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Sunday, January 29, 2012

Back to life

  Well, I've finally made it- to the end of a swim/bike focus phase that began six weeks ago, and to the end of the extra work hours I took on back in mid-August when my coworker went out on maternity (the last few weeks have been a bit tiring, to say the least).  Anyways, next week will be back to a 32hr/week schedule, with two mornings a week completely open and three other days of starting at 9-11 AM- can't complain there!  It also coincides with recovery week (whatever am I going to do with myself?  Laundry?  Cleaning?  Paperwork?  Ew.  Walk the dogs in the woods?  Better).  So, although off-season life is less than thrilling, I'll update a bit on the highlights.

  Training- A few hours ago, I wrapped up what I've always considered to be a rite of "I'm training for an Ironman" passage, which is the 20 hour training week.  This was my final week (or so I've been told) of a swim/bike focus build phase, which means the past three weeks featured a grand total of 100 minutes of running each.  Needless to say, that means that
A. The faint order of chlorine follows me everywhere
B. Every part of me that touches my bike saddle hates life right now
C. I learned how to not hate swimming (I still hesitate to give Mary the satisfaction of saying "like" and "swimming" in the same sentence).  I will admit that I sort of enjoyed myself in a pool during Mary's birthday swim, though (minus for when I had to do stuff that didn't allow me to breathe every stroke).
D. The only thing saving me from getting really, really feisty from not running is the total body fatigue that comes about from raising training volume by, say, 50% from what I've been doing for the past two years.

   When this past week started, I honestly had no idea how my body was going to respond to the volume increase.  Fortunately, it behaved; my stubborn streak came through to push me through, as well.  I'm well aware of how fortunate I am to be able to race professionally this year; I know many people would love to be in my position; and I feel that I have a responsibility to make the most of the opportunities I've been given and the chances I'll hopefully have in the future.  Giving in or slacking off doesn't factor into that.  Now that it's all said and done, I'm beginning to see some results.  In the offseason, they're small and of debatable significance (I know how to interpret running workouts; without them, though, biking remains somewhat mysterious to me), but I'll take what I can get.  My second of 2x1600y was swam on Wednesday at the 800 time trial pace I celebrated five weeks ago, which was swam at a pace that I used to be happy to swim 200y at.  Finally, hope that (if I can hold it together in open water for once), I'll at worst be a close last out of the water.  Every Computrainer ride this week was done at the same HR and just slightly higher wattage than the same ride last week, which was done at the same HR and just slightly higher wattage than the week before (and so on).  Given that this is the first winter I've trained on the Computrainer or with any sort of power numbers, I have zero frame of reference for how to interpret this; I don't know how many watts it takes before it means anything, I don't know what it means for outdoor riding, I don't know if what I'm riding at is even remotely respectable (if I don't bike any faster than what it's telling me I'm doing, after all, I'm screwed), but I'll take it.  And then today, even with the minor amount of slow running I've been doing, my body decided that it'd stay in zone 1 while running a pace that I can almost feel ok about for the first time, well, ever.  Baby steps.  My faith in what I'm doing, in my coaches, and in QT2 continues to grow day by day.

  In other news, UPS and the mail both brought some exciting stuff to me this week.  On Wednesday, Dave came home to this:
Good thing UPS hid it so well.  Apparently, in Irondequoit it's not ok to leave a $7 laptop stand outside a house, but leaving a bike is totally cool.
Inside that box was my new ride- a Kestrel 4000 Pro SL (thank you Kestrel!!!)  Although I'll be sad to say goodbye to my Cervelo (he served me well), I cannot wait to get on the Kestrel.  She's super pretty, and she looks fast as heck (and I have no idea why I've personified the Cervelo as a male and the Kestrel as a female, but it feels right to me).  It'll be up to me to provide a worthy engine to her speed.  I still can't believe Kestrel gave me this, after all.  Here she is, only partially assembled right now, but still looking good:
Bailey approves.
 Then, on Friday, the mail brought me this:

Although my status has been updated on the USAT site for close to two months now, somehow having this little piece of plastic in my hand provided some sense of relief that I'm all official now and stuff.  Here goes nothing.

  Another partnership of sorts that I'm pleased to announce is with Ridecarbon.com.  Ridecarbon.com was the company that gave me one of the best (and most generous) race prizes I've ever won-the Gray race wheelset I received for winning Musselman.  I still remember sitting in the grass before that awards ceremony, watching a wheelset being pulled out of a box and thinking, that cannot be my prize!  Well, somehow, (very) fortunately for me, I walked away with a wheelset that I love, and that certainly played a role in my improved bike splits over the rest of the season.  Ridecarbon.com is in the process of becoming a source of gear, nutrition, and information for triathletes.  I'll be doing some article writing for the site on various topics in order to contribute to the information part; I was excited to be asked to do this, and I'm certainly looking forward to getting started.

