Medieval Hernia Surgery courtesy of Medscape.

You may not know this, but I’ve been injured for a while. It’s been a trying twenty-two months (so far). As one Twitteronian put it, “Man, that’s the longest groin pull in history.” I took this as a compliment. To those who have endured my interminably personal posts, comments, tweets and updates, I thank you from the bottom of my, well, you know.

Alas, my nether-regional monomania has alienated at least one woman. A long-lost friend resurfaced on Facebook to write, “Why are all your status updates about your groin? I know we haven’t talked since 1988, but I have to tell you point blank, I’ve had enough!”

Such are the vagaries of human perspective. I feel as if I’ve shown remarkable restraint on the subject. I’ll spare you the specific details of my reply. Suffice it to say, groin jokes tend to write themselves.

Obviously, I haven’t yet recovered. I run a bit, but nothing like I used to. Recently, I was sent into a near apoplectic tizzy at the prospect of an honest-to-goodness diagnosis (a sign of how far I’ve lowered my expectations). Apparently, I suffer from something called Athletic Pubalgia. Think of this as a sports hernia equipped with a Romulan Cloaking Device. For some time, I have described pain, and sophisticated medical instruments have revealed no cause.

Only through careful process of elimination and diligent reflection have my medical team (yes, team) come to the conclusion that I have the dreaded, nebulous AP. It seems surgery is the only solution. This doesn’t bother me, but can a man truly embrace a procedure called Pelvic Floor Repair?

This sounds suspiciously like home improvement. “The lateral support in these joists are shot. You need a full pelvic floor repair. Yup.”

Next thing you know, you’re constantly at Lowe’s, spending more money than Lady Gaga spends on translucent acrylic undergarments. Nothing goes as expected. Midway through the repair job, an improbable, ancient sarcophagus is found in the subfloor, necessitating a visit by the Smithsonian Institution’s artifact recovery team. The extraction causes so much damage that the contractor tells you, with no hint of empathy, that the wiring and plumbing for the entire house must now be replaced. You’ve become the manic-depressive speculator in an exceedingly disturbing, highly personal episode of Flip This House.

Yes, it’s fair to say I’m nervous about groin surgery.

But I’ll do nearly anything to solve this problem. Fellow runners understand this implicitly. Assuming my insurance company agrees that the solution to two years of chronic pain is something they might consider covering, I’ll give it a go; even if it means being strapped upside down to a medieval operating rack.

I just want to run again.

– Dean
@zerotoboston

I’ve tried everything shy of ritual sacrifice to solve this vexing groin problem. Now it has come to this: I’m reading medical journals. Normal folk waste their evenings with Facebook, YouTube and detective dramas. I read “The Groin Triangle: A Patho-Anatomical Approach to the Diagnosis of Chronic Groin Pain in Athletes.” Exciting stuff.

Written by professionals for professionals, medical journal articles like this are hopelessly dense. They’re full of esoteric terms like “anthropometric,” “trochanteric” and “tuberosity.” It took me less than three seconds to find these words after I randomly selected a typical three-sentence paragraph.

Technical jargon can be forgiven. But these articles habitually break the most sacred laws of sentence structure. I’m reading English, but it feels like German. I keep wondering when the verb will rear its fearful head. Such is the dilemma for the common man. How can one gain knowledge when it requires both an advanced degree and an interpreter?

Consider the abstract (introduction) for the article I’m currently reading:

RIDICULOUSLY COMPLICATED ABSTRACT
(skimming recommended)
Chronic groin pain is a common presentation in sports medicine. It is most often a problem in those sports that involve kicking and twisting movements while running. The morbidity of groin pain should not be underestimated, ranking behind only fracture and anterior cruciate ligament reconstruction in terms of time out of training and play. Due to the insidious onset and course of pathology in the groin region it commonly presents with well-established pathology. Without a clear clinical/pathological diagnosis, the subsequent management of chronic groin pain is difficult. The combination of complex anatomy, variability of presentation and the non-specific nature of the signs and symptoms make the diagnostic process problematical. This paper proposes a novel educational model based on patho-anatomical concepts. Anatomical reference points were selected to form a triangle, which provides the discriminative power to restrict the differential diagnosis and form the basis of ensuing investigation. This paper forms part of a series addressing the three-dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately.

