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 PAIN...it isn't black and white, it's GREY..it'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 train...to 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.

...to be continued...

Getting to Dizzy

Three weeks ago today I woke up with terrible pain in my left lower leg.  If you look at the picture...it 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" test....to 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!))

...to be continued...

:D

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...
:D

*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.

From Kindergarten to College Math

Yesterday at ITF we warmed up on the rowers, and practiced double unders (I didn't even get one yesterday, but I did manage to spank my own butt with the rope--THAT takes real talent!).  Then we learned how to do the push press and "knees to elbows".

The push press is like the strict press, but with a little dip and jump.  So much of what we do in there is about coordination....making this muscle snap/activate when that other muscle does this other thing.  This move requires the glutes and quads to snap while the arms push the bar up, which also requires the lats to activate.  It's a thing of beauty when it all works together...and all those muscles working together to accomplish the lift means heavier weights can be moved.  

I just realized I added TWENTY POUNDS yesterday to the weight I was struggling with on the strict press last Tuesday!!..

((Sorry...I had to take a moment to do a happy dance!!))

...Then we moved over to the super scary pull up bars.  The rings used for the dips on Monday were on the pull up bars, but they hang down so I wasn't too nervous going over there.  (You think I'm kidding...I'm not really kidding...it's like going to a Halloween haunted house.  You KNOW there are things in there that are going to jump out at you and you KNOW they are not really going to hurt you, but your blood pressure rises anyway.  That's how I feel when I even think about the pull up bar.)  I started to get nervous, but then the coach broke down the movement.  

Side story about the coach...there are three coaches in this gym, two males and a female.  They all have their own personality (naturally) but the female comes from a gymnastics/dance background.  She really knows how to break movement down in a way that makes it feel like taking baby steps...which is REALLY comforting to me.  It's not "we're going to go over to this bar, jump up and bring our knees  up to our elbows...", it's "we're going to jump up and hang.  Then we are going to activate our shoulders forward and back.  We aren't going to swing like this (demonstrates swinging), but we are going to control our bodies like this (demonstrates the difference and shows us how to tell...)".  

We all had a favorite teacher in school...so far she's my favorite coach in the gym (sorry guys, I know you are the favorites of other people there...).

So...she broke down the movement into pieces I thought I could handle and then I put my big girl pants on and faced that stupid bar.  I hung from it, then I moved back and forth, then I attempted to bring my knees up to my elbows.  I didn't really make it but I sort of did something that almost looked like I was trying to do something like it!  :D

And...theeeen we were introduced to a "new" concept.  

10!

ITF has all kinds of abbreviations for the WOD to making the writing of it simple and easy.  The "!" doesn't mean it's a really excited 10 like I originally thought ("OH--we only have to do 10 really good reps of two things! YAY!!!"  I mean, come on, who wouldn't get excited about that!?)  Uh...no...not quite.  The coach called it a "differential" but my mathy husband told me it's actually a "factorial".

Whatever it's called, that lovely exclamation point means you do 10 reps of both, then 9 reps of both, then 8 reps of both....and so on down to 1.  If my math is correct that means you are doing 55 of each thing.  I think there should be another way of expressing that because (as everyone who knows me knows) I LOVE the exclamation point!!  (Someone said I AM an exclamation point, and I LOVED that!)  I think seeing that in this WOD and now knowing what it means, and feeling the after effects of it this morning, I don't really think using that symbol is appropriate.  I think it would be better to use something that resembles stairs would be better...or a ladder (although ladders generally go up and down...).

When we got to the WOD I was back to being nervous.  My shoulder didn't REALLY like knees to elbows, but it wasn't hurting.  It was mainly just coming off the bar that it really didn't like at all.  At. ALL.  But once I was off the bar I was pretty okay.  So I decided to just do my best.  I could always take weight off the push press or do V sit instead of K2E (another abbreviation).

I don't think I did, but there is a chance I lost count in there somewhere.  I really tried hard to keep up with what I was doing, but somehow I ended up finishing before the guy in our group.  Now...he was lifting A LOT more weight on that push press that I was, but I was sure he was ahead of me the whole time...but when I thought I was done he was still going.  I have got to get better at that.  (I know it will come with practice because I used to not be able to count swim laps either.)  Either way I didn't take weight off and I didn't do V sits and I didn't hurt myself because I did listen to my body!  

I'm happy to report today that my lats are sore enough I know I worked them pretty hard, but my shoulder does NOT hurt!!!!!  In fact, I would go so far to say it feels a skinch better than usual!!  (I think shoulder day is going to be my hardest and my best day of the workout week.)  Who would have thought?

We also talked about hand care.  I don't know if I talked about it here, but when I was considering doing this ITF thing I watched a video (that I can't find anymore) talking about "hand care" for "rips".  That was almost a non-starter for me but I talked to Turtle (who has been doing CrossFit for years) and she told me rips don't have to happen.  (For anyone who doesn't know what I'm talking about...when you do a lot of work with barbells or on the pull up bar your hands can get callused and that skin can rip...)  Well...the coach ((I have to think of a name for her)) talked about how to care for your hands to avoid rips, not how to care for them after rips.  (Yet another reason she elevated in my estimation.) I know some of you are thinking it's crazy to do an activity where you have to worry about ripping your hands, but even guitar players have to callus their fingers up in order to play.

One more day and I'll be officially half-way through this introduction.  I'm still loving it....

Until next time...

