Stressed by Stress Injuries

When I asked Lucas Heinzerling ’20, a distance runner on the men’s varsity cross country and track teams, about the injuries he has sustained during his seven-year career, he rattled them off quickly: Achilles tendonitis in both legs, plantar fasciitis in both legs, tibial stress fractures in both legs, IT band syndrome in both legs and hip abductor injuries in—you guessed it—both legs. 

Despite Heinzerling’s limitations during his junior year, he ran at conferences and made the regional team during the cross country season, but was too injured to compete at the regional meet. 

During the next season, he continued to run and qualified for the conference meet. “But I really shouldn’t have raced,” he told me. “In the past, it’s usually been that I’ve definitely kept running even through injury. Sophomore year, I was limping pretty badly before I stopped running. And I think that’s just stupid on my part.”

This summer, Heinzerling got a tattoo of a broken shinbone to “commemorate” his injuries on his hip. “I thought that would be the end of my injuries,” he said. It wasn’t.

When I interviewed him on Oct. 8, he had been injury-free for the first few weeks of cross country, but shin pain had forced him to scale down his training significantly that week. At the time of publication, he is awaiting the results of a bone scan, but he is still able to race.

Celia Parts ’22, a long-distance runner who runs all three seasons on the women’s teams and calls cross country her favorite season, has also sustained multiple injuries in her year and a half on the team. 

Parts, too, continued to run while in pain, but attributes this more to a false diagnosis than to personal stubbornness. For four months, doctors, trainers and physical therapists attributed her pain to hip misalignment rather than what it really was a—spinal stress fracture. It would put her out of commission for at least four more months following the diagnosis. 

“It was really frustrating because I’d take some time off, like a week or so. And then I’d be like … ‘I’m feeling all right now, I’m going to try and go run this workout.’ And I’d be able to run a rep or two, but it would be really painful,” she said. “So that was kind of indicative that it was something more. But it took a while to officially get an MRI done.”

She is now recovering from another injury, a tibial stress fracture that was at first diagnosed as shin splints. 

Injuries like those sustained by Parts and Heinzerling are far from uncommon among runners. Studies estimate that anywhere from about 20 to 80% of runners sustain injuries each year. To make matters worse, injuries are not only common, they’re also chronic. Runners who have been injured in the past are much more likely to be injured again, according to the British Journal of Sports Medicine. 

Between 50 and 75% of all running injuries are repetitive stress injuries, according to a literature review published in “Sports Medicine.” Because of this, the longer a runner continues to aggravate the injured body part, the worse the injury will become until they correct the underlying issue.

The question of why runners ignore their pain and continue running on injuries is complicated. 

Head Men’s & Women’s Cross Country/Track & Field Coach Peter Carroll explained why injuries can be so frustrating to runners as opposed to players of a team sport.

“In running, you kind of need to be 100 percent,” he said. “You’re your own person and you can’t get a sub at mile four.”

Injuries are also particularly difficult to come back from, Carroll says, because running is a sport that relies almost entirely on aerobic fitness, strength, and “very little on skill.” Success depends on fitness that must be constantly maintained.

“If you’re a basketball player and you miss a couple days of practice, you’re not going to go back to practice three days later and forget how to shoot free throws, but if you miss five days of training … now your fitness level might change a little bit,” he said. 

Because running requires such constant maintenance of one’s fitness level, Carroll said, runners on his team sometimes continue to practice instead of listening to their pain. He feels that in many cases, running through injury tends to increase the chance that the injury will worsen later on. 

“They have a great work ethic, and sometimes they’ll make a bad decision for the short run [instead of] looking at the long run and [saying] ‘You know what, I have 103 fever, I should go home,’ or, ‘I’ve got a sore calf, I should go on the bike for two days,’ he said. “They don’t want to fall behind, and then on the pecking order, they don’t want to feel like they’re missing a workout that’s going to put them behind somebody who they were ahead of.”

It can also be hard to tell whether such injuries are serious or less serious. As in Parts’ case, the diagnosis of stress injuries in particular can often be finicky, frustrating, and complex; they often escape X-rays, if they are fractures, and even MRIs and other high-definition scans, as some can be soft-tissue injuries. 

Parts’ X-rays came back negative for both of her injuries, which may have delayed diagnosis. Since stress injuries are also not visible on the surface, diagnosis partly relies on subjective reports from the patient. 

