I've Started Physical Therapy Again

I’ve started physical therapy again.  I was in PT last summer, but once I resumed running marathons every weekend, there wasn’t much they could do for me.  Now I’m finally at a point where I can make progress again.

I’m doing my PT at TRIA Orthopaedic Center.  For years, I drove by this glass office building on my way to and from work.  I never knew what it was before.  Now I’m going there for PT.

When I had my consultation with an orthopedist two weeks ago, she was able to recommend four therapists who work with runners.  Today was the earliest I could get an appointment with one of them.  In the meantime, I made a conscious effort to improve my walking mechanics, so I’m getting some hip rotation.  Before that, my walking motion resembled the waddling of a penguin.

My appointment today began with a review of the history of my injury and an evaluation of strength and flexibility in various muscles of my lower body.  The therapist immediately noticed that I lean to one side when I tried to stand on one leg.

Before we can strengthen my weak adductors or improve my tendonopathy, we need to strengthen several other muscles.  For months, my mechanics were severely compromised by my injuries.  As I tried to compensate, I stopped using my glutes and the muscles surrounding my hips.  That, in turn, put undue strain on other muscle groups.  I still experience soreness in different places in my right leg.  I used to have soreness from muscle strain.  Now it’s from trying to overuse muscles that are weak.

My therapist gave me five exercises to improve both strength and flexibility in my glutes, hips and hamstrings.  I’ll do them every day until my next appointment.  As I improve, I’ll get more exercises.  In a week or two, I’ll have an evaluation of my running form, but I’m not ready for that yet.  For now, my only training will be on a stationary bike.

My short term goal is still to run the Boston Marathon.  I have no illusions about running fast.  I know I won’t be in shape.  I just want to be healthy enough to finish the race without having any setbacks in my recovery.  My therapist thought that was a realistic goal.

A Different Kind of Marathon

When I told people I’d be taking a break from racing after the Honolulu Marathon, some of my friends expressed skepticism that I could go nine weeks between races.  That was the plan.  My last race was Honolulu on December 13, and my next scheduled race was the Los Angeles Marathon on February 14.

It’s not surprising that people would question my commitment to taking a break.  In the last three calendar years, I ran 157 marathons or ultras.  That’s more than one a week.  The last time I went nine weeks between races was six years ago.

I’ve really missed being able to train, but I haven’t actually missed the racing.  Between mid-May and mid-December, I toed the starting line 34 times, each time knowing I was injured and shouldn’t be racing.  You can only do that for so long.  Then you really need to take a break.

Most of my races involve travel to other states or countries.  Racing almost every weekend means traveling almost every weekend.  I usually leave the day before a race and return home the day after a race.  That’s a minimum of three days away from home.  Some trips are longer, either because I’m doing multiple races or because it’s an international trip.  On average, I’ve probably been away from home almost as many days as I’ve been home.  That’s hard to sustain for one year, much less three.

For the most part, I’ve really enjoyed being home.  Deb has enjoyed it too.  We’ve been able to spend more time together.  I’ve also made quite a bit of progress on my to-do list.  In late December, I had to catch up on a whole year of financial bookkeeping.  I’m still behind on a few things, but I no longer feel like my life is getting out of control.

I’m also starting to rediscover other interests that I put on the back burner.  I’m reacquainting myself with my music collection and updating my catalogue.  I’m also going to board game meetups.  I used to do that once or twice a month.  Lately, it’s been once or twice a year.

I didn’t miss the races too much in January.  I knew for several months that I’d be taking the whole month off.  February has been tougher.  Several of my friends recently did a series of races where you travel by cruise ship to six different Caribbean countries.  Each day, you run a marathon in a different country.  Had I been healthy, I wound have found that series tempting.  As I starting seeing posts by friends who went on that trip, I has a bit envious.

This week has been particularly difficult.  The Olympic Trials are being held in Los Angeles on Saturday.  The Los Angeles Marathon is Sunday.  I’m registered for that race, and I was originally planning to get there a day early to watch the trials.  I realized about a month ago that I wouldn’t be healthy in time.  I cancelled my travel plans two weeks ago, but since then I’ve been getting emails with my bib number, corral assignment, and other last-minute race info.  I’ve also been reading about the trials.  The constant reminders of what I’m missing don’t help.  I’m having some serious FOMO.

