PT Update

I met with my new physiotherapist on Monday, Kathy. She's very experienced and thorough. I was really impressed with my assessment appointment. I was contorted into all kinds of great pretzel-like positions, twisted, turned, lifted and bent. We also had a nice chat about footstrike, shoes, ChiRunning and more.

The interesting news is that my foot hasn't hurt at all since the half marathon. A little bit the day after, but really, it's nothing compared to two weeks ago. My lower back was quite sore, though, which should give you an idea of where I'm going with this....

Her conclusion is that my upper back (thoracic spine) and gluteus medius are not doing their jobs. Honestly, my glute is non-existent and that's not good when it comes to running long distances. Their underperformance means that my lower back does all the work and bears all the weight. And when I ask too much of it by running long distances, it freaks out, compressing the nerves, making my feet hurt.

So the new approach is to address this over the long term. We want to work on opening up my upper back and strengthening my glute. I think this is a good idea, given that the pain has subsided and my back is no longer in freakout mode.

I ran a short run on Sunday morning on her advice, but I had quite a few cobwebs in my legs and it was ridiculously humid, so it was only 3K. But no pain or tightness in the foot. Tonight I'm going to play an ultimate frisbee game (my first since late 2009) with Husband's team and then PT in the morning. Hopefully she'll give me the all clear to resume running regularly again.

Verdict & Plan

I visited another physiotherapist last night for a second opinion. I saw Jordan last year during my injury then and he was the one who suggested the treatment plan that allowed me to recover, so it made sense for me to reach out to him this time around.

The verdict:
I am more flexible now than I was last year. Yay! Though this may be a product of going to physio three times in the last 10 days.

I didn't do anything "wrong" with my training plan. Double Yay! This is not an overuse injury.

The problem:
The pounding of running causes my nerves to splinter and become irritated. The muscles guard the nerves to protect them. Then my back seizes up and all the joints in my back harden and compress the discs further on the nerves. And it goes around and around in a cycle. The remaining good news is that this is treatable, not just in the short term, but I can "undo" it with hard work over the long term. What that involves, I have no idea.

The plan:
I'm going to run the half marathon on Sunday. I ran a test run today of 5K and there was some discomfort, but no pain. I never stopped running and it didn't change my gait. It went in waves of no discomfort to more discomfort, and each subsequent wave was less uncomfortable than the previous one. The worst that could happen during the race is that I have to bail partway through, but then at least I tried.

I'm switching physiotherapists. Unfortunately my current one isn't the right match for my situation. I have a consult next week with a new physio that has been recommended to me by a couple of different people.

I want to thank everyone for their encouragement and support. This has been one helluva rollercoaster ride and it isn't over yet!

Punishing myself

As I alluded to in my last post, I really overdid it on my long run on Sunday. The sciatic pain that sidelined me for 5 months in 2010 is back, but on the other foot. Great.

I've done this twice before: I ran really hard runs right before the Ottawa 10K in 2009 and the Army Run 5K in 2009. In the first race, I aggravated a nerve on the outside of my knee, but still was able to run the race. In the second one, I got sick and didn't run, as it was 2 weeks before my wedding and I didn't want to end up even more sick.

I've gone to physio twice since last week and I have two appointments this week. I'm diligently doing my exercises and applying heat to loosen up the muscles. The foot seems to feel better each day, so I'm trying to stay positive about the half marathon. I'm treating this as an extreme taper. In a test run on Thursday, it hurt to run. So I have to be honest with myself. Not running the half is a real possibility. If I can't run the race, it's not the end of the world. I'll be disappointed for sure, but there are other races to run.

What I need to figure out is why this keeps happening. I thought I had been doing well: I was going to physio every 6 weeks to get my back/muscles addressed, I was stretching regularly and doing my preventative exercises. But I still ended up here. It's incredibly frustrating that it's the same injury as before, just on the other side.

So this leads me to wonder: what am I doing wrong? I'm fairly sure the sciatic pain is related to cumulative muscle trauma - I'm damaging the muscles repeatedly before they have time to heal, and eventually the muscles and nerves end up in a cycle of swelling/overtightening/shortening. I need to figure out why the muscles are not healing. Is there a medical reason, like say, anemia or poor circulation? Is it my training, like I'm running all my runs too hard? After this is said and done, I'm going to find a running coach to go over my training log and help me design a training plan so I can avoid this in the future.

