Tuesday, August 17, 2010

A History of Aggravations...Part Two

Bursitis, Spring 2004

After fracturing my left femur in 1999, it would be a few years before I conquered my first marathon and managed to post a Boston qualifying time.

Entering 2004 with a qualifying time in hand, I registered for the Boston Marathon. But, a few months into 2004 I began to feel a disconcerting pain in my right hip that was not entirely dissimilar from what I felt in 1999 when I fractured my left femur.

Unnerved and still haunted by the most traumatic running related injury I had ever experienced, I demanded an xray and mri. While the xray came back negative, my orthopedist indicated it appeared there was a fracture in my right hip as per the mri.

I couldn't believe that I had sustained what sounded like the exact same injury in the opposite hip. Fortunately, my orthopedist would quickly recant this statement indicating that in actuality I had bursitis in my right hip. I'd take an inflamed bursa sac over a fractured femur any day of the week.

Sadly, Boston would not be in the cards with this diagnosis as it would take nearly a month for the pain/inflammation I was feeling to fully subside. Time and two shots of cortisone would finally take care of it, however.

The only real insight I gleaned from this one was that I likely was overtraining. Whether it was too many miles or too many INTENSE miles, this injury was clearly tied to my training approach.

Achilles Tendonitis, Summer/Fall 2004

While Boston came and went in the spring of 2004, I remained hopeful that I could still manage a solid marathon later in the fall or winter and salvage the year with a quality race.

The Chicago Marathon became my target as I ramped up my training during the summer. I had broken 3 hours for the first time at this event in 2003, so this event had a special place in my heart. Built for speed, Chicago presented a tantalizing opportunity to post yet another personal best.

But, as my training started to approach taper a nagging discomfort reared its ugly head in my left achilles. Unwilling to jettison my training given I had already been derailed earlier in the year, I stubbornly trained through this aggravation which meant I spent an inordinate amount of time icing, stretching, and massaging my left achilles and calf.

While the achilles held up, I toed the line on race day not sure if I could even complete the marathon let alone post a personal best. Fortunately, it was right around this time I came to understand I was a bit of an overstrider. Which meant I was placing more stress on my calves/achilles than I should.

With this in mind, I tried to focus on taking light/quick strides throughout the race to minimize any strain/stress on my already balky achilles. Once again, fate would smile on me as I managed to complete the race and squeeze out a modest personal best.

However, the left achilles still flares up once in awhile reminding me that virtually no running related aggravation/injury should be trained through and some never fully go away if you don't treat them properly.

Plantar Fasciitis, Summer/Fall 2006

While I have encountered a number of running related aggravations and injuries over the years of varying degrees of severity, nothing has driven me so close to the brink of insanity like plantar fasciitis. In my attempts to get rid of this albatross, I came to regard it on more than one occasion as a demon that had taken up residence in my foot. Unfortunately, even a ritual exorcism wouldn't get rid of this one.

My first encounter with this monster occurred in the summer/fall of 2006. The onset was subtle and insidious. A vague discomfort in my right heel in the morning that dissipated markedly upon walking around was the only sign of anything problematic. In short order, this vague discomfort would matriculate to near omnipresent pain that made walking to the farmer's market uncomfortable and running a veritable nightmare.

I likely spent thousands of dollars on bodywork, Active Release Technique, ice, Strausberg Socks, stretching devices, athletic tape, and everything in between to rid myself of plantar fasciitis. While all of the aforementioned helped to one degree or another, none of it rid me of this beast.

In an act of desperation, I opted for a surgical procedure that would induce trauma and serve to kickstart my body's healing process and allegedly get rid of the foot demon. The surgery would keep me away from running for a couple months and require copious amounts of physical therapy, but eventually I got back to running on a regular basis in 2007.

The real lesson I learned from my first battle with plantar fasciitis is not to take it lightly. Plantar fasciitis can set in and sideline you for MONTHS or YEARS in some cases. While it's always a good idea to be aggressive and proactive in treating any running related aggravation or injury, plantar fasciitis requires this more than any other aggravation or injury out there.

Once you've exhausted all the conventional treatment methods for plantar fasciitis, there aren't a ton of other options that don't involve surgical intervention, a lot of pain, and a LOT of money.

