One step forward, 5 thousand back

My review of the Rock 'n' Roll Las Vegas race, and everything pertinent leading up to this blog can be found at (or through) this link:

Post-surgery Final Week

Setbacks happen during recoveries, sometimes.  We try to prevent them but cannot always succeed; it’s part of being human.  I’ve tried to do everything right after the surgery on my left hip as well as during physical therapy (perhaps I did or maybe I didn’t do enough) but I ended up injuring myself shortly after my big “debut” at the November 15, 2015 Rock ‘n’ Roll Las Vegas 10k.
 

The RnR 10k went pretty well despite Sis and I getting up very early in Anaheim, CA for her Avengers Half Marathon.  Immediately after she finished the run and stretching we then drove back to Vegas for the 10k.  We arrived in plenty of time to get warmed and loosened up before the starting gun sent us up the Strip.  My right hip complained a lot during the run, especially with the interval change from walking to running (which has always been a problem for me).  It continued to let me know it was unhappy after crossing the finish line and finding our way through the finisher’s zone; that was due as much to the nasty turn in the weather as it was to being tired from the first long run in many months.  I was definitely very tired after the race; almost marathon tired by way of comparison.

My quads and hamstrings were really sore and stiff Monday:  I didn’t really push myself beyond hard racing levels but my muscles were telling me plainly that I’d pushed it a little too hard during the 10k.  I felt very thankful that my right hip felt great though, it didn’t twinge or give any pulling sensations (neither did the left side for that matter).  I took the off of running, just walked a little at work to stretch my legs.  Even my session of home physical therapy felt great after work, the muscles seemed to appreciate the resistance training.

The Tuesday after the 10k my quads and hamstrings were still generally sore but moved easier than the day before.  My hips felt completely normal; not even a hint of the discomfort I had Sunday night.  The weather turned rather wonderful by the afternoon so I was able to get in a nice 2 mile track run during lunch.  I increased my interval time to 4 minutes running and 1 minute walking, but kept my speed low to avoid straining my legs further.  The run was very relaxing and with the 4 minute interval I could go almost 2 laps without walking so it felt more like training last year.  I didn’t have any issues at all this time, with my hip, no complaints during warm up or during the run itself: That was a big relief.  I stretched, foam rolled, and iced after returning to my office; being of the mindset that until I’m in true running shape I have to stay aggressive with my recovery activities to keep complications at bay.

The next day (Wednesday) my legs still felt tight but not alarmingly so; the hamstrings and quads still needed more recovery time.  I started using self-massage device to loosen my hamstrings while sitting at my desk:  It’s a hard rubber ball approximately the size of a racquetball that you can put your body weight onto to give a deep point massage to a sore muscle.  Normally it really helps me out so this seemed the perfect time.  My home physical therapy session that night went well enough too, it was a little tough starting with the tired and sore muscles but by the time I finished I felt stronger and relaxed.

Thursday, 4 days after the RnR 10k, life took a very wrong turn (well, I did anyway);  I overslept in the morning, missed my bus to work, had to rush to out of the house in time to drive myself, and ended up forgetting half of my lunch on the kitchen counter.  I never got out of the “rush” mindset that day (as I bet everyone can understand); I couldn’t get my head straight regarding my everyday job, I forgot to eat or drink enough through the morning, I even felt late and rushed for my training run even though I’m free to do it whenever I want (within reason).  I allowed myself to feel so rushed that I only performed a cursory warm up before running, the kind of thing I could get away with before the hip surgery and I think that caused me to cast the final “straw” onto my left leg.  I planned on running only for 20 minutes but to increase my running interval to 5 minutes with 1 minute of walking.  The first interval went well but I started to feel an irritation in my left shin/knee area near the end of the second interval.  It calmed down during the walk period but ramped up again as soon as the 3^rd run interval started.  I tried adjusting my form, especially to ensure I wasn’t dorsiflexing (pulling my toes up toward my knee), I thought I moved better but it felt like I really lacked grace.  The irritation remained as I transitioned to the walk period.  This time during the walk period the irritation remained but being so close to my goal time I allowed myself to start the 4^th running interval since it would only last for a minute.  That minute was very uncomfortable as my irritation progressed to ache and then pain.  The quarter mile walk back to my office was very uncomfortable after that; stretching and icing didn’t even help once I returned to my office.  I figured I’d pushed too hard and given myself shin splints again, a rooky mistake but one I’ve dealt with before.  By the end of the work day I couldn’t walk without a limp and the 10 minute walk to the bus stop for the ride home left me shaking and hurting for the entire 1 hour ride.

I’d hoped that my shin would feel better after a night’s sleep but it felt about the same; tight and very sore.  I could walk, with a limp, but it certainly wasn’t comfortable.  I made sure to tell my physical therapist when I talked to him and pointed out the singular spot of pain (while it radiated out from there, the sore point felt like an invisible bruise) during my normally scheduled Friday appointment.  As soon as I showed him where I felt it he said I have something called Pes Anserine Bursitis: An inflamed bursa sac in the area of my knee where the hamstring tendons come together into one big band and then anchor to the inside of the lower part of the knee.  

He told me to start icing the entire knee multiple times every day, apply an ice cube to the hurt spot itself and rub it there for 7 minutes (no more than 8 minutes) to give it a deep chill.  He said I could continue to do the workouts for my hip, and that I should take some kind of over-the-counter anti-inflammatory medication to decrease the inflammation in the knee. 

 

The weekend went pretty rough:  I spent the majority of it in my living room icing the left shin, resting, and wishing I could take my leg off and leave it in a different room.  There were a few bad hours on Friday when the bursitis hurt so bad that I dug out my crutches and wouldn’t even put my foot on the ground to support the weight of the leg itself.  It actually hurt worse than anything I’d felt after hip surgery; so bad I even took one of my post-surgery pain pills (which didn’t help any with the pain but it made me dizzy and stupid so I cared a little less).  Over Saturday and Sunday things didn’t improve much except that I didn’t have to use the crutches again.  I was thankful that I didn’t have home physical therapy scheduled over the weekend, I couldn’t have done it.