:D

Double Unders...Not to be Confused with Double Dutch

Tonight at ITF we REALLY went to kindergarten and not only jumped rope, but we also "played" on the rings (at least everyone but me "played" on the rings...I did box dips instead because I was too scared to try the rings since my shoulder is really NOT even close to 100% yet).

Double unders...in case you don't know, this is a jump rope thing.  You jump once and swish the rope around twice before your feet hit the ground.  Shockingly it's a wrist movement.  Embarrassingly enough at first I couldn't even get the single under down.  Mercifully the coach told us most people don't get the double under the first night, and many people take months to get it down.  You can guess, I had one goal for the night-to get at least one double under done.

We learned how to do ring dips but I opted out of that one.  The coach said it's not a strength issue for most people but a stability issue.  I can't afford to have my shoulder any more unhappy than it is right now already so I said no to the word "stability", and like I said earlier, I did box dips.  I have to say I didn't think I could do those either.  They didn't feel good, but I did all of the ones I was supposed to do and I'm okay so far.

Lastly we learned how to do a proper weighted front squat.  This seemed to be the thing that hurt my shoulder the most.  Mainly, I think, because the bar is resting on the part of my shoulder that hurts the most.

After we learned our new exercises we partnered up and did the WOD.  A partner workout is one in which you have a set number of rounds/reps and you split it however you want between partners.  We had 3 rounds of: a ridiculous number of double unders ((or WAY more single unders which everyone was doing instead)), some front squats and then ring dips (or box dips in my case).  Only one person could be working at a time and you could switch back and forth as you needed to.   I felt bad for my partner...I was REALLY struggling to jump rope and then my shoe came untied...and then my other shoe came untied!!  I was just glad she didn't beat me with that jump rope!!

On that first round I could't get more than a few jumps in at a time.  But, by the last round I got 40 in a row!!  Then I DID IT...ONE double under!!  I couldn't do another one, but I did ONE!  Goal MET!!  :D  I can't honestly say, but I don't think my partner and I were last tonight.  I think there was one other group that had a little bit harder time than we did.  I was consumed with the fact I couldn't jump rope and with the fact I was too scared to even try a ring dip to really notice anyone else's time.  But, if I don't listen to my body no one else will so it's up to me to decide what I can and can't do...what I will and won't do.

Still lovin it.

Until next time...
:D

SLURP....(that's me drinking the Koolaid)

Thursday at ITF we got to use the rowing machines!  I know it's silly, but these are the nicest rowers I've used (that's not saying much, I haven't used many...), and I was rocking the row.  And we learned how to do a proper dead lift.

Unlike rowing, I've had experience with the dead lift.  But, as I told my coach when we got started, I know I've never done it correctly because I have NEVER felt it anywhere (except sometimes my lower back, but not in a "oh that's working a muscle" kind of way, more like a "that's not supposed to feel like that" kind of way).  The theme of the day was "you can't recover from a bad set up"...so we spent a LONG time on proper set up for this exercise.  We build the move from the ground up starting with where our feet belong all the way up to our head.  Since there were only three of us there we got a lot of individual attention along the way.

The WOD was three rounds of rowing/dead lifts/squats-for time.  I came in second (the guy beat me so I'm not crying over it...).  I realized when it was over that I really could have lifted a good bit more weight...but I didn't know what to expect so I went with the standard "women's 101 weight".

I have to say...I'm three classes in and I'm hooked.  I love it.  I absolutely love it.  It's short enough that it's not onerous.  It's varied enough that it's not boring.  It's tough but doable.  And, since you are doing it for time there's an element of competition (with your tribe mates and with yourself).  I love that we encourage each other, we push each other (well, I see the regular classes doing that with each other...we are just starting out so we aren't really there just yet with each other....well, I do it because that's just who I am...)

I can't say that I'm at the point I will tattoo the logo on my chest (I'm not even there with Iron Man)...but I have definitely hit the "Koolaid Point" and I'll be downing another big pitcher full this week.

***

Running update:  After Thursday's workout I did my long run (18 miles and they were pretty decent trail miles).  Friday I ran another 14.5.  But yesterday I didn't do my run because I am in fact listening to my body over the slurping of the Koolaid.  I hadn't gotten nearly enough sleep all week so I went to bed early Friday night and slept late Saturday (6:30!!).

***

"Diet" update:  (I really dislike that word...maybe I'll call it the "lifestyle update"?)....Well....I should probably change the title of this blog post to "drinking the Kombucha", but I won't since only a few people would get it.  I have become "that person".  I had a "big cooking day" today in order to get ready for the coming week.  I made a chicken and deboned it.  I made a huge batch of sausage.  I made tuna and chicken salad.  And I have a menu planned for the week.  All-in-all I think it's worth the effort I'm putting into it.  I haven't seen any change on the scale but I have seen a slight change in the way pants are fitting.  More than that, I've felt a change in my brain (no brain fog) and in my gut (although that isn't great yet...it's better than it was).  I think the reason it's not great is that there is a group of foods (FODMAPs) that cause digestive issues for a lot of people (i.e. gas, bloating...irritable bowl syndrome...).  Cleaning up my diet has almost spotlighted the fact that FODMAP foods give me trouble.  I have hit a decent groove with food right now so I'm not going to complicate things more by taking that group out too right now.  But I am trying to pay attention to it as much as I can.

Now...let me get back to my Koolaide/Kombucha....  

SLURP

Until next time... 

:D