Tuesday, September 9, 2014

Ankle sprain forces DNF from Superior 100

2014 Superior 100 photo album (captioned with mini race report)

Somewhere around 9 PM a few miles from the Finland aid station, my right ankle became weak and floppy. It hurt on the front of my ankle when I pointed my toes, and the strength to support my weight on that ankle was waning. I was all-but sure I had suffered a high ankle sprain. (If only because I had recently read the linked article).

We had been running very well. The section from County Road 6 to the next aid has some of the longest, flattest, gentlest sections on the entire course and we had run them hard. Everything was going well - food, fuel, salt, pace, everything. I do not recall any specific, acute trauma that did anything to that ankle - no fall, twisting, or misstep. All was normal, and then the pain showed up out of nowhere.

What to do now? We were 48 or so miles into the Superior 100, a rugged 103.3 trail race. It was three-or-so miles to the next aid station (Finland) at mile 51.2. I could still run on perfectly flat and gentle ground, but running on anything else was a no-go. So we marched on.

I had taken a misstep and rolled my left ankle on the Tuesday before the race. That left ankle was supported with a compression sleeve on race morning, and I had been wearing it since Wednesday AM. Together with my pacer, we resolved to get a medical evaluation at Finland, tape the ankle, and continue. Barring that, we would move the compression sleeve over. The left ankle had been giving me no troubles and so I was comfortable with that plan.

We rolled into Finland at 9:50 PM, the party in full swing. I sent my wife to find someone who could tape an ankle. The aid station did not have anyone. They also did not have any athletic tape. The only tape we had was Leukotape, which I use for blister prevention. It has no elasticity and was not something I wanted to tape an ankle with. I also couldn't carry the roll with me should I later change my mind between now and the next time I saw her in 11 miles - my pack was full and my pacer couldn't carry it either. And so we switched the sleeve over and kept rolling. We walked, gingerly, out of the rocky spur trail that had lead to the aid station. I chalked my uncomfortable footing up to the chill that I underwent after sitting in the aid station for 15 minutes eating, drinking, and determining what to do with my foot. I did have a fleece hat and two shirts on. Once we hit the dirt road off of the spurt trail that leads back to the main SHT trail, we were running. All was again perfect with the world.

To Sonju

It lasted about four miles. The section to Sonju is notoriously rough, and it beat my feet into submission during 2013's event. And so we walked and maintained a decent clip. I expected to slow down if only because of the terrain, and we did. Whether the pain returned because of the terrain or not, four miles in I was back to the weak ankle and cringe-inducing steps. Again, how to fix it? I sat down on a rotted-out stump and laced up my right shoe to the top pair of eyelets - those one you never, ever use - and tightened up the laces as taut as I could comfortably manage. The additional lacing through those top eyelets provided additional downward pressure to the front of my ankle and stabilized the whole joint. And we kept moving.

We pulled into Sonju aid station, mile 58.7 at approximately 1:20 PM. Larry Pederson and his daughter were there, as were several runners huddled around the fire. I asked for medical assistance with taping the ankle, and they did not have any. They also lacked tape. I asked for some ibuprofen. No dice (and was later glad they didn't have any).

"You can't drop here," Larry said. Best to keep going to Crosby, they'll likely have medical staff and supplies there because, well, it's Crosby, we agreed. It had taken us 24 minutes per mile to get here, although my brain calculated our pace closer to 20 minutes per mile. That faster pace was sustainable at a walk, and running the math out - remember, it's dangerous to do basic math during a 100 miler - it was also a finishable pace, Larry and I agreed.

To Crosby

And so we hoofed off at 1:24 AM. The 4.2 miles to Crosby is actually closer to 3.66 because you need to get out of the aid station (~0.2 miles) and then once you get to the gravel road, hike up that gentle grade into the aid station (~0.33 miles). It was an easy section. At my erroneous pace guess of 20 minutes per mile, even on my now-supported ankle, we were going to shoot for arriving at around 2:50 AM.

But just like the compression sleeve, the relieve the additional lacing provided did not last and within a mile or two I started to hobble on the ups and down. I shuffled down declines sideways with my feet perpendicular to the trail. When the pain returned my pacer and I concluded that I was not going to run another step. We determined that once we got to Crosby, we were going to get a medical evaluation. If it was safe to continue, i.e. I wasn't running the risk of a serious or permanent injury, we would tape up the ankle or do whatever else was necessary and keep going at our power hike pace. I would hike to Lutsen if necessary.

But the ankle only got worse with each step. By the time we hit the road, I was in a full-on limp on the flat and hard dirt. For a third time, we had reached the question: What to do now? I grimaced as we plodded up into the aid station. For the first time during the race, I did not run to meet my wife. I hobbled.

