#288 Ironman taught me about running injuries - DOC

#288 Ironman taught me about running injuries

Today on the Doc On The Run podcast, we’re talking about what Ironman taught me about running injuries.

When I was a kid, on the weekends I would sit on the floor on shag carpet, with my back leaned up against the couch and eat Cheerios while I watched a program on television called the CBS Wide World of Sports. I still remember in the opening seeing the commentator mentioned, “The thrill of victory! And the agony of defeat!”

There was one day when there was one particular formative moment as a kid when I was watching that show, eating my Cheerios, when my perception of what was possible changed forever.

It was an episode highlighting this crazy race called the Ironman triathlon. I head never even heard the word triathlon, and had absolutely no idea what it meant to become and “Ironman.” But I learned that day, as I sat awestruck with back leaning against the couch.

The Ironman triathlon is widely considered to be one of the worlds most grueling single day athletic events. The start of the event begins in Hawaii with all the participants treading water in the open ocean off the Kona pier.

When the cannon goes off at 7 AM, the day begins. The athletes swim away from the pier, straight out to sea. Once they are 1.2 miles offshore, they turn around and swim back. So the first portion of the event consists of a 2.4 mile ocean open swim. 

I watched, mesmerized at all those guys swimming through ocean waves, helicopter shots of swimmers from far above looking down these tiny dots in the ocean. The whole scene give me goosebumps.

As soon as they got back to the pier the athletes climbed out of the ocean and hopped on bikes and took off for a 112 mile ride through blazing hot lava fields in brutal winds. 

And if all that wasn’t enough, long after the morning had shifted to a scorching hot afternoon…it was time to run a marathon.

2.4 mile swim, 112 mile bike ride and a full 26.2 mom marathon all in the same day.

What really got me wasn’t the distance. It wasn’t even the combination doing all those same things on the same day. It was Julie Moss. 

There on TV, in the dark of night, she was making her wait to the finish line and totally collapsed from exhaustion. But did she give up? Hell no! Julie was bound and determined to be an Ironman.

So she crawled all the remaining distance until she’d made it across the finish line. 

Even though the medical personnel had to pick her up and carry away, Julie Moss had done it, she was an Ironman.

Watching that scene changed me forever. I decided in that moment, sooner or later I was going to do Ironman Hawaii, even if I had to crawl across the finish line. 

I started running. I got my dad to get up early on a Saturday morning anytime there was a race within driving distance. He would drive me to places like Lafayette, Georgia, Oak Ridge, Tennessee. Anyplace there is a 5K a 10K or anything else, I wanted to run it.

On the afternoon when I would get out of school I would go for a run. I got a Sony Walkman for Christmas so I could listen to cassette tapes of Cheap Trick, Rush and this new band called Van Halen while I ran.

During the summer we would go to the lake and my grandfather would follow me in a canoe while I tried to see if I could swim all the way across Chickamauga lake and back.

Because I was going to be an Ironman.

But unfortunately, one of the things that I did not fully understand was that no matter how hard I trained, or how much are tried, they were not going to let a 10-year-old kid enter that race.  

So instead, while my dream was put on hold I ran cross-country. I did other, more normal kid stuff. But I never forgot about the Ironman.

Then one day, fate struck in the Dallas airport. I was on my way home from Birmingham Alabama where I just finished running my first marathon. I was in a book store in the airport and I saw a magazine sitting on the bottom shelf of the stand called, “The Road to Kona.”

The Road to Kona was a special edition of Triathlete Magazine that explained and highlighted the details of all of the existing Ironman triathlon events around the world. It talked about the courses, talked about how many “Kona slots” there were for each one of the particular races.

As a sat on the plane reading the The Road to Kona I realized that there were now several different Ironman races around the world. Not just in Hawaii but another places, too. All of those other Ironman races were now set up as an opportunity for people to go and prove themselves, become an Ironman and, if they were fast enough maybe even when chance to do the super bowl of all triathlons, Ironman Hawaii, The Ironman Triathlon World Championships.

That same night, when I was at home in bed sitting there with my laptop, I pulled out my credit card and registered for Ironman Arizona. When I did, it made my palm sweat. Somehow, deep inside I knew this was going to be an enormous undertaking.

At the time I was living in Salt Lake City, where I was doing my Foot and Ankle Surgery Residency training at the University of Utah. On those rare evening when I would get out of clinic early enough, I would go to Liberty Park and run lap after lap around the 1 1/2 mile loop surrounding the park.  