Plantar Fasciitis-THE REVENGE, Summer/Fall 2009

Apparently, plantar fasciitis didn't have enough fun with me in 2006, so it opted to make a return visit to my other foot in the summer/fall of 2006. Fortunately, I HAD actually learned something from our nasty encounter in 2006.

I was EXTREMELY aggressive in dealing with plantar fasciitis this time around. I hit it with everything at my disposal immediately. Cue massage, ART, graston technique, laser treatment, taping, etc. I coupled this with a marked reduction in mileage.

Fortunately, this return visit was relatively mild in comparison to what I dealt with in 2006. But, it was still a source of discomfort and made running unpleasant most of the time.

Once again, throwing money and treatment at my plantar fasciitis would do little more than reduce pain/inflammation. Eradicating it entirely proved to be as challenging as before. But, I discovered a new treatment method with a lovely moniker, 'dry needling'.

Dry needling entailed 'perforating' the fascia and inducing fascial bleeding. The idea was to induce trauma (not unlike what my surgery did years before) in order to fully engage your body's healing process. It took me some time to find someone who had experience with this treatment method, but I finally did. Dry needling was the closest thing to a silver bullet for plantar fasciitis I could find via my research.

That being said, dry needling sounded pretty uncomfortable. My initial impression was proven correct upon subjecting myself to this treatment. The specialist did her best to numb my heel, but the first injection of lidocaine felt like a dagger of flame. Breathing deeply did little to reduce the pain. Fortunately, the lidocaine kicked in just as I felt the needling begin.

The needling was one of the most disconcerting experiences I had encountered in awhile. There was minimal pain, but I could feel odd pressure deep inside of my foot and could feel almost a cracking sensation which was apparently the specialist identifying the worst adhesions in my fascia and 'needling' them.

Not too surprisingly, I couldn't walk comfortably for a few days after this treatment as it induced a MASSIVE inflammatory response. But, this unpleasant treatment method would pay dividends as I found myself running again just a couple weeks later and would salvage the year with a solid performance at the California International Marathon in December.

I suppose the biggest learning from this was that dry needling is an effective treatment method for plantar fasciitis....at least in my case.

Femoral Stress Fracture-Summer 2010

For nearly 5 years, I had been in one way, shape, or form training with the idea that someday I would crack the 2:30's for the marathon. I posted a 2:45 in 2005, a 2:43 in 2008, and had planned on doing so in 2009 before falling prey to plantar fasciitis.

2010 started on a high note as I found myself logging 10 miles/day at around 6:30 pace...comfortably. All I would need was 6:05/mile to swing a 2:39:59. In April, I pulled the trigger and signed up for the Seattle Rock N' Roll Marathon in late June.

I kicked my training up a notch layering on some speedwork and increasing my mileage a bit which is pretty much always a bad idea. But, I was gambling a bit as I had trained this way before and had positive results.

I knocked out a number of very high quality long runs that had me convinced I was in the best running shape of my life and a time in the 2:30's was going to happen.

One of my final long runs before taper was on the horizon. I was feeling ok, but there was a nagging heaviness on the outside of my right leg. I couldn't quite place it, but it seemed minor.

I hit the road with the plan of running 22 miles with most of these miles near my target pace. Within 6 miles, the nagging heaviness had become an unnerving, amorphous pain that I felt on the outside of my leg and above my knee with no rhyme or reason.

I know I have a high tolerance to pain as evidenced by the femoral stress fracture that felled me during Bay to Breakers in 1999. This pain felt frighteningly similar. This is the only kind of pain that has ever forced me to stop running. I tried to convince myself this was not a stress fracture, but the pain I was feeling was significant and was not alleviated by rest or foam rolling.

It would take an xray, mri, and bone scan to confirm my instincts. I had sustained a femoral stress fracture in my right leg. Fortunately, this was not an injury that would require surgery, but there was no chance of running Seattle and I was looking at several weeks (if not months) of not running.

What I neglected to mention is in the midst of my training cycle for Seattle, I was moving to a new apartment and doing most of the heavy lifting myself. My old apartment required walking up two decent sized sets of stairs. In the week or so leading up to sustaining the injury, I spent an inordinate amount of time carrying a variety of large, heavy objects down both flights of stairs.

