Sunday, November 23, 2014

Posterior Tibial Tendon Dysfunction-Shades of Grey

Before I write about my Dizzy experience I want to take a moment to look at my foot/leg "injury".  I put that word (injury) in quotes because I'm not entirely convinced it was a real injury.

There is sometimes a fine line between discomfort and injury.  Discomfort can certainly lead to injury. You will most certainly have discomfort with an injury.  But there is a point at which discomfort turns into actual pain and that is usually when injury is either imminent or has already happened.  Because I'm very much like the Princess in the children's story, for me that fine line is like a vast mountain range.  When something hurts, I generally perceive it as isn't black and white, it's's always grey.

However, in the last four years I have been attempting to learn the difference and embrace inevitable discomfort that comes with endurance sport.  When you cover a large number of miles (large is a relative term...) there WILL be discomfort.  Being able to determine if a sensation is actually pain is difficult if you don't have experience with discomfort in the first place...until you've crossed the line and end up with a diagnosis that confirms actual injury.
Side story...the first athlete I started coaching learned about this dividing line the hard way.  She was feeling something in her leg quite a bit, but she defined that sensation as discomfort (and didn't tell me about it), until the day she realized she couldn't walk properly.  She had more than one stress fracture!! 
The athlete in my side story is much tougher than I am.  See, I don't like to be uncomfortable.  I know some of you are laughing.  How can anyone who doesn't like to be uncomfortable participate in long course triathlon?  How could anyone who doesn't like to be uncomfortable go out in sub-freezing cold and jump in a lake to start a race with 140.6 miles to cover before the finish line?  How can anyone who doesn't like to be uncomfortable run a marathon?  That's why I redefine what is comfortable.

So when I woke up that Saturday morning with undeniable pain in my leg I knew not to run that day. When that pain dissipated it became less clear what to do.  I went to the doctor in the hopes he would tell me the feeling I was having was simple discomfort.

He didn't tell met that.  He said there was a chance it was a stress fracture because when he pressed on the bone in one specific spot it was very tender.  (It wasn't shin splints because the pain wasn't anywhere else except that one spot.)  However, I was most tender on the tendon that runs right beside the bone.  That could have meant it was a fracture right under/beside that spot, or it could have meant the tendon was "irritated" (inflamed or possibly torn).  

He STRONGLY encouraged me to not run the 50K that was to happen just four days later but he didn't have an actual diagnosis for me.  There was about a 70% chance an MRI might give an answer, but there was a 30% chance it would either give a false negative or be completely inconclusive.

I left his office and cried.  I felt like I was right back to where I had been two years ago with my shoulder.  The first doctor I saw for that issue told me I had tendonitis in my bicep tendon and I needed to completely rest it.  I did rest it but, because of a weakness in certain muscles and some bone spurs, even every day movement caused it to be irritated. This new tendon issue (if that is what it was) was likely pretty much the same thing in a different place.  You can't walk without using that tendon.

But I wasn't convinced it was a significant issue.  First of all it had stopped really hurting.  Second of all, it didn't hurt when I walked around.  And third it didn't hurt when he had me put a load on that tendon by pressing my foot into his hand in different ways.  Those same kinds of tests with my shoulder HURT in unmistakable ways.

As convinced as I was it wasn't a significant issue, I was convinced it was on the dangerous side of the "injury continuum".  (If I were better at graphics I would draw a really cool picture to insert here to illustrate this idea, but alas, I'm not!) If no discomfort is "white" and full on injury is "black"...this was more dark grey than light grey.  I knew this because I had been having some issues with the underside of my foot and my calf off and on for a while.  I had attributed it to the discomfort that comes with an increase in mileage.  It was usually gone within around 24 hours so it seemed reasonable.  It made sense that these three issues were all related, quite possibly to the tendon in question.

But, in my mind, I had two distinct options.  I could decide to take the safe path and stay off of it for a while until there was no discomfort at all at any time.  This would assure me, as much as possible, I would go back into the "white" area on the continuum.  Or,  I could test it out to determine how grey the situation really was.  I decided I would not live in fear.  It was silly to me to stay off of my foot in anticipation of it being a full blown injury. I wouldn't really know until I tested it out.  Usually a test would be a short run (or something even less "offensive") but if it was a ("light grey") tendon issue I wanted to give it as much time as possible to resolve before the race.  So I elected to stay off of it as much as possible until the morning of the 50K, and let each mile of that race be the test.  I committed to myself (and my entire support system) that I would not start the race if it hurt that morning, and I would stop if it started hurting.

