What I’ve learnt from being Injured (and it’s not what you think)

Mountain biking in New Zealand about 6 months post-op. Probably wishing I was mountain running instead, but not a bad option B….!

We rarely come away from life’s challenges having learnt nothing. How we propel in the aftermath of major setbacks can be the major shapeshifter in our lives, and indeed in who we become as people thereafter.

I am finally at the point where I’m fairly comfortably through the trauma of what we shall call the “Everest” of my injury history. If I were to sketch a visual of my colourful history, it would look like a scattered flow of 13 stress fractures, starting at age 12 in relatively non-important locations and then escalating into some more heavy terrain as my eating disorder and distance running career progressed, finally reaching the peak at doing an Ironman with a stress fracture in my foot at age 29 and subsequently ending up needing major reconstructive foot surgery and a total of over 12 months off running. I can confidently say that that will be my peak, as I have finally, definitively, learnt how to respect my body. Which brings me to the 2 (yes, only two, but they’re BIG ones) things that this last 18 months has taught me:

1) Respect your body – you only have one (Yep That Old Chestnut)

Love it or hate it, your body is the only one you’re going to get. Sure, a surgeon can plate and drill you back together, but ultimately the bones and healing capacity that you have is still dependent on just that one body; you don’t get a new one just because you treated the old one like a rental car.

During the worst of an eating disorder it’s near impossible to comprehend or love your body, such a minefield is your brain at the time. And certainly, it’s something that I have really struggled with well into recovery – which is going on over 5 years now. It’s funny how it sometimes takes something so huge as threatening my ability to run and race – the loves of my life – to really “get it”. I guess in the aftermath of your eating disorder, those early months and years are spent just trying to survive the new life that you’re supposed to embrace – the daily climb of having to face food and weight gain, doctors, dieticians, psychologists….it’s all so much to cope with at the time. It’s often only years later that you can look back with some perspective and truly see what your body went through, and indeed how blessed you are to now still be standing here. Able to run. Able to love, and laugh. Able to grow a baby from scratch. It’s truly remarkable, what the body can come back from.

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Eventually the trauma ends, the memories get softer and we get back into our routines….and then along comes a “choice point” in life. I had one of those a fortnight ago. After having a good few months of pain-free and enjoyable running, I started feeling an all-too-familiar pain in the butt….well, my right sacrum (tailbone) to be technical about it. I’ve had two stress fractures there in the past, so I know what it feels like. The fact that I’ve had two, indicates I failed to learn from the first one, as with most of my injuries up to this point. However this time was different: I was able to use my “logical” (Physio) brain, take a step back and assess the pros and cons of continuing to run on this. For the first time ever, I was able to take a week off running, knowing that it was the best thing for me because I want to be able to run not only after the baby arrives in a few months, but also when I’m 60, or 70 years old. And my poor sacrum has already been beaten up enough. So even though I hated having a week off running now, in the long term, it was the best thing for me. And sure enough – my efforts were rewarded: I was able to go back to my 5km run yesterday morning with minimal butt pain. Seems so trivial, but such a huge step for me – in all my years of life, I’ve never yet been able to not just keep “pushing through”. I am finally confident that going forwards with training and racing, I will be capable of making the right decisions, rather than living in fear of what I know I can do to myself. The thought of training and racing injury-free seriously excites me. I have a plan, devised together with my “moral compass” aka my husband, on how I will approach training and racing coming back from this surgery and after the baby arrives in March. I know I have posted some awesome results in the past being tired, injured and generally unbalanced, so I am itching to see what the future brings. Bring on the post-baby running and Ironmans!

Hamilton Island - hiking up that hill at 7 months pregnant was totally worth this view!

Hamilton Island – hiking up that hill at 7 months pregnant was totally worth this view!

2) Enjoy the mundane routine of life – it is truly a blessing.

This is the big one. The surprise I got out of going through this surgery and the months of healing and rehab after was how much we take for granted the routines of our lives. Never before have I appreciated so much the simple acts of being able to walk, sleep, work, drive, cook dinner, do the washing up, hang out clothes washing, water the garden, and not to mention walking my dogs in the sunshine – that’s like ecstasy! The “daily routines” that I used to think got in my way of being…well…busy/productive/important/useful, I now see with a completely different light. Being in plaster and unable to do much of anything independently gives you a fair amount of time to think about these matters. The thing is, what we fail to realise while we get tied up in our own “busy-ness” and in seeming important all the time, is that the majority of our lives are, in fact, made up of us doing the daily routines. They are life. And if we can truly learn to appreciate how blessed we are to be able to have the health and the homes to do those ‘chores’ every day, then the daily grind suddenly becomes more magical.

As a pleasant secondary offshoot to this, this new appreciation for the simple things in life has translated into being able to be still, and just be with “me”, for the first time in my life. A big factor in eating disorders is that inability to relax and enjoy the quieter moments in life – for so long, I was fearful of weekends or holidays, and always had to plan every moment. I’m still not great at it, but I am much, much better. And it’s just so lovely to be able to take a big sigh of relief and know that everything will be OK with the world if I am just still for a little while.

Every experience in life – good or bad – can be a blessing in disguise if we can learn from our experiences. Sometimes this takes time, so be forgiving and gentle on yourself, especially in those early stages of recovery. You are a champion just for embracing the fight of a lifetime and let me promise you, it will all be worth it in time. Life truly can be a beautiful thing.

K xoxo

Even looking at this photo is hard....early days post-op.  Never again!

Even looking at this photo is hard….early days post-op. Never again!