I suspect it was this additional physical labor that simply sent my body over the edge. I was not doing a good job of giving my body the rest/recovery it needed and it finally gave out. Some lessons need to be learned again.

Sunday, August 08, 2010

A History of Aggravations....Part One...

I recently found myself reflecting on my past or my 'history' of aggravations and injuries. What was the first one? Where did it begin? How did I overcome it? What (if anything) did I learn?

It's a cliche to say what doesn't kill you makes you stronger, but there is some real validity to this. A bone that is broken and heals properly will be stronger after the fracture...or at least this is what I've been told by a few MDs.

There's little question in my mind that one can become mentally stronger by overcoming an injury. In some respects, I think one can gain more in this department than any other. Chances are you'll learn how to train better or differently or simply learn when to pull the plug on a run.

So, without any further ado, I'm sharing my history of aggravations (or at least the 'big' ones). If nothing else, my battle scarred past may provide a way for you to identify something that is ailing you or learn how to bounce back.

Sprained Ankle, Spring 1992

I had fallen in love with running in the fall of 1990 and the romance was in full bloom as I entered my second season of track. I had gone from a 14:34 for 2 miles to a 10:34 in six months. I was regularly running 15-16 miles for my long runs. I was young and felt pretty invincible. Oh, how the mighty fall.

I was logging a few miles on the trails at Phoenix Lake with some teammates. It was (and still is) one of my favorite places to run. I remember heading downhill and some loose gravel under my foot slid and my right ankle buckled. I lost my balance. I felt something pop in my right ankle as I slide downhill.

The pain was unprecedented and screaming a few expletives didn't do much to assuage it as I struggled to get back up. Hobbling, I eventually made my way home, but quickly went to the hospital when I couldn't put any weight on the injured ankle.

It was a third degree sprain that required crutches and an aircast for several weeks. This first injury derailed my entire track season and still haunts me to this day as the ankle will always be a bit weaker than the other one. Contrary to popular belief, not everything that doesn't kill you makes you stronger.

But, I learned to protect this ankle and do what I can to strengthen all the surrounding tissues. It hasn't stopped me from running frequently and at a high level. The ankle is prone to tipping, but it's manageable.

Fractured Left Femur, Summer 1999

A seven year interval between running related injuries is pretty good. But, between the end of 1993 and 1997, I wasn't doing a ton of running. It was during training for the first marathon of my life that I incurred an injury that would derail me and bring me perilously close to never running again.

I had been running on a regular basis for the first five months of the year and was feeling strong. I toed the line at the Bay to Breakers that year with the intent to actually run the race and possibly post a personal best. About 4 miles in, I started feeling an excruciating pain in my left hip.

I'd never bailed out of a race for any reason, but I couldn't run anymore. I hobbled my way to the finish line and called my brother (who is an MD) and asked if it was possible I had a stress fracture in my hip. Highly unlikely was my brother's assessment.

So, I hobbled around for 2-3 weeks self diagnosing myself with IT Band Syndrome. I got a shot of cortisone hoping this would relieve the pain and a day later I was in pain that made me lightheaded and nauseous.

I went back to my orthopedist and demanded an x-ray just to 'rule out' the possibility of a stress fracture. x-ray revealed my worst fear, a complete compression fracture of the left femoral head.

I needed to have surgery immediately to insert pins my hip to stabilize the fracture. If the hip displaced, I could contract avascular necrosis and the hip could die....this mean no more running and hip replacement surgery for the rest of my life.

After a deep incision, the insertion of three metal pins, and several metal staples to suture the wound, I was far from running, but at least I knew my hip would survive and I would run again....some day.

A few months later I would have to choke back a few tears as I successfully ran a single mile through Golden Gate Park without pain. Running a marathon was the last thing on my mind, but this injury made me realize how much I loved being able to do it.

I'd be fine with never running a marathon in my life, but losing the ability to run at all put everything in perspective and this injury in many ways acted as a catalyst for a veritable 'running renaissance' that is still running strong today.

Stay tuned for bursitis, Achilles tendinitis, plantar fasciitis, and more!