Revisiting Belgrade

For my 100th blog post (can you believe I've written that many?), I wanted to post about a lingering issue from one of my very first posts about the Belgrade Marathon.  In fact, it was the story of my experiences in that marathon that inspired me to start this blog, so it seems fitting to post about it almost a year later.

I ran the Belgrade Marathon in 2009 as a member of the USA Military Marathon Team.  The Serbian Military hosted this International Military Competition in conjunction with the Belgrade Marathon, so we were competing not only for our national teams, but also as individuals eligible for a fairly sizable prize purse.

I came in 3rd in the military competition and 4th female overall.  Military awards were presented on the spot, but the monetary awards would be "sent directly to our bank accounts", according to race officials.  I won 2000 Euros for my 4th place overall finish.  That's $2700 and more money than all my lifetime race winnings combined.  Not only did I work my butt off in that race which was hot and miserable, but I also went through the full drug-testing protocol ordeal as detailed in my race blog.

I tried to get as much information about payment before I left the country and even gave the military contact that had the best command of the English language a voided check with my bank account information on it to expedite the payment process.  As you might have guessed, I still haven't seen a single Euro from my Serbian friends.

Over the course of the last year, I have attempted to make contact with the race organizers via e-mail about eight separate times.  I received two responses.  One e-mail from Dejan Nikolic (race director, I believe) came in over the summer after I contacted the head of the military competition organization (CISM) with my complaint.  The excuse:  they were waiting on the doping test results and payments from sponsors which would be coming in within the next week.

After several more months passed with no word, I checked out the 2010 Belgrade Marathon website.  It is still a go, however the tab that reveals "prizes" is not enabled for the 2010 marathon though it still shows up for the 2009 marathon.  While I have another source of income to support my running habit, there are professional athletes that won prize money that probably rely on it to live.  I was now on a mission for us all (assuming that they were also stiffed).

About two weeks ago, I sent an e-mail to the general contact address at the IAAF, since they show up as a sponsor of the 2010 Belgrade Marathon.  I wanted to inform them of this wrongdoing.  A week later, I see a series of unintelligible numbers flash on my cell phone, and I ignored the call.  The caller left a voicemail, and it was Dejan, the race director from the Belgrade Marathon, calling to apologize.  He even called me back later, and this time I answered.

Dejan explained that all of their sponsors reneged on their donations to the 2009 marathon and that they had no ability to pay the prize money.  He said that they were sorry for not keeping me informed, but they had been waiting to hear from their sponsors who were all devastated by the bad economy.  He did say that they have a plan to pay me and the rest of the athletes.  They will take this year's sponsorship money and pay last year's winners.  I'm okay with that as long as this year's winners aren't expecting the money.  He sounded quite sincere in his sorrow, saying it was hard to work on the event every day knowing that he had this cloud hanging over him from last year.

I fully expect to not get paid, but there was something satisfying about getting that call.  I really do feel sorry for the professional athletes who won 5000 Euros and probably do rely on that money to live.  Maybe, just maybe, we'll get a nice surprise after the 2010 sponsors pay up.     As they say in Serbia,  Srećno! 
          

Better. Stronger. Faster.

I was hooked on the Six Million Dollar Man television series growing up and often pretended I was the bionic woman, Jaime Sommers.  I'm sure, if someone had asked me back then whether or not bionics would be available for failing body parts by the year 2010, I would have believed they would be.  While humans have invented replacement body parts, they typically do not perform as well as the real thing (maybe excepting Oscar Pistorius' blades).  I have not yet found a bionic replacement achilles for sale even on the internet, though apparently the Bionic Beauty Salon was once available.  How did I miss that?