When I was running my way through the park I would see couples pull up in their cars get out and start running. And then I would see those same couples get back in their car and drive away. And then another guy would show up get out of his car start and finish his run and then leave. All while I kept a running circles around Liberty Park. 

One night I got to liberty Park it was cold. I was just above freezing. I started to run and it started to rain. Then it started to snow. I kept crunching along in the snow try not to slip and fall while icicles formed on the brim of my hat. I wanted to quit and get back to my car go home I would think of Julie Moss. And then I would run another lap.

It was painfully tedious, it was boring, but I kept picturing Julie Moss crawling across the finish line. And I kept trying to convince myself was going to be an Ironman, too.

Since that time I spent a lot of time thinking about the backstory and why finishing the Ironman was actually so important to me. 

One day, many years later I finally realized why. I was sitting in my office talking to an eight-year-old boy and his mother. The kid and his mom were there because he was pigeon-toed and had trouble running. His pediatrician it said a should come see me to try to help with the problem, to get his feet straight.

The moment I was struck by why all of this Ironman stuff was so important to me was when I was telling the kid a story.

When I was a kid I had been pigeon-toed as well. My feet pointed inward, awkwardly. 

But everything in life it seems like a disadvantage often turns into an advantage, because more often than not, our own individual struggles often give us an opportunity to relate to someone who actually needs help and can benefit from whatever struggles we happen to think we suffered from.

Just like this kid I was talking to, when I was little boy I was so pigeon toed I would start tripping over my feet when I started to run. 

When I was eight years old my parents signed me up for T-ball.

When my dad would get home from work, it would take me out into the yard throw the ball with me. He got me a practice tee ball set. All summer long, I would go out into the backyard, set up the tee ball set and I would knock baseballs way into the woods behind our house. I wanted to be good at it.

One summer afternoon, while all of our parents were sitting in the stands at the tee ball field, it was my turn at bat. I pulled the bat back, swung is hard as I could and hear the back ring as the ball launched into the air, on its way deep into left field. It was a home run hit if there ever was one.

For split second I stood there motionless, somewhat in disbelief, watching the ball fly through the air. But I was suddenly snapped out of it when, Coach Stamps yelled, 

“RUN ZIGGGILLER!!!!!!!!!!!”

Even though my name is “Segler” he always called me Zigillar. I hated it, but it definitely got my attention. Well, anyway, that’s not really relevant to the story….

When Coach Stamps yelled at me, I took off running as fast as I could heading to first base. 

Unfortunately in all the excitement I lost my focus and I actually tripped over my own feet halfway between home plate and first base. I heard some of the parents gasp and I heard some of the kids laugh. Truth is it was both humiliating and painful.

But I explained that story the kid sitting my office not told him it didn’t have to be that way. And we could fix it so he didn’t have to tripped over his own feet anymore either.

The day I had that talk with that boy I think I actually realized a large part of what I thought it meant to me to make it to Ironman Hawaii would mean that I was not that kid who would blow a home run, and trip over his own feet, in front of Coach Stamps, being embarrassed  in front of his friends, and all of our parents. 

When you’re getting in the water a for the start of an Ironman, it is intimidating. A couple of thousand people all wearing wet suits, dark goggles and swim caps that say “IRONMAN” in huge letters on the side of them. They all look like really fit, serious, tuff athletes. Yet for some ridiculous reason you decided to compete with these people.

The water in Tempe town Lake was cold, and we are all treading water waiting for the start of the race. I looked up behind me and I could see all of the family members of all the race participants standing on the bridge waiting for the race to start. I turned around and looked toward the start of the race and was glaring straight into the sun, which was low on the horizon.

Fact is, although I’d like to think I had warm excitement running through me I was actually terrified. I had never been swimming in open water with a group of people, ever in my life. And now I was about to begin what was supposed to be that much grueling single day athletic event on the planet.

The cannon fired and the thrashing began. 

“Just stay away from people see you don’t get clobbered.” 

“Just keep moving.”

Little by little, as I would tilt my head to take a breath I could see people on the side of the lake slowly drifting by. I was moving. 

“Just keep swimming.”

About an hour and a half later I was out of the water and heading for the change tent. I got my bike and took off. I made it through the swim and I made it through the bike ride and then when I took off on the marathon I actually thought I had a chance to finish.

But about half way into the run started to have chest pain. This sharp throbbing pounding sensation, left side, just over my heart. 

Interestingly, about a week before the race I had been working in the emergency room I admitted a guy, same age as me for heart attack. So I started to walk. I walked one mile and my chest pain started go away. But when I look at my watch I realized I was seriously in danger of failing to make the cut off of midnight.

