Tuesday, April 17, 2007

Learning about Compromise...and 1 more thing...

A journey of a thousand miles begins with a single step.
--Confucious
This week is all about compromise. I tend to be an all or nothing person. Go for a 60 mile bike or do nothing because it's not worth it. Even though I know that rationale is not healthy, I still do it. It's hard to relish the little workouts, the little efforts, the baby steps forward. But in reality, these are the most important steps, the ones that lead to great things.
HIM Recovery--Longer than I Expected:
Last week was sort of a wash. Apparently, I need 2 weeks of R&R after my first half-ironman, not 1. Looking back, I wish I had taken more walks or done Yoga or something to help loosen me up. Fitness-wise, I don't think I've lost too much. I think I'll bounce back nicely within a few weeks of being back on a regular routine. Anyway, I've been listening to my body, loud and clear.

The first week after the H-IM, I waited an entire week before going on an 8-mile run (too long). Probably too much for my first time back. My legs were pretty stiff and, after only 4 miles, I ended up walking the 4 miles back because of outer knee pain on the right side (probably a combination of tight IT band and tight peroneals). That was my low point. Then, I went for a great, little 4-miler mid-week with no knee pain and was ecstatic about it. The PT appt. almost put me in a wheelchair for the next 2 days, until my deep-tissue massage rescued me.


My Personal At-Home Physical Therapy Program:
On a side note, I have decided not to continue, at the moment, with the PT appts. I have decided to try my own at-home program with a religious, daily stretching and strengthening regime. Now before you get all excited, let me explain. First of all, I may decide that I need more PT but if I go back, I need to go somewhere (or to someone) else because the person I was going too was a) way too agressive with me (she wanted to loosen me up too much too fast; this takes time; little bits over a long time; compromise--remember?) and b) she didn't know what she was talking about (she had no idea what periodization was or what a long run constituted and she thought I had shin splints and flat feet. I have neither. In fact, I've been told by several specialists including a podiatrist that I have extremely high arches). Second, if I don't see improvement in 6 weeks with my at-home program, or if my knee gets worse at any time, I will pursue professional physical therapy more aggressively. Third, I had a great PT in St. Louis when I first started getting knee pain, and she set me up to do an at-home program. She told me if I had problems in the future, it would probably stem from the original problem she had diagnosed and that I should return to the prescribed stretches and strengthening exercises. Fourthly, I have not been doing any of the prescribed stretches or strengthening exercises I'm supposed to so my homework has been very poor.

The Self-Prescribed Diagnosis:
No stretching and tons of working out over long hours and distances for the half-ironman left my legs extremely tight. Now that I'm starting to train for the marathon, my natural biomechanical issues and tightness is starting to form a pre-overuse injury. I suffer from excessive internal hip (adductor) rotation. This is common in many women, who have tight adductors (the muscles you use when you cross your legs--BAD!) and weak abductors (outer hips). This is me to a tee! Basically, I'm knock-kneed. This predisposes me to IT-band syndrome. Check. Plus, my left side is weaker (and tighter) so my right leg has to work harder, which is where the knee pain resides. Combine that with high arches which causes me to land on my toes when I run, and that produces additonal stress from the bottom (feet), which is why my peroneals (tendon from side of knee to foot) are tight. So my knee is getting it from the top and the bottom. If you examine my feet, I have well-developed callouses on the balls of both feet but on the right (where the knee pain is), the callouses are more to the inside of the ball of my foot. Because my hip is rotating in when I land, I'm landing on the inside of my foot.

