Tuesday, December 30, 2014

2014 Year End Update

Well, I'm finally forcing myself to publish a blog post before 2015 arrives. There isn't too much to review about my 2014 racing season due to my injury, but I'm overdue for an update. I'll try to make it quick.

The injury that sidelined me for almost all of 2014 actually started during the summer of 2013 so I wanted to begin there. It was then that I began experiencing mild groin pain on the left side that felt like a muscle pull. I ran through the summer of 2013 and raced Hood to Coast, a small road 50 miler in Cincinnati, and Run for the Toad 50k in Canada all as my injury worsened. The pain had spread and grown more severe by Tussey Mountainback and I was forced to drop. I dramatically reduced my mileage and temporarily recovered enough to race the North Face 50 mile championship last year. Despite still being in pain, I finished a respectable 11th place off of residual fitness.

After North Face I ran an easy 3 miles every day to maintain my stupid 7.5 year daily running streak. No trails, no hills, no workouts. In late January 2014, I attempted to race the Mtn Mist 50k while clearly not yet healthy. At this point, the loss of fitness was beginning to catch up with me, and I had a horrible race. I stubbornly continued my running streak into March when I finally decided to visit a sports med doctor.

I knew groin injuries were notoriously hard to accurately diagnose and I felt confident I had a "sports hernia," but was hesitant to see a Dr. that didn't specialize in this type of injury. So I delayed until I got a strong recommendation for a doc in Cincinnati. He ordered an x-ray, MRI, and blood tests.

And the MRI showed a huge stress fracture in my pelvis. My doctor said "You damn near broke all the way through the bone" when he saw the image. What's more, my blood work showed I had low vitamin D and high blood calcium levels. Without going into too much detail, that's a bad combination when you're body is trying to repair damaged bone.

Once the stress fracture diagnosis came back, I completely quit running and ended my streak. I knew a pelvic stress fracture would take longer to heal that a typical stress fracture because it's a big bone that doesn't get much blood flow, but I did not know exactly how long. After 6 weeks of no running, I could feel barely any improvement. It still hurt walking the dog. At three months, I felt better walking so I tried couple days of running, but it was clearly not healed enough so I shut it down again. Moderate hikes were still bothering me at 4 months.  In August I borrowed a bike and started cycling just to be able to do something outdoors.  In September I started doing weekly 1 mile test runs but wasn't ready. In October I was able to do 2-3 mile runs every couple days.

Finally in November, after 7 months of virtually no running, I worked up to 24 miles in a week with no groin pain. Unfortunately, lingering imbalances from my weakened left hip caused tendonitis to flare up in my knee. I backed off for a while, but it still wasn't healing well enough, so I stopped running again December 21st and have decided to wait until the new year to resume running.

To say the least, it was a very tough year for me. In some ways, the stress fracture news was a relief because it allowed me to let the streak go and begin healing. But I didn't think it would take this long to heal. I enjoyed the time off for a while. Unlike some folks, I don't go stir crazy when I quit training, I just find other stuff to do. I don't love exercising; I love training. I love competing, racing, and improving myself. And I love running. Cycling is fun, but it isn't running. I still have the fire. I just need to finish getting healthy. The good news is that I feel better today than I have at any point in the last 18 months.

Finally, I want to say a big thanks to Salomon and Suunto for sticking with me this year even though I wasn't doing much to support the brand. They are part of a great company that clearly cares about their athletes as much as their bottom line. I'm also excited to announce that I'll be on the team again in 2015. Even though I wasn't running much in 2014, I still discovered some great products that I plan to share in an upcoming blog post, so be ready.

I hope to see you all out on the roads and trails in 2015.

Thursday, April 3, 2014

All good things...

Locked down no more.

I was supposed to see my sports med doctor for a follow-up appointment yesterday. He wanted to review the results from the MRI that he ordered just in case. Unfortunately, my doctor called in sick and had to reschedule me (for April 16!!!). This would normally have been an unacceptable delay, but it really didn't matter on this occasion. I completely quit running last Saturday.

When you get an MRI, a generic radiologist reads the images and sends a report back to your doctor. My doctor likes to read his own MRI scan following the full examination to support his diagnosis. After he diagnosed me a couple weeks ago with osteitis pubis and recommended no major changes in my training, I had planned to wait until I saw him again to decide how to approach my future training and recovery. Then last Friday, while I was working in Paris, I received the generic MRI report via email. It stated that my MRI findings were consistent with a non-displaced stress fracture on the left side of my pubic symphysis.

Stress fracture. As much as it sounds like bad news, at some level I was actually relieved. It was also frustrating because I've struggled with an injury for almost 9 months that did not match any of the symptoms of a stress fracture. It never was tender to the touch at the location of the fracture and it never hurt during high impact activities like jumping. It always felt like a muscular injury. Granted, it's very clear that groin injuries are notoriously hard to diagnose. But back to relieved ... I was relieved that there was now a clear issue that I could focus on fixing.