   Finally, and somewhat ironically, given my recent training breakdown, last night Dave, my parents, and I enjoyed the Greater Rochester Track Club's annual Rochester Runner of the Year Awards banquet.  I had managed to nab third place overall last year; Dave had found himself with an age group award, as well.  As always, I enjoyed catching up with the running community and watching the Hall of Fame inductions (some moments did bring about a little former Penfield pride, too).  I know I'm going to miss participating in the running scene as much as I have next year, but I did put down "Ironman Lake Placid" as my goal race for 2012 on my awards bio form.  I then came home, went to bed, and woke up ready to hit the bike, continuing to trust that it'll be worth it in the end.  Until then, I'll be enjoying my recovery week (instead of complaining about it), and counting down the days until QT2's Florida training camp the week after next!  

Monday, January 23, 2012

Highs and lows

  First off, I should just express that as a person, I'm not hugely emotional- that is, until it comes to athletics (or animals.  Just reading Marley and Me did me in.  Don't ask me to watch the movie.  I cried during Homeward Bound as a child).  I hated Titanic and The Notebook for their sappiness, I didn't cry my way down the aisle at my wedding, I can hold it together during Hallmark commercials.  But, I can't watch a freaking Ironman finish without nearly losing it.  The Olympic Marathon Trials broadcast nearly did me in.  Maybe it's just because it's something I can relate to (anyone who's been exposed to my marriage knows that speaking overly dramatically about our love and passion for each other realizes that this isn't how Dave and I operate), or maybe it's just something about what happens to a human being when you cross the line, but sports make me lame.  So, sometimes when the body doesn't want to work, I begin to rely on pure emotion to get me through- and many times, that's when the numbers respond, as well.

  Today was one of those days.  Apart from being Monday, it also represented the beginning of my third build week, in which I had been putting in more volume than I had, well, ever.  It also marked one more week until my time spent at work will decrease to a glorious 32 hrs/wk.  With the fatigue of the past two weeks of training beginning to set in, I dutifully dragged myself out of bed at 5:30, hit the pool and sprinted, hit the trainer and sprinted, and hit the road (no sprinting there, though).  The bike workout, two hours with 8x2:30 best effort right smack in the middle, was the kind that I've done enough by now to know not to take lightly, no matter how minor it may sound.  Plus, I know what kind of wattage I've held during those intervals, and I'm too competitive with myself to let that drop, no matter what I feel like going in.  Two and a half minutes can feel tormentingly long, so I began taking myself places to survive.  I went back to the finish line of all of my best races; I recalled those feelings, and I pictured (to the best of my imagination, at least) where I'll be in the future- Galveston, NOLA, back to Mooseman, and finally, Placid.  Remember the good, remember what it was like, remember the highs.  You didn't get there without these lows.  Think of those times, and you'll know why you're doing this.  On a tough, ugly day completely lacking of any glory or glamour, I knew- I had to be here to get back to there.  Ironically, I needed my highs to get through my lows.

  If I rewind a few months to those good races, though, something else becomes clear.  I wasn't running along, say, ten miles in during Vegas thinking about some easy run over the summer when I'd felt effortless as I glided along.  Nope, I was thinking about some Sunday spent toughing it out through fatigue over my favorite long run loop, cresting the pedestrian bridge over the river and trying to work my way up Titus towards home without losing speed.  I wasn't biking uphill 40 miles in, thinking of some time in which I was easily cruising along at 23mph with a tailwind.  I was thinking of the Monday mornings spent repeatedly grinding it out up and down Bayview Rd, until I never wanted to have to go into my small ring again.  At those times, I needed to know that I had suffered in the past to know that I could make it through the present.  Thus, I needed to remember my lows to get to my highs.

  And so it becomes some sort of positive feedback loop- in training and racing, highs and lows are inevitable and intricately intertwined.  One feeds the other.  So, with that, I'm going to embrace whatever pain the rest of the week gives me (although, I can't say I'm going to be unhappy once recovery week hits!), because I know that in just over two months, when I'm x miles into the ride of my first pro race or y miles into the run, I'll be bringing myself back to days like today.  And hopefully, with any luck, I'll be able to finish in something that I can draw upon the next time the workouts don't come easy.  And I'll survive them yet again.

Saturday, January 21, 2012

Identity crisis

  For the past month or so, since my trip to Boston, I've been in the midst of a swim/bike focus, which is something that I originally embraced with a "bring it on" attitude, despite my well-publicized love/hate relationship with the pool.  The honeymoon came to a gradual end last Sunday, when the fact that I've been running less than 15 mi/week, mostly at 7:30 pace, began to frustrate the longtime runner in me.  I finished the run less than inspired, and Mary was required to talk me (email me?) down off the ledge (ok, slight exaggeration, but I had reached a new level of unnecessary hostility).  The thing was, I've been in the midst of a shifting personal identity: from that of Jennie the runner, who happened to do triathlons and got away with relying on the strength of her run, to Jennie the triathlete, who sometimes runs open races but will now be competing at a level where everyone runs sub-1:30 half marathons off the bike, and who needs to get her butt on a bike and in a pool if she wants to stand a chance at not getting embarrassed.  The shift has been subtle; I should have noticed it earlier, but I've been stubborn, and until now, not entirely ready for it.

