If It's Not One Thing, It's Another

For most of 2021, chronic inflammation in my right knee prevented me from running.  While I was recovering, I pivoted to race-walking.  I walked several marathons, and also posted fast times in 5K and 10K races.

By November, my knee had recovered enough that I could finally run marathons again.  Then I started having lower back problems.  During the winter months, I cut back significantly on my training, but I still managed to run a few marathons.

I was experiencing intermittent soreness on the right side of my lower back.  Sometimes I had pain just to the right of my tailbone.  Other times, I had pain near my right hip.  After running the Surf City Marathon in February, I started to notice some minor pain or tingling along the outer edge of my right thigh.  These symptoms are consistent with pressure on the sciatic nerve.

My doctor diagnosed a muscle strain in my lower back, but he also ordered an MRI.  The MRI showed a few minor issues in the lumbar region of my spine, but it seemed more likely it was the strained muscle that was causing the tension on my sciatic nerve.  In retrospect, they were probably both contributing factors.

I started physical therapy in February, and my back improved significantly over the next few months.  By the end of March, I was back to running marathons, and I was also able to resume race-walking.

It’s easy to take for granted how good it feels to be able to run.  Most runners take that for granted until they have an injury.  It’s been two years since I was last able to go for a run without worrying, “is this too much for my knee?” or “is this too much for my back?”  I was just getting to that point around the beginning of the summer.  My right knee was no longer an issue, and my lower back was also improving significantly.  Then I started having hamstring issues.

I first noticed my left hamstring felt tight as I was starting to run a marathon on a chilly morning in May.  I ran that race and my next two races at a cautious pace to make sure it wouldn’t get worse.  It was never a big issue during the FANS 24-hour race in early June.  It didn’t flare up until about two weeks later.

While training for FANS, I was deliberately training at a slow pace.  As I recovered from the race, I also trained at a slow pace.  It wasn’t until I started to pick up the pace of my training runs, that I felt soreness in my proximal hamstring tendon.  That forced me to go back to running at a cautious pace.  I held off on race-walking.

I was able to get through several marathons in July be keeping my pace slow enough that it didn’t aggravate my hamstring tendon.  Then I tried race-walking.  I wanted to know if I could still walk competitively at the Minnesota Senior Games.  I didn’t realize it until the next time I ran, but race-walking at a fast pace seriously aggravated this injury.  Since then, I’ve limited my running to every four or five days, and I’ve held off on race-walking.  Most days, I get exercise by going for frequent long walks at a casual pace.

A week ago, I traveled to South Dakota to run the Sioux Falls Marathon.  That went better than I expected.  By taking short rapid steps, I was able to finish the race with only minimal discomfort in my hamstring tendon.  The next day, everything changed.

My hamstring tendon bothers me most when I sit in a car for a long time.  It’s OK on short drives, but it was painful driving home from Mankato after the Minnesota Senior Games.  On the way to Sioux Falls, I was able to manage my discomfort by sitting with my weight shifted to my right side.  On the drive home, I expected to have much more discomfort.

For the drive home from Sioux Falls, I took a neck pillow and positioned it so I wasn’t putting any pressure on the sore spot near my left hip.  Instead, I had extra pressure on my right side.  That worked fine at first, but after about an hour, my right leg felt uncomfortable.

After stopping at a rest area, I removed the pillow.  I continued driving, but my right leg still felt uncomfortable.  When I stopped for lunch, my right hamstring felt tight as I got out of the car.  My first few steps were awkward, but I gradually loosened enough up that I could walk.

After getting home, I continued to have discomfort along a narrow line on out outer edge of my right hamstring.  Over the next few days, the perception of a tight muscle was replaced with pain or a mild burning sensation.  The location of the pain was consistent with sciatica, which is pain caused by a pinched sciatic nerve.

I’ve been doing physical therapy since February.  Most of my exercises are for strengthening my core muscles or correcting minor issues with my posture.  A few others are for my hamstring and the muscles around my knees.  During the week, a few of these exercises caused an uptick in the pain in my right leg.

On Friday, I went for a short run.  As usual, I had a little mild soreness from my left hamstring tendon.  My right leg didn’t cause me any difficulty.

