On a Friday night in October of 2018, I took a bus from New York City down to Washington D.C. to run the Baltimore Marathon the following morning. As an obsessively frugal 20-something, I had elected the cheapest bus line possible. The dubious (now defunct) brand allowed riders to purchase a ticket for $20 cash from a handler outside Penn Station, operated largely without air conditioning, and on one occasion (yes, I was a repeat customer) dumped us all at a rest stop for an hour while our driver took a nap.
Of the many luxuries not afforded to passengers was the loading and unloading of baggage, so I found myself crawling around in the bus’s humid cargo hold in downtown D.C. trying to excavate my suitcase when we arrived. After a minute or two of shoving strangers’ bags out onto the street, I finally located my own and with one mighty yank, dragged it from underneath a pile of luggage. More focused on escaping the bus than paying attention to my surroundings, however, I proceeded to whack my head on the overhanging door.
Embarrassed, disoriented, and bleeding slightly, I stumbled away as quickly as possible, loudly declaring “I’m fine” to my horrified fellow passengers and rushing off to find my brother who was driving me to my carb-loading dinner.
By the next morning, the bus was the last thing on my mind. Baltimore would be my sixth marathon, and I’d trained for months, so during the cold trek to the starting line and waiting in line for the porta-potties, I was focused on my goal for the race: breaking 3:45.
As I waited in the corrals, I noticed I wasn’t nearly as nervous, excited, or even interested in this race as I had been for previous marathons. Was I getting bored of marathoning? I wondered.
Nevertheless, the gun blasted, and I shuffled off with the 3:45 pace group, winding through downtown Baltimore, all the while feeling fine but somehow disengaged from what was happening around me.
Clearing Baltimore’s Inner Harbor and the halfway point nearly two hours later, everything began to crumble. My head hurt. I felt nauseous. I had no energy. I felt worse than I had in any of my training runs or previous marathons, and I was only at mile 15. I fell off from my pace group. By mile 17, I had stumbled to a walk. Was I dehydrated? Did I need fuel? I slurped down several cups of Gatorade at one aid station and ate a cup full of doughnut holes soon after (lord only knows where those came from.) I moved into a slow trot, but I felt like death and promised myself I’d never run another marathon. I wanted to lay down on someone’s yard.
What felt like hours later, I staggered back into downtown Baltimore and crossed the finish line, angry at myself for such a horrible performance and craving nothing but a dark bedroom.
The rest of the weekend, I continued to feel like crap, but I chalked that up to normal things like having run a marathon, my brother’s notoriously swerve-y driving through D.C.-metro traffic, and my return trip to NYC on Satan’s bus line.
But on Monday, when my headaches at work made it nearly impossible for me to look at the computer screen without throwing up, and on Tuesday when I wanted nothing but to sleep, and on Wednesday, when even checking a text on my phone felt like my brain was ripping itself from my eyes, I began to wonder if there was more at play than a crummy run.
I called my parents (a doctor and nurse), and after a few minutes of Grey’s Anatomy-style detective work, we realized it wasn’t the Baltimore Marathon that had screwed me over, it was that literal last second run-in with the overhang of the storage holder on the bus.
I’d likely given myself a concussion. And then I’d run 26.2 miles with it.
A concussion is a traumatic brain injury usually caused by an outside force hitting the head. Felicia Gliksman, D.O., M.P.H., a board-certified neurologist and the director of the Adult & Pediatric Concussion Center at the Hackensack University Medical Center, describes a concussion as “when the brain gets jarred, causing it to hit against the skull.” The impact creates a stretching of nerve fibers and cells, making typical brain function difficult, and so your brain shifts into overdrive to repair the damage. This increased activity, or hypermetabolism, diminishes blood flow, leading essentially to an energy crisis in the brain.
While concussions are common among athletes, they are not a frequent concern for runners, as running is (hopefully) not a contact sport. However, if a runner should suffer a concussion—via car accident, something falling on you, or an evil bus—treatment is largely the same for runners as for other athletes. The general advice is to rest until your symptoms start to dissipate. “Usually within seven to 10 days, most of those mechanisms normalize,” Gliksman says, “if we just have you rest for a few days, then you can slowly go back into what you’re doing.”
Something that doesn’t qualify as resting after a concussion is running 26.2 miles to earn a race medal shaped like a crab.
“The risk for anybody who returns back to an activity such as running too soon before symptoms have resolved, especially during that acute stage in those first couple days like you did, they really are at a significant risk of prolonging symptoms,” says Dennis Cardone, D.O., the codirector of NYU Langone’s Concussion Center. “You could take symptoms that are mild or so mild that the person doesn’t even recognize those symptoms, and you can absolutely worsen them.” Resting allows everything to recalibrate, whereas bouncing your brain around for four-plus hours extends the time it takes to heal.