   On September 20, 2009, I started the morning as a wreck of an injured runner who had spent her summer on the bike and in the pool, who had this crazy idea that she could try a triathlon.  Less than 2.5 hours later, I finished the Finger Lakes triathlon, and I was transformed...into a runner who had done a triathlon fairly well, despite my Walmart helmet, oversized drifit t-shirt worn on the bike, and small panic attack early on during the swim.  My transitions were hideous, I didn't drink an ounce of fluid on the bike because I didn't have the skills to get at my water bottle (this might still be a problem...), I took in half a gel only because a more experienced competitor had taken me under wing and told me I should, I had figured out how to shift into my big ring the day before and hit 30mph for the first time ever, I swam way off course, and I was completely unprepared for what running off the bike would feel like (given I hadn't even been running yet, I shouldn't have been surprised by that one).  And I loved it all.  I didn't know where I would go with the sport, but I knew that triathlon wasn't going to be a one night stand; it was going to be a whole freaking relationship, for better or worse.

   Fast forward a few months, and there I was, registering for Musselman 2010, my first 70.3.  But I was still a runner who dabbled in triathlons.  I ran my way from 12th to 2nd there.  After that was a small sprint tri in Massachusetts on our way to Cape Cod for vacation.  I exited T2 in second, and ran to the win.  The 2010 Finger Lakes tri played out the exact same way.  I relied on my running strength in tris; my swimming was mediocre at best, and my biking was just adequate.  In between tris, I jumped in every road race I wanted to run.  The runner identity remained.  I clung to the "runner" label over the "triathlete" label, despite mounting evidence to the contrary as time wore on.  The following winter, my husband bought me a top of the line, expensive tri bike (goodbye, bike split excuses!), I developed a singular focus on qualifying for Vegas, and I trained for a marathon on two runs a week, with the rest of my days filled with biking or swimming.

  Sometime over the course of last summer, the shifting balance began to become more obvious to me.  Unless I was racing, I didn't run without biking first.  Heck, half the time, I felt better running off the bike than open running.  In June came a first for me: I skipped a local 5k I would otherwise have done because I thought a long ride would be more valuable as I trained for Musselman.  I had been able to use my run at Mooseman to secure the Vegas slot, but I wanted a better bike split to go along with it, as well.  I still wanted to be a runner, but I was beginning to have an identity crisis: was I becoming a triathlete who runs races on the side, rather than vice versa?  Vegas threw me for even more of a loop: among amateur women, I placed higher on the bike than on the run.  What?  That'd never happened before.  After Vegas, I spent a couple of months experimenting with actually running while marathon training, trying to regain the runner identity; yet, when all the dust had settled after NYC, my marathon pr remained the same, and I had an elite triathlete license.

   Which brings me to now.  After last Sunday's breakdown, I woke up Monday, and did what every runner who's just beginning to admit she's a triathlete first does: I sucked it up; I hit up the pool and put everything I had into some 50y repeats; I kicked my own butt on the bike during some intervals, pedaling until I was grunting and near tears, fighting with everything in me to keep the wattage up; finally, I ran one good mile, and then settled into my trot of a zone 1 pace.  The rest of the week played out similarly.  Wednesday's swim workout, which hadn't intimidated me too much on screen, turned into a battle.  I ended up struggling through 2x600 at a pace slightly faster than the greatest accomplishment of my pre-QT2 swim life, which was a 7:15 500 (try not to be too impressed...it's ok to pity clap)- but I was still annoyed.  This, though, was a big step: swim times got to me.  I'm done being satisfied with swimming sub-1:30 (up to a certain distance, of course), which had been my previous benchmark for a decent swim workout.  I can't count on making up that kind of time on the run anymore.

  The transformation to triathlete was nearing completion.  Yesterday morning came the highlight of my weeks lately, which, at a mere 40 minutes, is the longest run I'm doing at this point.  My HR monitor was misreading, which I used as an excuse to let it rip a bit towards the end.  It felt great, until I considered the fact that after a full day of work, I'd have to come home and put in a 1.5 hour tempo ride.  I fretted about it a bit, hoping I hadn't screwed my ride, and I spent the day finding excuses to sit when I might otherwise have stood.  My legs were certainly feeling it, but I managed to improve upon the previous week's effort at the ride, and went to bed feeling more satisfied from the bike than the run.  This morning, four hour trainer ride time rolled around.  In the early stages of the ride, for the first time I can remember, I was working to keep my HR up, rather than fighting to keep it down.  When I reached the final half an hour, I just started smiling, and I couldn't stop.  I felt strong, my wattage for the ride was the highest it's been at the same heart rate I'd been averaging, and I could finally tell that I was getting somewhere with my QT2 training.  Plus, I was just enjoying being on the bike, and I was enjoying the fact that I could still feel good riding after 3.5 hours, when I'd been on the bike every day for over two weeks.  Afterwards, I scrolled back in my logs and looked at my long rides from the previous few weeks- the improvements weren't drastic, but they were real and they're happening.  I have faith that once I get into more running, I might just see the same pattern.  And I'm now willing to admit that I have a new identity.  I'm a triathlete.  I can still be a runner, but that's just part of what I do now.  I've been biking daily, I've been swimming five times a week, and I've now accepted what that makes me.  So, that's what my identity will be moving forward.  All in all, I guess that's what I get for waking up in Vegas (and I'm not ashamed to admit that that song makes the "suck it up and go" list on my mp3 player during particularly miserable moments!)        