In my last post, I discussed my new plan to slowly ramp up my running mileage.  I had a nice 6 mile run on Friday where I actually decided to run over some rolling hills rather than walk up them,  and I hit 6 miles with no pain.  My achilles was slightly sore following this run, but a little massaging of the tendon relieved that almost instantly.  Saturday morning and afternoon got away from me with various errands and tasks, so I decided to just go ahead and do another "long" run that evening--discarding my short, long, short pattern.  This was a bad idea.  My achilles tightened up after the first 4 miles of 6 total.   I had to do some walk/jog intervals to get home in order to minimize the tightness and pain, which were both mild.  Again, massaging the achilles helped, but I was still sore.  I was really hoping that I would have one of those breakthrough runs where I was gamboling recklessly along the bike trail free of any tightness and pain.  Saturday's 6 miler made me realize that I may have a longer row to hoe than I thought.

This sequence of events led me to the realization that I needed to make a tough decision.  The easy part was deciding to throw in the towel on the Eugene Marathon, scheduled for May 2nd.  The tough decision was whether or not to bag the idea of running a spring marathon altogether.  I researched the hell out my options and came up short.  There are some potentially fast races out there, but most of them occur too close to Eugene for me to feel confident in being able to ramp up.  The reason I would try to run a marathon this spring would be to capitalize on the great fitness that I have (had?) before becoming injured.  I finally realized that leaving the possibility of running another marathon hanging out there was causing me to make decisions that are not helping me heal.        

Enter Plan B:

• take as long as it takes to get back to pain-free running, 
• maintain my mad cross training regime, 
• and start training for some speed!  

I first divulged this new plan to The Genius and felt instantly like a weight had been lifted.  No more worry about missing out on yet another week of long mileage and hard, long runs.  Instead, I can focus on staying fit, healing and look forward to incorporating quality speed work into my training.  As I have mentioned before, I have been solely focused on marathon training since I began running in 2004, and have spent nary a month focusing on short-distance speed.  This will be a change.

The prospect of training for a fast 5k and/or 10k race is exciting to me.  Aside from striving for PRs in these distances, I know that developing my speed will make me a faster marathoner.  Right now, I'm tentatively thinking about a 10k race over Memorial Day weekend (heel healing dependent) and running at least the 5k in the National Masters' Championship Track Meet here in Sacramento in July 2010.  I'd love to get my 10k time down into the low 36s and my 5k into the low 17s.  Of course, I have to be careful with my training not to injure some other random body part in the process, but I feel like a slightly wiser runner at this point.

I am fired up about this focus for my future training.  I assure you that I am cross training like an animal so that I can step back into my running, when my non-bionic tendon is ready and willing, with zeal and a renewed lust for this crazy sport of running.  We can rebuild her.

P.S.  My focus race for the fall will be Chicago.

"She's Actual Size...

But she seems much bigger to me."  For some reason, those lyrics to the classic They Might Be Giants song run through my head when I think about my achilles tendon.  I think anyone else looking at my ankle would think it looks the same as the good foot, but to me it seems ginormous.  I still find myself favoring my left foot here and there when phantom pain presents itself. However, for the last couple of days, I go for long stretches without even thinking about it.  Progress.

This is an improvement that makes me happy, of course, but I am being more careful about my rehabilitation.  I found it interesting when I looked at my training log that I have actually run 12 days since I was afflicted with this injury 28 days ago.  Most of those days were trial runs, between 1.5 to 6 miles, that showed promise until I pushed it a little too hard.  Over the last three days, I have run slow, short runs.  I have been paying close attention to any tightness or pain I feel during the run.  I have found that, if I feel tightness for more than a mile during the run, the calf/achilles will be sore later and usually the next day too.  My new threshold is no tightness and definitely no pain during the run.  If I feel it, I stop.  I am happy to say I’ve met that mark for the last three runs.

