Monday, August 21, 2017

Ultra Loony in jeopardy?

Ugh, it seems like every August I end up with an injury not usually caused by running, well the cycle repeats.

Back on the 5th of August, I chose to relive my youth and paid a price. The price a strain of my right hip. How did it happen, well I was doing something that I have done for about 50 years and apparently it wasn't a good idea. We were at a friends cabin in Northern Minnesota and decided to go water skiing, I have slalom skied most of my life but couldn't get up, besides my age and apparently lack of strength, the boat seemed to pause then accelerate and the rope just seemed to jerk out of my hands so I decided to go for 2 skis, something I haven't done as much but the last time at their cabin it's what I did. So I donned the second ski,was headed up, the boat jerked again but with 2 skis no problem, right? Very wrong! I felt a tearing in my right hip, let go of the rope and knew I had done something bad.

After the injury I refused ice and ibuprofen as I wanted to deny it. The denial didn't go so well as although I could walk certain movements (bending, standing, sitting, turning, you get the point) caused significant pain. I had some bruising appear but then a week after I had a lot more bruising, see picture below, the interesting part to me is the point of initial pain was about 12 to 16 inches further up towards my hip.


I had to go to Atlanta for work this past week and since I had convinced myself that it was getting better, I tried to run, Suffice to say that was stupid, way too painful. So after my failed run I debated going to the Dr, just to make sure I knew what I had done and could do to get back to running ASAP. Well, last Friday I went and got it diagnosed, his prognosis was an adductor strain, grade 2 and I might not be running by Twin Cities Marathon, meaning it could derail me for another 6 weeks, double ugh!!.

So I am facing my current reality, no running, this week, if it seems better I might try this weekend, if not try over labor day. Mentally this is a tough one, the only thing I can do is walk carefully and potentially bike. I tried elliptical, no go, swimming, no go, I did do the exercise bike and that kind of worked, no significant pain but I noticed I was doing some compensation so not sure what I will do.

Right now, I am hoping to use the training plan below as my ramp to get to the start line of the Ultra Loony. It might not be a great idea but as a charter member, I have to right? I should add that I have done three marathons this year, the last being Grandma's so I had some base but will probably continue to lose it while not running.

- 3 3 - 3 5 7 21
Sun, Sep 3, 17
5 2 3 2 2 6 13 33
Sun, Sep 10, 17
- 2 3 2 2 5 18 32 September Sun, Sep 17, 17
- 2 3 2 2 5 13 27
Sun, Sep 24, 17
- 2 3 2 - 9.3 26.2 43
Sun, Oct 1, 17
Stay tuned, as I have been meaning to post more often and who knows maybe I will as it's good for my mind to capture my thoughts as I work through this.


Wednesday, June 14, 2017

Trails and my knee

I have been focused this year on just running healthy, losing some weight and enjoying my runs. It has gone well, the knee has held up with manageable pain but I have not ventured onto the trails.

In my desire to get back to the trails, I had a recent email exchange with a Dr Ben Shatto (check out his blog - The Physical Therapy Advisor) who has been on the Marathon Training Academy (thanks Trevor and Angie) podcast where he has provided insight on running injuries.
So I decided to ask for advice and I was pleasantly surprised that he got back to me almost immediately and when I asked a follow-up question, he again got back to me. I also think his advice is worth pursuing as I have tried the traditional methods without any success. Check out his site and take a listen to the Marathon Training Academy podcast, I especially enjoyed their recent show where Trevor provided his recap of the Flying Pig Marathon which was my first marathon of the year and things went well. My next race was MedCity and things went ok from as it related to the knee but it was a bit warm and my back acted up so I just slowed it down and got to finish line in one piece.
Marathon Training Academy
Next up for me is Grandma's and then my intent is give Dr. Ben's advice a try to see if I can work myself back on the trails

Here are the emails:

Hi Dr. Shatto,

I have a question for you and it may be too specific to me to be worth answering on your page so I will understand if you don't answer, as well as if there is no answer.

