Three weeks ago I was diagnosed with a stress fracture in the second metatarsal of my left foot. I was outfitted with this very sexy shoe which I have to wear until my follow-up appointment on November 20. No dancing for five weeks, minimal walking, minimal activity. Just..."rest".
In the same week that I found out about my fracture, my roommate let me know that she was moving in with her boyfriend.
In two days, the two things that I loved most about living in New York were dropped away from me.
Now that I'm in a better mindset, I hope to write more often about my healing process...I hope other dancers can learn from my own experience, to either prevent it, or feels less alone when it happens to them. Most of the more physical aspects has been compiled from hours of obsessive Googling about my injury, which will hopefully save others the work of having to do it.
The first weeks (mental):
Though my recovery time is supposed to be relatively short (especially in the scheme of a long dance career ahead), in the first week and a half, I struggled with a great sense of aloneness. First of all, because I work from home, the majority of my social time came from being at Manhattan Ballroom Dance. Secondly, much of my identity came from the image of myself as a dancer - if I wasn't dancing, what did that make me? I suddenly saw myself as an injured, inferior version of myself. And third, I battled the pure chemical loss of endorphins that kept me picked up during other difficult times.
It's easy to go down the mental rabbit hole with this kind of injury. Even looking to the internet for hope wasn't helpful. There weren't other competitive ballroom dancers who were discussing these types of injuries, despite the fact that almost every serious female dancer I've spoken to has at some point had a significant foot/ankle injury. Although many runners with this injury were back to running within six weeks, I read just as many stories from principal ballerinas who had dealt with long fracture recovery periods - not particularly encouraging.
For the first week, I hid the fact that I was injured - maybe out of shame, or sadness, or denial. That was perhaps the most difficult time. I felt like I should go to the studio to stay connected, and yet being there just reminded me of what I couldn't do. My friend Peter gave me the best advice, "Just do what will make you feel healthiest, not what you think you should do."
When I was struggling with depression in North Carolina in the fall of 2012, before moving to New York, I recall my own listlessness. My inability to get out of bed, how I didn't want to interact with people. The random bursts of anger and sadness. How I lost my esteem and energy day by day. And although my dear friend Robert once yelled at me, "You don't have to suffer alone!" I was so locked in that all I wanted to do was hide at home.
Remembering that makes me so grateful that in New York, my support network has pulled together around me to keep me from that. One thing that annoyed me about many existing stress fracture posts was how cheery people seemed - probably because most of them were written post-healing. Being injured really, really sucks. There are mornings I haven't wanted to get out of bed. There are days when I sit on the subway and just stew about all the negative possibilities ahead of me. Someone told me, "use this time to do all the things you want to do in NYC, but have no time for because you're always dancing!" Unfortunately for me those things are: go hiking, go to museums, walk around the city -- all things which are not resting. My challenge every day is to reach for daily happiness, to stay positive and not lose focus.
C and I had so much momentum in our dancing, and both of us are feeling that loss deeply. We had to miss DCDI, and we'll be missing Ohio Star Ball, Big Apple Dancesport, and possibly others that we'd planned into our season. I think it's even worse for him because he could dance but because I'm injured he can't. But he checks in, gets me out of the apartment either for cross-training or just to get out, makes sure I'm laughing and looking forward. And our amazing coach has continued to involve me in our lesson every week, working on right-foot-supported line figures, frame, and teaching me how I can keep working on my dancing in the absence of movement.
At work, my bosses ask about my foot, tell me to stay happy and hopeful. And my parents, as always, have guided me to think deeply about what I can learn from this experience. My friends are stepping up to visit me, check in on me, send me love and advice. So despite this setback, I feel so incredibly lucky. More on that in future posts!