What came as an even bigger surprise to me was the concept that I should run during the rehab phase.  This first came from my Miracle Worker when I suggested I just take another week's rest from running. He shook his head and said, "No.  You need to keep running, just not as much."  His explanation was that without the stretching that occurs during running the scar tissue that inevitably forms with this type of injury would heal the tendon to a shorter length or at least create a tendon with less running specific flexibility.  This was my interpretation of what he said, anyway.  The second place I saw the suggestion to rehab with running was in this article about the achilles tendon that focuses a lot on the concept of "active loading".  The authors state:

A short period of rest from running during the initial acute painful phase followed by a specific loading programme is sensible. However, the tendon loading and coordinative challenge of running suggest that running should become a central component of your rehabilitation strategy and indeed there is scientific support for continuing to run during rehabilitation, as long as the pain does not exceed moderate intensity (26). Accepting a tolerable amount of running discomfort may also help avoid the negative tendon and muscle consequences of protracted rest. The margins are vague, however, and the line between acceptable discomfort and disabling pain is very individual.

This advice is definitely contrary to what I've read almost everywhere else, and that's probably why I like it.  I think the key is in making sure that the use of running in the rehabilitation phase does not cause further damage.  That's the fine line I walk these days.

While somedays I am frustrated with this injury, I have been enjoying my cross training.  Tonight, I tried out my alien swimmer outfit at the Y and made quite a splash (couldn't help myself with that pun).  I purchased these AQx aqua running shoes and was quite pleased with how they performed.  I also bought my own floatie belt. So, picture me walking next to the pool in my cornflower blue bikini, black swim cap, goggles with Michael Phelps tune case attached, shoes with fins and a bright red swim tube around my middle.  Dead sexy.

I also enjoy my bike rides on the bike trail where I do fun interval sessions.  The best part of these rides is passing people like they're standing still.  The other night, I was doing 3 minutes hard/1 minute easy repeats and had this dude come zipping past me while I was spinning before starting the workout.  He passed me decisively and I thought to myself, "I'll see you again soon enough Postal Service Bike Dude."  Once I started my intervals, I started gaining on him.  As I approached his bike, pushing about 23 mph, I could see him kick it into gear and speed up to keep me from passing.  He lasted about 30 seconds before dropping back as I pounded right on by.  Now, my heart rate zipped up into the 170s during that little frenzied episode, but I didn't see him again until I turned around at the 22.5 mile marker.  He gave me a big smile and a wave.  Love it!

Here's what I've been up to the last two weeks:

I'm looking forward to a little longer test run tomorrow morning and hope to report that it is pain free.  I have a super long and hard bike ride planned for Saturday and an even longer run planned for Sunday if all goes well.  The spin instructor at my gym (complete with calf-muscle triathlete branding) is trying to recruit me and Sprinkles to the dark side of triathlons.  While I might be competitive in an aqua-jogging-run-bike tri, I would totally lose it in the gang swim.  For now, I'll stick to running with a side of bike and aqua jogging as cross training.       

A sample size of one

These last four weeks have taught me a number of lessons, many of which have not been pleasant.  I do know that they are important nonetheless.  The biggest lesson is one that I mentioned in my last post:  we are each a sample size of one.  I have immersed myself in both scientific literature and anecdotal threads on various websites looking for a preponderance of evidence that might lead to a few key treatments for my achilles tendonopathy.  As I also mentioned in my last blog post, the recommendations are all over the board and often contradictory.  I have also been surprised (or maybe not so much) by the very few scientific studies available on the subject.  The ones that have been done (on humans rather than rats) are so over-cited that they tend to take on the form of gospel or law rather than what they really represent, which is a single study using at most a couple of dozen subjects.  I realized that I have been basically conducting a mini experiment on myself during this injurious cycle and decided to go ahead and thrust my findings into the cyber world as well.  

My decision point for things that I've tried and continued versus those that I've tried and thrown out has become simple:  does it make me feel better or worse after doing it?  While you might have just breathed a heavy sigh and rolled your eyes over that revelation, think about who you're dealing with here.  I am a runner that is used to pushing myself hard through pain and discomfort all with the goal of improving my fitness and becoming faster.  So, pain in a twisted way, is my friend and helps me improve as an athlete.  Now consider that my best friend just shat all over me, and you might get a sense of why this simple question is novel to me.