I am a 59 year old marathon and ultra runner (50+ marathons, ~10 ultras up to 50 miles) and have had medial meniscus surgery on both knees, the injuries happened while playing indoor soccer and basketball in the 90's. After my surgeries I was able to resume running on all surfaces with no limitations or issues. Unfortunately I injured my left knee again in 2014 and had a second meniscus surgery. After the surgery, I was told I had no functional medial meniscus left but was told that I have no arthritis of note and I again was able to resume running a few weeks after the surgery. Prior to the surgery, I had adopted the Galloway run-walk method (90 seconds of running, 30 seconds of walking) to help manage the pain and as an attempt to continue with the races I had signed up for. 

The one thing though after the 2014 surgery I have not been able to run trails as the knee stability isn't good and after a few downhills or uneven surfaces the knee hurts to where running is problematic. I tried braces and they didn't help enough to be able to run trails. As a final note, last year I had an issue around mile 20 of a long run, eventually had a MRI, they noted another medial tear and a cyst on the joint towards the lateral side. He thought the cyst might have been related to the tear but didn't think that there was enough left to cause the pain so figured it was the cyst. We discussed that I might have some loose material or something else but decided to take some time off along with PT which focused on core stability and that seemed to help resolve the issue plus avoiding the trails.

I would love to get back to running trails and I know I need to always work on my core and proprioception but is there anything else I can do that might help my knee to get me back on trails? 

I very much enjoyed your podcast on MTA and appreciate the info on Facebook and your website.

Thank you,

Mike

Hi Mike,

Thanks for the email and kind words.  Sounds like your knees have been through a lot.  It is hard to say if you can get back to trail running but it is always worth the try if that is what your goal is.  So I know you have don't a lot of core stability work which is good and I would encourage you to keep up with it, along with the proprioceptive training.  I would also hope that you have been doing a lot hip strengthening work.  Particularly for the hip external rotators and glut medius.  In addition I would put a "strong" emphasis on weight training of the legs in general.  The stronger the legs are the more they can help absorb shock and support the joint.  

Thinking a little outside of the box I would also make sure you have adequate hip and especially foot/ankle mobility.  As you know the uneven surface of the trail can be an issue so if your foot/ankle and hip can accommodate for the unevenness even a little bit more then the knee would need to do less.  So foot/ankle mobility is huge.  Also, there is newer evidence that in the cases of medial knee pain having a flatter shoe without much medial support (basically without a lot of arch support or built up too much) is helpful.  It goes against what may appear logical or traditional thinking as often times one would build up the shoe with a medial post to help support the medial knee but that added support is like a beacon and the body tends to move towards the perceived extra stability.  What we want is you to move away from it.  The only way to know is to try.  Also a less support shoe allows the foot/ankle complex to do more.  Though this does expose you increased risk of ankle sprains.  

Lastly you may consider a knee off loading brace.  This would be a custom fit brace.  They can be pricey and would need a bracing expert to measure and fit for you.  But they can work well.

Hope that helps.  Good luck!

Ben

Ben,

It actually does help out a lot, if I could ask a follow-up question to make sure I interpreted your response correctly. I have run generally in mild support shoes but have migrated to low drop shoes like Brooks Pure Cadence, Altra Provision and Intuition and more recently Hoka Infinite and Claytons. 

So my question is do you mean minimal drop and no support like the Kinvara or Merrell Vapor Gloves or is what I am running in ok? I have found the Hoka's to be generally too narrow or too cushioning but the Infinites I like as they are wider and somewhat firm, of course they are discontinued :-) so I will need to find an alternative. I do like my Altra's and have found that they work well.

If so, if I notice some knee tweaking as move away from stability do I keep the mileage low and let the knee and more importantly the foot adapt?