Remember, the abstract is the simplest part of an article. Call me crazy, but I’m still trying to find the verb in sentence four. Reading becomes more laborious in the body of the article. Unless you’re a trained grammarian, you’ll exhaust your patience quickly.

If you just want to learn about your groin injury? Never fear. I’ve rewritten the article’s introduction:

MY REWRITE
Groin pain is common and worse than you think. Injure your groin and you won’t run, play or compete for months. Forget about a straightforward diagnosis. The human groin is a class-A mystery with anatomy more complex than the plotline of LOST. Groin pain can be maddeningly difficult to pin down. It comes and goes and moves annoyingly from place to place. We triple-dog dare you to clearly describe your vague symptoms.

Your doctor is probably flummoxed, which doesn’t bode well for you. If she can’t figure out precisely what’s wrong, you’ll be up the proverbial creek. Inconclusive tests await. Kiss that deductible savings good bye.

But don’t despair! We have a way to solve this problem. It involves drawing an imaginary Triangle™. Really, that’s all you need to know. We’re pretty sure this will help but promise nothing.

I’ve submitted this rewrite to the authors. I’ve yet to hear back from them.

Longing to run again,
– Dean

Symptoms of my ill-defined lower abdominal injury first appeared in August. Now, the Winter Solstice approaches and my Inov8 Rocklite 305s still lie fallow in the closet. In Orwellian Newspeak, this whole predicament is DoublePlusUnGood.

I feel trapped inside an uncooperative body and I’ve grown obsessed with the injury that has incarcerated me. More pointedly, I fell I’ve lost something. In my hour of desperation, I turn to the only book that can truly help the beleaguered runner make sense of it all: On Death and Dying.

Writing in 1969, Dr. Elisabeth Kübler-Ross, death expert (and apparent enthusiast), introduced the groundbreaking Five Stages of Grief. Her model predicts the emotional roller coaster people typically experience when confronting the specter of death. The stages are remarkably similar to the experiences of the injured runner.

Stage 1 – Denial
Runners are world-class deniers; just like the WWE referee who won’t acknowledge that the Undertaker is pummeling John Cena with a flagrantly obvious foreign object. We won’t admit what’s in plain sight. So naturally, we push through injuries that would down a bull moose. This is done for extremely important reasons like “shaving 10 seconds off a 9.5 mile trail run” or “Winning an online mileage contest with someone from Uzbekistan.”

When confronted with an injury we can no longer ignore (like debilitating pain in the pelvic socket) we howl with melodramatic angst like the overacting Mark Hamill in The Empire Strikes Back, “That’s not true! THAT’S IMPOSSIBLE!”

We refuse to accept facts, and Darth Vader predictably kicks our whiny ass.

Stage 2 – Anger
Like petulant toddlers who haven’t gotten their way, we feel that life has purposefully struck us a cruel blow. “How could this happen? I wanted to qualify for Boston.” “I was going to run a marathon up a mountain.” “Now how will I test the wind shear resistance of my new Saucony running shorts?” It’s just not fair.

Divorced from our primary means of stress relief, we runners become ill-tempered monsters. A toxic stew of displaced aggression and unseemly narcissism rule the day. It’s best to avoid us entirely, especially if we’re related to you.

Stage 3 – Bargaining
Injuries can help runners regain lost faith, though the recovery may be shallow. The temptation to mold divine providence to our purposes proves difficult to resist. Spirituality may compliment running, but offering bail-out funds to a higher power in return for a pain-free hash run hardly amounts to sound religious practice. Even if we promise something noble, like never again out-kicking a senior citizen in a marathon finishing chute, our injuries will not magically disappear.

Yet we still try to control the uncontrollable. Rather than endure the consequences for our folly, we want to buy some sort of Medieval Indulgence to get early release from Injury Purgatory. Didn’t America fight a Reformation over this or something?

Stage 4 – Depression
The sick sometimes wonder if they’ll ever be well again. Injured runners wonder if they’ll ever compete again. We sit on the sidelines as the race calendar inexorably rolls on. As days turn into weeks and weeks into months, we succumb to listless melancholy. We lose hope.

