Confusion

The most frustrating part of this injury is not knowing where my pain is coming from, and how hard to push through it. One of my best assets as a runner is my ability to push through pain. Unfortunately its also one of my worst assets.

I ran 4 miles with Scott at the Scituate reservoir on Sunday. It was amazing to run even for a short while with an old training buddy. The run went really well for the most part, a little uncomfortable for about 5 minutes, and then everything went swimmingly. However, for the past 3 days, I haven't felt quite so great. This is where the confusion sets in.

Before being given a green light to start training again, 99% of the time that I felt my knee was ascending or descending stairs. These days I barely notice it on the stairs. Sounds great right? Well now i notice lateral knee pain more than anything. The problem is that I never know if its the stress response (which would be bad), Kristen doing Graston stuff to the area, or just general joint pain/wearing from getting used to running again.

On one hand, I get tempted to say its just joint pain because the right has been a little achy as well. However, I get little signs that tell me something else must be going on. It has to be one of the most frustrating things that I have ever dealt with. I'm going to continue to push through for a little bit and then reassess. Worst case scenario, I will just make another appointment with the ortho and go from there. Can't help but get down at times though.

Scituate Sunday?

I woke up feeling surprisingly good today. To clarify: Feeling good these days means that I get very little resistance from my ITB as it clears the lateral condyle. I still feel it, but very very minimally. I have a few daily tests that let me know how things are going to go. One of them is the stairs. If the stairs cause that resistance/catching, i know it will be a rough day. Today I got very little. Also, if i'm driving and I extend my knee, It will be sharp pain at the end as the ITB is forced against that condyle. Today I felt very good in these regards.

I went to the gym after work today and decided that i would do some hamstring and ITB stretching before my run to see how that worked. It definitely did something, because I made it to the last 30 seconds of the run before I started to tighten up. This is good for a number of reasons. Mostly its because if I stop before getting to that point, i recover faster.

After the run, I did my standard hip, core and hamstring stuff. I felt like my strength had improved, if only a little since I first started doing it 3 weeks ago. I also found that after thoroughly stretching my hamstrings, quads, adductors, gluts, ITB, calves and hip flexors, my knee felt pretty much perfect. There is definitely a flexibility issue going on. I find the most improvements when i stretch my hip flexor, hamstrings, calves and quads. All of these affect the posterior capsule of the knee to a degree...even the quads. If you angle just right on that stretch, you can get a stretch on part of the ITB. It all helps relieve my symptoms. I'm hoping that by staying on top of everything, I can get ahead of it.

I skipped the Voltaren for the day. I need to see how things are in the morning so i can assess exactly how much help its giving me. I feel good still right now though, so i'm thinking its not too too much. This is good because it means i'm not heavily relying on it to get through these runs. I'm planning on running before work tomorrow, and in my neighborhood on the ashphalt. That will help me to figure out how much of the good running is being caused by being on the treadmill. Weird stuff to think about, but its how my brain works. I need to figure out what the cause is of my feeling better for the past 2 days.

I figure it the way a researcher would. You take the 4 variables that I mentioned yesterday: Voltaren, Treadmill, rest from massage and flexibility emphasis, and you start to eliminate some of them. I eliminated the Voltaren today and actually did better that yesterday while on it. Tomorrow, if I wake up still feeling good, I will run on the asphalt and see what happens. If things keep moving in the same direction, then i know that i need to get massage a little less frequently so that the tissue can heal, and I need to stay very consistent with the flexibility. That would be the ideal situation, and its what i'm hoping for.

PC alumni track banquet tomorrow. I'm not an alum of PC, but i'm friendly with many of them. Ray Treacy invited Kristen and I to go, and we of course accepted. I'm looking forward to seeing everybody.

Still not sure where this is going

I had two difficult runs on Tuesday and Wednesday. Not from a fitness standpoint, but rather from a knee pain standpoint. My hamstring is still tightening up, but i was also having some difficulty with my lateral knee (IT band area). I was getting frustrated, but trying to stay resilient.