  Once again, thank you to everyone who continues to support me in my journeys!  Next week will bring about another exciting new chapter-my new ride, a sweet Kestrel 4000 Pro, is scheduled to arrive.  I'd also like to thank Woolsports for their sponsorship; although I haven't been running much, the running that I have been doing has been scheduled on the coldest days of the winter, and my Woolsports socks have been a total lifesaver in keeping my raging Raynaud's in my toes at bay-give them a try!

Friday, January 13, 2012

10 lessons from the dogs

  I know I've mentioned our troublemaking charming dogs here and there on this blog before.  They're often a source of conversation at work (most patients think it's more normal to talk about pets than, say, four hour training rides), and sometimes I think that Dave and I spend more time interacting with them at night than we do with each other.  Heck, Bailey even sleeps between us practically every night, and gets all cranky if we try to move her.  So, on Wednesday, I was walking the dogs back home from a romp in the woods, where they had rolled in crap, and thus needed baths.  Somewhat frustrated with them at the time, I began to think that although we often question their intelligence (or, in Bailey's case, lack thereof), maybe they could teach me a thing or two.  So here goes (and yes, I realize this is entirely random).

1. Movement=pleasure
One Monday over the summer, after a weekend of hard training, I had just finished up an hour of hills on the bike, after a long swim.  Tired, I debated if I a. even felt like going for a short, 30min trail run, which featured unrelenting hills and b. felt like taking Bailey with me.  Well, guilt won out, and five minutes into our run, with me still dragging a bit, Bailey turned around at the end of her leash and just flashed me a giant, dopey dog smile.  In that moment, she was in a state of pure doggy bliss.  Try to enjoy this even half as much as her, I thought.  You do this as a labor of love, after all.
Galloping through snow=happy Moose

2. It's ok to get dirty sometimes.  Do it with enthusiasm.
In the Durand woods near our house, there's two areas that tend to get very wet and muddy.  Of course, when we get to those areas, Bailey and Moose plow through the dirtiest, nastiest, grossest of the mud, while I cringe and calculate if I have time to bathe them before work.  Or, they'll smell something awful on the ground, and before I have a chance to even react, will dive into it, headfirst, and just cover themselves in nasty.  I can just see them thinking, oohhh.  It's so disgusting.  But it's soooo good.  While I don't recommend bathing yourself in dead animals or crap, sometimes it's ok to run through the mud and nasty up my sneakers, to embrace finishing a bike ride on wet roads with dirt splattered up my legs, or, after a week of having to look all professional at work, to just enjoy getting on my hands and knees in my garden in the summer, putting in vegetable seeds.  That's what showers are for, after all. Which leads to the next lesson.


3. Having to bathe kind of sucks sometimes.  But, it can be pretty awful if you don't do it.
Bailey sort of puts up with baths ok.  The Moose, on the other hand, hates them, and will only face out of the bathtub.  Try to turn her around to spray the other end, and she'll gradually rotate herself again.  Sometimes, I think of how much more time I'd have in life if showering daily wasn't a necessity.  But, clearly, bathing a mutt when it rolls in who knows what is needed, and not being a gross, smelly person is pretty necessary to function normally in society, as well.
The bathtub is so awful!

4. If you want something, go after it.  Give it all you've got to chase it down.
For Bailey, this means squirrels.  For the Moose, this also means squirrels, but, to an even greater degree, deer.  Will Bailey ever catch a squirrel?  Probably not.  Will Moose ever catch a deer?  Not unless it's injured.  But they don't know this.  They'll continue to chase after them time and time again, never losing hope or enthusiasm.
Sometimes, though, you'll just get handed what you want, especially if you have a cool aunt.  It's ok to accept that sometimes, too.

5. Some of us are natural born swimmers.  Some of us can learn.  Others of us will avoid the water entirely.  Some prefer to run.  To each their own.
At ten weeks old (maybe), my sister's yellow lab puppy Otis had his first experience with water up at Lake Ontario.  An adorable little puppy, all floppy ears and huge paws at the time, Otis was swimming away off the bat.  To this day, he'll happily swim in anything, never tiring of retrieving a tennis ball from the family pool.  Her other dog, Abe, wasn't a swimmer before Otis, preferring to stay where he could touch in the water.  After observing Otis (and with some coaxing), Abe has finally gotten to the point where he'll do some limited swimming.  Abe, though, is an eager running dog, making it through 15 miles with me one time, without ever lagging behind, prior to collapsing for a couple days with skinned paws.  I prefer to think of myself as similar to Abe.  Then there's Moose and Bailey.  Moose, being a sensitive little thing at times (that's a nice way of saying "shelter dog issues"), will splash through streams, but will run scared from anything that might require her to swim.  Then there's Bailey.  We've tried taking her in my sister's pool before, and I wish I had video of it.  That dog absolutely cannot swim correctly, to a comical level.  She'll thrash at the water with her front paws, like she's trying to climb out.  But, provided it's not too hot out, that animal is one fantastic runner.
Otis meets water for the first time.  

