Race for fitness

On Monday, August 2, three weeks before the Olympic marathon, I did my final 2hr 15min run down at the lake near Font-Romeu. It was as good, if not better, than any of the long runs I had done that summer. I was in very good form. The next day we left for England, where we would spend five days before going to the south of Spain to acclimatise for Athens.

We based ourselves on the edge of the Doñana National Park, south of Seville. There were lots of trails, we had a nice place to stay and the temperatures were close to Athens. We wanted to replicate my build-up for my previous marathons as much as possible.

On Sunday, August 8, exactly two weeks before the race, we did our last long training session: a two-hour tempo run in the evening to replicate the Athens marathon. Gerard (Hartmann, my physiotherapist) wasn’t feeling well and didn’t come. Gary (my husband) and I went in the car to the cycle path from where I would set off.

Warming up, I felt a little tightness in the vastus medialis muscle in the quadricep of my left leg. Had Gerard been there I would have asked him to have a look, but it didn’t seem serious enough to drive back. If it became sore during the run, I would stop. Through the first hour and a half I was aware of it, but it wasn’t painful. In the last half-hour it gave me a little more trouble, but as soon as the run was completed the leg seized up.

Gerard told me not to worry; the muscle causing the problem was not essential for running. As soon as he touched the area that was in spasm I was in agony. To loosen it, he had to be incredibly gentle with his massage and clever with his psychology; he didn’t want me worrying about this. The next morning it felt bruised but otherwise seemed OK. I went for my run as normal, but five minutes into the warm-up it was obvious there was a problem. It felt as if I couldn’t bend my leg properly. On the massage table, I didn’t have to be told it was serious. I could feel the same squeakiness in the area above my left knee that had been in my shin before the Chicago marathon two years before and again in 2003. Crepitus had come back to haunt me.

Gerard said the muscle didn’t seem to be damaged; it was aggravated and in an inflammatory cycle. By evening it felt better and the squeaky sensations had disappeared. The next morning, there was still no sign of the crepitus and I decided to give it another 24 hours before putting it to the test.

That afternoon we went for a 20-minute walk on the seafront and returned for more treatment. When Gerard looked at it, his face fell. “It’s back,” he said and I could tell that he was shaken. So we turned again to Dr Hans-Wilhelm Müller-Wohlfahrt (the German doctor). We had to get this sorted and quickly. Gerard and I went to Munich.

Dr Müller said I needed an ultrasound scan so he would know what he was dealing with. That showed no damage to the muscle, just a lot of fluid between the muscle and the sheath, hence the crepitus. He treated the area that Wednesday with anti-inflammatory homeopathic injections.

Feeling much happier, we travelled back to Seville; I rested the next day and when I ran on Friday the leg felt OK. But an hour later the crepitus was back. Gerard, normally so reassuring, was freaked by what was happening. Here we were, nine days before the marathon, isolated, far from the medical back-up that we needed and the clock was ticking.

After a phone call to the doctor, I tried again to run on Saturday; again the leg was OK during the run, but the awful creakiness was back soon afterwards. Gerard tried to stay positive, but I could see his anxiety. I was scared all our hard work was going down the drain.

Mum and I spoke on the phone. I was upset. The injury and the uncertainty were making me stressed and, through the tears, I told Mum that I would fight it all the way.

“If it was a normal race, I would pull the plug on it. But I don’t know how I could survive if I can’t run in Athens.”

“Do you want me to come out and be with you?” “Thanks, but there’s nothing you could do. All we can do is hope it will clear up.”

That was my mistake. It was getting to me. I was very worried and the stress was draining my energy and disrupting my sleep. Maybe if Mum had come out she could have helped me cope with the psychological wear and tear.

We needed more medical help and back-up. I tried to see Dr Müller, but there were no flights. We considered joining the Great Britain team in Cyprus but realised it would make more sense to go directly to Athens, where we would have access to the Olympic facilities. Bruce Hamilton, physician with UK Athletics, agreed to leave Cyprus for Athens early so that he would be available to treat me. In the meantime, the injury wasn’t going to get significantly worse and I could run enough to maintain fitness, although it was uncomfortable.

We left for Athens early on Sunday, August 15, one week before the marathon. I got up at 5.45am and went for a run. Normally at that hour I feel terrible, but on this morning I was wide awake, energetic and driven by the almost manic desire to run in Athens. UK Athletics booked us into a hotel in Marathon, about 35 minutes from the athletes’ village. Bruce booked me an MRI scan for 8.30 that evening.

I was out running in Marathon when the arrangements were being finalised and we had a frantic rush to get accredited and into the village in time. The scan was meant to last half an hour, but lying there, it felt a lot longer and I couldn’t help thinking the worst. Once out, I checked the time: I had been in there for an hour and a half.

“What did it show, what did it show?” I asked Gerard.

“We’ll explain it when we get to the Lodge,” he replied. “Bruce will be waiting there. I have asked Gary to be there as well. Some decisions may have to be made.”

It was midnight and everything was quiet. Bruce was there when we arrived. He got out the scans and looked at them. I watched his face and the horror that came over it.

They could see the problem in the vastus medialis where the crepitus was, but that wasn’t the biggest problem. Underneath the muscle, between it and the femur, they found a haematoma. The scan showed that some of it was dried and congealed, but there was also some fluid there. They had no idea what had caused it. What they did know was that the haematoma was the underlying problem that led to the crepitus building up on the upper side of the muscle because of the pressure within the muscle sheath. Getting rid of the crepitus was a waste of time if the haematoma was still present; it would keep coming back.

