A Challenge, Not an Obstacle

What do you do when your biggest fear becomes a real challenge?

As a toddler I fell down the stairs. All the way apparently. From the very top, down all thirteen timber treads to the stone floor below. I'd been carrying an armful of cuddly toys that blinded me to the edge of the landing and over I tumbled. Being so young my bones and soft childish body coped well. I've a strange dent in my crown, but nothing was broken. Mum told me the story years later when I was about 5 or 6 and went through a phase of being paralysed with fear when I tried to step off the landing. Anyway, I grew out of the fear and became the family go-to person for cleaning guttering or clambering over roofs to secure a loose tile. On the whole I think I'm fairly good about facing my fears and I relish a challenge. Those qualities help shape us as runners don't they?

A challenge is a welcome break from a stale routine - it's something to analyse, a problem to solve, a tool for gaining perspective, a chance to make something better than we had before. Occasionally life and work through up so many obstacles that we yearn for a simple rhythm and flow. One leg in front of the other, arms swinging, breath synchronised, rhythm and flow. We runners are the luckiest of people - we've running to provide both challenges and solace.

However now my biggest fear is a real challenge. That fear of falling never left me and I've been diagnosed with osteoporosis - a disease more usually associated with the very elderly, rather than someone active and non-postmenopausal. That the diagnosis has been made so early is partly due to running. During a road race last year I suffered an acute, excruciating pain in my back as I simultaneously twisted and leapt over the rise of a small humped-back bridge. I didn't go to the doctor immediately - if I'd suffered a compression fracture in my spine there wasn't a lot they could do. I just kept up with pilates, cycling, rowing (when recovered sufficiently) and running, finding that the right sort of motion eased pain rather than causing it. I quietly stopped racing, other than for a few events such as the national XC selection race from which I withdrew after about a mile. When I could put it off no longer, I saw a doctor and shared my fears re osteoporosis - family history on both side, a lifetime at low body weight, having a very slight skeletal frame, a few years on medication that may lower bone density, living in northern latitudes with less access to sunlight for Vit D and, of course, being a middle-aged woman. On the plus side, I'd always exercised without over-doing the miles, never smoked and my alcohol intake was negligible until age 40 and since then has been low-to-moderate. I'd a lingering hope that the positives would 'outweigh' the negatives, but it was a tiny hope. Osteoporosis has a heritability of ~80%, meaning 80% of the disease variance is due to genes rather than environment. Genetically things were stacked against me and I've had a lifetime of carrying around only a small body weight. This means that, despite daily carrying heavy book and computer bags, my bones weren't being challenged sufficiently to build dense bone. They could get away with a low density that was sufficient-for-purpose, so they didn't waste resources in depositing more mineral. I kept putting off weight training as it required (did it really?) a trip to a smelly gym. To run all I had to do at the end of the working day was change and head to grassy playing fields or a beach. Anyway, there's no point in regret. A bone density scan confirmed osteoporosis in my spine, neck and hips ie everywhere they looked.

Now the common advice to someone with osteoporosis is to (a) stop bending the spine forward (b) address any potential dietary deficiencies in terms of calcium, Vit D and Vit K (c) exercise with brisk walks, rather than running and (d) minimize the risk of falling e.g. add handrails around the house. The advice itself is devastating. Most of it is about avoiding risks and assumes the patient is doddery, wobbly and ready to give in to a future of being bent double, seeing only the floor. Some advice suggests running may be OK if you keep to flat surfaces, where you're not likely to trip. However, over the years I've noticed that I'm more likely to trip on a pavement than in the ruts and mire of the fields. Running in fields and trails helps challenge my balance and makes me more responsive, less likely to fall over. I can't face the thought of not being able to run in fields. I've already given up on running alone with my dogs as they occasionally trip me up. I've also had to give up running with a dog attached to my waist by bungee lead. The dogs have adjusted reasonably well. We still run together when David is there to help control them or attach both to his waist. After a few hiccoughs of trying to pull him in two different directions, they quickly learned to run as a pack in one direction. I don't want to give up on all of this and I'm not, not yet. I'm under no illusions. When I see an icy path, I think immediately of an old farm labourer, Billy, who died of a broken leg one winter. The idea of compression fractures bending me over until I have a widow's hump terrifies me - deformity like that is painful, changes how people treat you, affects your breathing and self-esteem. 

What to do? I eat less spinach - who knew it had oxalates that interfered with calcium absorption? I feel someone could have mentioned it. I love the stuff. Otherwise my diet was bone-healthy. I've sorted a standing desk with my computer propped even higher on big books. I'm careful to bend at my knees rather than through my spine and I only pick up heavy objects when I've checked my posture and that the muscles of core and pelvis are engaged. I've been better about weight training, using heavier weights than usual in the privacy of my kitchen. I need to speak to someone at the gym about a programme, but I'm deeply embarrassed by my lack of muscle & the guys in the weights area seem a tad more focused upon body image than body utility. The weight training is vital. It will help maintain what bone density I have and the muscle will provide some physical protection over the bones. As balance and responsiveness are vital in minimising falls, I'm continuing with those weird stand-on-one-leg exercises whilst waiting for the kettle to boil, ironing, brushing teeth etc. I'm doing most of my miles on an elliptical machine, but I still venture into the fields. I really ought not to be racing, not until I address my over-striding. However, I did our local Church Island 10K. I ran fairly slowly, with a shorter stride, taking the impact pressure in my calves rather than my hips. The strategy went well until ~4 miles when my right calf had enough. I limped to the finish, but did finish without hurting my back or hips. There are always problems when you try to adjust form, different muscles and joints being put under strains they haven't felt before. Further tweaks and twinges lie ahead. I'm far from done. I'm not ready to be defined as disabled or invalid. I remain valid and able. 

For advice on osteoporosis try the National Osteoporosis Society. Their leaflet on exercise and osteoporosis is here. If you have advice to share, please comment, tweet or email (mojorunningclub@gmail.com). 

Footnote. I'm not whinging. Worse things happen. I needed to explain to some people why I couldn't race and thus why I was repeatedly unavailable for team events. Keeping the diagnosis private ceased to be an option.