Even so, I admit that part of my mind tried to rationalize that I could keep running until I saw my doctor again. Who knows, maybe he would disagree and say it wasn't really a stress fracture. But, why? Just to keep my daily running streak alive and so I could say I had a streak? If you're going to have an addiction, I guess running is a good one to have, but even this addict knows too much of a good thing is just that.

I spent all day Saturday walking around Paris and riding a boat up and down the Seine, but I'm proud to say that I never ran -- my first day off in over seven years. I will say, if you're going to pick a place not to run, Paris in the spring is a great place to be.  It was an absolutely gorgeous day.

When my doctor cancelled on me yesterday, I was so happy that I'd already made the decision to quit running. It would have been absolute torture deciding what to do for the next two weeks while I waited for my appointment if I had kept running.  But now I'm free.

Where do I go from here? I don't exactly know. But it will be at least a month before you see me running again.

...must come to an end.

Sunday, March 23, 2014

Injury Update

Well friends, it's been a long and slow process, but I'm confident I'm making progress. Since North Face 50 in early December I've averaged less than 30 miles per week of mostly just light jogging on the roads and treadmill. Against my better judgement, I did "race" Mtn Mist 50k in January but I haven't done any races or trail runs since that time. I have continued to jog a few miles every day, but looking back it's probably easy to say I should have completely taken off a couple months. The problem is, the level of pain I've experienced is not indicative of the severity of the injury. I almost wish I had an incapacitating stress fracture that hurt so bad that I had no desire to run. My injury has never been like that. Although limiting, it has always been more uncomfortable than painful. I want to share a few more details in case it would help someone avoid the same injury in the future. 

First, a little background information. This whole story starts sometime last summer when playing with the dog out in the yard I pulled/strained the adductor in my left leg. The adductor is a muscle in the groin that allows you to squeeze your knees together (remember the Thighmaster?). It's also a very important muscle in running, and especially trail running. Unfortunately, I didn't realize the significance of the injury and continued my normal training. It felt like some tendonitis in my groin, but something I thought would gradually heal on its own. It stayed like this for months, but slowly started to cause me to overcompensate and alter my stride. Eventually it started to cause discomfort in my lower abdominals and affected my ability to stabilize myself on trail runs. It really wasn't until October that I really understood the root of the problem, but it was effectively a chronic injury by that point. I rested enough to get through North Face respectably, but ran through some pain, and realized I had to back way off afterward.

Fast forward today and after several months of no real training, I'm 90% there. I never felt that I needed to go to the doctor. I was confident that I had an adductor strain turned sports hernia. Complete rest or surgery...I knew those were really the only options...and I wasn't ready for either choice. But this week I finally decided to go see a doctor just to make sure it wasn't something more serious like a pelvic stress fracture that I needed to know about before I started ramping back up. I got an informal referral with a sports med doc that had experience treating sports hernias. He took an x-ray and diagnosed me with osteitis pubis. 

Any amateur radiologists our there?

Osteitis pubis is a noninfectious inflammation of the pubis symphysis that causes varying degrees of lower abdominal and pelvic pain. The symptoms are nearly identical to a sports hernia. The doctor also observed that my hip mobility was very limited. He prescribed physical therapy to improve my hip mobility and ordered an MRI just to rule out other possibilities. We are still waiting on the results of the MRI. He did not tell me to stop running, just to not make any big changes in what I'm currently doing.

If you get really curious about my diagnosis you might want to check out this article. It really helps explain why I've struggled with this issue for so long. It will also scare the crap out of you.
Groin injuries can be the most difficult sport injuries to accurately diagnose and treat. Osteitis pubis is a painful, chronic syndrome that affects the symphysis pubis, adductor and abdominal muscles, and surrounding fascia. If misdiagnosed or mismanaged, osteitis pubis can run a prolonged and disabling course. The abdominal and adductor muscles have attachments to the symphysis pubis but act antagonistically to each other, predisposing the symphysis pubis to mechanical traction microtrauma and resulting in osteitis pubis. These antagonistic forces are most prevalent in kicking sports, such as soccer or football.
...or trail running apparently.

The article describes four classifications of the injury with the 4th being the worst. Symptoms of stage IV include pain in the adductor and abdominal muscles with sneezing or walking on uneven surfaces. Check, check. I can proudly say that it no longer hurts to sneeze as it once did. Unfortunately, no one in the referenced study group had stage IV osteitis pubis. The lone stage III athlete required 10 weeks to fully recover. It's all beginning to make sense now.