I discussed things with Kristen, and we both agree that its possible that I'm the person irritating the thing. I tend to go overboard with the soft tissue massage and foam rolling etc. So the plan was that Kristen would do a heavy dose of graston technique on me (tuesday night) and then i would leave it alone for a week, with the exception of stretching.

I think my soreness yesterday came from all of the graston stuff on Tuesday night. Its a really really deep and painful massage technique, but it works wonders. So anyway, this morning I used a little bit of Voltaren on the knee, did some bis/tri's at the gym, and then went to work. I noticed throughout the workday that it didn't seem to be very sore. I went to the gym after work to do some running on the treadmill, and it went pretty well. I'm not sure if it was the treadmill, graston, leaving it alone or Voltaren, but something helped because it was a good solid run.

I'm curious to see what happens tomorrow, but my hamstring is still tightening up at about 2.8 miles or so. I'm going to wait until that stops and then work it up for 4 miles. Keeping it slow and easy for now...

Moving in the Right Direction, But Still Fighting the Hammy

I woke up today feeling really good. I wasn't sure how it would work after moving up to 20 minutes yesterday, but i was pleasantly surprised.

I have been spending so much time on hips and core it isn't even funny. I know i say that often, but i've been doing literally about 40 minutes of strengthening a day, 10 minutes of flexibility and probably another 10 minutes of soft tissue work. About an hour a day on just my hips/alignment/muscle imbalances. It has to be working though because things seems to be moving in the right direction.

I went to the gym this morning and did some chest lifting, as well as my standard hip/core program. I knew it would be nicer this afternoon weather wise, so i decided to put off the run. This also gave me a "double" workout of sorts.

After missing out on finishing 3 miles yesterday due to my hammy, i was determined that today would be the day. I went to Dionne track in Woonie to keep it ghetto style. I went 8:18, 7:38, 7:32. I swear I was flying. I thought for sure i was going like 6:45 pace or so. Not so much. Anyway, i felt really strong and deliberate. Of course this was all until the last lap. About 100m into the last lap i started to feel the hammy tighten up again. This was 22 minutes in, so i made it 4 minutes further than yesterday before it happened. I'm looking at this as progress. The plan is to keep it at 3 miles for the rest of the work week. If things stay consistent, i won't feel the hamstring for the rest of the week, but then when I move up to 4 miles i will feel it. I guess we'll have to see. Regardless, things are moving in the right direction.

Being smart and patient

I woke up feeling pretty decent today. I had gone down into the basement and didn't feel a thing on the stairs. This is a huge milestone for me. I haven't descended a staircase in 10 months without a sharp pain.

I decided that I would go down to the bikepath and attempt a 3 mile "long run". I got to the turn around point in 11:30 feeling pretty good. However, at 18:30, I felt my hamstring tightening up. I decided to stop at 20 minutes and call it a day. I'm trying to do more and more of this to keep things moving forward. I decided to skip the hips/core today and give my gluts the day off. I did some flexibility and light soft tissue stuff to my TLF and ITB and now i'm done.

All in all it was a productive week as far as i'm concerned. I managed to run 7 straight days and got better not worse. Hoping for more of the same next week.

More of the same

Friday after work I ran for 15 minutes on the bike path in (S)cumberland. I thought i would have more grass to work with, but was unfortunately forced to stay on the asphalt. It actually ended up working out nicely, and my knee felt fantastic on the way back. I went to the gym and did some hips and core as well as bi's/tri's. All in all it was very positive.

I ended up having the weekend off from work, so i went to Woonsocket High this morning to run a little bit on the trails at Cass Park. I didn't like how the uneveness (is that a word?) of the trails felt after 5 minutes, so i took it to the asphalt for the last 10 minutes. All i felt was a little bit of irritation at the exact insertion of the IT band, but it was really minor. It went away as soon as I stopped the running. I actually think that the trails did it. Anyway, i also did quite a bit of hip and core stuff before the run, and I wonder if that made it tougher. Regardless, it was still much much much better than anything i've done in the previous 10 months, so i'm still very upbeat about things.