One very important point about the recovery cycle post-injury that I just realized over the weekend is that your body goes through phases in the healing process.  Maybe the rest of the world knows this, but I had never really picked up on it.  This is the primary reason that I had such trouble understanding the various recommendations regarding the use of ice.  It appears that ice is super important (as a component of P.R.I.C.E.) during the initial (acute) phase of an injury (first 3-7 days).  There seems to be general agreement on that.  However, the use of ice beyond that point is not agreed upon.  Some say that it can impede healing by decreasing blood flow to the affected area while others say it does no harm and at least keeps pain in check.  My point here is that treatment recommendations require context relative to the phase of recovery you're in, and, often times, they are not written in that context.

Another interesting recommendation that I found and actually really liked was to perform eccentric heel exercises.  I was super skeptical at first about this one because it appeared to be based on one of those one-hit wonder scientific studies and treated as gospel forevermore.  However, this was a case where the study spurred doctor's and physical therapists to try it out on patients en masse.  There now exists an impressive body of evidence from people, like myself, trying this technique out with some success.  Other studies have also been done to refine the technique.  To read all about it, go here.  What I can say about it is that my achilles and calf feel a lot better after I do these exercises even though it might hurt a little while I perform them.
   
So, the things that seem to be working for me are (including their recovery context):

• not running (during the acute recovery phase)
• icing after runs (during rehabilitation phase)
• eccentric heel raises 3 x per day (once I could do these with only a moderate level of pain)
• working out the adhesions in my calf muscle (for the first 2 weeks)
• massaging my achilles using these techniques (after the acute phase, but continued during rehab.)
• stretching my entire leg using trigger point massage, especially my hips and IT band (throughout)
• stretching and massaging my foot (throughout)

The things that either haven't worked or I stopped because they didn't seem to help:

• heel lifts in my running shoes (led to a change in gait and stressed my peroneal tendon)
• stretching the calf while running (I felt relief at first, but then seemed to irritate the achilles later)
• heating the calf prior to running (had a neutral effect at best)

I have tried to return to running three times so far typically with initial success followed by rapid decline by the third day of running.  Each time I started with a short 15 minute run and then ramped up to 4-6 miles the second day followed by an even longer run the third day.  I think testing my leg out in this way has been important, and I don't think it has set me back.  How else would I know whether or not I'm ready to run again except to go do it?  I completed an uneventful 15 minute run today and will do a hard bike ride this evening.  I'll try running again tomorrow, a bit longer, but will back off again on Thursday.  This seems to be a more sustainable pattern: short, longish, short...

The bike is currently my cross training activity of choice.  I am becoming super strong in the saddle and have found it very enjoyable to go out and hammer a hard workout on the bike trail.  I am now one of those bike jockeys that I complain about as a runner, exceeding the 15 mph speed limit and passing with reckless abandon.  I am actually quite courteous and do know how to cross over that magic yellow line in the center of the bike lane to avoid runners and other cyclists.   I have learned to use my heart rate monitor to gauge my effort level, but have to use a lower HR max on the bike to make the percent effort comparable to running.

I still haven't pulled the plug on Eugene, though each day that goes by makes the probability of making it to the starting line seem more and more bleak.  But, Eugene was a random proposition anyway and one that I am not at all married to.  So, I'm making like Bonnie Franklin, Mackenzie Phillips and Valerie Bertinelli, and taking it One Day at a Time.              

There is no "I" in Injury. Oh wait...

Hi Peeps.  I realize I have been off the grid for about two weeks, and I apologize for leaving you hanging.  In summary, I have not been running for these last two weeks and you know what?  The sun still came up every day, nobody took away my birthday and I am likely just as fit today as I was two weeks ago.

The Miracle Worker may have worked a miracle on me, but it was a slow-release miracle that required three additional visits to materialize.  I am not saying in any way that his treatment was ineffective because, ultimately, his diagnosis of what was really wrong me, along with a prescription for a series of targeted stretches, has been key to my recovery. 