I've been running competitively since the 7th grade...20 years now. Up until now, I had never had a serious running injury. Although I don't believe the root cause was directly related to running, it clearly became a running injury over time. It's really hard to talk about running and my injury when I am unable to perform like I once did. I have largely withdrawn from the sport and haven't been reading magazine or internet articles like before. On the positive side, I've tried to make good use of my extra time and invest in relationships outside of the sport that I had previously neglected. In any sport I have ever played, I've always been more of a participant and not so much a fan. Running is the same. I want to participate. I want to compete again. 

I'm only sharing this information in hopes that it might help someone else struggling with the same issues. The bottom line is this: If you have a groin or pelvic injury, do not ignore it. The pelvic region is incredibly complex and too important to the running motion to let it get go as far as I did.

I wanted to wait until the MRI results were back to publish this, but I'm heading to Paris for work this week, so I needed to get this post out today. If the MRI changes anything, I'll let you know.

Au revoir!

Tuesday, February 4, 2014

Mtn Mist Race Report

So here's the deal. I'm injured. I strained my groin sometime last summer and didn't think much of it. I continued running normally for months and it gradually got worse and worse. It turned into tendonitis where the adductor connects to my pelvis. Eventually the pain spread up into my abdominal wall in what's commonly called a sports hernia. I didn't really understand the depth of the injury until last October. I backed off for most of the month of November, but I still wanted to give The North Face Championship a good shot in December, so I brought some intensity back into the program and ran through the injury to stay sharp. I actually had a decent race at North Face off my residual fitness, but I knew my current trajectory was unsustainable and I needed some time to heal.

After TNF50, I backed way off. I continued jogging, but did no hard workouts, no trail runs, and my weekly mileage was only in the 20s. I thought 7 weeks of shuffling around would allow the adductor to heal while keeping me sane before Mtn Mist. But progress was extremely slow. Everything I've read about groin injuries and sports hernias indicates they can be very slow to heal, especially if they have lingered as long as mine has. Going into Mtn Mist, I knew I still wasn't 100% and running 31 miles on an untested injury was a risk. The Mist is the only race I would have started -- even though I don't live in Alabama any longer, it's basically my home course, where my trail running career started.  I'd won it 4 times and wanted to get another step closer to a 10-time finisher jacket. I was hoping I still had enough fitness to sneak out the win.

A cold smile.

The start was cold and windy. I was in no mood to take the race out fast. Most everyone thought the frozen course was going to run fast, but a minor course change at the beginning threw off my normal pacing checks. I knew Scott Breeden would be my competition for the race.  We separated from everyone else around an hour into the race. Twenty minutes later, I stopped for a quick pit stop and Scott kept running. At the second aid station, I knew we were really slow. But I didn't feel like I was running slow, I felt totally flat. I was hoping that Scott was just throwing in a surge, and I'd catch back up, but it wasn't to be. I was low on energy, foggy-headed...more like I was at mile 80 of a hundred miler than mile 15 of a 50k.

I went more into a finish mode than a chase mode at this point. The second half of Mist is much harder than the first, so I knew I would need to keep some energy in reserve just to finish based on how I was feeling at half way. I didn't have my normal trail agility and could barely lift my knees. I caught a toe on a rocky section and nearly went down. I caught myself with my Ultimate Direction water bottle and hit so hard that it actually busted it open. It leaked all over my gloves, freezing my hands and pouring valuable calories out on the trail. I had to ditch the bottle at the next aid station and run the hardest section of the course with no nutrition.

I was totally spent after climbing the waterline trail, but I was determined to finish. I shuffled along, continuing to trip uncharacteristically. I proceed to walk the final climb of the race. There was no power hiking here, just a defeated walk. I was checking my shoulder to see if third place was going to appear. In the end, I finished alone in 2nd place, ten minutes behind Scott and 9 minutes in front of third place. I was over 30 minutes slower than the course record I set last year. That's hard for me to fathom. Scott was 20 minutes slower than last year as well, but I think a lot of that was me going out so slow the first half of the race.

Just happy I finished.

My groin injury wasn't a major factor in the race itself, although obviously it severely limited my preparations. Evidently, I underestimated the amount of fitness, sharpness, and trail agility I would lose after 7 weeks of jogging. I knew I wouldn't be in CR shape, but I didn't think I would be 30 minutes slower either. Now I need to continue my focus on getting healthy. I don't think I set myself back too much racing the Mist, but the process is just really slow. I don't have a race on the calendar until Boston Marathon April 21st. I wanted to run the Mad City 100k in early April, but I don't see any way I can get healthy and fit enough to make it worthwhile to run that one now. So my plan is to continue running very minimally and add in core work that doesn't aggravate my groin. If that doesn't work, I may have to take some time completely off so this tricky injury doesn't become chronic.

The course has some beautiful views when it's frozen.

Big thanks to We Run Huntsville for all the awesome pictures!