Dr. Lifrak also gave me a few samples of Voltaren Gel to rub into my lateral knee a few times per day. Its an NSAID class drug, but he figured that since i could put it right over the area it might help. Not sure if i've noticed anything yet, but i'll keep you posted.

The plan for tomorrow is 15 more minutes, then reassess. I have to admit, its getting tougher and tougher to stop running after 15 minutes. Especially considering that i'm feeling pretty decent now. I'm slowly working the pace down too. I would guess i'm down to about 7:30 pace or so by the end. Gotta keep doing my hip strengthening/flexibility exercises and take it slow.

Making Smart Decisions

The next week or two are going to be among the most important in my rehab process. I say this because I ran 15 minutes today, and it was a pretty reasonably comfortable run overall. I tightened up in my hamstring a little in the last minute, but nothing drastic. The important thing now is staying on top of my hips/core, but also making sure I take a day off if I do feel a little more tight or sore than usual. This always poses a problem for me. Running for me is like crack, so once you give me the green light to train, I don't like to stop.

That being said, I am gauging things by my right knee (the good one). The right knee is also a little stiff today, and in an exactly similar manner as the left one, only to a much smaller degree. However, I've been on my right one for about 10 months now, so it would make sense that it would handle the running better than my left. Regardless, I was a little stiff after the 15 minutes last night, but I woke up much better than I had anticipated, and that's exciting for me. I have been doing my running after work, only because I find that logistically it allows me more chances to run on something soft. If I run before work, I either have to be up early to do it, or I run on the asphalt in my neighborhood. For now, I will stick with grass and trails after work.

I went to the gym yesterday morning though, and I did shoulder weights as well as hips, core and flexibility stuff. I'm really making a concerted effort to stay on top of this stuff, especially as I start to feel better. We always seem to slack on the "pre-hab" stuff once we feel fine. As I feel better, i'm forcing myself to keep on top of it. Its been dreadful doing nothing for the past 10 months, and I have no interest in going backwards.

My goal at this point is to run the Pie Run on Thanksgiving day with either my sis or one of my cousins. They all run a nice easy pace for me, so it will keep me from attempting to race it, yet I will get to enjoy the company of the wonderful running community in RI. I miss the community and interactions more than anything. Looking forward to it whether I can run or just cheer.

More Progress of Sorts

Today is the 3rd day in a row that I ran. I felt a little sore from last night. The Graston technique stuff works amazing, but it bruises you up. The more I go through with this, the more I'm becoming convinced that my IT band, lateral gastroc and lateral hamstring tendon are the secret to solving my injury woes. I've been doing between 30 and 60 minutes of core and hip strengthening per day. Its only been about a week, but today I started to feel just a tiny little improvement in my left hip stability/strength. Its definitely encouraging. At the same time, I'm noticing that my knee feels better supported while running. Hopefully the combo will have me running pain free soon.

I went 10 minutes again today, however this time it was completely on asphalt. This wasn't my turf of choice, but I often go to visit my parents after work, and because I had no running shoes with me, I had to go home after visiting and run in the pitch black. I decided it would be safer on the roads of my neighborhood than on the grass in the pitch dark. Wise move I think. The only thing I can honestly say I felt was my IT band. I'm not sure if i'm feeling the end result of Kristen hammering it with her graston tools, or just the strain of it, but the important thing is that I didn't have any of my "injury pain". That is my biggest fear. That pain is so distinct that I will know it the second it returns.

After the running, I came inside to do some more 4 way hip strengthening as well as clam shells, planks and physioball hamstring exercises. Lastly I did a little bit of light soft tissue massage to my hamstring and posterior ITB. I feel like that resets it and keeps me from tightening up. So far so good....continuing to proceed with great caution.

Trying to keep myself grounded

I ran again today, however this time it was a little more deliberate. I still kept the pace slow, but i tried to focus on just running naturally. I used a grass field near (S)cumberland High School figuring it would be an easier transition from sedentary to run. It seemed to be decent. I didn't have any of the sharp lateral pain that I normally get, but i still have some quad type of tightness. Regardless, it went better than I expected it to. My plan was to run for 5:00 and instead I did 10:00 forcing myself to stop. I kept it nice and slow, probably between 8 and 9 minute pace. The important thing is that I got through it and it wasn't horrible.