There’s one good thing about the timing.  One of the board game events I sometimes attend is the Minneapolis Board Game Marathon.  This is a monthly event that happens to be going on this weekend.  Instead of running a marathon, I’ll play Eurogames.

I’m seeing some improvement in my legs.  For two weeks, I’ve been doing daily workouts on a stationary bike.  I’m only doing about 35 minutes a day, but it’s a start.  I still need to make a conscious effort to use my hips when I walk, but it’s getting a little bit easier.  I begin physical therapy on Tuesday.  Then I’ll have a better idea of when I can resume running.  I probably won’t do any other races before the Boston Marathon in April.  Until then, I’ll have to settle for board game “marathons.”

I Have Answers. Now I Have Work To Do.

This is a follow-up on yesterday’s post.  I got the result of my vitamin D test, and I spoke with my doctor about all my recent test results.  My vitamin D level is 24 ng/mL.  That’s considered “adequate,” but ideally it should be in the 30-50 range.  While some foods are fortified with vitamin D, you mostly get it from sun exposure.  It’s tough to get much sun exposure during the winter months.  I don’t actually have a vitamin D deficiency, so it’s probably not causing any major problems.  Just to be on the safe side however, I’m going to start taking a vitamin D3 supplement.  I would have preferred a week on the beach of a tropical island, but the D3 supplement is cheaper.

My doctor is also starting me on a low dose of a medication that should help with my Raynaud’s Syndrome.  I should notice a difference in about a week.  I’m currently experiencing cramps in my legs every night.  If it’s from the Raynaud’s, I should see improvement soon.

He also confirmed that the arthrogram didn’t show any major pathology in the area of my right adductor.  I still notice a little bit of discomfort there, but I shouldn’t have to worry too much about reinjuring it.

There are a number of motions that used to cause pain in my right adductor.  One by one, I started avoiding them.  For example, I avoid squatting down close to the floor, as this used to cause pain.  A few months ago, I started running with a bouncy side-to-side motion.  I didn’t have much hip rotation.  Eventually, I started walking the same way.  With disuse, the muscles around my hips got weak and stiff.  Before long, I was barely able to move my hips.

The alterations to my stride and my day-to-day activities were originally done in reaction to pain.  If something hurt, I stopped doing it.  Eventually, however, I was motivated not by pain, but by fear.  I avoided certain motions, because I was afraid of making my injury worse.  I don’t need to do that anymore.

I don’t start physical therapy until the 16th, but I feel like I have a lot of work to do just to get to the starting gate.  Call it pre-therapy.  When the orthopedist told me I would have a running evaluation as part of my PT, I couldn’t even imagine getting on a treadmill and running.  I wasn’t afraid it would hurt.  I wasn’t afraid I’d be slow.  I wasn’t afraid I’d be out of shape.  I was afraid I’d be physically unable to run, even for a few strides.  I wasn’t sure if my body was still capable of that motion.  That’s how much my mobility has declined.

In preparation for PT, I’m starting to force myself to do motions I’ve been avoiding.  When I walk, I force myself to have a normal hip rotation.  It’s uncomfortable, but I can do it with effort.  The more I do it, the easier it gets.  I’m also able to get into a deep squat without pain.  Getting back up, I notice the weakness in my quads, but that will gradually get better.

I’m sure my PT will include a number of new exercises.  Until then, I’ll practice normal day-to-day stuff.  I’ll also gradually rebuild my fitness by riding a stationary bike.  I started doing bike workouts a week ago.  At first, I was doing 15-20 minutes a day at the lowest resistance level.  To put things in perspective, my bike has 15 resistance settings.  When I was in shape, I used levels two and three for warm-ups and cool-downs, and I used levels four through seven for the rest of my workout.  I’ve never used the higher levels, because I don’t want my pedal rotation to drop below 80 RPM.  Level one is like spinning in granny gear.  Today, I started in level one, but did most of my workout at level two.  I need to test the waters to convince myself I can use more resistance without hurting my leg.  Last summer I couldn’t do that.  Now I probably can, but I’m proceeding cautiously.

 

I’m feeling upbeat today.  I finally have plans for addressing all of my problems.  I’m also finding I can do things that seemed impossible a week ago.  Mobilizing all of my muscles will be a challenge.  Rebuilding strength won’t be easy.  Getting back in shape seems daunting, but that’s probably the easiest part.  I’ve done that before.

I have my answers.  Now I have work to do.