“I think I might have a slightly higher pain tolerance [than other patients], so when they are trying to diagnose something maybe it’s not as painful as it should be to the normal patient,” she said “I think that it’s just a little frustrating that twice I’ve had injuries and felt a lot of pain, and that hasn’t been necessarily properly diagnosed or taken to the fullest extent.”

The college staffs a full athletic training department that is open to in-season athletes. Two days each week, they also bring in an orthopedic doctor—Dr. Charles Hummer III—who sees students whose issues have been deemed serious. But as a small D-III college, Swarthmore cannot maintain a program such as a large D-I school’s expansive running program that hires doctors and physical therapists who specialize in running injuries.

Another reason why runners might be a little too eager to get back on the pavement, track, or trail is obvious: they love running. Missing runs is not only bad for their team, but also for their mood and mental health, Parts and Heinzerling said. 

“My junior year was overall really hard mental health-wise, and not running is really, really awful when you’re already not in a good place,” Heinzerling said. “Especially since you take away the thing that you love doing and the thing that brings you happiness, and then on top of that, you have to deal with this injury and you’re actively doing things that cause unhappiness.”

Among the things that could cause unhappiness to athletes in recovery: biking in the Matchbox in order to keep up the cardiovascular fitness they’ll need to tap into during a race; repetitive hip, glute and core exercises prescribed by a physical therapist; doctor’s appointments. 

Parts mentioned that her injury made it harder to find the stress relief she often found in running. Even more, she said, it made it harder to find social time with her teammates. 

“It feels isolating because you’re sitting there alone in the Matchbox on your bike, or you’re at the pool doing laps by yourself,” she said.

There are ways in which the athletic program addresses issues that go beyond physical conditions. For student-athletes who want support from someone who understands the unique challenges they face, for example, the program reserves several hour-long sessions per week from a Counseling and Psychological Services center counselor who specializes in seeing student athletes. There is also the built-in support system of the team members themselves. For Heinzerling, his friends on the team were the saving grace of his year of injury. 

“I think that if you don’t have someone actively talking to you throughout the [recovery] process, it’s really hard to deal with [it]. And I’m really grateful that I have had those people. I think that the team is a really great place for creating those kinds of connections,” he said. “I just don’t know how I would have gotten through without all of those people.”

As a captain of the men’s cross country team this year, Heinzerling said he makes an effort to check in on younger runners who are injured as well as those who aren’t. “I mean, I’ve injured so many things that there is very little that I can’t give advice on,” he acknowledged with a laugh. 

And though running injuries still continue to frustrate and perplex runners and coaches, Carroll and Assistant Coach John Michael Noon have also discovered some surprising patterns and effective treatments in their many years of combined experience, ranging from iron supplements to regular chiropractic care to easing off of their runners on academically difficult weeks. They also typically encourage runners to take time off when they’re in pain in order to prevent injuries from worsening, both Parts and Carroll said.

In addition, according to Carroll, his team has been healthier overall since runners began doing twice-weekly lifts with Chris McPherson and his assistant strength and conditioning coach, whose positions were created by the Athletic Department in 2016. They’re not the only ones who have seen improved health and performance, either, as The Phoenix reported last April.

And of course, there’s the fact that not every runner is plagued by chronic injury. One cross country runner I spoke to, Brendan Penfold ’22, completes a substantial amount of mileage each week —“I hit 80 [per week] this summer,” he told me, and he completes eighteen- and twenty- milers during the team’s Sunday long runs at Wissahickon Valley Park — yet he has not suffered any serious injuries in his four years of distance running, both in high school and college. His injuries, he said, have mainly been small.

“I run in the Crum [Woods] fairly often. But I’d never sprain my ankle in the Crum… I’d be on a fairly wide road with really no obstacles. And [the obstacle would] always be something stupid like a curb or, I remember one time it was a chestnut that fell out of a tree that was in the road,” he said. “My foot came down on the chestnut and then my ankle rolled.” 

The chestnut story has a good ending. 

“I limped down the road until a friendly motorist picked me up,” he said. His ankle healed, too.

Editor’s note: The article previously misstated the location of Heinzerling’s tattoo. The error was corrected on Oct. 24.

Bayliss Wagner

Bayliss '21 is from Vienna, VA. She is majoring in English literature and minoring in computer science and French.

Leave a Reply

Your email address will not be published. Required fields are marked *