And I'm going to join the Ottawa Running Club. I've been meaning to do so, as they have track sessions and group runs. Since I don't play Ultimate anymore, I want to make my running more social, as running alone is not conducive to meeting new people!

Feeling like a runner again

Today I ran my longest run of the year: 12K.

It was glorious.

I felt like a runner again as I ran along our picturesque Rideau Canal at 7 a.m. - the only other people I saw were other runners. I exchange hellos and good mornings with almost everyone I passed. It really was wonderful.

I also saw the editor of iRun Magazine, Mark Sutcliffe, as he ran his our personal marathon to celebrate turning 42.2 years old. He was running a 5:00/km pace as he ran the 12K out and back. He and his posse passed me several times... I wish I could've run with them, but that's a little fast for me! haha.

I've been feeling much stronger, fitter and faster as of late. I also popped into see my trusty physiotherapist this week to make sure all was okay with my back... and it was. We spent some time working on it and my flexibility, but it was really encouraging to know that I can continue to up my mileage as long as I keep an eye on my flexibility.

My army run post is coming soon, I promise. I was hoping to steal a few minutes at work to post it, but that didn't happen this week.

My Butt Hurts!

I had my last physio session last night. She worked my butt and hips pretty good... so good that they're still sore today.

The great news—sore butt aside—is that I am now going to physio on an as-needed basis. This means that I can go see her whenever I want for the little aches and pains that build up in my back. I also have to start doing massages every 4-6 weeks.

It's so time to celebrate! It seemed like just yesterday that I was holed up on the couch in pain with no relief in sight.

Yoga for Runners

My physiotherapist suggested I start crosstraining, specifically with some sort of activity that promotes flexibility. She pretty much said that I need to do this if I want to ever run any races longer than 10K. Certainly I need to maintain my flexibility if I want to avoid injuries over the long-term.

So, today I'm going to try Yoga for Runners. It's offered at a local yoga studio at a really convenient time. I've done bikram yoga before, but I had a lot of difficult with the heat. I often felt sick and faint, often for days after. Hopefully I'll have better results with this new class!

I'll be sure to report back on the class.

Settling into a routine

I'm slowly getting back into my running routine again. It's funny how life adapts itself to more or less free time.

Life is busy right now and it's actually getting difficult for me to fit in my short little runs. Husband and I started taking our wine courses again, which we'd put off for a number of reasons. They're not cheap when there's two of you taking them and they're a big time commitment. This class is done after this weekend, thankfully just in time for us to start a new project.

Car shopping. Joy. Our car got a death sentence on Thursday, so I ended up nixing my run yesterday to look at cars. But in one evening we only managed to look at two cars. Ugh. No matter what, we need a new car ASAP. Husband works in the other end of town and the bus isn't a viable transportation method for him over the long term.

I got good news at Physio on Wednesday: I'm down to one appointment every other week. She's hoping to discharge me in July, if all goes well. Now just to fit in those runs!

Torture

Nope, not a post about physio today. It's going well, though. The new focus on flexibility, involving ART, back manipulations, and tractioning of my hips and back, seems to be working. We're seeing drastic improvements in my flexibility during sessions... now we just need to get it to stick from session to session.

The torture I speak of is the torture of walking home from work on a 20C degree day. On those days, I'm passed by runner after runner. I start to feel a mix of emotions:
- Self-pity: "Wah, why can't I run???? It's a perfect day for a run. I want a back transplant!"
- Jealousy: "Not fair. I want to run. I'm in better shape than her!"
- Anger: "Stupid *^%$%* back"
- Envy: "Oh, she's obviously prepping for the marathon."
- Upbeat: "She's struggling, maybe I should say something to encourage her! Wait, she won't know I'm a runner."

I know this is a bump in the road, but going through the gamut of emotions like that really doesn't motivate me to walk home from work. If only I could just close my eyes and walk that way...

Racing like a test subject

I have to admit that I don't feel much like a runner these days.

Last week I had medical appointments every day. I saw the second physiotherapist, who believes that my treatment plan needs to focus more on flexibility issues than on building core strength. He felt that a 10K was a reasonable goal for later in the year.

Part of me agrees with his idea to focus on flexibility, but a big part of me doesn't. I agree with it because I am clearly inflexible. I've never been able to touch my toes. Ever! Most people are amazed by how inflexible I am. But it's never been a problem until now. Which is why I don't necessarily agree. I spent 8 years dancing several times a week. It was a high impact sport that had a similar force exerted on my body as running (if not more). In the last few years, I danced for a minimum of an hour 3x a week, if not more. The worst injury I had was shin splints. I was the same weight I am now, so that's not a factor. I would say I am in the same physical shape now as I was then.

