I don't think I'm quite clever enough to come up with the term "treatment fatigue" but somewhere in the midst of this journey, I may have heard it or said it or stumbled on it and have been referring to it as part of my experience ever since. Before I get into what it means to me, and maybe to other runners out there, let me preface that in the grand scheme of treatments, and the grand scheme of "chronic" things, a running injury is hardly serious. Annoying, yes; at times heart breaking, but nothing like cancer, or Polycystic kidney disease, or even substance abuse or eating disorders. There are many things in this world that require "treatment" and I don't want to undermine anyone else's treatment with my seemingly petty injuries. We each have our own battles and struggles... If you've stumbled on this blog due to any more serious conditions, you should know I'm writing this as an injured runner, but if by some chance I'm able to help anyone else, that's good too... but I wouldn't know enough about everything else out there to even know where to begin to broaden my perspective on this! I wish you the best! While I'm at it............ :
Disclaimer: I'm not qualified to give out any advice about any thing in life except for maybe how to help your child learn to read. I've been a competitive runner for 21 years, so this is all based on my experience!
What Is Treatment Fatigue?
Treatment: "medical care given to a patient for an illness or injury."
Fatigue: "extreme tiredness resulting from mental or physical exertion or illness."
Put them together and you get:
Treatment Fatigue: "Extreme tiredness resulting from medical care given for an illness or injury"
Just like you get training fatigue, you can get treatment fatigue too. Especially when you are working so hard and are not seeing results (just like running!) No one knows the treatment fatigue for running more than I do (okay, maybe that's an exaggeration, but I know it well), Apart from the nearly 2 years of on again off again calf and foot injures, I also struggled with Fat Pad Impingement syndrome for just shy of 2 years, I was in constant pain and had consistent swelling from every activity I did. Swim, bike, walk, I struggled to get up the stairs. It took over a year to finally check all the "to-do" boxes before we did an exploratory surgery which I had done at 21ish weeks pregnant with Raea (before you judge for having surgery pregnant, I was paranoid about falling down the stairs pregnant or with the baby because my knee couldn't support my weight as it was... read more on that and see the list of treatment I tried: here). Before the knee surgery I had a few back injuries that took 4-6 months. One a back sprain from work that I swore was a bulging disc, but it just couldn't get better because I was always restraining small tantrumming children at work. It finally got better over the summer. Then I had a fractured T12 at the end of my last college season, which I briefly mention on my most popular post since the rebirth of my blog... (the story of how I met Matt). This doesn't include the countless fractures to my 4th metatarsal (which I'm now finding out is likely a result of my super narrow feet... these orthotics better work!), the sprained ankle that never healed, and the debilitating shin splints... Probably all related! I've found out along the way that although extremely talented from a cardiovascular standpoint, my genetics are out to get me in terms of my duribility (Read: Tale of Two Thresholds). I have an abnormality in my spine, hypermobile and narrow feet, and super bowed legs. Additionally, my career choice is highly demanding. So, yeah, I know about injuries... I know about treatment for them.... and I know about fatigue from said treatments... and the feeling of hopelessness when all has failed... but I've come out of all of them. I'm still here after 21 years of at least 21 injuries, I'm still here so something I'm doing during the injury phase is right... otherwise the mental fatigue would have swallowed me whole a decade ago. Here are some tips to cope with Treatment Fatigue
How can I prevent Treatment Fatigue?
Tip 1: Don't get Injured
If you're reading this, you're probably already injured... so don't hate me and hear me out. Obviously, I'm the queen of injuries, and I own it. BUT, I can't do a blogpost on Treatment Fatigue as it relates to running injuries without first addressing the obvious: Don't do dumb shit that will get you injured! Even professionals get injured, so of course, not all injuries are preventable... but here are some general rules of thumb
-DON'T train like an A-hole. Example: Don't train at your goal pace... even if your goal is reasonable. If I were trying to teach your kid to read if they didn't even know their letters and then I wrote a note home saying "Johnny was crying and threw a fit during reading" and you were like "duh, it's too hard for my kid, he doesn't know his letters yet, you should teach him his letters first" .... Well, Obviously! Right? Why would you torment yourself the same way? You may not tantrum or cry when you are overreaching... but your body will rebel. A gradual approach is advisable. This is not to say that you will never run your goal paces... your goal marathon pace may actually be your current threshold pace, so it's not like you'll never train at that pace, just the workouts should be appropriate for the intensity of the pace. Jack Daniels has a great system based on science (not on your emotions and feelings about your goals) that is highly successful. I'll link his book below. Every runner should own it (and don't just skip to the tables! It wont help you to do that!)