If you are looking for a quick update, here’s my executive summary:

• I have been cross training like a demon to maintain my fitness.
• I have been using (self) massage and stretching as my main therapeutic techniques.
• The Eugene Marathon is still a goal, but I will not jeopardize my long-term health or running career to run it.

As I mentioned in my last post, the genesis of this problem was my fancy-pants cross country race in Spokane (I am the Effin' Giant in picture on left) where I ripped a hole in the bottom of my left foot.  The hole in my foot threw my gait off and my left foot reacted by becoming super tight, especially the tendon that runs from the big toe and eventually becomes a muscle in the calf area, called the flexor hallucis longus.  The lack of free movement in my foot caused my left calf to take too much stress damaging the soleus muscle.  The adhesions on the soleus kept that muscle from moving freely which then put strain on the achilles which attaches to bone and therefore can only stretch so far before crying uncle.

My 6-mile test run on the Saturday following my ill-fated hill workout did not go well.  I continued to feel a bite in my achilles tendon throughout the run and realized I was looking at taking some down time from running.  Luckily for me (not for her), my coach suffered this same injury doing the exact same thing as me about the same amount of time out (9-10 weeks away) from the Olympic Trials marathon in 2004.  She not only took over a week off from running, but she ran a huge 15k PR a couple of weeks later and did very well in her Trials marathon.  She has been an invaluable resource and has given me great perspective during this process.  I will say that it took a few emails with lots of bold type to get me to start to see the importance of taking the rest and listen to her advice.  I did come around eventually.  However, I have to say that my initial resistance was not out of denial.  I knew full well what I was doing as illustrated in this note to my coach:

“While I want to stay healthy, I recognize that I am at the point where I am testing my limits.  I have kept pushing myself harder and harder all the while knowing I would eventually reach a limit in some form or another.  I expect this and don't want to run in fear of that limit.  I don't want to be anxious about every little pain and ache.  It is paralyzing.  While I may do stupid things like run up a hill when my calf is sore, I do learn from this.”   

This being my first bona fide injury, I had little experience with cross training activities that would maintain my fitness level but not exacerbate my calf and heel.  While I resisted my coach’s proposal to pool run initially, I have since found that it is a preferred alternative activity to running and not just for the more catastrophic injuries that leave an athlete unable to put weight on their leg.  There is some science to support this too as outlined in this article about pool running on Pete Pfitzinger’s website.

In the middle of August, I will have no problem finding outdoor pool options for my deep-water running activity.  Here in Sacramento in the winter, the outdoor pools are closed, and I have found few indoor pools that are deep enough to properly run under water.  Lap pools do not work.  For those of you unfamiliar with pool running, you wear a flotation belt around your middle (or not if you don’t care about your form) and try to mimic running as much as possible by moving both your arms and legs in a running motion.  To do this, you need a pool deeper than 6 feet (deeper if you're super tall).  You’re not swimming at all.  You’re sort of running in place though I end up moving forward very slowly in the water.

The indoor pool at the local YMCA is the best option I was able to find.  It costs $10 per visit without a membership (membership includes a big initiation fee, so pay-as-you-go is cheapest in the short term).  They have the floatie belts and their open swim hours are convenient.  I am also blessed to have Sprinkles in my life, who, unfortunately, is also injured right now.  She was willing to give pool running a go and even accompanied me on my long (pool) run last weekend where we ran for 2 hours with over 90 minutes of interval work.  Now, all I have to do is text the word “Marco?” to her, and she responds with “Polo” meaning she’s game for pool running.  I heart Sprinkles.  I did convince the Dissin’ Genius to join in one day.  I think he doubted that pool running could be a good workout.  The beads of sweat atop his bare scalp convinced him otherwise.

GADGET MOMENT:  One cool gadget that I found is this waterproof case (pictured below on weed warrior Michael Phelps) for my iPod Shuffle 3G.  It attaches to swim goggles and has fabulous sound.  I also Macgyvered a way to attach it to my bicycle helmet by threading it through an elastic headband and placing that around my helmet.  It is a thing of beauty.