6. Sometimes, we should just forget about our back halves, and let them work naturally.
One night, my mom and I were observing Bailey perform the very normal dog behavior of scratching her face.  Suddenly, she stopped, looked at her leg in confusion, and began to gnaw on it (I never said she was the sharpest knife in the drawer...).  Then, she began to scratch again.  This cycle repeated itself a few times, to our amusement.  But, sometimes I try to forget about my legs, too, and just let them work-i.e. at the end of a long run, when everything is fatigued, or when pushing out bike sprints, when my quads are burning to no living end.
I know my head is getting petted.  My legs are just doing something.  I don't really know why.

7. No matter where we come from, what our pedigree is, or what we look like, we all have the same basic needs and wants.  There's no need to judge.
Moose and Bailey are certifiable mutts.  Bailey's some sort of greyhound/pointer, to our best estimation, whereas Moose is maybe part cattle dog, part chow, part beagle, and part anyone's guess is as good as mine.  Do they know what the heck they are?  No.  Does somebody's purebred dog know what the heck it is?  No.  It cracks me up when I see some sort of purebred fluffy little dog, all perfectly groomed and dressed up with bows or sweaters or whatever else; I'm also amused by anyone at work who tries to tell me that their dog is particularly clean or proper in some way.  In my opinion, a dog's a dog.  No matter what their AKC papers or haircuts say, they all lick their own buttholes, sniff each other's buttholes, roll in gross crap, hump inappropriately, and poop in the backyard.  It's not like some purebred dog is going to avoid my dogs because their parents weren't the same type.  Dogs don't know.  People should be more like that sometimes.
Some purebreds, some mutts.  They actually all started humping each other shortly after this picture was taken.  They didn't care.

8. Use your strengths when you can.
Bailey is one fast dog; part greyhound, she can sprint.  The Moose, all short, stocky, non-aerodynamic 35 lbs of her, is not nearly as swift.  But, the Moose is as agile as Bailey is fast.  Bailey, on the other hand, has no control over her lanky, awkward body when she's moving full tilt.  When they chase each other around in the backyard or in the woods, Bailey will run huge circles, practically wiping out sometimes as she tries to turn.  The Moose, with her superior intellect, will keep up with her by cutting tangents, making sharp turns, or suddenly reversing directions to cut Bailey off.  They end up matching each other well.


9. No matter where you end up, always know your way home.
Three days after the NYC marathon, when I was still sort of decrepit, I took the dogs to the woods, let them off leash, and started on a different path that wouldn't tax my quads as much with steep downhills. Within a minute, the dogs spotted a deer, and took off (see #4).  Bailey came back to me within a couple of minutes, but, ten minutes later, Moose was still gone.  Dave met me in the woods, and, after another 20 minutes of frantic yelling and walking around, still no Moose.  He grabbed Bailey to run the rest of our normal loop, and I decided to walk back home. Half a mile away, Moose came running out of the neighbor's backyard to greet me, giving me a look of I was home.  Where were you? I have no idea where she had gone, but, she knew how to get back to where she's fed.  Stupid, yet smart, dog.
We're not necessarily convinced this one could find its way out of a cardboard box.  But we hope she'd miss being a spoiled pain in the butt and sleeping all cozily in the bed.

10.  Not everyone will love you.  Many people may not even like you.  That shouldn't stop you from at least trying to be nice (unless, of course, someone is threatening you in some way).
Self-explanatory!

Sunday, January 8, 2012

Analyzing the run

  So, about a month ago, after long hoping to get a chance to mix work and pleasure, I had the chance to go to a running injury/form course in Chicago.  As I recently got around to describing, I've suffered from my fair share of overuse injuries common and strange in the past, and I've tried every pair of shoes, orthotics, stretching, and strengthening exercise imaginable.  I've heard every theory from tight hamstrings, to tight calves, to tight hip flexors, and finally to inactive glutes, which, coincidentally, has made the largest difference to work on.  But I digress.  I've always enjoyed working with runners in the clinic (having a patient complete a marathon is something tangible to me, a sense of satisfaction I can relate to and be glad to take a part in), but even though I've done my reading when I can and had my own experiences, I wanted to be able to offer something more.  So, off to Chicago it was, where I would finally learn about the nuances of video gait analysis.  The course was awesome, and since then, I've had the chance to start some taping and applying what I learned (nerd alert).  Really, though, I'm enjoying taking something as ingrained as someone's running style, slowing it down, dissecting it, trying to figure out what's going wrong where, how it matches with clinical presentation and static exam components, and figuring out where to go from there.  Without further ado, then, because he always complains that I "never want to help him" (and because I can't legally broadcast pictures of actual patients), I'll highlight some of the stuff I look for using Dave's video.  I should add that I've been dabbling around with different free trial version of software for analysis, so if some of my little lines look sort of amateur-ish, they kind of are, given my technology impairments.