-Rest is Best. You might find people on instagram glorifying training on 4 hours of sleep and "Make the Time!"... WRONG! Just don't. If you don't have enough time to sleep, you don't have enough time to run... Make the time somewhere else, but not sleep. I struggle to sleep because I get anxious about my following day so sometimes when I'm injured instead of doing PT and drills, I do everything possible to remove stress so I can sleep. I lesson planned 12 weeks of work in a few sittings so that I didn't have to worry about work so much. I'm averaging 7 a night now! Yay!... but I track my sleep every night and try to monitor my workouts according to how much rest I get. If I get 5, I'll opt for an off day and just do drills.
-Little Things Add Up. There's a million and one "Little Things" you can do... obviously prioritize sleep, but if your body says it's thirsty, it's too late, if it feels off and like you really need to foam roll? you're already behind... When your body sends you signs and you don't listen... you end up like me... Writing blogs about running instead of actually running. (do as I say, not as I do). Listen early and follow through.
Tip 2: Stop Blaming Yourself
To counteract Tip 1, you need to know that even if your injury was preventable, every part of this sport is a learning experience. Instead of falling victim to your training choices, use it to improve next time... because there will be a next time. I can't think of a scenario where you can not participate in this sport again. If she can do it, you all can. It is almost always just a matter of will and mental fortitude and willingness to withstand the storm. I've spent a lot of time thinking about how I should have stopped running while I was pregnant when I started feeling unbalanced.... (because, when you run pregnant, you feel balanced all the time, HAH!... sarcasm, guys) but I didn't have a Magic Crystal Ball telling me that the risks I was taking weren't going to pay off. As far as I was concerned, the baby was healthy, and the pain I felt running was going to go away when I was no longer pregnant. I had a goal of breaking 3 in the marathon at 9 months postpartum at the Boston Marathon. Taking risks is part of the sport. Our pros take risks and get injured and they have the best resources around... so how can we expect any different out of ourselves? I'm a big risk taker, always have been. I've been to two NCAA championships and have won many New England titles. I've very rarely set a goal and failed because with I'm prepared to fail and prepared to get up again. I never expect it to just go accordingly, I’m always ready to adjust perspective and the plan. It's part of it. It's not your fault, keep learning! (but, might I also suggest, if you are running and pregnant... hold off on time goals until you have had the baby!)
Tip 3: Make it FUN
Injuries suck, there's no way around it, but make the "treatment" part of it as fun as possible. It gets exhausting to keep doing all these little things and nothing is working It's been 3 or 4 or 5 weeks and nothing has improved. Think about how long it took for you to dig the hole. Probably a lot longer than a few weeks.... you just didn't notice the changes until it was too late (again, not your fault)! Healing works the same way, but in the reverse. Be as stubborn about your "treatment" as you were about your "training". Don't give up on it just because you're not putting up a result! Marathon cycles are 12-16 weeks, injury cycles can sometimes be marathons. Make it fun! Mix it up! Don't bite off more than you can chew. Sometimes I have no problem just checking the boxes of all the things I need to do (and I do it all) but other days I feel tired and blah... so I might write down six exercises and then roll a dice to determine which exercise, and then a dice to determine how many reps and one to determine how many sets. Something is better than nothing so when I'm feeling tired, if I "roll the dice" there's always a chance I might get an easy exercise and only need to do one rep one time (and never have I ever stopped at 1... but it got me started!) and then theres always a chance to get 6x6, so you can get some real work in. It feels less like treatment and more like a game or gambling... You can even add in your favorite hydration and a college drinking game to hydrate somehow. Another thing to try is to figure out how to make your "why" for running correlate to your treatment. If you run for the social aspect and you're supposed to be working on glute strength (every runner on the planet) see if you're allowed to try a Barre Class, or some strength class and ask your PT for what kind of modifications you will possibly need so you can still get that social aspect. If your'e running to get outside, try hiking or biking! If you're running for more likes and follows on instagram... reevaluate your "why".... and you might get some answers to your injury. We all need validation, but that's certainly not a sustainable approach to the sport....
