Tuesday, April 26, 2011

You're the doctor

Julie, of the fabulous blog Races Like a Girl, was dealing with an injury last fall and in this post offered a prize to anyone who could accurately diagnose her problem.  She was, of course, receiving the appropriate medical diagnostic tests for the issue as well.  I ended up being the grand prize winner having guessed stress fracture of the femur or pelvis before anyone else did, but I was shocked at how many people guessed correctly!  My prize was a Barnes and Noble gift card, which, ironically, I used to buy ebooks for my iPad to read while I was rehabilitating my own injuries after the Athens Marathon.

So, I am enlisting your help, dear readers, to figure out what causes my left leg to tighten up about 30-40 minutes into each and every run.  I have been treating my IT band (stretching, rolling, icing, time off from running, strength training, acupuncture, active release therapy) for the last month and am now quite sure that, while the pain I feel is coming in part from an irritated IT band, this is a symptom and not the cause.  I am looking for the root cause here, so I can treat it and get back to running longer than 40 minutes at a time.

During my run, a typical progression goes something like this:
  • the first 3 miles feel awesome;  
  • some tension just above and to the outside of my kneecap appears or the lower part of the outside of my leg tightens up; 
  • that tension goes away, and I might feel some pulling or tightness below my kneecap;
  • the outside of my upper leg eventually starts to feel a little weak or achy and;
  • finally, I get a fairly persistent ache in the outside of my kneecap where the IT band rubs over the end of the femur.  Sometimes this is felt behind my knee and even into my calf.  This comes and goes later in the run and does not become worse the longer I run beyond 45 minutes, though I haven't done too many runs over 45 minutes.  Oddly enough, when I put direct pressure on the point where I feel this tightness, it does not hurt at all.  During the latter parts of many runs, I have felt as though my lower left leg is a peg leg, with no ability to push off at all.    
I have been doing everything right according to Dr. Lau: stretching every day after my run, rolling out my legs each night, regular strength exercises for my core and glutes.  The problem has not gotten any better or any worse over the last month despite all of this treatment.  I had a fantastic run last Thursday night, running 6 miles with 30 minutes at 6:30 pace.  I felt awesome the entire run, with no tightness at all in my leg.  The next morning, I tried to jog just a few miles and felt the tightness within the first 15 minutes.  So, Coach T decided it was time to try some cross training over the weekend.  I biked and pool ran for three days and did not run a step on land.  I ran today to see if anything had changed, and I still felt that insidious tightness off and on during my 8 mile run.   It came on, you guessed it, after 30 minutes of running.  It's not a run-stopping tightness at this point--so, no sharp pain.  It's just there, and I am afraid to push it.

I was traveling for work last week and had to run on the treadmill in the hotel gym.  I had my iPhone with me and decided to see if I could get some video footage of myself running.  It actually turned out pretty well.  I have been carefully analyzing these videos, and I see lots of things wrong with my form, of course.  But what I really want to know is if any of you see clues that may indicate what is causing this leg tightness.  I'm hoping something will jump out at one of you and that you will add your diagnosis in the comment section below.  The quality needed to be lowered so that it wouldn't take forever for you to download, but I think you can still make out the important things.  I left the sound unedited so you can hear my feet thudding on the treadmill in a Godzilla versus Mothra sort of way.

If you have trouble viewing the embedded video here, I've also loaded it on YouTube.  I will say that I was treated after my morning run today (I won't disclose what part of me was treated since that might give something away) and am hopeful that the adjustment will help.  Fire away!

Tuesday, April 19, 2011

Ch-ch changes

I made a tough decision this week.  I will, for some undisclosed period of time, self coach.  For those who think I'm copying Ryan Hall with this move, I assure you I am not.  While he is getting help from God, and that appears to be working well for him, I am doing just the opposite and getting my help from Dog.  Her name is Coach T, and I think she is highly qualified for the job.  She knows how to use a whistle and a stopwatch.  She works for treats and has lots of spots.  I'm not sure what more an athlete could ask for.
Coach T
All kidding aside, the timing for this decision coincided with my six month anniversary with Focus n' Fly.  I had initially paid for my first six months, treating it as an evaluation period.  If you've followed my blog over that time period, you know that there has not been much to evaluate in terms of training. I started out broken and haven't been able to stay fixed.  One of my main reasons for switching up my program was to be able to train with other runners.  Because I have been injured on and off, that has not happened.  I have learned a lot from Coach Tom--some very valuable lessons that will indeed make me a stronger runner.  However, when faced with the decision to invest another chunk of change without a good feeling about whether training with others or training at all is probable, I decided to look to Dog for help.  

I realized as the deadline for renewing my membership loomed, that I was putting way too much pressure on myself.  I was taking myself too seriously.  I tend to see myself more as a hard working runner that happens to be able to pull off some fast marathon times rather than an "elite runner".  I think a lot of this pressure stemmed from the fact that I was spending a lot of money on coaching.  In some warped way, I felt that I needed to get my money's worth and that was affecting my judgment.  When I think about what really matters to me, I realize that first and foremost I just want to run.  I have to get back to it, and I have to get back to a place where I enjoy it.