Liaising with Dr Müller, Bruce suggested a cortisone injection to clear the crepitus. Dr Müller felt that at this late stage it was the only option because we were talking about the Olympics. I had always said I’d never have a cortisone injection because I didn’t want to risk any long-term problems, but this was a low-risk area.

Bruce was the doctor with responsibility for treating the injury. “I can give you a cortisone injection into the side to help treat the crepitus, but for the haematoma I’m not happy to go in there tonight. We’ll decide tomorrow.” He did the first injection that night and put me on a heavier course of anti-inflammatories.

The next day I iced the leg for 15 minutes every hour. Around noon, Bruce asked me to come to the village. He had booked an ultrasound scanner to help to guide him and make sure he hit precisely the right spot with his needle. A female doctor took us into the centre.

“I am going to need you to guide me in here,” Bruce said.

“I am sorry,” she said. “I can’t let you do that medical procedure here.”

“Look,” replied Bruce, “we’re all doctors, we’ll take responsibility for what we do.”

“I’m a doctor, but I can’t let you do that here.”

We walked into a normal treatment room and Bruce basically did it blind. Using the thinnest of needles, he went through the muscle, barely touched the coating around the bone — but enough for me to flinch. That told him he had gone a fraction too far. Then a blood-stained fluid came seeping back into the syringe. He had found the right spot and he injected diluted cortisone to get rid of the dried blood.

Bruce told me I would have to rest for two days and continue with the high dose of anti-inflammatories, especially when I tried running again. I was bothered by the level of anti-inflammatories, but both doctors reassured me they were necessary.

On Wednesday morning, I ran for 40 minutes with Gerard watching, iced the leg and then we treated it. The fear that the crepitus would return and my Olympics would be over was huge. When Gerard checked the leg I was almost shaking with fear.

“It’s not there,” he said, moving it. “It’s not there.”

I burst into tears, overwhelmed by relief.

“Can we just try it again?” “OK.”

“No, it’s not there. It’s definitely gone.”

That evening I ran with Gary around the village, so relieved that the crepitus had gone that I didn’t pay much attention to the fact that I needed to use the toilet three times. “It’s just the anti-inflammatories,” I said to Gary. It didn’t occur to me that this would have serious repercussions. I was eating food normally, yet it was passing straight through me. Nothing was being absorbed.

The stress levels decreased a little, but I still had the feeling we weren’t out of the woods. On Thursday I wanted to try out the racing shoes I would use in Sunday’s race. “Don’t do it,” Gary and Gerard said. “You don’t need to do it.”

“But you don’t wear new shoes in a race without first trying them out,” I said. I had the feeling they knew something that I didn’t. Why else would they want me in cushioned trainers all the time? Something was wrong, but I couldn’t put my finger on it. After an ice-bath, I became momentarily dizzy when walking back to the apartment. Was I hypoglycaemic? Was it the anti-inflammatories? I asked Bruce if it was possible for me to come off the course. Worried about my leg, he wanted me to stay on them.

The leg was almost fine now; certainly it would hold out to do what I needed it to do. The problem, as I was about to learn, lay elsewhere.

Tenosynovitis is a condition that occurs when the sheath surrounding the tendon becomes inflamed and swollen. As the tendon moves within the inflamed sheath, there is an audible creaking or crunching sensation called crepitus.

Crepitus is the most demoralising injury because there is no easy cure. Fluid builds up between the muscle or tendon and the sheath around it, causing the creaking sensation because the muscle cannot slide properly in the sheath.

Apart from constant rest and icing, there is little else that can be done. It plays with your mind too because there are times when you are convinced it has disappeared only for it to return after the slightest exercise. It can vanish overnight only to return during the day; it gives you hope, only to kick you in the stomach time after time.

One of the dreadful things about crepitus is the crackling, squeaking, crunching feeling it gives. Without even touching it you know it is there just by moving your foot up and down.

On the day before the race, Gerard left a note on my pillow. He wrote that we had all been through a really tough and difficult time but the experience had reminded him of something told to him by the great Kenyan distance runner, Douglas Wakiihuri. Gerard and Douglas had worked together a lot and been good friends; Gerard helped coach him for a while. He remembered Douglas telling him that he believed the marathon was like a rose.

“A rose, Douglas? What do you mean?” “In this way, Gerard: at the top of the rose you have a very beautiful flower. This is the race and it can be a very wonderful sight. Yet, along the way to the top, there are very many thorns. These are all of the difficulties that must be overcome. Have you noticed, the more thorns, the more beautiful the rose?” Gerard went on to say that though we had been through hell in the previous four weeks, something told him it was going to be all right. He still felt I could do it. Douglas’s likening of the marathon to the rose stayed with me.

Gary: She was warming up for this long run, she felt something not quite right in her quad but she never said anything to me. We have talked like a million times since and she said she was scared to tell me.

Why should she have been scared? Probably because I would have said, “well, what the hell are you doing here? What are you doing this for? You’re not going ahead with this run.” That’s where I go wrong. I would have said, “you’re not doing this”, and there would have been a scene.

“Yes I am.”

“Well then, go and do it by yourself. I’m not staying around.”

Maybe if she’d thought I would react more calmly she would have mentioned it.

This crepitus was something Paula had experienced before, even though it was now in a different place and it was different in nature. But the bottom line was she knew it was a tricky injury. It comes and goes, it plays with your mind.

We had to make quick decisions. We had a crisis situation. It was 11 days to the biggest race of your life, what do you do? Do you sit back and hope it will just come right or do you do something proactive and try everything you can? You can’t just give up. She was never going to give up.