Tip 4: Don't take Data
Don't count the weeks, don't count the miles missed or compare the amount of miles this month to the same month last year. Don't add up the dollars or the time spent. Don't log something on strava that will not serve you later. Don't count down days to a race you wished you'd run. Get rid of all numbers. Hell, don't count your PT repeats... Just do it until if feels right or until failure (if you're doing it right it will be a good burn, not injury pain). Get more in touch with how you feel doing something than the metrics. Too many metrics. I was at the Boston Marathon Mckirdy shakeout and I had three different people tell me I needed to charge my watch. I had only been running 30 minutes every other day MAX. I was barely even using my watch. Honestly, I wish I had the diclipline to never run with a garmin again. I don't need it. Maybe that will be my goal when I comeback...go back to my trusty timex (I'm breaking out in a sweat thinking about it even though I loved that thing)... We are addicted to our metrics, but your metrics don't know when you need to foam roll or when you need to back off. Getting rid of these external measures will help you get in touch with internal measures... and it will also just take away some of the obsession and make you forget a little bit. For me, when I"m in the thick of injury treatment... the best way to avoid fatigue is to not give it any more of my energy than it deserves. I (try to) do the work to treat it, and let it stop there. My husband would disagree, but... these are tips! Easier said than done! I will say that ever since I took a break from Instagram for Lent, I've been so much happier with my injury... I stopped feeling like I needed to come up with a post about it every day... now I just post here if I feel like it and if I don't I basically just go to the gym, do all the things, and go about the rest of my day. No checking in on anything (except Vdot with my coach... and my patient portal for "treatment protocol") but no strava, minimum feedback on instagram, and NO garmin. Nada.
Tip 5: Enjoy the Time Off!
Back to Jack Daniels... Principal 7 of Ease of Maintenance. During an injury you are going to detrain. If you are experiencing a long term injury It is OKAY to just STOP . If none of it is giving you an ounce of hope or making you happy... STOP. Don't worry about losing fitness... you're losing it anyway. Even if you bike or swim like a maniac, your muscular/skeletal system are still going to need to adapt to impact and stress... You are going to need to start back slowly regardless of how well you keep your cardio up. Cross Training does not mean that you will be able to increase training faster, it just keeps your engine strong. There are benefits to that, of course (if you're only taking a few weeks off especially...) but for much longer layoffs, if it doesn't serve you, get rid of it and don't stress about losing your "cardio". Ever blow up a balloon? That first breath is always really hard to get in... but then it gets easier. And if you deflate the balloon... it is a little bit hard to re-start, but still easier to blow that first breath for a second time and even easier a third time... because the balloon has already stretched a bit... so you're able to stretch it again with less effort (and you've also trialed and errored the best way to hold the balloon or pace to add air.... (aka: what worked and what didn't in your training). Do something, anything else that will make you happy. For me, it's been sleeping in, blogging and eating cadbury eggs (RIP Easter Candy), for you it might be going to the movies or the bar. Maybe it’s a different sport that you don’t want to try in training- like skiing. Do it-don't do it forever- and be responsible about your general health, but stop being caught up in running. It should not make you unhappy. It will be there for you when you're ready.... and unless you take many decades off, it's highly likely you can still run PRs ... and there are many of people that run PR's really late in life. Why not you? I PRed within a year of every major injury I've had (two back injuries and knee surgery) and I'm 100% positive I will PR after all this. I literally don't question if I question when. If the orthotics don't work, I'm at the point where I will take serious time away.... but mostly because I really want to try something new in the meantime (rock climbing!) and see what I can gain from totally different stuff! Live your LIFE! Running is just part of it, and there are many many ways to be involved in the sport without actually running.
I hope you found some of these helpful. If you are struggling for an injury, and need moral support, I feel like I"m really good in this area (again, no qualifications other than experience....) DM me on instagram, comment here, or hit the contact tab and it will email me directly. I try to share my experience because it brings purpose to my struggle. Again, in the grand scheme of things, it's minor... But I SEE YOU it doesn't feel minor. It feels like you've lost everything and the balance in the rest of your life is in jeopardy. I get it. I do. But I promise you will find stability again one way or another.
Welcome to my blog! I've been blogging for a long time on various platforms. My intention has never been to reach the masses, but rather to give myself a chance to reflect and journal. I feel it at least challenges me to be somewhat coherent, however you can expect ramblings and grammatical incorrectness here!
I've recently been diagnosed with CECS and fPAES and had it treated with BOTOX of all things... So I suspect to see more and more people looking for answers with that in the future and hope to continue blogging so there will be easy to access follow-ups as that was helpful for me.
NOTE: Apologies that some of the pictures incorrectly load sometimes. I try to keep up with the glitches, but can't always! Hope it doesn't impact the blog experience for all the PAES visitors.