In reading through my own recent blog posts, I recognized that, somewhere along the line, I lost confidence in my own good judgment.  I reflected on my success leading up to Chicago.  It was no fluke that I improved enough over a six year period to qualify for the Trials.  While I credit good coaching and a solid training plan for a lot of that success, I hadn't realized before how much responsibility I had for my own training and health.  Over the last three years, Coach Nicole advised me, but I made the decisions. Before that, it was pretty much all me.  Those decisions led me to six years of (nearly) injury-free training. On top of that, in the three years leading up to Chicago, I completed all but one scheduled workout.  That's like hundreds of workouts, and it's not like my training was easy either. I did this by knowing myself and listening to my body.  Nicole told me that over and over, reminding me that I knew my body well and should listen to it.

Being the analytical type that I am, I have enjoyed looking through all of the running books I own and ordering new ones to see what type of a program I might follow next. I am not foreclosing on the prospect of having a coach in the future, but for now Coach T is cheap and I think being fully responsible for my own training is a good way for me to get my mojo back.  I know a number of self-coached running superstars that give me faith that it can work.  As far as I know, they don't have anyone like Coach T on their side, so I think I will have a distinct advantage.

As for my running plan: I ran 37 miles last week and have 40 planned for this week including strides and a mild progression run this weekend.  I'm back to fitting in some cross training and have added back into my program some of the strength work I was used to, like the Rock Circuit which I did this morning and realized I kind of missed.  I think my runner's body is used to and thrives on variety.  It certainly kept me strong for 3 years, so I'm going back to the stuff I know worked.

Coach T told me to go out and ride my bicycle for as long as I wanted on Sunday.  It was fun to set out without an agenda and just ride.  I rode 20 miles to Coffee Republic in Folsom, had coffee and apple pie, and rode 20 miles back home.   It was lovely.
Hey!  Get your ass to work!
That Coach T is a hard ass.

Saturday, April 9, 2011

Pins and Needles

Despite all my talk about cross training in my last post, I have been running nearly every day.  I have also been continuing to get treated by Dr. Lau every few weeks, where he works out the little adhesions I’ve developed and tries to get my limbs and torso to move like they’re supposed to.  I added another therapy last week: acupuncture.  A friend of mine had gone to see Steve Phillips, an acupuncturist here in Sacramento, with very positive result for a neuroma on his foot.  I decided it was time to give it a try.  It seemed smart to establish a relationship with one more person with an interest in helping me heal.

I think I was expecting Steve to be dressed in robes and have a long beard when I showed up at his office.  Instead, he was wearing khakis and a button down shirt, was clean shaven and had a very inviting and humble manner.  (Shame on me for stereotyping).  I knew I was going to be able to work with him when I told him it was my first time and that I would like to learn as much as possible.  I asked if he would please explain how this whole thing works.  He sort of laughed and said, “Well, we don’t really know.”  He then went on to explain it from the western-medicine perspective and then the eastern, energy-based model.  Either way, he said, it works.  I like that.  It reminded me that, just because I haven’t quite figured out how something works, does not mean it does not work. 
So, he put pins in my hip and all down the side of my hurt leg, then added some electricity to get the muscles jumping around internally.  He then used suction cups along the same meridian or line of my leg to further encourage blood flow to the area that needed healing attention.  He first asked if I minded having bruises, and I laughed.  He said, I thought not.  Athletes are often proud of their bruises.  He tended to some soreness in my lower back with needles sans electricity.  I left with a line of bruises on my legs and a feeling of relief.  I then went out and ran 5 miles and felt great.  My runs have continued to go well, though my training has been very conservative.
Enter, the Brain...
One night last week, I awoke at 2 a.m. and could no longer sleep.  I think I was worrying about this injury, actually, because that was on my mind as soon as my eyes opened.  I grabbed my iPad from the nightstand and went to iTunes to look for anything I could find on healing and meditation.  Why, I don’t quite know.  I found two audiobooks that sounded good and downloaded both.  I didn’t listen to them until a few days later.  One was a book by Dr. Andrew Weil and Dr. Marty Rossman about using guided imagery for healing.
The first part of the book had a pretty profound impact on me.  It reminded me that healing is something that my body does, not something that somebody else does for or to me.  For example, if I go to a doctor with an infection, I will probably walk out with a prescription for antibiotics.  While my symptoms probably subsided after taking the drugs (if the diagnosis was correct), neither the antibiotics nor the doctor healed me.  Rather, the doctor diagnosed the problem and the drugs reduced the bacteria living in my body to a level that allowed my body to heal itself.  
In some ways, it’s convenient to think of all injuries or illnesses as things that happen to us that are only curable with drugs, therapy or surgery.  Unfortunately, this can distract us from taking on our share of personal responsibility for both the injury/illness as well as the healing.  Doctors and therapists are great at diagnosing illness and conditions and also very capable at applying treatments, but only we can do the healing.  Further, we are more in control of our instances of disease, illness and injury than we know.  How many times have you blamed a co-worker or child for giving you a cold?  They exposed you to the virus, yes, but your body could not fight it off for whatever reason.  That reason probably had something to do with being run down, poor nutrition or some other factor within your control.   
This is powerful stuff because it makes me see that I can do more about my symptoms and healing my injuries than I thought possible.  It also reminds me how powerful a tool my mind can be in terms of keeping me sick and injured as well as helping me overcome these ailments.  
So, how am I using this?  One big key, and maybe the most important, is I am learning to relax, recognizing that in that relaxed state, my body will heal fastest.  That’s why sleep is so important.  This applies not just to my injury but also to my training in the future.  What would happen if I spent 30 minutes more a day laying around, meditating or in just a generally relaxed state.  Will my body heal faster?  Will that help with my recovery and resistance to injury?  What about thinking about relaxing when I am stretching after my workouts--directing “healing vibes” to my muscles rather than allowing the monkey chatter in my brain to run on about all of the craziness that awaits me in my day.  What about doing this when I'm running? Yesterday, I threw on my headphones during my run and just enjoyed running on a sunny day along a beautiful river listening to upbeat music.  This is very different from most runs where I spend the time thinking about the report I have due, or the messy house I'll be going back to or, worst of all, thinking about injury and pain. 
I think this focus on healing is leading me to make smarter decisions about my training too.  Remember my story about my visit to the acupuncturist earlier in this post where I went out and ran right after treatment?  I spent $65 on treatment only to go out immediately and (possibly) reverse the healing effects?  Was that 5 mile run that important?  Sometimes, I can be pretty thick.  I am trainable, however.  The other night, I not only decided not to run after my treatment, but I decided not to cross train either--just let the needles do their magic.  Coach Tom was very proud!
I am a work in progress, but at least there is progress.  