I think ultimately it's something wrong with my back. I saw the doctor on Friday and had x-rays done. I will likely need an MRI. My primary PT believes there's scar tissue in my back from my previous back injuries in 1999 and 2008, and that this scar tissue is putting pressure on my nerves.

I've considered just giving up running altogether. But I love running. I really do. I've invested 2 months of time and money into PT... I'm not ready to give up this fight just yet.

News to come

This week has been the insane week. Tons of work to get done and just not enough hours in the day to do it. Long weekends usually create all kinds of headaches at work, as the nature of my field is that the craziness of 5 days gets compressed into 4 days instead!

My personal life schedule has been crammed full of appointments. Tuesday: sports massage. Wednesday: Physio. Thursday: Physio. Friday: follow-up with doctor, physio.

Why so much physio, you ask?

Well, my awesome PT decided it was time to send me for a second opinion. So today I get to go see him. His resume is outstanding and I was impressed by just looking at his website. Hopefully he'll have some ideas. I'm not looking forward to going through a full assessment and history again... but if it'll help, I'll do it.

Tomorrow I go back to the doctor to see what he thinks. I will likely get x-rays of my back and possibly a referral for an MRI as well. I wanted to get the ball rolling on them as the wait times for MRIs can be long, and I didn't want to spend another 2 months in physio only to be sent back for an MRI. That would mean 2 months wasted that I could've spent on a waiting list.

Riding the Pine...

I submitted my request to be put on IR to our Miles Game team captain on Runners World Online. I've run 4K in three months. I didn't think it was fair to keep posting zeros when the team could use a player in my spot to actually post miles. There has been a shortage of players for the Miles Game recently, but I hope the team can get a new player in my place.

I think I'll be going back to the doctor as soon as I can get an appointment. I've read up on my pain and what my symptoms are and I get so totally overwhelmed. Should I see a chiropractor? I'm not a fan of them, but if it'll help, maybe I should see one. Should I see a different sports medicine doctor? Do I need cortisone shots? Do I need surgery? What about a physiatrist? So far I've just booked to massage therapy appointments for my back, at my physiotherapist's request. In other news, the exercises are coming along. The pain isn't really improving or going away. The dry needling appointments are pure torture... I try my best to do as much as I can.

In the meantime, I've started cooking. I made quiche on Saturday from a recipe from Eat, Shrink and Be Merry. It was a pretty good recipe, using brown rice as the crust, and with a head of broccoli, roasted red peppers and swiss cheese. Yum!

On Sunday I roasted a chicken, following another ESBM recipe, the Roastess with the Mostess. I have a hard time doing roast chicken properly. It never cooks through, despite following the directions and using a meat thermometer. I think our chicken was still frozen on the inside, despite the fact it sat in the fridge for two days. The marinade was really tasty - lots of lemon and thyme flavour that carried through the meat.

I decided to stop wasting chicken carcasses, so I promptly cut off the leftover meat and tossed the chicken into water, along with some herbs, onions and carrots. I left the stock to simmer for 4 hours. I'm hoping to transform it into chicken soup tonight!

Same old, same old.

Not much is new with me. I'm not running yet. I'm still going to physio, though not much has changed. The pain is no longer in my foot, but in my back, pelvis and hips. She added in ultrasound to dull the back pain, which I absolutely love. Last week she buttered me up with the ultrasound and then did some dry needling... that was a bit of a shock to say the least!

I've been good about doing my McKenzie method exercises, which she calls cobras. It's a set of 10 yoga-like stretches for my lower back that I do lying on the floor. I even brought my yoga mat to work so I can do them in my office. But, I need to get better at doing the other exercises.

So I'm bribing myself: if I do the exercises every day for a week, I can buy myself the stainless steel waterbottle I want at Lululemon!

During my layoff from running I'm working on getting our house in order. I've started shredding old documents and organizing my filing. It's almost a spring cleaning mission! We bought a new cabinet for over the toilet, which has added some much needed storage to our bathroom. I'm looking forward to painting the bathroom in the near future, too! I really hate the colour in there... it kind of looks like pablum. I'm also trying to finish off some projects that I started and never completed... like lining all the shelves in our cupboards.

At this point I'm trying not to think about running.

Panic

I had a mini-meltdown last week. There, I said it.

