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Archive for the ‘injuries’ Category

Well, my running is still curtailed by this pesky hip problem which has now become a literal pain in the butt..some sort of piriformis/sacroliliac/who-knows-what syndrome  (that’s HKWS) that’s causing pain in my, um, derriere and halfway down my leg on one side.  But enough about that..what I really want to whine about in this post is PT.   I’ve been thinking a lot about why I dislike PT so much.  Sure, there are the usual intellectual reasons..the huge amount of time it takes, the fact that each visit costs me the same as a doctor visit but there are 8 or 12 times as many of them; the fact that it often amounts to nothing more than supervised exercise..but lately I’ve been noticing that it’s not just the rational objections that make me dread it.  There is something sort of unpleasant and stress-indusing about the whole experience, and I think I’ve figured out part of it.  It’s the togetherness.  When I go to a doctor, it’s pretty much a private 1-1 experience.  But when I go to the PT, I’m there in a room  with a bunch of total  strangers , all bring treated at one time, usually by the same practitioners.  That’s weird, isn’t it?  I mean, imagine going to the doctor and sharing your time slot with three other people in the same exam room?  And yeah, I  go to group exercise at the gym with people I don’t know, but PT is not like going to Zumba, where you’re basically doing a group activity and there’s music playing and it’s all happy happy.  It’s more like being in a stranger’s hospital room, where no one is having fun and you’re trying hard to ignore one another.

At my most recent therapy  session I had to do my exercises on a table about 2 feet from a guy with back trouble and try as I might, I couldn’t avoid hearing him telling the therapist all about how much pain he was in.  It felt intrusive.  And then I had to listen to the therapist having a long detailed and loud conversation with the woman on the table to my right, all about her wedding plans,  for at least 15 minutes while she performed some manual therapy.  (Believe me, there is nothing less interesting than someone else’s wedding plans. )   The therapist was, I guess, quadruple booked, so I can see how it was convenient to have everyone close together but from my standpoint, it wasn’t much fun.

I don’t know.  I suppose that PT couldn’t make economic sense if it were always 1-1 but for me it’s just one more reason to avoid it.  Anyway, I only lasted 1 session at that particular PT, and I am switching to one where, for whatever reason, there seem to be only 1 or 2 patients there at a time usually.  And if that doesn’t work out, I guess I’ll have to take the last resort and go to the ortho, which I doubt will be productive.  I suspect that what I really need is a good trigger point therapist but my insurance doesn’t cover that. That’s probably ironic, right?

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So, finally, I’ve reached the point where my trochanteric pain syndrome-slash-hip bursitis-slash- IT band syndrome has made me stop running.  I’ve promised myself I’m not going to run until I can run 5 miles pain-free, and also walk and sleep pain free.  The sleeping part has been the hardest so far.  No matter how I start out sleeping, I always end up  rolling onto my affected side (the left side) which causes pressure on the affected hip and eventually an intense pain that wakes me up.  So then I roll over onto my right side and somehow that causes the same left side pain as sleeping on the left side..I’m assuming that the IT band or some other structure in there is compressing the inflamed bursa  in that position.  But  my body really, really wants to curl up on my side to sleep, even though my brain knows it’s gonna hurt.  Back-sleeping is just wrong!   Of course, it goes without saying that I asked the Internet how to keep from rolling onto my side, but all I got was advice on how to keep a baby from rolling over.  Apparently side-sleeping is bad for babies?    Anyway, unless I figure out how to somehow affix my back to the mattress,  or construct some sort of bumpers to hold me in place, I think it’s going to be a while before I can get through the night.  But meanwhile, (thanks to the internet  of course), I’ve learned that sleeping on my side is actually good for my brain.  So, there’s that.

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They say a picture is worth a thousand words, and a video is worth a million words. This week I had a video analysis of my running gait. Here’s what I learned.

  • I’m a forefoot striker. (Mildly surprising..I would have said I’m a mid-foot striker)
  • I have pretty good foot and ankle control. Slight supination on the left; more pronation on the right..apparently nothing too earth-shattering.
  • My right foot toes out but my left one points straight ahead. (I’m surprised I don’t end up just running in endless clockwise circles!)
  • My pelvis isn’t as level as it wants to be. (Not unexpected, and confirms what I thought from looking at still photos)
  • I don’t overstride and I have a decent amount of forward lean.
  • According to the guy who went over my results with me, most of the bad stuff that’s happening is around my hips and upward.
  • The more I look at it, the more I think my whole right leg is sort of rotated at the hip, which would help to explain the knee injury and the achilles tendinopathy on that side.

So, not a million words, but still a lot of information from a 15 minute exercise.  The question is, what to do about it?

 

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I know, I know, I’m always having epiphanies about this or that.  Shoes, cross-training, heart rate training, cadence, form, exercises, blah-blah-blah, and every time, I think my running life will be miraculously made better, and it hardly ever is.  Nevertheless, I persist in having epiphanies.  It’s fun.