The first weeks (physical):
The second metatarsal is the longest metatarsal in our feet. It's the most injured bone in dancers, particularly females who may not be eating enough and are lightweights (i.e. lower bone density). Our metatarsals take the most weight when shifting from flat to "demi-pointe" position. For standard dancers, this is every single driving step. Tight calves means less time in a stable flat-footed position, and more time with pressure in the forefoot. People who are flatfooted, like myself, put the most pressure onto foot bones, whereas people with high arches tend to place the pressure into their tibia and higher bones in the leg.
THIS IS NOT MY FOOT, but this is what a stress fracture on x-ray looks like, with a little cloud of calcium around the bone that indicates the healing process has started (versus normal foot to the left). My fracture was pretty advanced - the doctor saw it on the xray where as most stress fractures require MRIs to be diagnosed if it is within 2-5 weeks of injury.
Stress fractures occur with sudden increases in intensity or amount of physical activity. Physicians recommend that athletes increase activity by no more than 10% a week to allow the bone time to remodel and strengthen. Studies have also shown that have significant rest periods (days of NO/VERY LOW activity) interspersed with high activity allow the bones sufficient time to adjust.
Sometimes doctors will give the full CAM boot. But I got the sexy shoe aka surgical shoe. I realized quickly that most of my other shoes were not the same height as this shoe. Walking unevenly was leading to all kinds of lower back and hip pain. I'm learning to rock the "I-own-one-shoe" fashion.
It took me a lot of experimentation to figure out the right sock thickness to be able to wear the shoe without pain from the straps and buckles, and to build up a good walking rhythm. My savior has been these thick wool socks from REI that my dad gave me for Christmas last year (picture above).
Unexpectedly, not being in 2.5" dance heels six days a week has lengthened my calf muscles, released a lot of chronic tightness in my hamstrings and quads, and frankly, I am more physically relaxed and flexible than I have been in a long time. There is some atrophy of my left calf :(
The swelling across my second metatarsal went down after about a week. I was using Traumeel (an herbal NSAID) but stopped after about a week. I had a recurrence of swelling and pain over my left foot metatarsal when I tried to wear a rain boot on my non-injured foot - perhaps because it was forcing my injured foot to be more mobile. So I'd recommend as flexible of a shoe as you can bear on the non-injured foot. As soon as I stopped wearing my rain boot, my injured foot felt much better.
Most NSAIDs (Advil, aspirin, etc) are a huge no-no as they inhibit prostaglandin synthesis - one of the most important processes for signaling tissue synthesis in the early healing stages. NSAIDs also lead to poor formation of bone callus (both soft and hard), which means a weaker bone.
In the image above, the first stage happens almost immediately, the second stage takes between 2-4 weeks from cessation of activity, and the hard callus in weeks 4-6. Because ater 4 weeks the bone is new, it has to be reintroduced slowly to normal stress in order to not be reinjured. Bone remodeling, in which the callus is slowly shaved down to become normal bone sized again can take between 8-12 months.
I've been taking vegetable and algae-based supplements for Calcium, as well as Vitamin D, and a number of other ingredients including Vitamin C, Vitamin K2, magnesium, and silica that are proven to help fix calcium and therefore build stronger bones. The best one I've found is Nature's Way Bone Formula. I'll definitely keep taking it once I'm healed.
There's some debate as to whether or not alcohol inhibits healing (smoking definitely does but this was not a concern for me), so I've laid off of it...aside from a sip here and there :P
Sleep is amazing because that's when HGH (Human Growth Hormone) surges. When people don't sleep when they should, or miss out on sleep, it suppresses the body's immune system as well as our abiility to maintain healthy tissue, and to regulate stress hormone. My stress fracture, though only diagnosed a few weeks ago, actually started during a time when I was sleep deprived and stressed about a big work project. It really hit home how important it is to lead a balanced and healthy life, particularly as an athlete.
Lastly, our bodies need between 150-200% more calories when we are healing a significant injury. I've been eating almost a full meal every few hours which is way more than usual. I have not, that I can tell, put on any weight, so I do think it's all going toward healing!
That's probably enough for a first post. I'll continue blogging as my healing continues!