If I didn’t do something, I wouldn’t even get a chance to crawl across that finish line.

I started to run. About 2 miles later my chest pain came back again. So I walked. And then my chest pain went away. Being both a slow learner and a risk taker, I started to run again. You’ll never guess what happened…

No, my chest pain didn’t stay away. It came back. What happened as I realized that I have a long family history of heart disease, and while I was in medical school my father had dropped dead in the kitchen at age 59, while he was talking to my mom.

This is a probably another story, but at age 28, before I went to medical school, I also had a stroke after knee surgery. I was paralyzed on the right half of my body and while I was in the hospital, the doctors told me things like… 

“You’ll never walk normally again.” 

“You’ll never be able to ride a bicycle.” 

“You probably won’t even be able to drive a car.”

Just in case you’re wondering, I wasn’t exactly inspired by the prognosis of all these medical experts.

In any event, as the the sun dropped and the evening turned to night in Arizona, I looked at my watch and I realize if I walked the rest of the way I could probably make it in before midnight. And so I walked. I walked a long, long way. But after nearly 17 hours a continual forward motion, when I crossed the finish line, I heard Mike Riley the official announcer at Ironman races, boom over the loudspeakers…

“Christopher Segler…..YOU…ARE….AN…IRONMAN!!!!!!!!!!!!!!!!”

The next day a wife and I were having lunch with her parents. We’re all standing front quarter getting ready to order our sandwiches and the woman at the front counter looked at my Ironman Finisher T-shirt and her job literally dropped open.

She said, “Oh. My. God. Did you really do the Ironman?”

And I said, “Well yeah, actually I sure did…yesterday.”


Now, I have to tell you that felt pretty good!

But the story doesn’t really end there because Ironman Arizona, although it is an Ironman…it is 140.6 miles… it’s not Ironman Hawaii. And if I wanted to go to Hawaii and I wanted to get in the water off the Kona Pier, I was going to have to get a whole lot faster than just barely making it in before midnight. 17 hours I was not going to cut it.

So I trained. I did my long runs in the middle of the day when the sun was at its highest. I switch from running in the morning to running in the afternoon.

After all, if you’ want to race Ironman, you may as well get used to starting a marathon in the afternoon.

Because the only marathons that were going to matter to me from then on all start in the afternoon, once you get off the bike.

Slowly but surely I started to get faster. 

I started to do some research. I went and combed the Internet for Ironman triathlon race results. I made a spreadsheet. I looked up the names of every athlete in my age group who had qualified for Ironman Hawaii. I went to every single race and found the spreadsheet of race results. I looked up all of those athletes to find out how fast they had finished in order to secure a Kona slot and a chance to race the Ironman World Championships.

I basically typed a mock up of the race results they print out after the event and pin on the bulletin board at events. I entered all the athletes who previously qualified fro Hawaii and right in the middle of them, I added a blank row, and I put my name and a finish time of 10:59:59…just under 11 hours. And I stuck that on my refrigerator with magnets.

I got one of those bracelets they give away at marathon expos that has a tally of all of the specific pace per mile for all marathon finishing times. I circle the pace I thought I needed to run that would be fast enough to qualify for Ironman Hawaii and I wore that bracelet.

Every bike ride, every run and every time I swim I pictured getting out of the water, getting off the biker crossing the finish line within my goal. And in short, I trained my butt off.

And then, one day I signed up for Ironman Louisville and decided and I could go 12 hours. I figured out how fast I would have to swim, how fast I would have to ride and how fast out have to run. And every time I road I tried to stay on pace. Every time I ran I try to think about seen the finishing clock at 11:59:59. 

All that visualization work paid off. And at Ironman Louisville I crossed the finish line in 11 hours and 57 minutes.

Ironman Florida was a few months later. And the way I figured, Kentucky has hills but Florida is flat. So I decided I could chop a full hour off my time.

I told my friends in the triathlon club that I was going to go 11 hours at Ironman Florida. Most of them laughed. They said, “No way dude, you can’t chop an hour off your Ironman time in just a few months. That’s ridiculous!”

Lesson Number 1: don’t always expect support from the people who actually understand your event.

I told my family that I was going to go 11 hours and Ironman Florida. Most of them said, “You’re going hurt yourself. What about the chest pain thing? What if you have a heart attack? What if you have another stroke?”

Lesson Number 2: don’t always expect support from the people who love you. 

But with or without support or encouragement I was determined.

Everything was going great and my fitness good. I could hold my pace on the bike for hours without any trouble. I felt strong when I ran in the hot sun. About a month before the race I made one of the dumbest mistakes you could possibly make.