The hard part was going to be making the delineation between hurt and discomfort.  Doesn't it all go "grey" in a 50K?  I was about to find out. be continued...

Saturday, November 22, 2014

Getting to Dizzy

Three weeks ago today I woke up with terrible pain in my left lower leg.  If you look at the was exactly in the spot that is labeled "tibial stress fracture".  Yikes.  

I knew I had pushed some limits the week before with working out at Iron Tribe (specifically running and jumping wearing VERY minimal shoes) on top of my longest run all year (18 miles on trails on Thursday) followed the next day with another longish run (one that was supposed to be 13, but I ended up making it 14.5 for a number of reasons).  

That second run felt GREAT.  I was completely surprised.  About 80% of it was on trails but I ran the other 20% on the road with my worn out, non-stability, trail shoes with their completely worn out inserts.  On trails I don't really seem to need the stability as much, and it usually doesn't matter at all...but running on the road with those shoes was quite obviously a terrible choice.  I have to admit that I did know it at the time, but it felt good so I kept going.

All the choices I had made during the week came flooding back to mind as I tried to make a little hop on that leg (that's a classic "do I have a stress fracture" be clear, I failed that test miserably).  I was scheduled to run that day, but I was smart and not only skipped it, I put my leg up most of the day.  The next morning I woke up and it wasn't much better.  I got on the elliptical for an hour and it seemed to feel okay.  I started telling myself there was no way it was a stress fracture, it was simply sore from the week's work.  

But it hurt.

Monday I tried to stand up in Spin class and felt it acutely so I stayed in the saddle for the entire class.  I had a massage appointment and the therapist really worked my foot and leg over.  She said she really didn't think it was a fracture either.  Whew.

But it hurt.

I tried to run mid week, but the first step HURT so I stopped after 100m.  So I didn't work out that week at all other than Spin class, rowing and modified movements at ITF.  And I started to worry.  I had my first 50K race coming up in a week.  I am signed up for the "Grand Slam" (3 50ks and a marathon in November, December and January).  

I kept telling myself it would be fine...but it hurt.  It didn't hurt all the time so I took that as a very good sign.  But, it did hurt and I couldn't overlook it.  So I went to the doctor 11 days after I failed the "jump test".  After a very thorough examination he told me it might be a stress fracture, or it might be a problem with the tendon.  I'll spare you the details (or I'll put them in another post), but he STRONGLY encouraged me to not run the race.

THAT hurt more than my leg.

I had a heart felt discussion with my husband, my best friend, my coach and another friend who all said it was a very bad idea to run the race.  They all knew I was set on doing it if at all possible and they all tried to talk me out of making a stupid choice.  The doctor had said to let pain be my guide.  The problem with that was that if it was the tendon the worst thing I could do is to have partial healing and then injure it again.  So there was a good chance it would feel fine before and during the race but hurt the next day (like it had done before).

All I could think about was the last two years of dealing with my shoulder...which started out as a diagnosis of tendonitis.  But at the same time I did not want to live by fear.  How on Earth was I going to know if it was going to hurt after the race if I didn't do the race.  I honestly believed if it was really injured it would hurt.  I honestly believed if I hurt I would stop.  And, I honestly believed it was going to be okay.

I made the decision to get up Saturday and go to the start line and see what happened.  I was going to take it mile by mile and be willing to quit if I had to.  I have never quit a race before, but I was willing for this to be the first if that's what had to happen.

So, a week ago today I woke up, got ready and toed the line for my first 50K.  ((I know if you are a reader of my blog, you already know what happened...sorry about that, I should have given a spoiler alert on my last post!)) be continued...


Final Exam and Graduation

I was on a roll there for a while, posting after every Iron Tribe Fitness 101 class...and then life got crazy (as usual!).

We learned several other exercises to finish out the training which will set us up to do the "big kid" workouts.  Then, the last day of 101 was the retest.

If you remember the first night of 101 we learned how to do a proper air squat, kettle bell swing and sit up and we had a baseline test to see where we were starting out with fitness.  I came in "third" out of about 15 with a time of 6:09 (one of the two people who "beat" me was a female...insert glaring competition face here).  During the 4 weeks of 101 I had a few long runs, ended up with a little injury to my leg (more about that in another post) and had a little run in the woods (it was a 50K, 31 miles, a week ago today...I'll write A LOT more about that in another post).