In addition to pool running, I have been riding my bike and doing workouts on the elliptical machine at the gym.  Here are my workouts for the past two weeks:

You can see that I’ve had a couple of test runs including the one I did today.  The tests earlier this week indicated that I needed to bake my calf a little longer.  This was a big disappointment to me.  I had my mind set on a return to running similar to my coach’s experience and when I still felt enough pain to indicate I wasn’t ready to run, I was thrust back into the black hole of darkness.  When I had a roadmap for recovery, I was fine with the cross training.  People were commenting on my good attitude.  I kept thinking, “I can do this.  It’s only for 10 days.”  When that 10^th day came and went, I was not so cheerful.

One of the really interesting facets of this experience for me has been in knowing when I am healed enough to start back to running.  I have developed this self-assessment for my progress each day:

• Does it hurt when I walk?  
• Can I wear my brown boots without irritation of my achilles? 
• Can I stand on my left toes and lower myself down without pain in my achilles?  

I finally realized today that these tests likely have little bearing on my fitness for running.  I have concluded that I may still feel pain doing some of these things, but the only way I’ll be able to know whether I should run is to try it out.  I made a pact with myself, however, that, if I felt sharp pain, I would cease the test.  My first test run went well on Monday, but I was getting a little twinge of pain at the very end of the run that left me worried about running the next day.  One mile into Tuesday’s run I felt a sharp pain in my achilles, so I shut down the test and walked home.   I attempted a run again today and, while I felt tightness, I did not feel the same sharp pain in my achilles at any time.  My coach explained how her running progressed and indicated that she continued to feel sore, but that it was not the same kind of pain that she felt when she injured herself.  She reassured me that I would know when it was time to run again.  I haven’t felt any pain as a result of my test this morning, but I’m still unsure about whether or not tomorrow’s test run will go well.  Taking it one day at a time is not my typical MO, but I really don’t have a choice.

As with all things in life, this situation has taught me some valuable lessons:

• I can cross train and (think I can) maintain a high fitness level. This is a key lesson.  I remember watching my friends come down with various injuries and thinking to myself that I didn't think I could do the intensity of cross training needed to maintain my fitness.  Now, I believe I will be less hesitant to cross train when I am presented with a menacing ache or pain in the future.  A few days of cross training can go a long way to preventing a more serious injury.
• Little problems lead to big problems when multiplied by 100 miles.  The sore on the bottom of my foot appears to have caused all of this.  Had I taken a few days off immediately following the cross country race to let that open wound heal, I would be running 90 miles this week.  However, I also believe that I needed a break (see next lesson).
• You have to exceed your limits to know where they are.  I am typically not a fan of the school of hard knocks, but my best life lessons have been learned through experience.  The limits in this case had less to do with the mileage and intensity of my training but everything to do with the limits of my body to heal.  I was pushing myself so hard in every possible way before all of this happened, that it is almost a blessing that all I ended up with was this simple injury.  I honestly believe that my body needed a rest and that I will be a faster runner for having taken this forced break.
• You will never know what works to heal an injury the quickest.  There is a lot of information out there, much of it contradictory, on how to heal various running injuries.  The bottom line is that each of us has to try something and it either works or it doesn't.  Without a replicate Effin' J out there that I can use as a control, it is impossible to know whether what I've done has helped or hindered the healing process.  I offer my short list of conclusions about healing (which may or may not work for you):
• Ice doesn't help the healing process after the first 72 hours;
• NSAIDs are just a bad idea all the way around;
• working out the trigger points or adhesions on the muscle with your knuckle or a hard object is good;
• stretching is key (hip, foot, calf for my problem).       

I‘m not out of the woods by any means, but I am healing.  I have not counted Eugene out at this point.  My coach was able to quickly ramp up her mileage and intensity following her bout with this injury once it healed sufficiently.  Here’s to hoping I follow in her footsteps.