But there was no medical staff at Crosby. My wife asked the aid station workers for someone who could tape an ankle, and it got to Matt Patten - who was captaining party known as the aid station - who determined that he was going have to be the person, who despite a lack of medical training, upon whom the task would fall. He also lacked the medical supplies to complete the task.

Somehow, a crew member of another runner heard my plight and came over. Jen was a physical therapist and graciously agreed to examine my ankle. With my shoe, sock, and compression sleeve removed, she wrapped her hands around the base of my ankle and squeezed, putting pressure with a single fingertip.

"Does that hurt?" she asked.

I moaned, reared my head and thought I was going to cry. She moved her hands, and squeezed again.

I repeated my wincing, and announced to the world that I was going to throw up. The pain had sent me into shock.

You've definitely strained the ligaments on the outside of your ankle, she explained - likely by rolling it - and you likely pinched a ligament on inside of your ankle at the same time when it rolled. She could tape the ankle up and that would brace it very well, but she was unfamiliar with the Leukotape we had.

Now I have rolled ankles in the middle of races before. During the 2011 Superior 50K, I took a wrong step and a later fall rolled my left ankle. Obviously sprained, I could and did continue to run on it. I sprained the right ankle en route to finishing the Zumbro 100 in April 2012. But none of those affected my ability to maintain forward progress like this injury.

My wife asked the penultimate question. "Does he risk serious or permanent damage if he continues [with a taped-up ankle]?"

Well, she said in a tone that told me I wasn't going to like the news, you're risking a longer recovery from continuing. You're looking at eight to 10 weeks of recovery if you stop now, and longer of you damage it further. You could also tear the ligaments and risk immobilization, she said.

During the hike up and into Crosby, my pacer and also discussed the collateral effects of the sprain on other parts of the body. I would be compensating for the weakness and my gait was noticeably affected. It was all too easy to injure another body part as a result of my altered stride.;

I knew the trail that was coming next, too. I would need to descend over boulders into the Manitou River gorge and then hike up and out of the same. If something went wrong, I was toast and could need professional rescue. And other hard parts of the course remained - the Cross River and the hike up and down the hill prior to the Temperance River and then up to, around, and down Carlton Peak were primarily on my mind.

My pacer looked at me and all-but told me to turn in my number. You don't want to be out six, nine, 12 months because of this, he said. I knew he was right, and I told my crew, Jen, and Matt Patten that I was done. My wife removed my bib and took it to the radio operators and made sure I was properly DNF'd. I thanked Matt Patten, Jen, and sat there for a little while in warm clothes consuming soup and grill-fired pizza. I dragged my right foot as I walked to the car, dazed from the effort and what had just occurred.

Aftermath and evaluation

My injury-forced DNF has left me with an emotional emptiness, like a nagging Monday morning quarterback who has nothing critical to say about the prior day's performance. Just a shrug, a better-luck-next-time.

Why? Because everything went right on this race except that ankle, and everything continued to go well after the ankle injury (except of course the ankle). And even with the ankle injury, I still cannot point to a specific event which caused it. I did not fall, and none of my stumbles over roots or rocks were out of the ordinary. I do not remember rolling my ankle (which is why I thought it was initially a high ankle sprain caused by running down hill), or any specific point on the trail or event that was occurring when and where it first gave out.

So what did go well?

---Weather

How often do you get three perfect days in a row on the North Shore? Almost never, that's when. The days lined up to be mostly sunny, temps in the mid 60's, lows in the low 50's/high 40's and a nice breeze. Zero rain was in the forecast, although we did get about five droplets hit us by a passing cloud en route to Sonju.

It did rain earlier in the week and so the trail was muddy in many spots, but that was manageable. I'd rather have water on the ground than it coming from the sky.

---Nutrition

I went into the race planning on relying almost entirely on Clif blocks while taking a gel once per hour, salt tabs every 30 minutes, and taking two 225-calorie bars (made from this cookie recipe, which I have used in cookie form at prior ultras) at each aid station, and then consuming bananas, other fruit, HEED, Coke, ginger ale, and PB&J sandwiches at aid stations. My watch was set to a 10 minute timer so I could take a block, and everything was based off of that. My world was confined to 10 minute increments, and I had the timer field showing all the time on my watch. I only looked at the time elapsed (or the actual time) at aid stations, but never in between. I can do anything for 10 minutes.

In the end, I consumed 12 tubes of blocks (2,400 calories), four gels (400 calories), several bars, and other goodies at aid stations. I probably easily cleared 5,000 calories and felt great the entire time. When my brain did start to fritz out while walking to Sonju and then Crosby aid stations, I was easily able to recognize it, take a salt tab and get some calories in, and keep going.