My Hips Are OK. My Glutes ... Not So Much.

Welcome to another episode of “The Continuing Saga of David’s Legs.”  In our last episode, David went to the doctor with two problems and came home with three or four problems.

To recap, last week we discussed the stiffness and cramps in both of my legs and the groin injury in my right leg.  I didn’t learn anything new about the stiffness and cramps.  I had several blood tests, but they all came back normal.  The doctor agreed that it might be a worsening of my Raynaud’s Syndrome, but we didn’t know for sure.

As for the groin injury, my X-rays suggested that I might have arthritis in my pelvis. The X-rays also revealed an abnormality in the shape of my femur.  That raised the possibility of problems with my hip joint as well.

It’s funny how the power of suggestion can work.   Before that visit, I felt discomfort in both legs, but it all seemed related to stiff, weak muscles and poor flexibility.  After that visit, I was suddenly conscious of discomfort in my hips.  I had to wonder.  I had been running with an abnormal stride for several months.  Did I damage my hips?

On Monday, I had an MR arthrogram on my right hip.  I originally wanted to know if tore something in my right groin, but this test would also show any soft tissue damage in my hip.  I got the impression from the doctor and technicians who prepped me that they all expected to discover a torn labrum.  The labrum is a thin layer of cartilage that lines the inside of the hip joint.  It helps maintain an appropriate spacing between the bones.

 

An MR arthrogram is a series of MRIs of the area around the hip.  First they injected a contrast medium into my hip.  The injection also included pain killers and a saline solution.  Before they started, I was told to notice how my hip felt after the procedure.  Simply injecting the fluids can reduce hip pain temporarily.

After that, it took about 40 minutes to take the images.  During that time, I had to lie perfectly still inside a cramped imaging chamber.  It took several minutes for each image, and if you move, they come out blurry.  I don’t recommend this procedure if you’re claustrophobic or have trouble sitting still.

For what it’s worth, my right hip did feel better after the procedure.

Today, I had a consultation with an orthopedist.  We discussed the history of my groin injury, and she put me through several tests of the muscles in my right leg.  Then we went over the results of the MR arthrogram.  There was good news and bad news.

I’ll start the good news.  The arthrogram didn’t show any major tearing.  In particular, my hip is OK.  One of the images showed a small partial tear in my labrum, but apparently that’s normal for someone my age.  The orthopedist seemed surprised that I ran as many races as I did without having more damage.  My hip isn’t perfect, but it's not a problem.

Now for the bad news.  In addition to pain and weakness in my right adductor and tightness in my hamstrings, I also have almost no strength in my glutes.  I have a condition called tendinopathy, which renders my tendons almost ineffective.  I’m not sure if the muscles are weak, but they aren’t able to do me much good.  Your glutes are among the strongest muscles in your body, but the orthopedist could move my leg using only two fingers, and I was completely unable to resist the movement.  Trying to resist was painful.

It made me nervous when she asked me to hop a few times on only my right leg.  I was afraid that would really aggravate the pain in my adductor.  She didn’t seem concerned.  Since the appointment, I’ve been feeling soreness there, but maybe it’s just the soreness that comes from overusing a weak muscle.

I’m going to begin physical therapy again.  The earliest appointment I could get was February 16th.  After that, I’ll go once a week.  I’ll have a therapist who works with runners.  I’ll also have a running evaluation.

For now, I’ve been cleared for swimming, biking or elliptical.  I’m supposed to hold off on running until I get the OK from my therapist.  I’ve already been doing short bike workouts with light resistance.  I’ll continue those.  I don’t belong to a gym, so swimming and elliptical training aren’t as accessible for me.

I’ve already cancelled plans for two marathons in February.  Those were races I scheduled almost a year ago, when I was healthy.  I don’t have any other races until the Boston Marathon in April.  To do Boston, I would probably need to begin running in early March.  I don’t expect to be in shape.  I just want to get in a little running, so I’m able to finish the race.  The orthopedist thought that schedule sounded reasonable.

She couldn’t tell me much about my stiffness and cramps.  After reviewing my test results from last week, she ordered two more blood tests.  Today they tested my calcium and vitamin D levels.  My calcium level was normal.  I’m still waiting for the result of the vitamin D test.

My hope originally was that my stiffness and cramps would go away if I could return to my previous activity level.  That’s still the plan, but it’s going to take time.