Prescription:
Even though I wear corrective shoes with custom orthotics, they only help to a point. Now, I need to do 3 things. 1) Focus on correct form when I run. Recruit my glutes and abductors more when I run to take the pressure off my knees. Basically, think about squeezing my ass when my foot falls. Also, lengthen my stride slightly to help my foot land more mid-sole to lessen the shock from landing on just my toes. (Sounds counterintuitive, I know, but it works for me. Coaches always emphasize short strides and running on your toes for good form but apparently, you can do too much of that!) 2) Stretches and foam roller daily to loosen my very tight hamstrings, calves, peroneals, glutes, quads, and IT band. Did I miss anything? Avoid stretches that exaggerate my internal hip rotation fault (anything where I'm crossing my leg across the body). 3) Focus on strengthening exercises 3x/week on targeted, weak muscles e.g. abductors and glutes. Avoid strengthening already overdeveloped muscles e.g. calves, quads, adductors, hamstrings. 4) Okay, 4 things. Continue with regular deep-tissue massage to help loosen trouble spots. This has been a life-saver for me! It's probably kept my pre-injury from becoming a full-blown one. And 5) Last one. Ice after every long run (or every run). 6) Oh, and take my long runs slower and with walk breaks (see race strategy below). Also, walk the hills. These are murder on my knees (both up and down. surprisingly, up is way worse than down).

Prognosis:
Too early to tell but I think I'm starting to see improvement already (see below)!



Race Strategy for the Marathon:
I've decided I want to run the marathon but without injuring myself. So I have 2 scenarios. 1--my knee pain gets worse and I back off right then and there. I'm not going to push myself through the grueling long runs only to make a pre-injury worse. I'd rather bail on the race then hurt myself. 2--However, if I can work with my knee, maybe I can coax us through the marathon with a different set of goals. First, no time goal whatsoever. My goal now is to finish without injury. Compromise. See? This theme just keeps popping up. To do this, I will a) run slower (lessens impact) and b) take planned walk breaks (30 sec to 1 min at each aid station). No, I won't be fast but I just might, if I'm lucky, be able to finish a marathon. And that, in itself, is something to be proud of.



Exercise--the homeopathic antidepressant:
On Saturday, I was moping on the sofa when Jason got up and left for the pool. I was brooding about how late in the day it was and how I would never get all the workouts in that I had planned (bike and swim). I sat on the sofa miserably for about 10 more minutes before dragging myself to the pool. I'm SO glad I did. I felt sluggish and depressed through the first half of the workout. Lots of negative thinking about how slow I am at everything despite how much effort I exert. Then, I got a 2nd wind and finally stopped beating myself up and started just enjoying the feel of the water. I was doing a descending ladder so by this point, I was going faster for shorter sets. For some reason, it seemed like getting my heart rate up a little more put me in better spirits. All I know is by the time I got out of the water, I felt like I had worked through my blue mood and felt 100% better. I am true testament how exercise acts as a natural antidepressant...if I can just drag myself off the sofa. Compromise. Going for a swim and not biking too is better than doing nothing at all.


I've had more energy the rest of the weekend. I even did my seasonal (spring) cleaning. Although it only took an afternoon since I go through everything so routinely, I still managed to drag out 4 trash bags of junk. Every season, 4 trash bags. How does this happen?



Long Run--Form, form, form:
Sunday, Jason and I headed out for our weekly long run. We do have a marathon coming up, you know! Originally, I had overzealously (the all-or-nothing approach) planned a 16-miler. But the rational me (and my knees) convinced me to do a 12-miler instead. We headed up the coast for an out-and-back. That way, I could turn around whenever. I decided if I felt great, I would push it to 14 total but if I was feeling catious, I would do 12. I ended up doing 12 at a slow pre-planned pace of 10 min/mile with walking up and down all hills. Again, compromise.

We headed out and it was gray, windy, and chilly (56 degrees). I realize I have become soft and wimpy after living in SoCal for a year. About 1.5 miles down the road, 3 cyclists zip past, the middle one looking very familiar. By the time it registered, they were gone. It was Michellie Jones! If that doesn't put a spring in my step, I don't know what does. I love the fortuitous celebrity sightings around here. I settled in and found a nice pace. About mile 4, my knee started hurting. Uh-oh. I'm so sensitive to it right now, I can feel the beginning of it come on, and it sends me into a panic. How bad will this get? Will I have to stop the run? What am I going to do about all the races I want to do? And my mind just keeps going....