Exercise and Recovery

I’m going to be a little controversial with this post. I’m going to suggest that for a large majority of ED sufferers, recovery would be best done while they maintain their work or school, and for athletes, their training.

Before everyone gets riled up about it, I am not talking about those so severely undernourished that they are at risk of dropping dead from a massive heart attack at any minute, or those with suicidal tendencies….clearly an inpatient program would be best for these patients (at that stage in their recovery, even if those programs for the most part keep people alive but do not really assist in long term recovery and have notoriously high relapse rates….but that’s a post for another day). I am talking about the majority of ED sufferers who are under their individual ideal weight (note I did not say “under BMI 18” – how ridiculous, what about the person with a bigger frame who is still starving but able to maintain a BMI of 21? Are they “less sick”? of course not), are still participating in work or school, and particularly those who are athletes and see that as a part of their identity. I’m talking about the people who are functioning in society, but are significantly affected day to day by their eating disorder – maybe with the accompanying depression, lack of energy and concentration, fatigue, social isolation and the other joyous side effects.

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Here’s why. Think about this: What is the biggest challenge in recovery? I would argue that one of the hardest parts about recovery is learning to lose the “ED” identity and to learn who you really are as a person. Only once that has occurred can one begin to truly move on with their lives and to want to nourish their mind and body. Only then do they have a sense of self to take care of – a reason to recover, if you will. For recovering for someone else, or to get out of Inpatient care, or for the sake of a “goal weight”, will never do it. That typically leads quickly back to a relapse and the cycle that entails.

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Inpatient care, while necessary to sustain a life on the edge, takes away all the other factors in the patient’s life that will be the foundation of their true identity as they return to health: their job, their hobbies, their social network, and for athletes, their training and usually tightknit support crew – coaches and fellow athletes. Not only does it take those things away, it actually forces the patient to focus 100% of their time and energy on the eating disorder. Their days are spent focusing on food, psychology, analysis, resting, scales, and usually the added bonus of in-house competition between patients on who is the “most sick”. Statistically, success rates aren’t good – the weight is temporarily gained, yes; but in the long term, recovery rates can be as low as 20% for patients who have had an ED for an extended time period. The statistics have not improved even after a few decades of treatment in this way. Why not?

At some point, the patient needs to learn how to function in society in a healthy way, and for this to happen there needs to be a reason for the patient to want to get better. Want being the key word here. When an athlete-patient is allowed to keep training, albeit at a reduced load, there is an all-important reason for them to put in all the hard yards day to day that go with recovering from an eating disorder. There can be clear goals and rewards: you gain X weight, you get to train X amount. You eat X foods, you get to attend X training sessions. If you don’t, you can attend but you have to sit out and watch. Sure, it’s harder to gain weight while still training. But guess what? Eating like an athlete is hard, full stop. Years on I still find it a challenge day to day. When you train hard, you have to work even harder on fuelling your “machine” (body), and the sooner a patient gets used to that process the sooner they can master it. Secondly, gaining the weight as muscle, bone density and fat via increased food and some continuation of training is much healthier and less traumatic for the patient than gaining fat alone on a resting protocol. Lastly but most importantly, there are three overwhelming psychological benefits to this approach:

1) the motivation-reward system is clear and immediate;

2) the social interaction with teammates and coaches is maintained, which is so important;

3) the patient is nurtured through the process of minimising their ED identity and replacing that empty space with their “healthy athlete identity”. {You can replace “athlete” and “training” with anything else relevant – student and school, physio and work, etc.}

The key to this process is to have a fantastic support team who can facilitate this transition. For me, it was a brilliant Sports Dietician (it was her idea to allow me to keep training – every other rehab program I had entered forced me to rest and spiral into depression), a brilliant Psychologist who specialises in treating athletes with eating disorders, a Coach who was on board with the plan, and a flexible workplace (I was still studying at University but my part-time job as a research assistant allowed me to set my own work hours, so I could go in when my energy levels were highest – early in the morning). For the most part, my dietician set out my goals for the week and my rewards – when and if I could train etc. All the while she communicated with my psychologist, who from the get-go has focussed on establishing my identity as an athlete. As he reminded me recently, I have always done best when we focus on what my body can do (as an athlete), not how it looks. All body fat % and weight measures were taken away from me, and replaced by more relevant measures like time trials and power outputs. And the only way I can get stronger, fitter, faster, and keep up with my teammates? To eat. Simple as that. I know when I skimp, I fall behind, and as a competitive person, that is motivation enough to nourish my body.

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The best part is that the system WORKS. And it’s not just a bandaid fix – it works in the long term. To this day, years on from the start of my “recovery”, I still have a crappy day at work, feel “fat” as my go-to coping mechanism, and then know that if I go and do a solid training session, by the time I walk back through that door at the end I am going to be happy with my body and what it can do for me. Nothing to do with how it looks or what it weighs. Simply what it can do. And that’s pretty cool. Add in the extra bonuses of a good training session – fresh air, endorphins, improved fitness, mental clarity, relaxation – and it’s a win-win situation.

I make it sound easy and like the obvious solution, which for me, it was (obvious, not easy!). Nothing else had worked over the decade beforehand. And certainly this system wouldn’t work for everyone either, but for athletes, I would argue that it is the best way to structure treatment. Realistically, there needs to be a change in the way we treat eating disorders in Australia as the current inpatient systems are not working in terms of long-term outcomes and relapse rates. There is no easy answer.

Food for thought anyway.

Happy training xo