I had planned to run the race in Newtons. But I actually hadn’t been running in the Newtons since Ironman Louisville. You have to sort of build up your tolerance and strength when you’re running in Newtons because they force you to land on your forefoot.

Sometimes little micro decisions we make can add up from tiny bad decisions (all independently justifiable) turn out to be one collective huge bad decision with a serious consequence.

That weekend I was planning to do a long run on Sunday. As we all know long runs are suppose to be slow. 

Bad decision number one: thinking is slow run equals an easy run.

My friend Katie asked me if I wanted to run that weekend. And I said, “Sure that would be great.” Katie always likes to talk when we run so I figured we be running slower than normal. But what failed to occur to me was that Katie was also a track star in college. She can run and talk, both of them fast at the same time.

Bad decision number two: thinking running with Katie would be in easier than usual.

And then I also realize I needed to run in my Newtons. 

Katie and I wound up running 16 miles on a relatively hilly course, relatively fast in shoes I was not used to, at all. I noticed I was having an aching pain in my ankle at about 10 miles. But of course Katie kept talking I kept running.

The next morning I woke up and when I stepped out of bed I felt a searing pain in my ankle. I look down and I had an enormous bruise on the side of my foot.

I sat on the edge of my bed, staring at that bruise with my head, literally in my hands, in complete and total disbelief. I guess I was hoping that if I stared at it long enough the bruise would vanish and turn into a bad dream instead of the crippling reality in front of me.

What I had was a really bad case of peroneal tendinitis. Based on what I knew, what I learned in medical school, what I learned in my foot and ankle surgical residency training, and because of the size of the bruise on the side of my foot, and the amount of pain I had in my ankle, I figured it was actually pretty good chance I actually split or torn peroneal tendon.

The normal treatment for this condition is widely accepted as 4 to 6 weeks of immobilization and protection in a fracture walking boot. And of course, no running, no biking. And certainly no trying to go 140.6 miles in a single day.

But then I started thinking about what everything I really and truly know about the way our bodies heal as runners. And I tried something different. I put on a fracture walking boot. I doubled down on all of the things I do to recover from hard workouts. I tried to do every single thing I could think of that might maximize my recovery in the hopes of calming down this injury.

Two days later, I took off the boot. My foot was still bruised, but I didn’t have any pain. I walked around house and the didn’t have any pain. So I went for a short bike ride. No pain. 

I waited a day and then I went for a longer bike ride. No pain. I started to think I might have hope. 

Now, although evidence might suggest otherwise, I am not a complete idiot, I did stay off of running. But that really wasn’t a big deal because I also realized it was almost time to start the 3-week taper for the race anyway. 

When I got to Florida I did a short test run of 3 miles. No pain. The dream was back online.

Ironman Florida has one of the worst swim course set ups of all of the events. You start on the beach and you run into the water pushing and shoving and elbowing all of the other competitors. It’s really more rugby than swimming. It’s a two loop swim corse and you have to round these big floating buoys and everybody gets bunched up. It’s a little bit like a wet boxing match. But I survived and I got on the bike.

The bike ride was going well until mile 75 when a yellow jacket flew straight into the front vent on my aero-helmet and stung me on my poor defenseless bald head. I was frantically trying to get my hand under the helmet to squash him, but didn’t want to risk a DQ from a chinstrap violation. So we buzzed along together for about 7 miles. Twenty minutes of a bee-in-my-bonnet-later, I pulled over at an aid station, dismounted, took of my helmet, and the assailant flew away into the pines.

As I pedaled back toward town, it felt great riding with a tailwind at 26-30 mph. But then the last 10 miles are right into the wind. I tried to relax and slow down on this stretch to make sure I could run off the bike.

I set off on the two-loop run course at an easy pace. I did the math and realized that to finish under 11 hours I needed pretty close to a 4 hour marathon. I aimed to hold a 9:00 per mile pace for the first 10 mile warm-up. I had the idea that I should also shoot for a sub-4 hour marathon, but didn’t want to risk overdoing it and missing my goal finish time.

Three miles to go I came to the sobering realization that I was in trouble. These would have to be my fastest miles of the entire day if my 11 hour goal was going to materialize.

I saw an aid station just a couple of blocks ahead. I figured that when I got there I would sip some chicken broth, do some more math and re-assess. My body was aching, my neck was stiff, my back hurt and my quads were vibrating. I realized that even if I finished in 11 hours and 5 minutes, that would be respectable. It would still be a personal record by almost an hour. I also knew no one would really care.