My shin pain didn’t improve at all during the first two work days before Thanksgiving, at times the throbbing was so bad I couldn’t even focus on my computer screen to get any work done.  It was bad enough that I took the day before Thanksgiving off to see the physical therapist; I just couldn’t wait another week for my regularly scheduled appointment, the bursitis pain was too much for yet another week without help.  After the he tested it he had me stop almost all activities, increase the icing frequency to every 2 hours (10 minutes with general ice pack, 7 minutes of direct spot icing with an ice cube), and start taking ibuprofen plus aspirin 3 times a day to fight the inflammation and pain.  My physical therapist also restricted all resistance training for the hip to remove any of the exercises that would stress the leg.  I even chose to shorten the stationary bike rides because they would hurt after just a few minutes.  He did give me a small nugget of hope; once we got the bursitis inflammation decreased enough the majority of the pain would vanish and then the lingering aches would fade away fast.  I just had to keep on it and be patient.

The bursitis really had me feeling beaten down over the first two weeks after it struck; I had to give up the Turkey Trot (a favored race I had run 3 years straight up to that point), I couldn't walk a single kilometer without sheering pain there was no hope for 5km or even one mile.  I couldn’t help but feel like my running hopes in general were dwindling; it put my recovery on hold; my December runs were in danger of being cancelled all together; my plans to run the Rock ‘n’ Roll Arizona Half in January could even have to be cancelled depending on how long the bursitis lasted.  I saw a lot of negative changes happening with this setback and they were just piling on top of the other negative aspects of the injury and subsequent surgery that had dominated almost the entirety of 2015.  I won’t go so far as saying I was depressed (I am all too familiar with that disorder, this wasn’t even close) but the despondency had its effect:  I started drinking a lot of soda again, I increased the amount of sweet fruit I eat a day, I gave up on taking the bus to work for fear of the pain associated with walking to the bus stop at night, I dreaded (and considered stopping) icing every two hours because it leaves me feeling cold all over despite it being a necessity.  I even began to feel disconnected with my joy of running, as if it were a thing of the past that really didn’t have much to do with the person I have become.  The only things that kept me from giving up the desire to run again were my sister and knowing that what I was feeling was a natural part of the process and I’ve actually expected some type of setback; if I’m anything, I’m pragmatic.  I just didn’t expect the pain, but who does? 

 

It took about 2 weeks (and 2 physical therapy sessions) to be able to walk without a limp and 3 weeks before I could risk trying to run again.  I couldn’t help but feel like this could well be the last time I'd try to run again, fear of pain and disappointment make powerful deterrents.   I got to the point of feeling so disconnected from running that one evening while driving home from work I spotted a new section of road near my house, I immediately imagined someone running on it (like trekking through fresh fallen snow) but that someone wasn’t me.  I felt a slight twinge of regret but thought to myself in all honesty, "I bet some runner will enjoy being able to test that road while it's still closed."  Last year that someone would have been me without a doubt, but looking at it at that moment I had zero connection to the action.  Perhaps it was a form of runner’s amnesia; the kind that lets us foolishly sign up for marathon after marathon (my preferred distance) despite how we felt moments after crossing the finish line barely able to walk to the medical tent.   Maybe my mind and spirit had put up some kind of protective wall between the once overwhelming desire to run and my damaged body so I would give it all of the necessary time to heal.  Maybe, for a time, I really was prepared to simply quit running and go back to the sedentary life of a recluse.  What I am positive about now is that moment of heartbreak allowed me to acknowledge the potential loss; the need for patience and continued healing; and while I “Want” to run, simply wanting isn’t enough I have to put in all of the work needed no matter how long it took.  I won’t allow myself to be ruled by fear, even if it’s fear of pain.  We’re going to hurt a lot throughout our lives, sometimes chronic (my left arm) sometimes acute (my left shin, my left hip), I’m not going to live in fear of it.

The A.R.T. (Active Release Techniques) and massages my physical therapist gave me over the first three weeks of the bursitis plus the icing, anti-inflammatories, and self-treatments I performed at home and at work put me back onto the road to full recovery from the original surgery.  The bursitis acted a lot like my PT said; once we calmed the initial bursitis inflammation based pain the rest faded away after just a few days.  It ended up taking 23 days to get over the bursitis completely and return to running.  The PT and I discussed which exercises and stretches I need to do regularly to prevent another instance of this Pes Anserine issue, and don’t doubt that I make sure to do plenty of dynamic stretches and warm up exercises before every run.  If I can avoid the kind of mind blanking pain the first two weeks of that bursitis gave me, I’ll happily spend 20 minutes warming up for 20 minutes of exercise (hell, for that level of pain I’ll spend 2 hours warming up for 10 minutes of running).

I’ve never actively considered myself indestructible though I know I’ve been guilty of it as a kid and guilty of pushing my good fortune as an adult.  I’ve had people accuse me of being a robot and/or “unbreakable” but it’s never been anywhere near true:  I’ve suffered many minor injuries up to this point, they just weren’t bad enough to stop my running and they were correctable through minor adjustments in my running form or in fixing muscle conditioning imbalances.  The torn labrum, femur birth defect, and subsequent surgery were beyond my control.  The Pes Anserine Bursitis; maybe it was a complication of the surgery, maybe it’s just one of the other semi-common injuries runners suffer often, I prefer to believe it was my fault.  That may initially sound dumb but think about it as a point of control:  If it was my fault then it’s mine to control and prevent in the future.