Gels did not work so great because they were so sweet (I had a couple of ones from Clif), but they were a good pick-me-up when I knew I was low on sugar. Mix with some water and take it slowly and all was fine. As the race was progressing, my plan for them was to keep a couple on me to get me through any low-glucose-induced rough patches.

Fluids also went well, and was able to drink to thirst without worrying about draining my supply.

---Footwear

I went to New Balance 1010v2's for additional support and protection in this race. And they worked. My feet did not get pounded to a pulp, although I did end up jamming my big toe on my right foot and will lose the nail on my right big toe again. I don't think this is so much of a shoe issue as it is my own tendency to use that foot as my initial stepping-off foot, i.e. it bears the brunt of any contact. The shoes themselves also held up very well, and only one lug became partially detached my the aggressive trail. I'd wear them again.

Other issues with my feet I am chalking up to the loss of form caused by the ankle sprain. 

---Pace 

I planned to take the pace slow an comfortable. Apparently my reputation - earned or not - of blowing up in races precedes me, and there are a few people who have scrapped my butt out of an aid station and pushed me to the finish. I chalk most of these prior errors up to plain inexperience, and I was going change that rep at this race.

I hope I have. I arrived at Split Rock, mile 9.7, at approximately 10:10 AM. I had run with a group of people, the leader of which was taking the pace gently and making sure to walk and go slow over technical sections. The transition was quick, and later I shortly caught up with T.J. Jeannette as we walked out of the aid.

T.J. and I ran to Beaver Bay together, again, going nice and slowly. We let a few groups go and T.J. kindly let me lead. We pulled into Beaver Bay, strong and comfortable, at 12:30. The exchange was quick, and T.J. later caught up to me after I stopped to urinate. We hit the dirt road and he left me, but I kept going slowly.

Somewhere prior to Silver Bay Kevin Langton caught me and I told him we were going to hit Silver Bay at 1:45. I had been running 15 minute miles comfortably, and he gave me a Woo! as he passed. I hit Silver Bay right on time, 1:45 PM. I had passed Kevin during the transition, and he would later catch up to me just prior to the Drain Pipe in Tettegouche.

Next was Tettegouche, a 9.9 mile section. That 15-minute pace would mean 2.5 hours on a generally difficult section. I pulled into the aid station at 4:30 PM, a 2:45 split for 16.5 minute miles. I was pleased, as I was still running very well and not slowing noticeably on the flats or down. I still had plenty of legs on the ups.

I did forget to grab something solid to eat at Tettegouche, and by the time I realized it I had made sure I wolfed down half of a bar. The climb from Highway 1 past Tettegouche to Inspiration Point is slow and shallow, but it also is not runnable. I had my first bad patch here, and I fought through it with a gel and determination. I hit County Road 6 at 7:10 PM, again comfortably running everything runnable after I fought through the low spell. The section was done at about an 18:12 pace and I was in over 20 minutes ahead of where I had been been in the past. Of course things then went south after mile 48 en route to Finland with the ankle injury, but we did the next 7.7 miles in 2:20 (18:18 pace). Even after the ankle injury I was consistently moving at 24 minutes per mile for 12 miles.

Had it not been for the ankle injury, I have no doubt that I would have finished.

Could I have finished, and if so, what would it have required?

I doubt it. Looking back, it would have required the ankle to be evaluated and taped at Finland. I could have also taped it myself at Finland. I also think poles would have helped, although I made the conscious decision while packing for this year's race not to bring them because I felt I had relied on them too much with too little gain at last year's event. And even then, it was a big unknown.

What's next?

Very simple. Recover, and recover well. Rest. Ice. Compression. Elevation. I'll be back next year.  

5 comments:

Greg Geiger said...

sorry to hear. I have enjoyed following your path. seems you always have everything down to a science. best of luck with the recovery.

Anonymous said...

Uuurggg...you made a WISE choice Matt. I made a wrong choice 5 years back to finish a race, and it cost me 3 longgggg years of recovery. Heal up fast and hopefully see you again soon on the ultra trails. Jim W. From Kato

Emmett Fletcher said...

That is definitely too bad. Sports activities shouldn't have to have those things as potential hazards, much less blockages. The best you can do then, once you literally step into such a pass, is to circumvent it and keep on again, with medical treatments that will relieve your pain. Take care!

Emmett Fletcher @ CK Physiotherapy

samh said...

Devotion, Matt. You are devoted, plain and simple. Keep strong, my man. Keep strong.

Mitchell Winslow said...

I think you should have taken a break the moment you got injured, so that your body can heal before you go on strenuous activities again. Anyway, just continue resting for now, and let your ankle recover fully before you start running again. That way, you won’t have any problems with them in the future. Take care!

Mitchell Winslow @ Primary Care