I then went to the gym and did back lifting as well as my standard hips/abs stuff. I also threw in my usual hamstring strengthening exercises.

After this, I met my wife at PC and had her do some Graston technique on the IT band and lateral gastroc. Its definitely a huge advantage having a wife who is an AT. So now my leg is sore, but from Graston, not from working out. Hoping for more of the same.

A light?

I met with Dr. Hulstyn today and was very impressed. He took about 30 minutes to examine me, which i believe is the world record for an orthopedic surgeon appointment. We went very thoroughly through my history, and he still did his own physical exam despite having the MRI's in front of him.

One of the things that i mentioned to him was that my pain is very lateral and posterior (back of the outside of the knee) and my injury is anterior. So basically it doesn't make sense. He agreed, and seems to agree with me about it being more IT band and Hamstring. He gave me the yellow light to proceed forward, but with caution. I told him i would go very slowly and just keep reassessing. Its still kind of a crappy answer, but at the same time he doesn't seem to think I will be unable to run again, so that is a plus.

After the appointment I continued to run parts of our conversation through my head. The more I think about things, the more i don't believe that i'm being limited by this osteochondral injury. I decided to google "posterior lateral knee pain" and got a slew of hits on these types of injuries. Apparently they are rare, but usually include the biceps femoris (hamstring tendon) and the popliteus muscle. I have had chronic hamstring tendon pain in that knee for years. Its very tight, and at the same time very weak. Its been one of my primary targets in the past year. It seems that in a small population, this becomes a major problem, but what caught my eye is that it said, "This can happen by falling on flexed knees, and will often cause pain with running and climbing and descending stairs." This pretty much sums up the past 10 months for me. Fell on flexed knees, can't run, can't squat and can't do stairs. It was unreal how much it made me think of my own situation.

That being said, I was sitting in my car, drinking a coffee before my next patient, and decided to try to palpate the area a little. I found that i have some incredibly irritated tissue near the hamstring tendon as well as the gastroc head. Turns out that you can also herniate the gastroc lateral head quite easily ,and its painful to compression. Anyway, I did about 3 minutes of loosening on that area and was relieved of my symptoms for a brief while. All of this has me thinking that i'm onto something. In the meantime, i'm going to try to start building back up. I read that a cortisone shot to the gastroc head can completely relieve symptoms. Just a thought for the future.

I got home and decided to test things out on flat ground. I walked up my hill, then ran an incredibly slow and cautious 5 minutes. It felt awkward and glorious all at the same time. I then came home and did my hips and hamstrings. I had already done core, hips and chest this morning, so i didn't want to overdo it. After a little bit more soft tissue to the area, I feel decent. The trick now is to ramp up while not worsening symptoms. I'm cautiously optimistic at the moment.

Bottom of the ninth

At least that is how I feel today. I'm going to see a new ortho today with hopes of getting some sort of answer/game plan outside of, "I really don't know what to tell you. Why don't you take like a year off and see what happens". I understand that medicine is "practice" but you would think that I could get a little more time and understanding than that!

On a related note, i did some core and hip over the weekend, but definitely slacked off a little too. I ate some halloween candy and generally took most of the weekend as downtime. It was good though, and I don't regret it. I also tried to jog the grass on the side of my house and it wasn't bad at all. I don't really know what that means, but hopefully I will get something this morning.

One final thought: Couldn't help but get incredibly choked up watching Meb yesterday afternoon. I watched the entire race, texting back and forth with Matty. We knew he looked good, but when he made that move in Central Park, i knew it was over. NYC is one of the toughest marathon courses I have run so far, and if you see a runner picking it up in the park, they are having a great day. Very exciting day to be an American runner yesterday! I also got some sparks of positivity (is that a word) from watching the people finish after the elites. Made me remember what that was like, and more importantly, it made me feel like I wanted to do it again. Meb also spoke at length about his injuries and fracture, and it made me relate to him heavily. I just hope i can comeback even a fraction of what he has.