Exhibit A: Dave's left leg.  Some background here is that Dave has a history of some on and off left knee patellofemoral pain.  He was seen by one of my colleagues for it, who helped him out a good deal.
The line connects Dave's hip joint center to ankle joint center.  Ideally, the knee joint center should also fall along this line.  Dave's falls slightly to the inside of it, which is a pretty common finding in runners with knee joint pain (one name for it is dynamic valgus).  It's fairly mild in him, though.  There's some left hip drop, although again not too bad.  Interestingly, his left shoulder is also lower-generally, the spine would sidebend opposite the hip drop to keep the shoulders/head more level.  I never said Dave was normal, though.  My coworker who had worked with Dave was somewhat surprised to see any dynamic valgus and hip drop on this side, even mild, as this can be caused by poor hip abduction strength, something she was unable to appreciate on static exam alone.  A good number of studies have shown decreased hip abduction and external rotation strength, as well as this dynamic valgus with different tasks (usually step-down tasks) in patients with patellofemoral (front of the knee) pain.  Here's where it gets fuzzy, though-is strengthening those muscles alone enough to help treat?  Is the weakness the cause or effect of injury?  Right now, while strengthening likely helps, adding in an awareness/neuromuscular control component is thought to be just as important.  Just providing real-time feedback (using fancy computer stuff that most normal clinics wouldn't actually have) to get runners to avoid this valgus has been shown to help.  More practically, part of Dave's theoretical treatment program would include some sort of step-downs in which he focused on preventing his knee from collapsing to the inside of his toes, as well as an awareness of it while running.

Exhibit B: Dave's right leg
Pretty good.  The center of his knee falls closer to that line, and his pelvis (and shoulders) are more level.

Exhibit C: Initial contact from behind
Dave lands slightly to the outside of his heel, in slight supination.  This is fairly normal-"normal" is considered to be landing in slight supination, pronating a bit in midstance as the foot flattens out a bit to help attenuate shock, and then resupinating prior to toe-off in order to lock the foot into a more stable position and provide a more stable base for push-off, usually over the second toe or so.

Exhibit D: Midstance
Dave does some interesting stuff here that I'll attempt to postulate about.  During midstance, the average runner will show a little bit of rearfoot eversion (heel turns slightly out).  Dave's probably about normal with that.  Also, some "toe out" is normally seen-usually the lateral two toes can be seen.  It's hard to tell with the shoes on, but it does look like Dave's a little more toed out than "normal".  But, this has to be taken with a grain of salt due to the camera angle-the "too many toes sign" should be determined by looking directly into the back of the heel.  Dave's entire foot seems like it's rotated a bit, i.e. I'd have to move a little bit to the left to get the right angle on him.  More likely, part of this rotation is occurring at his hip/knee, rather than from excessive collapse of the forefoot on the rearfoot.  It helps that I know that Dave has pretty high-arched, rigid feet.  So, my thought, given that he always complains about pain in some of the hip external rotators and his lateral hamstrings after he runs, is that he's overfiring those muscles.  The end result is that his leg rotates out in an attempt to bring the inside of his foot down closer to the ground.  The dilemma is what to do about this.  If I was a nice wife, I'd maybe try mobilizing his foot and making it more flexible.  Or, because I'm me, I'll make sure he's wearing a cushioned shoe with some give to it (he is), and tell him to keep working at strengthening, foam rolling, and stretching his glutes/smaller butt muscles (and to suck it up, I'm really nice sometimes.  But Dave's whiny sometimes, too).

Exhibit E: The front view
   The front view helps to confirm the back view.  Again, the foot/leg rotation are evident here.  The valgus (collapse in) at the knee doesn't look too bad from this angle.  I just tried to rotate my leg out while letting my knee collapse in a bit-quite a recipe for knee pain!

Exhibit F: Initial contact

A few weeks prior to this, I had filmed Dave for a work inservice.  At that time, he was running with a cadence of about 80-85 strides/min, and had been overstriding a bit, landing with a fairly extended knee pretty far in front of his center of mass.  Since then, he'd been working on increasing his cadence to about 90-95 strides/min in these videos.  This has helped him land with a little more knee flexion and the foot closer to his center of mass, which helps decrease the force transmitted through his shin and up to his knee.  In this picture, Dave's best classified as a rearfoot striker-he's not coming down excessively hard on his heel, but is still landing on the back of his foot.  Nothing wrong with this, though; a worse braking force would occur if his heel was landing further in front of him, with his knee in greater extension.  The angle between his foot and the ground looks fine, as well- too great of an angle can stress the anterior shin muscles (from pulling the foot up), and also possibly cause some Achilles pain (puts it on greater stretch).  What can also be seen from this view when the video is running is something consistent with his left hamstring pain- his left heel doesn't rise up quite as far as the right during swing phase.  This is more likely to be a result of the pain (he's not generating as much force with the muscle) than the cause of it.