Thank you once again,

Mike

Hi Mike,
Yes I would suggest moving to more of a minimal drop shoe and particularly something without a lot of medial posting.  Meaning a shoe that offers some support for a more flat foot.  The theory has always been to support the arch and foot to help keep the knee from wanting to roll inwards. (the Infinites or something similar may work fine).  But some research now shows that it actually encourages the knee to roll in more as it feels there is external stability there.  This of course is not what you would want.  You want your body to naturally try to stay clear of the medial side.  So try to find a shoe that is wider and if possibly not overly rigid to allow the foot an increased ability to adapt to the trail surface.  
Though as you eluded....the progression onto the trails needs to be very slow as the foot and entire leg need to adapt to the surface.  This may be the hardest part of all as you are used to long distances but for a while you need to keep them short.  The rest of our body will be capable but the leg may not be.  And of course during this process keep working hard on all the other strength and stability drills.
Best of luck.

Ben  

Thursday, April 13, 2017

Another update (yes long overdue)

The UltraLoony was completed and I thoroughly enjoyed running each event with my family. What a thrill for me to run the 10k with my wife, the 5k with my eldest daughter and then to run (ok start) the marathon with my youngest daughter and watching the granddaughter run in the toddler trot.

It was a great weekend and the joy of seeing the smiles from each member as they enjoyed their experience, I will never forget.

They all did great and I got through them all. It was not my wisest choice and I have held off on posting as I wanted to understand if I had done any longer term damage and what the solution for me knee is. Long story short, each race hurt and TCM was not pleasant after the 1/2 way point especially but I hobbled through.

Back to the knee, well since I started this after TCM and it's now April, I guess I gave it time, right?

Anyway, the knee is kind of ok, I did some PT as I debated surgery, injections and other things that didn't thrill me. Well the PT helped along with throttling back and I am hopeful to avoid anything. I am now ramping up my mileage for the Flying Pig, then Med City, then Grandma's. So all is well, I have pain but as long as I stay on roads it's manageable. I still hope to get back to trails later this year but am happy to just be able to run.

I have a lot of posts, I need to write to catch up the blog and will see if I can, one thing I will give an update on is shoes. I finally found some Hoka's that seem to work for me. I bought them from Running Warehouse at pretty extreme discounts. The first pair are the Infinite and the second pair are Clayton's. I also picked up a pair of Brooks PureCadence 5's and another pair of Altra Provisions.

More posts will follow,................



Wednesday, September 21, 2016

Knee update

In my last post, I said that my Doctor thought I had a "probable lateral meniscus tear" in my left knee,


I had the MRI last week and got the MRI results today and the news looks good, kind of. Meaning no lateral meniscus tear that is visible, he thinks I may have some loose stuff floating and/or my knee went through a bit too much wobbling or something that got it inflamed. He did note that I do have a tear in my medial meniscus but it appeared small and since I don't have pain there he wasn't worried (he also knows that I don't have a lot left either as he did my last knee surgery). 

We discussed options and he felt my best option was as follows (which I agreed to do).  

Image result for dean karnazes running quotes
A cortisone shot today and he asked me to not run long or often over the next 2 weeks, he is hoping that with some rest that the knee will come back to pain free. We discussed how the cortisone shot could mask my pain which could potentially cause additional damage if I got carried away. So he is hopeful that with some rest, I can then run all of the TCM events with ideally no pain, so my plan is to run when I can, walk to recover, repeat and just work my to the finish.

We discussed that there could still be a tear on the lateral side or loose particles and if so the cortisone shot wouldn't help long term or even at TCM and that I should continue to look for signs of catching or the sharp unexpected pain when I resume running and if it happens we will need to discuss things further.  Last, he was not optimistic that my knee will ever tolerate uneven surfaces (i.e. trails), I am still optimistic that if I strengthen the muscles around my knee I have a chance (my winter project) but first things first. 

He also gave me my MRI scores for my knee (0 - Perfect, 4 - Not good (basically bone on bone). 
    Image result for images of dealing with running knee injuries
  • Medial meniscus for cushioning 2 to 3, stability - not rated, previously he said a 3 to 4 as all that remains is the outer rim
  • Lateral Meniscus - 1 to 2 for cushioning, from what I have read it doesn't help as much with stability, so this seems good
  • Articular cartilage - 2 to 3, not great but he said fairly normal for someone my age. So all in all good, hopefully the cortisone helps me get back to normal. 

So with this all in mind, stay tuned for my TCM race weekend reports for how things work out. Here what I hope to report:

Image result

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