Once a concussion is identified, the protocol for runners is fairly straightforward even if it does vary from person to person based on the severity of the concussion. Namely, add short stints of non-impact exercise (elliptical, biking, walking) back into your regimen slowly. If symptoms keep lessening, then you’re good to increase the intensity or duration. If you feel worse, back off. “If you are an avid runner, find a physical therapist/coach who understands the return to sports functionality, who can help devise a plan that’s best for you,” Gliksman says.
Sans physical therapist, naïve and uninformed, I charged ahead with more marathon training. After two weeks of rest where my most intense symptoms retreated, I hopped right back into long runs as the 2019 Houston Marathon was only a few months away.
But as I trained, I felt worse. I got headaches. I spent most days starring hazily into the middle distance as focusing hurt. I was constantly tired, lost my motivation to do anything but the simplest tasks, and could feel my mind growing foggy. Prior to the concussion, I performed improv comedy regularly, jumping in and out of nonsensical scenes nimbly. Post-concussion, I had trouble tracking what was happening on stage. I’d lose my train of thought in the middle of jokes. I could feel myself fading.
But I pushed through, ran the Houston Marathon, and somehow (probably the flat course) gained a PR. And while I took a few weeks off after the race, I quickly started running again.
I’d won the lottery for the 2019 Chicago Marathon, and so I continued to run multiple days a week in preparation for the following fall.
And it took its toll.
“Running from both the standpoint of being a ballistic activity, in which force is spurred from your foot…up to your head, and the extreme aerobic endeavor that it is, makes it one of the worst things I could think of short of taking additional trauma to your head,” says Robert Cantu, M.D., the cofounder and medical director of the Concussion Legacy Foundation.
The headaches, light sensitivity, fatigue, and mental fogginess continued month after month as winter became spring and then summer. And weighing down all of this was an extended bout of depression. Because of both the never-ending symptoms and the concussion itself, I felt smothered. I didn’t want to see friends. I hated my job, my family, my own self. And even though I could actively identify these feelings as the result of the concussion and not rational thoughts, I couldn’t shake them. I felt as if an entirely different person had inhabited my body, and that my old personality was locked away in some vault in the back of my mind. I could hear muffled cries of my former self, but they were inaccessible to me.
Toward the end of my training for Chicago, I started experiencing suicidal thoughts and horrific postrun migraines that left me bedridden (once for over 24-hours,) and yet I still trudged on. I should have quit then, but I had family flying in to see the race, and I thought finishing the marathon would at least make the misery worth something. On a larger scale, I had created an identity for myself around running. Earlier that spring, I’d been hired by Rizzoli Publications to write a book about marathon running called MARATHONER. But after a year running with a concussion, I realized I had to stop. I had started running for fun, and somehow I’d let it obliterate my entire life.
So after the Chicago Marathon, I quit running for what I thought would be a month or two, and while the headaches started to lessen, they persisted. Two months became four became six became 12, and even as my body desperately craved a run, I continued to hold off. The days ticked by, as I wrote MARATHONER, worked on the book’s design it, and sat on publicity calls, and I still wasn’t running.
In the end, I waited 14 months before I ran another mile.
My first run back was a very slow, very short jog around a shuttered golf course in Florida this past December. I was quarantining there, alone, in my grandparents’ old house, and after several weeks of no headaches, I nervously laced up my shoes, dusty from a year’s disuse. The sun was setting and a cool breeze blew in from the Gulf—the perfect running weather. I followed the three-mile golf cart path around the back nine, nervously alert to every twinge in my head, praying the headache wouldn’t return.
I finished that short run winded and achy. I don’t remember much from the run itself aside from my fixation on how my head felt during it and in the hours after. When I ran the same loop again a few days later, I was more relaxed and less concerned about my concussion. It felt good to move my arms and legs again, to feel my heart rate climb and my breathing get heavier. I’d missed that feeling. Had I quit running after the first concussion marathon, I would have probably recovered in a month or two. Instead I had spent over two years in the grips of brain trauma.
Over four months later, back in New York and on the eve of my book’s release, I am still taking it easy. My body feels good, but I get nervous when I have a caffeine headache that the concussion might be returning, and I am determined not to let the sport overpower me. But as I look to the future, the warmer weather, and getting the vaccine, I’m excited to run another marathon someday. I’m looking forward to those early Saturday morning long runs, buying new gear, and guzzling down a glass of cold water after a sweaty ten-miler.
As I return to running, I’ve had to make a few promises to myself. I’ve promised to savor my runs, enjoying the sport for itself and not the accomplishment of it. I’ve promised to listen to my body and take breaks when I need them. Pushing myself isn’t worth it. And most importantly, I’ve promised I will never again, under any circumstances, crawl into the cargo hold of a bus.
Matthew Huff is a freelance writer and runner, and he is the author of MARATHONER: What to Expect When Training for and Running a Marathon, published by Rizzoli Publications.
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