But then I thought about about looking at the time of 10:59:59 I had posted on my refrigerator and as a bookmark in whatever book I was currently reading. I thought about the “21.33” taped on my bike stem to remind (every time I rode) of exactly how many miles per hour I needed to ride to reach my goal. I suddenly remembered that on 7 different days in past 9 weeks I had run mile repeats on the track in the rain and thunder so I would be able to RUN today. And suddenly 11:anything just wouldn’t do.

And so I RAN.

I ran right past the aid station and said “hold chicken broth.”

I ran that mile. And the next, staying wide of the aid stations to fly by the crowds or runners slowing to reach for water and bananas. And when I saw the lights of the finish chute and began to hear the finish line announcer, I ran like hell.

Every muscle fiber in my legs were screaming in pain. Most of the last mile my eyes were closed. I kept them clinched shut and told myself it was just the final lap of my last mile repeat on a track day. And it ended up being my fastest mile of the day.

When I rounded the last corner, out of the dark and into the bright lights, the clamor of cow bells and the screaming crowd lining the finish chute drowned out the noise from my quads, and I ran.

Just before I hit the timing mat, I opened my eyes and looked up at the clock.


Some guy grabbed me, wrapped a mylar blanket around my shoulders and a voice boomed over the loudspeakers…


And I started to cry. I started to realize I could run fast, in the dark, with my eyes closed, down the finishing shoot of the Ironman triathlon. And I wouldn’t trip over my feet ever again.

Over course of about 10 years I did 15 Ironman triathlon races. I never quit. I never failed to finish. And yes, I did Ironman Hawaii. I got to tread water with the best triathletes in the world in the Pacific Ocean, off the Koan Pier. And I got to hear Mike Riley scream my name as I ran down Alii’ Drive to the official finish of the Ironman World Championships.

My Ironman journey taught me a couple of really important lessons. 

No matter who we are, no matter what we do, no matter what we think happens for us or to us as kids, it is never too late to be what we might have been. No matter what happens, whether you have a stroke, whether you get a stress fracture, when you get tendinitis or you have some other injury you can always achieve your goal.

When I had that injury getting ready for Ironman Florida probably the most important lesson I learned was that everything we have been taught in medical school is not really designed to help patients. It’s designed make things simple for doctors.

The truth is, medicine is complicated. Patients are complicated, because we’re people. We are individuals. Athletes have goals. Runners want to run races and they want to finish.

I had reasons for wanting to finish Ironman Hawaii that I actually didn’t understand until years and years after I decided it was a goal.

You probably have things driving you that make you want to finish the races you hope to run for reasons you don’t even understand.

When you’re deep in your training and after you have been dedicating months of hard workouts and in the dark do your effort and you get injured there is nothing more deflating and having a doctor tell you have to stop running.

That episode of peroneal tendinitis when I was preparing for Ironman Florida, by all conventional wisdom, by everything were taught in medical school and frankly by what most doctors do and most of the same circumstances with runners like you, I would’ve been required to abandon that race and wear a fracture walking boot for 4 to 6 weeks.

And yet, on the very day I would’ve been taking off that fracture walking boot in some doctors office, I showed up on the starting line of Ironman Florida and crossed the finish line in what turned out to be the fastest Ironman of my entire life.

And for more than 10 years now I’ve looked at runners differently. I looked at running injuries differently and I actually started going to medical conferences and teaching doctors how to treat runners like you differently. Because we are not normal patients. You, a runner, you are different. 

I realized the standard of care was flawed. Everyone is different. Everyone heals differently. Certain approaches WILL help you heal faster but it has to be individualized and customized for your level of fitness, your physiology, your injury and your place in that specific recovery of that injury right now.


  1. I am a real runner.
  2. I help injured runners run.

Because I know what it feels like, when you think you can’t run, even worse, when a doctor says, you can’t run…but deep down inside, you know you can.

So in the end the most important thing Ironman taught me about running injuries is that you, injured runners have a goal. That goal is important! Even if you’re injured there has to be a way. You can get there!

The doctor’s job is not to tell you to stop running.

The doctor’s job is to get you across that finish line.

Of the things I talked about during this interview was a peroneal tendon injury I got just before Ironman Florida.. Peroneal tendon injuries can be notoriously nagging for runners.

If you have pain at the outside of the ankle and you think you may have peroneal tendinitis, and you are wondering whether or not you can run and still heal, this video will explain how runners can decide whether or not you can run when you have a peroneal tendon injury.

Check out the video here:





If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!