Sunday, April 3, 2011

Healing hard

My drive to push myself to the limit is what propelled me to a 2:45 marathon on a hot day in Chicago last October.  It is also the quality that keeps biting me in the ass as I come back from injury.  Maybe I'm a slow learner or just really thickheaded.  However, I think I finally get what Coach Tom has been trying to help me understand about the healing process and the double-edged sword of cross training.

When I was injured last spring, I cross trained like a mofo.  At first, this was because I was trying to maintain a high level of fitness to hopefully carry through to a marathon I was training to run in April.  When it became apparent that the injury wasn't going to allow me to run that race, I didn't back off the cross training.  I kept going.  I was doing ~10 hours of aerobic training each week often with 2-3 long, hard workouts in the mix.  I did strength training and yoga on top of that.  The reward for all of this effort was that I maintained a very high level of fitness--PRing in the 10k within 6 weeks of my return to running.  While I don't question the value of cross training for maintaining my fitness, I wonder whether I delayed my recovery from the injury and ultimately my return to running.

So, that is what I'm starting to understand: the tension between maintaining fitness and healing the injury.  This tension has become very clear to me as I have tried to "stay ahead" of my IT band tightness.  So, I use tension in the literal sense here.  If I tighten my muscles more with running, cycling, ellipticaling, strength training, than I can loosen them up, then I end up with a net tightness that will lead to re-injury pretty quickly.

When this injury first hit, my instinct was to go back into mofo territory.  Coach Tom said to me more than once that I might be hitting the cross training a little hard.  He said that, sure I was maintaining my fitness, but the only thing that would truly make me a faster runner would be to get back to running.  So, it's like balancing an equation: I might lose fitness by backing off on the cross training, but if I get back to running, say a few weeks sooner, which enables me to start regaining my running-specific fitness faster, then I might actually be better off.

The thing is: it's really hard to voluntarily give up the fitness.  We work so hard to build it up.  I have found the key is to put the energy I would be using trying to hold on to every molecule of fitness in my body toward healing the injury.  So, say I have 2 hours each day I can devote to exercise.  I would normally try to maximize my aerobic-based, frothy-sweat generation time.  I would go with maybe 90 minutes of aerobic training and 30 minutes of other stuff.  That other stuff would probably be 10-15 minutes of stretching/rolling + strength training or some exercises that I believe will help me heal faster.  Instead, I am trying this out:  45-60 minutes of aerobic exercise and an equal amount (45-60 minutes) of stretching/strength training/yoga or some activity that is focused on healing.  This is what I refer to as train hard: heal even harder.

I use the time spent on the maintenance activities as a time to heal hard, meaning that I direct energy or concentrate on healing.  With a rabid, fitness-maintenance focus, I constantly worry about feeling my injury and, even when I don't feel actual pain, wonder whether I am helping or hurting myself.  While I love the rush of a hard, sweaty workout, it further tightens my muscles which then requires even more time to stretch out: time that I can't always devote to it.  When I'm stretching, rolling, doing yoga and strength training I know that I am doing something positive to heal myself.  So, my thinking shifts from injury-focused worry and negative energy to focus on healing and positive energy.  It all sounds very touchy-feely, but I really do think that the constant worry and focus on pain (even the absence of pain) can keep us trapped in a vortex of injury.  I need to picture myself running care free (notice I didn't say pain free because then the focus is still on the pain!) and do everything within my power to get there.

The upside to this approach is that it has made me more positive in general about my running.  I feel like I'm doing something to move myself forward into a better running future rather than desperately trying to hold on to something that I had in the past.