I'd researched my injury (injuries?) and was starting to panic. What if I have something more serious wrong with my back? I saw all kinds of terms such as slipped discs, herniated discs, nerve entrapment. Lots of medical terms that would cause a state of panic in the most seasoned runner.

After almost 3 months on the IR, I'm starting to feel frustrated with my lack of progress. I feel hopeless, like I'll never run again. Sadly my husband doesn't understand how I feel. I can put it into words and he tries to understand, but he doesn't. It doesn't help that the pain keeps coming back. I do the exercises almost religiously. I go through the torture of ART and dry needling twice a week but the pain isn't going away.

Running is my stress management technique. It keeps me sane. It's part of who I am and how I define myself. So, naturally I feel lost without it. Now I'm doubting all my race plans and I feel like a failure as a runner. I know I shouldn't, but I do. It wasn't so bad when the weather was awful, but now that it's sunny and warm, I feel like I've been left out of the running party.

It also doesn't help that some people feel the need to offer their opinion on my injury. When they ask how I'm doing and I tell them, they want details. Then when I give details, I invariably get "How can you back cause your foot to hurt?" - what they don't know is that I've previously injured my back twice, once when I was 18, the other when I was 26. Overall, what I'm going through is just not something that's easy to explain, nor to understand. Which leads to more soapboxing by friends and family.

But I trust my physiotherapist's diagnosis more than I trust random people with no medical qualifications. My parents keep telling me I need to find a new physiotherapist for a second opinion. The thing is, I trust her completely. I know she's a diamond in the rough. She's well-educated, up-to-date on all the latest treatments and techniques. She's not milking me, as so many often do.

I need to remember that trust. I kind of lost it at physio on Thursday. She saw me at my darkest time, when I was doubting everything: myself, her, my future as a runner. My PT tells me that the fact that the pain has moved from my foot into my back is a good thing. I can't say that I agree... but I'll take her word for it.

Really now

Who schedules meetings at 4 o'clock? That's downright mean. I suppose it could be worse, as it could be a 4 o'clock meeting on a Friday. But really now, don't they know that I have things to do and places to be?

I would really like my first run back to be in the awesome sunshine and warm weather we're having right now.

Yes, that's right, I'm going for a run tonight. I'm so excited! I get to do 5K at a 7 minute/km pace. My physiotherapist wants to see how my body handles it. It's been almost exactly 2 months since my last run and it's been far too long.

I'll be sure to report back. :)

Could she be right?

I met my physiotherapist last night. She rocks!

She did a full assessment. She believes that I don't have a stress fracture! Hooray! She thinks my core muscles (glutes, piriformis, back etc.) are weak and not firing properly. I actually felt this in my abdomen. Thus it's putting pressure on my sciatic nerve and increasing the load for all the muscles below them (ankles, feet, knees). Running in the snow makes it worse, because my ankles and feet have to work extra hard to keep me balanced.

She thinks that this is why my foot hurts and it's why I keep getting recurring issues such as achilles tendonitis or plantar fasciitis. And, I believe her. I've known for awhile that I needed to work on my core, but I had no idea it was this bad. I pretty much sucked at all the stuff she did in the assessment, with my left side being worse than the right. Last night was like an epiphany!

The cure? Acupuncture and lots of strengthening exercises.

The best news of all? I should be able to start running in 2-3 weeks. She said I should be back to my old mileage quickly and that I should be able to run the half marathon in May.

Yippee!

Recovery time, excellent

I had my second round of x-rays yesterday. I snuck a peek at them and didn't see anything on them that cried out 'You have a stress fracture!'. I go for another follow-up with the sports medicine doctor on the 18th, so hopefully I'll have a diagnosis then. I've realized what's killing me is the uncertainty... that I can't move forward until I know what's going on and what to expect.

I've also learned that I'm fortunate in that it could be worse. I could have a stress fracture in way worse places, such as my tibia, hip or pelvic bone. Ouch!

I also know what I did wrong to do this to myself. I realized that I've worn my green superfeet insoles since I started running seriously 2 years ago. I was in physio at the time for a back/calf injury and she suggested that I lose weight and try superfeet insoles. That's what I did! So it really was stupid of me to run three times in a row without them, especially a 13K run. Those runs put a lot of stress and contortion on my lower leg muscles, resulting in injury.

I start physio tonight, which I'm looking forward to. I want to use this time to work on my muscle strength and imbalances. And of course, to lose those 10 lbs. that I put on over the past few months.