So this time, I was finally reading Ben Greenfield’s book, Beyond Training, which I’ve had on my Kindle but had forgotten about until I had nothing else to read on the train, and right there in Chapter 1, he described me almost perfectly..older athlete,  slightly driven, constantly injured, often tired, overtraining in a sort of dysfunctional way.  Long story short, I decided I need to stop the medium length, medium effort, death-march runs, do my easy runs as an easier pace, and add in some High Intensity Interval Training.  I’ve always found it hard to push myself to run at maximum effort unless I’m  in a race and sprinting for the finish line.  But I downloaded Tribal Tabata from Podrunner, and now I’m doing 20 minute Tabata runs on my 2 short-run days, and slowing down on my long-slow-distance run days.  The routine is 20 second going full-out, 10 second (though it seems shorter) rest, for 8 rounds, 4 sets.  So far, I like it, because it allows me to cover more distance in a shorter time on my Tabata days, while not feeling as much wear and tear on my body.  And I don’t get that exhaustion feeling.. as long as I keep the high intensity to 20 seconds.  I’ve tried it twice with running, and once on the elliptical at the gym so far, so it’s too early to tell if I’m getting any faster.  We’ll see how it goes.   I haven’t gotten to Chapter Two in the book yet, so I’m sure there will be more epiphanies coming up.

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Yesterday I ran 9.5 miles, the farthest I’ve run since my injury last October.  Actually, I had planned to run 9, but accidentally ran 9.5.  I blame it on Strava.

My system has been to add one mile per week.  So, next Saturday I’ll run 10.  Beyond that is anyone’s guess.  I just want to hit 10.  For no particular reason other than 10 miles is a respectable distance, and a nice round number.

I don’t have the sense that the meniscus is healing.  I have just as much pain and inflammation as before.  I just think I’m getting much better at compensating.  Or ignoring pain.  One or the other.

A coolish humid morning in the Wissahickon.  5 miles on the bridle path with Shawmont club, and 2.5 miles on the white trail, over Fingerspan bridge, then 2 back.  There was a race being run, going in the opposite direction.  I miss racing.

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My PRP injection was a month ago, and I have no idea whether it helped at all.  It may be too soon to tell.  I had my follow-up visit with the doc last week.  I explained that the pain was worse than before and he said he was not disheartened yet, (good!) but that he definitely wouldn’t do another injection at this point (I agree).  He gave me a bunch of PT exercises..the usual lying-down single-leg raises  in all directions, (more on that in a minute), the ubiquitous ITB stretch,  and also VMO exercises..for my Vastus Medialis Obscuram..no wait, that’s not right..Vastus Medialis Oblique, that’s it.  It’s the muscle that causes that weird little bulge atop my knee in some pictures I was looking at from a couple of years ago when I was not injured.    I realize I don’t have that little bulge so much anymore, so I guess that is what the doc meant by “quad wasting.”  Apparently I must build the quads up again so they can stabilize the knee, and apparently this is the part of the quad that is suspected of failing in its knee stabilizing role.   So, I do these twice a day now, because, you know, I don’t have enough to do and need more exercises to add to my list of daily tasks.   I think I have 22 exercises per day now.  30 reps each.

But back to the lying-down leg raises.  Why do PTs and doctors always tell you to do leg raises lying down?  Because, I don’t generally run lying down, and it seems pretty easy to do leg raises standing up, in all directions, so I would think that would be even more effective.  For one thing, you’d be adding a balance component to the exercise.  And for another thing, it is much easier to find a comfortable place to stand to excercise than to find a hard surface to lie on..at least at my house and my office.  (Yes, I have a floor, but it’s not really so super sparkly clean all the time and  also whenever I lie down on it the cats come and stand on me.) I don’t know..I’m thinking I will try doing them standing up..in front of the mirror, paying attention to form…because I think that it’s better than not getting them done.

Today I ran/walked 7 miles on trail sin the Wissahickon.  Because it was a nice day.

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I recently saw a chiropractor for a second opinion on my knee injury, and his opinion was that my pain and effusion might not be from the meniscus tear but might be from injury or inflammation of the ‘capsule’.  I had never even heard of the capsule and I still am not really super-clear on what exactly it consists of.  My impression is that it’s a thin sleeve of connective tissue that encloses the knee joint somehow. He suggested that my knee capsule feels like it has a fold in it, and that may be at least contributing to the pain on the lateral aspect of the knee. So my question is:  “Huh?”

I’ve heard of plica syndrome, where a fold in, um, something, gets stuck, um, somewhere, and causes pain.  But there was no particular suggestion that this fold in the capsule is getting stuck, just that it is causing pain, and that this injury happened concurrently with my meniscus tear and is confusing the issue with regard to healing.  I’m happy to believe in this theory, because it seems more likely to heal if this is the case.  It’s just the first time I’ve ever heard of it.

The chiropractor points out that the pain can be readily reproduced by applying  pressure to the spot on the lateral surface of my knee that is tender, and he says that if it were the meniscus it wouldn’t be so sensitive to palpation since the meniscus is way deep inside there.  This sort of seems to make sense to me, as a layperson, but then again, lots of things about the human body seem to make sense but aren’t really true.  The body is complicated.  The knee seems especially complicated.  Referred pain can happen in weird places.  So, really, I have no idea id the “capsule injury’ theory is true, or likely.  Still, as a working hypothesis, I like it.

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