When I did my exercises on Saturday, more than half of them were causing pain.  In retrospect, I should’ve stopped doing those exercises until my next physical therapy appointment.

Saturday afternoon, I helped Deb get ready to do a load of laundry.  I lifted a hamper full of dirty clothes and tried to carry it.  As soon as I took a step forward, I noticed severe pain on the back of my right leg.  The muscles in my lower back were like a powder keg, and the motion of walking while carrying something heavy was the spark that set it off.  After that, I had severe pain in my right leg any time I tried to stand up straight or walk.

Before Saturday, my right leg was most likely to feel tight or painful when I got up after sitting for too long.  It felt best after walking around for a while.  Since Saturday, it’s been painful any time I try to walk.  I’m pretty much only comfortable when I sit.

On Sunday, I went to the urgent care center of the orthopedic center where I’ve been doing PT.  Walking from my car to the building and through the hallway was more difficult than I anticipated.  The only way I could walk for that distance was to bend forward at the waist.  I probably looked like Quasimodo.

Before he examined me, the doctor had already reviewed my medical history.  He noticed that the lumbar MRI I had in February showed a synovial cyst between my L5 and S1 vertebrae.  At the time, it wasn’t putting pressure on my nerve root, but he ordered a new MRI to see if anything had changed.  In the meantime, he wrote two prescriptions and sent me to physical therapy.  I was able to see a therapist immediately.

After my intake assessment, the therapist told me my lower back was as tight as a drum.  He gave me a few gentle stretches, but told me to hold off on doing any exercises to strengthen these muscles.

A few hours later, I had my MRI.  It showed a change since February.  The synovial cyst at L5/S1 had grown in size, and it was now putting pressure on my S1 nerve root.  With this new finding, he recommended an epidural steroid injection targeted at the site of the cyst.  The spine center that does these injections isn’t open today, because it’s a holiday.  The earliest I can call to schedule an appointment is tomorrow.

It’s hard to say exactly why or when the cyst grew to its current size, or when it started to impinge on my nerve.  My best guess is that sitting in an awkward position driving to and from Sioux Falls caused a shift in its orientation.  That’s what caused the pain I’ve felt for the past week.  Then muscle spasms in my lower back made it worse.  I don’t actually know for sure how much of my pain is caused by pressure from the cyst and how much is caused by pressure from inflamed lower back muscles.

The timing of this injury couldn’t be much worse.  I was planning to travel to Estonia on Wednesday and run the Tallinn Marathon on Sunday.  I was planning to do all my sightseeing on foot, which would mean walking five or more miles each day, not counting the marathon.

Yesterday, I not only couldn’t imagine running a marathon, but I also couldn’t imagine doing all that walking.  Even walking through an airport with luggage seemed impossible.  At this point, I’m not sure if I’m going.

One of my prescriptions was for a muscle relaxant.  I started taking it last night, and I’ve already noticed improvement.  It was easier getting into a comfortable position to sleep last night, and I’m walking a little bit better today.  I’m still bending forward a little when I walk, but I can now stand upright briefly.

This is a trip that I was originally planning to take two years ago.  That year, the marathon was cancelled because of the COVID-19 pandemic.  This year, the race is happening, and international travel is getting much easier.  If I go, this will be my first international trip in two and a half years.

Although I’m starting to improve, I’m still not sure if I’ll be able to go.  I need to improve enough that I can be confident that walking through airports and around Tallinn won’t be a problem.  I’d also like to feel like I would have a realistic chance of finishing a marathon.  I’m not there yet.

I doubt if I can get the injection scheduled before the trip.  They’re unlikely to have an opening tomorrow.  Even if they did, they wouldn’t want me traveling the next day.  If I make the trip, I’ll have to schedule the injection for after I get back.

Cancelling this trip would be a big disappointment after waiting so long.  It’s also unlike that I can recover the money I’ve spent.  I booked my flight using an unused ticket from two years ago.  If I remember right, that ticket expires at the end of this year.  It’s also too late to cancel my hotel without paying for at least one night.

I’ll wait at least one more day before making a final decision about whether to go on the trip.  Yesterday it seemed impossible.  Today, it merely seems unlikely.  Wish me luck on a speedy recovery.