Beth Pascall on the Trail of Injury and Recovery

Injury is so closely linked with running that I’ve heard non-runners question why we lace up our shoes at all. But really, injury is a consequence of being alive. A couple of weeks ago I was taking a bed frame apart and managed to yank my shoulder so hard that I struggled to put on t-shirts for days. But when you injure yourself in a way that stops you doing what you love, life takes a whole new turn. 

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I skipped most of my runs in early May due to shin splints – my first experience with this annoying condition but not my first experience with run-stopping niggles. It’s been frustrating, particularly as I’ve had to miss two races, so I was keen to hear from someone who’s been dealing with a far greater injury. 

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Beth Pascall is a remarkable athlete. She’s the winner of the 2021 Western States 100 miler and the 2021 Canyons 100k amongst many other phenomenal races. A practising paediatrician, she’s not a full-time runner and, like so many ultra-athletes, she balances her work with her training and the rest of her life. Yet as you might expect from someone who runs 100-mile races on mountain trails, she trains a lot, often early in the morning; look at her Strava if you want to see quite how much. 

Slow progress

When we chat in mid-May, Beth’s recovering from an injury that forced her to stop running for months. Beginning in September 2021, the condition – inflammation of the pelvis – at one point caused her debilitating pain.

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“We knew what the problem was from the start and I began a rehab programme but the pain continued to get worse…I couldn’t run, swim or even walk without pain. Aside from the injury itself, the worst thing was that I didn’t have a solution. I was doing all the right things – or what I thought were the right things – but none of it was helping.”

Being a runner with an injury is exceptionally challenging. There are so many things that can cause pain such as muscle imbalances, weaknesses and poor form, and that’s before you even take into account training load, terrain, shoes, and diet. Learning to listen to our bodies is crucial but working out what they’re actually saying? That’s something else. 

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“To an extent, I just followed what my physios told me, reassuring myself that it would work if I just kept doing the exercises. But I had a niggling feeling that something wasn’t right. It just wasn’t getting better.”

Mental health

We all know that losing someone or something you love, a person, a job, can result in bouts of depression. While it’s rare to hear an athlete talk about this when it comes to injury, I‘m sure many athletes, pro and amateur, can relate.

“I was grieving in a way. I read every study ever done on my condition and I knew that the outcomes could be bad – this type of injury can end an athlete’s career. So, while a part of me believed I could get better, another part of me wondered if this was it.”

But, deep down, I could feel something wasn’t right and if I had trusted those instincts sooner, then I probably would’ve saved some time in recovery.

When it became increasingly clear that the rehabilitation programme wasn’t working, Beth decided to opt for another route. 

“Although my physios are fantastic and have helped with many other things, for this injury, it was time to see someone new. I felt really guilty about going to a different physio, searching for another way, but it was definitely the right thing to do. And I think this is what everyone in that position should do: if one method isn’t working, then try something else. With a new physio, we took a completely different approach from what I had been doing and that was when things started to change.”

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Overcoming the hurdles

Personally, I’ve found myself roaming the house in recent weeks. Despite being an amateur multisport athlete and still riding and swimming, there’s something I get from running that I just don’t get from anything else. So how did Beth get what she got from running, when she couldn’t run?

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“I never found anything,” she laughs. “I really didn’t find anything. Maybe that’s something I’m going to have to work on. Before this happened, I considered myself quite a well-rounded person; I didn’t think running was that important to me because it’s not the only thing I do, I have a lot of other things going on. It wasn’t until this injury that I realised I was very wrong,” she laughs again, perhaps seeing her former naivety. “Before, sometimes I thought that being injured would give me some time to focus on other things but with this condition, the opposite happened. When I couldn’t run anymore, I completely lost interest in everything.”

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She thinks for a moment and says, “I don’t know what the solution to that is. Runners are encouraged to be well-rounded, to have other things in their lives to do when they’re injured but I’m not sure how because I thought I had that!”

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I ask her how she fared given the all-consuming nature of her injury and how it prevented her from doing any exercise at all.

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“I didn’t handle it very well. With previous injuries, I’ve always been able to still do other things like cycling and walking. But with this one, for a while I couldn’t do much of anything and the things I could do, I just didn’t want to. I forced myself to go out and stay active – I tried climbing even though I could only do the kids walls – but I didn’t want to do anything.”

What did keep her sane and moving forward?

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“I found it very hard to talk to runners and so I leaned heavily on my non-running friends and colleagues, which was actually really helpful. My job was incredibly useful too. For those 8-12 hours a day, I could switch off from my injury and focus fully on my work. Without that, I would’ve struggled a lot more as I just couldn’t distract myself from it outside of work.

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When I started being able to run again, even just to go out walking again, I was so excited. I’d go on a two-mile walk with my dog in the woods and I’d just be on this massive high, like I’d won a 100-mile race. As soon as I could do that, I was absolutely fine again – I wasn’t even bothered about running. Which makes me think that even if I couldn’t run in the future, as long as I could do something else, then I would be okay.”

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Injury is part of the journey

Given that Beth only started running in earnest towards the end of her medical studies and then went on to win the Spine Race in 2015, I’m keen to hear how she managed to take on great distances fairly early on. After all, she’s only in her mid-thirties now. Maybe I’m asking her for a magic solution, some hack that’ll enable me to boost my distance faster – so, was there anything she did to ensure she wouldn’t get injured? 

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‘I didn’t do anything!’ she tells me with a laugh. ‘I just ran. I really didn’t do anything in particular. I’m much better now with strength training, I do it religiously. But back then, I just ran. It’s funny, then I did nothing to protect against injury and I rarely got injured and now I do loads of strength training, and I get worse injuries! But it’s inevitable really that the more you run, the more likely you are to get injured.”

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What I’m really in awe about Beth isn’t her incredible distances but her attitude. She’s very pragmatic about her injury, despite the considerable struggle she’s had with it. She comes across as a solutions-based person, which I suppose you have to be if you a) work as a doctor and b) want to win ultramarathons across incredibly varied and difficult terrain.

I ask her what she’s learnt from this injury, seeking some wisdom for my own recovery. 

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“I’ve learnt to trust my instincts more. I knew the initial physio plan wasn’t working but I kept telling myself to trust it and to just keep going. But, deep down, I could feel something wasn’t right and if I had trusted those instincts sooner, then I probably would’ve saved some time in recovery. It’s important to remember that if one approach isn’t working, find someone else who can help.”

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I didn’t get a magic answer from the amazing Beth, but I did get the truth. The truth about running injuries for the pros, the weekend warriors, and everyone in between, is that they happen. Injuries happen. They’re difficult both physically and mentally and there is no magic solution. Instead, the way through injury is getting help, listening to your body and your instincts, and doing whatever you need to keep your spirits up.

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Beth has her sights set on UTMB this year and while perhaps in the depths of her injury it seemed out of the question, I have little doubt that she’ll be running it with her characteristic zeal. 

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