All you have to do is look straight and see the road, and when you see it, don't sit looking at it - walk.
-Ayn Rand

Instead, I decided to focus on where the pain was coming from and, using the knowledge I have gained about my biomechanics, see if I could alter my running stride to correct my footfall and alleviate the pain. I've noticed when I'm running on a slope where the outside slopes up so that the outside of my foot lands first, the pain is sharply exacerbated. This is because is exaggerates my biomechanical deficiency, placing excessive stress on the inner ball of my foot, and thus, my peroneals and IT band, resulting in outer knee pain.

So, as my PT from St. Louis long ago had instructed me, I focused on squeezing my outer hip muscles (abductors) and glutes as each foot fell to help align my knee, and guess what? It helped. Then, I started lengthening my stride, experimenting to see what it would do. This seemed so counterintutive to me. I've always been told, land on your toes, take short strides; this is the "correct" way to run. As with everything, you can take it too far. My strides were too short and I was landing almost exclusively on my toes. By lengthening my strides, my glutes seemed to be engaged more, and I could roll through my entire foot more when it landed, instead of just on the toes. The knee pain suddenly disappeared, just like that (snapping of fingers). I couldn't believe it.

The rest of the run, I felt like I was in a dream. I was SO happy. Everything had clicked and I could run the entire 12 miles without pain. Plus, I wasn't too sore afterwards! Obviously, I stretched A LOT after the run (and before, and that night too). And I iced.

Currently:
I'm being religious about my stretching. It actually feels good! I guess stretching and strengthening isn't optional. Went for a 20-mile bike ride yesterday. Felt sluggish but I'm glad I got out there. It was my first time on the bike in 2 weeks! Yikes. I still have the remnants of my sinus infection--I'm on day 6 of antibiotics. I think they're helping, I hope. I just hope I don't need a 2nd course. I can't believe I've had a cold for 5 weeks! Anyway, I do feel less congested and I have more energy. This morning, I did my strength training. Whole body with emphasis on core, glutes, and abductors. It felt great! Only my ass is sore now.





Oh, and 1 more thing:

I SIGNED UP FOR IRONMAN ARIZONA '08!!!



"Some of the world's greatest feats were accomplished by people not smart enough to know they were impossible."--Doug Larson

8 comments:

bunnygirl said...

I'm with you on the PT thing. I've been to many PTs, practicing a wide variety of things, and never had one who actually fixed the problem I went in with. Usually my problems went away on their own or I fixed them myself.

Congrats on signing up for IMAZ!

Jessi said...

Woohoo! IMAZ 08! That is AWESOME!

JeffM said...

That's an amazing fix while on the run. You could teach the PT's some things.
IMAZ- very cool!

Chad in the Arizona Desert said...

So just as you get finished telling us how you are trying to get healthy and you are focused on feeling better and taking it easy during the marathon...you drop the "oh, by the way, I signed up for IM AZ next year."

You really are hard-core. Welcome aboard!

qcmier said...

Wow lots of stuff in that post. Going to be fun watching you get to IMAZ and crossing that line.

Paul said...

Go Rachel! IMAZ. Wahooo, what a race.

Kewl Nitrox said...

Is that what it's called - adductors. Sharon Stone had great adductors that sold movie tickets. :)

Come-on, don't be so hard on yourself. I know lots of people who will probably NEVER recover from a HIM, let alone 2 weeks.

Glad to read that you have literally found your stride in running. That is a HUGE break-through. Looks like you are going to kick IMAZ butt!

Cliff said...

Rachel,

Way to konw your body and your injury. I do not know that much about my own body. It is smart to not run up the hills if it hurts your knees.

You sign up for IMAZ? :) I can say you are crazy.but I will be doing an IM in a few months ;)