral-tears/

-This was incredibly helpful for me in the context of how long the recovery process takes: https://www.irunfar.com/2016/03/the-remodel-project-an-inner-look-at-injured-tissue-healing.html

Here are the people who have helped me get this hip back to tip-top-shape:

-Brad Ott, Priya Prince, and Becca Rauch at Rebound Sports and Physical Therapy: https://www.reboundsportspt.com/

-Dr. Tim Mazzola, ROSM of Boulder: http://www.rosm.org/project/dr-timothy-mazzola/

-Ginna Ellis, Boulder Acusport: http://www.boulderacusport.com/

-Shari Maccallum (Rolfing): http://sharimaccallum.com/

Parting thoughts on mental health:

For background and context for everything I just wrote: it should be noted that I struggle with OCD. I don’t have the kind of OCD you probably immediately think of...super clean (anyone who has seen my car can attest), constantly cleaning (I forget to shower constantly...sorry Dad…), super organized (ok wait, that checks out, spreadsheet/list-making-queen over here). No, obsessive-compulsive disorder is “a common, chronic and long-lasting disorder in which a person has uncontrollable recurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.” I have the kind of OCD that is centered on fear, and I struggle with extremely vivid thoughts that feel very real to me (i.e. running over a cyclist with my car, burning my apartment down, doing anything that will hurt someone or make them sick, getting fired from my job, etc). Everyone to a degree has weird thoughts come in their head, but mine come and won’t go, for hours or days at a time. It causes me to google things incessantly, re-check that nothing is touching the heater 5-10 times before being able to leave the house, be scared of driving, avoid social interactions, etc. At times I question whether a thought is real (i.e. did that happen? Did I actually do that?), and avoid any situation that might put me in a position of a thought becoming a reality. It can be really scary and disorienting. I went to the ER a few years ago with chest pains, went through all the tests, got an echocaridogram, etc, and when everything looked good, the doctor told me it might be from anxiety. It was only a few months after that, sitting in a therapist’s office, that I learned that I had been having panic attacks, and a little while after that we figured out that the panic disorder was related to OCD. Over the last few years, I’ve been doing a lot of work (primarily exposure therapy) with an awesome counselor to challenge OCD mind and re-wire my brain into being able to recognize thoughts for what they are. Running in particular has helped me tremendously, as it’s the most in-my-body I can get...that flow state, when you’re just breathing and moving, and nothing else. It’s not devoid of thought, just a different state of mind. Not being able to run has been tricky for me, not only because it had (honestly) started to become a bit of a compulsive behavior, but it was also a coping mechanism, and a way for me to challenge myself and do some self-exposure-therapy. Alternate titles for this blog post could have easily been “Running with (or is it from?) OCD” or “Getting run down by OCD brain,” as it’s been a huge part of this whole hip ordeal. It’s all intertwined. I’ve been extra challenged in the last year to find other ways to be in my body (effectively), face my fears, cope...but I’ve been doing it. Writing this (especially this last paragraph) is a way.

If you recognize any of these thoughts/behaviors in yourself, you aren’t alone! A lot of people have OCD. If you want to gain more freedom in your life from this pattern, I couldn’t recommend seeking help more. I could not have gotten through this entire process without it. A huge thanks to Jackie Johnson, Chelsea Cashman, and the women in our OCD group for all of the tools and support.

DANI&DIERKER

CONFIDENCE. RESILIENCE. FAITH. /August 8, 2019 by Dani Perrot

A hip story in progress