Exhibit G (last one, finally!): Me
Just figured I should throw on a picture of myself, too.  After all, I have had every common running injury in the books.  My left arm is wonky.  If this picture was taken from the side, my excessive lumbar lordosis (low back extension) would be apparently.  My static foot posture, which is pretty highly pronated, vs the foot posture seen at midstance here (slightly everted and pronated, but nowhere near where I am standing) provides a perfect example of why matching someone to shoe type based upon static foot posture isn't always the best idea.  The level pelvis seen here took a spring and summer of pounding out hip exercises day in and day out after hip pain became a bit sinister in early-April.  Watching myself, it becomes pretty obvious that there's no one form flaw that could have contributed to my injuries, and it's likely that I've changed the way I've run over time, as well.

Well, I'm going to wrap it up with that!  I could continue on and analyze more, as this stuff is quite interesting to me.  As Dave demonstrates, it's not always about finding one major flaw, but rather analyzing the nuances and seeing how they play into the larger clinical picture, which includes injury history and static exam findings.  For now, though, I'll enjoy the runners that are sent my way; the more I play around with this, the more I continue to learn, and hopefully I can sort of begin to shape my career in the way I had hoped to when I'd decided upon PT school six years ago.  Rochester runners, feel free to come on by!    




Sunday, January 1, 2012

Breaking point

  On an overcast day in the fall of 2005, I finished our team's 3k time trial, second on the team, in what was a decent time for me.  I should have been pleased.  Instead, I stepped off the track into the infield, and told Coach Mitchell what I'd known since the season had started a couple weeks earlier: I'm done.  My proximal right shin, just a couple inches beneath my knee and towards the outside (in such a weird spot that couldn't possibly be a stress fracture...right?), had ached with every step of the time trial.  I couldn't ignore it anymore, I couldn't keep pushing because I knew I was fit, because this was my senior year, because this was supposed to be a good year, because I'd run further and farther all summer than I ever had before in my life.  A couple of weeks later, I laid on the table at the imaging facility and watched a giant white hot spot of tracer form on the image of my right tibia that was displayed on screen, precisely over the area that had gradually rendered me a limping mess over the past month.  My denial was over; the hopes for a strong senior year cross country season that had been my singular focus through miles upon miles over the summer were dashed.  I remember crutching into the training room later that day, with an aircast enclosing my shin (Given that it hurts to walk still, I'm making you non-weight bearing, Dr. Jain had told me).  Most of the team was travelling to their meet that day, but our assistant coach, Doug, had stayed in Buffalo.  Words weren't needed; he enveloped me into his arms and let me gently cry on his shoulder.  The world would go on, my career wasn't over, but still, in that moment, cold reality had set in.

  That stress fracture certainly wasn't my first injury, but it was the first one that kept me out of competition, occurred when I was fit, and prevented me from running entirely for more than a few weeks.  I spent the fall graduating from crutches and the pool, to walking and the bike, to the elliptical, and finally to running again.  Baby steps at first, of course.  Two weeks of non-weight bearing and five total weeks in the aircast had withered my right calf down to a shadow of its formerly infamously muscular self.  Gradually, I was able to keep up on runs, and I began workouts again.  I was going to redshirt indoor track to get back into shape, and then take a crack at outdoor.  Sometime in late winter, I started to ignore shin pain again- this time further down and on the inside, likely a result of my weak and never rehabbed calf.  This time, though, I did quit early enough; the MRI showed nothing.  I bought new shoes and tried to start running again.  In the meantime, I'd met Dave and we'd started dating; the start of a new relationship was making me fat and happy, anyways.  One chilly, drizzly Sunday, we'd headed out on a run together.  Two miles in, I felt a slight pain on the outside of my right knee.  I dismissed it and tried to keep going for a bit, but it kept getting worse.  We turned around and headed back, but the damage was done.  The next day, I woke up and couldn't walk down the stairs.  An ice pick was stabbing me in the side of the knee.  Just some IT band syndrome that should clear up in a few days, I'd thought at the time, spring track isn't out.

   Well, days turned into weeks.  Weeks turned into months.  I didn't run that spring.  I barely ran that summer.  Last ditch attempts by my orthopedist in late August left me pumped full of Medrol and cortisone just in time for cross country.  I wasn't cured, but at least I could now sort of run.  Seven months off, though, had left me pathetically out of shape and ten pounds heavier.  As primed and fit as I'd been the previous fall, when I'd been denied my final xc season, was as beaten and unprepared I was the following year, when I had nothing left to lose.  My ITB syndrome would come back that fall (somehow, I could race, but couldn't run more than ten steps afterwards without the all too familiar stabbing pain).  I managed to scratch and claw my way back onto the travel team, but that was about it.  The season was subpar, but I'd made it through.  Somewhere along the line, after months of frustration with shots and doctors and every antiinflammatory in the books destroying my stomach lining, I somehow discovered that wrapping my knee made it so I could run.