I was more than a little concerned about how I would do in the retest.  I knew my legs were fatigued, and the night before the test I did a WOD with a "Try the Tribe" group* so my upper body was a little sore as well.  My injury didn't seem to be a big factor thankfully, but it wasn't completely gone either.  I not only wanted to beat my original time, I wanted to beat the other gal's baseline time.  ((I can NOT help it...I am competitive.))  Really what I wanted was for her to be at my retest so I could aim to beat her that day, but no such luck.

Anyway, I decided to just give all I had an to be satisfied with whatever result I got.  I started the 200 meter run like a BULLET.  I wish I had timed that run-it was seriously fast.  15 air squats, kettle bell swings (at the prescribed weight not scaled weight**), and situps, then 12 of all three, then 9 of all three...I could tell I was moving faster and I was holding on pretty well the whole time.  The test ends with a 200 meter run.  I was fast the 100 meters going out...but boy was I sucking wind on the way back.  It would have been nice to have someone there to race, but I ended up having to do my retest alone so all I had was my mind to tell me to PUSH.  The air was super cold and I sounded like an asthmatic trying to gulp oxygen into collapsing lungs!!  My chest HURT in that last stretch of run.  I could tell I was slowing down.

The first part of the run, and consequently the last part is a driveway into a parking lot.  You run on a sidewalk, so you go off the curb then back up to start and finish the run.  As I was coming back my mind started telling me I had better slow down or I might fall...what if I break a leg, or worse, my neck...I could hit my head and DIE!!!  ((Yes, I seriously had these thoughts as I was running as top speed.))  Interestingly enough, because of the previous two weeks of dealing with the "injury" I was able to put all of that out of my mind with one little phrase, "I do not live my life in fear."  I was able to push as hard as my body would allow and finish with a time of 5:31.

I cut 38 seconds off what I found out was a good time to start with anyway.  I did beat the other gal's baseline time, but I'm sure she will beat my retest time when she does her test...she is a beast.

Here's the thing...I was amazed at my improvement in the month.  Now, I know there is some speed with comes with familiarity.  But, we didn't do kettle bell swings or sit ups in the regular classes.  We did squats a good bit in conduction with various movements, but, in my opinion, speed wouldn't be a function of being more familiar with a squat.  I truly gave all I had in that baseline test.  I was gassed at the end of it, and I was sore the next day from it.  The improvement I made was even more significant when viewed through the understanding of what I had done in addition to the class in that four weeks.

There is no doubt in my mind that sticking with ITF will allow me to swim, bike and run faster (and more efficiently because I'll be using muscles that have been very under-developed in the past) and do it with less risk of injury.  I have said all along that I needed to add in strength training.  I just haven't done it.  It's very hard for me to go into a gym and do my own thing...and I KNOW what to do.  This "program", for lack of a better word, is more than worth the time and the money it will cost me.  (For the record, I will be going only twice a week since I'll also be swimming, biking and running.  If this were all the exercise someone was getting they would really need to go at least three times a week.)

This is going to be a banner year for me!  I. Can. NOT. Wait!

Until next time...

*What is "Try the Tribe"??  Every month they have a special class where people can come to check the place/program out.  I will be "hosting" my own "Tri the Tribe" event on December 17th.  If you are in the greater Huntsville area and want to come check the place out, please come be my guest.  I will have some door prize drawings and there will be a special offer for any athletes who want to join the Tribe with me.  If your are curious at all...this is the time to check it out!  If you are on FaceBook, you can "join" here.  If you aren't on there, you can comment on this post or email me to let me know you are coming.  There is limited space available and I want to have a good count for some give aways!!  :D

**What is "prescribed" weight and "scaled" weight all about?  Every WOD (workout of the day) has a "prescribed" weight to shoot for.  There is one for men and one for women.  When someone isn't quite strong enough to use the prescribed weight (or do the movement exactly as it should be, like a pull up), they "scale" it down.  So I think the prescribed weight for the kettle bell swing for women is 16lbs (not sure?).  If I couldn't swing that with good form I would go down to 8lbs.  There is "always" a scale or a modification to make an exercise safe and effective.