Because nothing seems to matter, self-destructive choices begin to make sense. We hop off the wellness wagon into the non-judgmental, deliciously nutritionless arms of our favorite junk foods. Complete lethargy follows. Supine on the couch, we command the nearest child to fetch us Mountain Dew and Pepperidge Farm Mint Milanos because “Soda and cookies won’t just walk to the living room by themselves.”

This is rock-bottom stuff; the injured runner’s equivalent to the post break-up ice cream binge. It’s all very sad.

Stage 5 – Acceptance
With nowhere to go but forward, runners grudgingly acknowledge reality and begin the slow crawl back to dignity and fitness. The journey usually begins at the doctor’s office. We visit specialists and submit to the inevitable X-Rays and claustrophobic MRI scans. We hope this will lead to a concrete diagnosis – a clear plan of action. Any plan will do.

Alas, such certainty proves elusive. Cosmologists have deduced the precise composition of the universe at less than a trillionth of a trillionth of a second after the Big Bang, but medical science can’t tell me why my groin hurts when I run. Apparently this is too much to ask.

For Kübler-Ross, acceptance is the last step before peacefully embracing death. Most runners just end up in physical therapy. There we’re measured, assessed, stretched, electrified, and put to work in the weight room. But we embrace it all the same. At least we’re doing something constructive.

It’s all quite simple. We do whatever our physical therapist tells us to do. Along the way we breathe the crisp, invigorating oxygen of a clearly defined goal, which reminds us of how it feels to run.

– Dean

In effort to keep physicians, physical therapists and makers of anti-inflamatory medication in the black, I proudly announce my latest running injury: the dreaded groin pull. It’s as uncomfortable as it sounds.

Worse, it’s completely disrupting my marathon schedule. I should be in the visceral, red meat section of my training regimen; the part where Burgess Meredith proclaims through grimy, clenched teeth that I eat lightning and crap thunder. Instead, I’ve been laid low by a deceptively nasty injury not easily described in mixed company.

Where to begin.

A groin pull is very much like a taffy pull, except you’re the taffy. Or, if you prefer vegetables; Imagine the Jolly Green Giant holds you aloft by your feet intent on slowly making a wishbone out of you. Distracted by his diminutive sidekick Sprout, he fails to finish the job. Sure, you may be alive but running is now out of the question.

One typically does not hear the word “groin” in polite conversation, unless of course you happen to know a runner. Then it’s mentioned frequently, without a hint of embarrassment.

Consider:
“Hey runner friend, what do you think of the new Asics Gel Nimbus 10?”

“The heel support is excellent fellow running aficionado, but there’s not enough cushioning to help with my groin.”

“That groin still bothering you? Provide exhaustive detail during our 10 mile training run.”

Things are different for non-runners, where references to the “groin” are uncommon. It’s a lonely word; too vulgar for high speech, and not offensive enough for low speech. The higher classes simply employ euphemisms like “nether regions” or “down there.” Lower classes proceed directly to the sterner, more colorful expletives. Neither are helpful.

Unless you’ve signed up for an Ancient Roman architecture class, you probably won’t read much about the groin, either. Even romance novelists avoid it. Why write wildly of burning groins, when burning loins will do nicely?

So we must turn to proper terminology. Medically speaking, I appear to have a strained, pulled or otherwise damaged adductor longus; one of the important muscles attaching the leg to the abdomen. Science then, has given us the ideal expression. A pulled adductor longus sounds vaguely alluring. Nobody wants a groin pull.

But if for some reason you’d like one, I suggest running incessant, high-mileage weeks with little or no breaks. When you feel the first twinge in your lower abdomen, by all means continue running, competitively if possible. In no time, you’ll be on the sidelines as your companions train in the gloriously autumnal weather.

For serious entertainment, return from the injury quickly, ignoring the sage advice of physicians, spouses, or runners with similar experience. Schedule a marathon immediately.

On that note, I hope to see you at the Lewis & Clark Siouxland Marathon on October 18th. Assuming I’m still in one piece, do flag me down at the Des Moines Marathon the next day.

– Dean