   I went with it.  The weight began to come off, running started to feel good again, and I started to look forward to indoor track.  I managed to make it to one meet, and ran my first decent (for me) race in a couple of years.  Still, this time, I was denying ominous signs from my left shin.  Two weeks after my fellow fifth year senior roommate Kate was diagnosed with her second metatarsal stress fracture, this time on the opposite foot, I was diagnosed with my second tibial stress fracture, this time on the opposite leg.  We commiserated in our boots (and bought each other cakes, it was a good winter for baked goods).  We also both refused to give up.  Kate would make her great comeback that spring to score in the 800 at our conference meet; I would scratch and claw my way to a 5k time within 10 seconds of what I'd run two years ago, moving from last at the mile to 14th (out of 23 or so, don't be too impressed) on a baking hot day in Miami, Ohio in my last collegiate race at the same meet.  I was done with injuries, I decided.  Or so I thought.

  The first several post-collegiate years (of running, I was still in grad school) were filled with road racing, club team racing, some successes, and some inconsistencies.  Tendonopathies became my nemesis.  A couple months for the peroneals shortly after finishing my last spring track season in 2007.  A consistent last summer and fall, followed by angry distal hamstring tendons.  A few weeks off, followed by a consistent winter and early spring in 2008.  A 5k pr.  A 10k pr, followed by sharp foot pain halfway through an 8 mile run two days later.  Several more months for the posterior tibial tendon.  Finally, a consistent fall and early winter.  I began ignoring the pain that was developing my left butt in early 2009.  Bursitis, I thought, or tendonitis at the hamstring attachment.  My right shin began to hurt again.  Shinsplints.  March of 2009 brought Johnny's Running of the Green, which still, to this date, was probably one of my best running races.  Being in shape, for me, meant that I was more willing to ignore the warning signs.  As the spring wore on, the hip and shin pain worsened.  I wanted to take another crack at a half marathon, something I'd been too fragile to train for since 2005.  The running days decreased; the cross training days increased.  I tried running once a week, and couldn't do it.  I still ran the Lilac 10k, but ran horribly.  I still tried to deny that anything serious was wrong.  I took a couple weeks off, then tried to run again.  Nothing was better.

  Finally, in early June, I reached the breaking point.  There was no pleasure in running anymore, only pain and frustration, and a hip that was seriously concerning me, as well as a very tender shin.  I found myself back at the orthopedist's office, this time bothering a different PA.  "How long have you gone without running?"  A couple weeks.  I tried yesterday, and made it five minutes.  My hip and shin killed.  "Well, those five minutes set you back another two weeks.  You just need to not run."  I know that, buddy, but I also know myself, and I know that something's seriously screwed up.  I need to know how long not to run for.  And did I not mention that there's anterior hip pain, too?  Want to miss something potentially career-threatening in a 24 year old?  Begrudgingly, the PA sent me down the hall to the x-ray room.  The hip looked fine on x-ray; the shin showed a lump at the site of my chronic pain.  "Could be the muscle attachment pulling at the bone.  Could be a healing stress fracture.  Just wait until it doesn't hurt anymore."  Finally, I managed to convince him that I needed a hip MRI.  Two mornings later, the test was completed.  By noon, the PA had left me a voicemail.  "Your MRI showed a fracture line on the ischial tuberosity, as well as some hamstring tendon thickening near the attachment.  We should probably move your follow up visit up.  Whatever you do, don't run."  Now do you believe me?? 


    I met with the orthopedist a short time afterwards.  He showed me my MRI picture, which revealed a little line, oriented vertically across my sit bone (I broke my ass, as I liked to put it), not even the orientation that would make sense for a hamstring tendon avulsion.  This wasn't a normal overuse running injury; typically, it's seen in adolescent male soccer players, sprinters, or hurdlers as a traumatic injury, in which the hamstring forcefully contracts and pulls a piece of bone off the still-maturing growth plate to which it attaches.  What the...?  Dr. Little, in his 30+ years of experience, wasn't even sure what to make of it.  "You didn't fall back at any point?  Are you sure you didn't fall?"  Either way, the bottom line was twelve weeks of no running, only swimming and biking.  And thus, my triathlon career was born.  That cloud's silver lining became so much more.  Looking back, it wasn't the 5k pr, the 10k pr, etc that's brought me where I am today.  It's been the low points that did it- stepping off the track after that 3k time trial six years ago, glaring at the training room doctor who asked me if I liked any other sports when my IT band wouldn't heal, getting asked by a couple of  fellow runners on the canal path if I needed help when my left hip and right shin were preventing me from running even remotely normally.  Compared to what some have faced, my injuries to date have been minor (bike crashes, anyone?); in the great scheme of life to date, I've been very, very fortunate (knock on wood).  As much as I've learned from the experiences I have had (and from my professional knowledge), I know that staying 100% healthy when training for an Ironman is a daunting task, even to the most careful athletes.  But, our muscles heal stronger after we break them down in training, and those that persist in the face of injury and setback, in the end, will have more preparation and strength to face what lies ahead.
Signs you're an absolute badass: you win Kona with a leg that looks like it went through a meat grinder, while smiling.  Suck up your ass fracture, Hansen!