Coping With Injury

Being forced to miss the Amherst 10 miler killed one of my 2013 goals: running all of the USATF Grand Prix races.

It also helped to put me in an even worse mood. Last Sunday I was on the treadmill for an hour with the first four miles alternating at a walk/jog/run, and then the final mile+ walked at full incline. I haven't run since then because...well...the shin didn't respond well.

So this Sunday, when I watched the clock slowly tick until it hit start time of 1:00, I just got more and more annoyed. I wanted to run. Even more, I wanted to race.

I tried burning off some steam by doing an hour and a half on the elliptical and a half hour+ in the pool - and while it was a good workout - it did not relieve any stress. I did not receive any endorphin high. I was still bummed. Totally. Bummed.

But this feeling has been par for the course over the past 6+ weeks. A series of lows and lowers. With the occasional feeling of 'meh'. Which is defined as the level below 'bah!'. Even though this Sunday was one of the more frustrating days, being on the elliptical for that long gave my a good chance to let my mind wander...Discipline and focus. That's where it wandered to.

I wanted to run the Amherst 10-miler badly, but that's not the goal race. I've been focused on trying to get healthy for Boston and Big Sur, and a 10 mile race at this point would have been a stupid risk. And so as I stood on the elliptical I thought to myself, 'I need to remain disciplined and focused.' After the elliptical I was wiped, but I did 3 sets of calf raises and a couple of sets of the Myrtl routine. I would have liked to head home, but...well - discipline and focus. Get to the pool.

Stretch. Foam roll. Eat right - extra calcium, glucosamine and chondroitin. Time on the bike. Time in the pool. Time on the elliptical. Core work. Hip strengthening. Resistance band work for the foot and ankle. Sports massage. Icing. Ultrasound. Sleep.

All of that has to be done on a consistent basis. It's not fun. I would rather be running, but that's where my mind wandered. Discipline and focus.

It reminds of of a quote that I've posted a few times now, and seems a fitting summary:
"One of the first lessons running teaches us about success in athletics and in life is that there is no one else. No one else can do your workouts for you. You alone must do the drills, repeat the core exercises, stretch, and lift the weights. You cannot hire someone else to do your cross-training when you are battling injury, or pay someone to run a race and get you a new PR. You are truly your own hero in running. It is up to you to have the responsibility and self-discipline to get the job done." - Adam Goucher, Running the Edge

Triathlon Training Going Great! Oh wait...

...that, of course, is sarcasm. Well, if it were in fact triathlon training - it would be going great, but it's marathon training. So, not as good.

My workout routine for the past ~four weeks has been some variation of the following:
1.) Go straight to the gym after work.
2.) One hour bike ride
3.) Three sets of the Myrtl Routine
4.) Three sets of fifteen eccentric calf raises
5.) One hour in the pool - usually 50 minutes of pool running and 10 minutes of swimming
6.) Get home around 9:00.

I have also started going to Yoga on Fridays during my lunch break to work on flexibility, and I purchased some resistance bands to do some shin/ankle/foot strengthening as well.

All of this is all well and good, but it does not feel like marathon training. My effort level will vary on certain days, with Sunday usually being my most consistent effort - and the fact that I'll need a nap after that workout is a good sign that I'm getting in a quality workout. But, it doesn't have the same feel as a two hour run - I crave that feeling badly. The first two weeks of this routine had me in running withdrawal and it turned me into an ornery a-hole.

I don't have much a of a choice though - if it hurts to run, then I can't/shouldn't run. I'm hopeful that all of this will help maintain fitness, and avoid future injuries. But to say that I'm eager to put my feet to the pavement/trail/snow is an understatement. It's at the point where I'm looking outside at 30 inches of snow thinking that it'd be a nice evening for a run around the Charles...it really would be pretty nice though. I'm sure no one else is out there.

Ok, Probably a Stress Fracture

At this point I'm not 100% sure if I have a stress fracture - but I think it is likely for the following reasons:


1.) X-Rays are ~20% likely to show an indication of a stress fracture. Therefore, they are moderately useful for showing a positive, but are not effective in truly ruling out a stress fracture.
2.) The pain is acute (<1 inch spot on the tibia), and in an area where running related stress fractures are most common.
3.) Pain continues to be noticeable while walking - closer to a .5 on a scale of 1-10, but noticeable nonetheless.
4.) If it were MTSS, the pain would be all along the shin with no swelling - I have minor swelling in the <1 inch area where I have pain. According to aafp - "Medial tibial stress syndrome can be distinguished from tibial stress fractures by non-focal tenderness (diffuse along the mid-distal, posteromedial tibia) and a lack of edema."


So while a decent amount of evidence seems to point towards a stress fracture - I still don't know for sure. And after researching for an obsessive amount of time...I stumbled upon this:


After seeing the attachment points of the tibial tendon on that video, I took a look into my trusty training spreadsheet - and back in mid November I started to experience pain in my inner right ankle. It seemed likely that it was a mild case of tendonitis, so I wasn't overly alarmed. By early December the ankle issue had run it's course, but I was starting to experience some tenderness in my shins. It felt like a familiar pain that I had previously trained through, so thus I continued running and started taking ibuprofen and icing. This tenderness gradually increased to a legitimate pain, and I reduced my mileage from 63 to 43/42/34/30 - and then finally zero.

However, during this time I went for a sports massage on two occasions to try and take care of any tightness that might be causing stress on my shin. The first massage occurred in December, and the therapist found an extremely tough knot on the arch of my right foot. IMO - it was on the navicular bone (as referenced in the youtube clip). I used a golf ball for about a week+ and the knot was taken care of. I had the second massage a few weeks later after the shins continued to worsen, and at that time the therapist found a really painful knot deep in my right calf and worked that out. The massage provided temporary relief, but only for that day. So since the video highlights both of the navicular bone and the middle of the calf as points of attachment for the posterior tibial tendon...maybe it could be really bad tendonitis?


In the end, I still think it's a stress fracture, but I really don't know. And so the best thing I can do is to continue to cross train and wait until it feels better.

Well...not quite! During the obsessive research, I also stumbled upon this! I researched how a LIPUS (low intensity pulsed ultra sound) device works, and basically - it's a bit above my head...But the results from independent research seemed to indicate that it could significantly reduce recovery time. So in my continued effort to be my own health advocate I thought the best place to go would be....craigslist! After a bit more research I purchased the Exogen 4000+ and have added that to my recovery plan.

I'll continue pool running, swimming, taking some additional calcium, calf raises, biking, foot strengthening, and the Myrtl Routine - and hope that the bone stimulator works as well. This time off has me itching to get back to marathon training, and frankly - worrying that I'm missing important training segments as well. I hope that because I started training in early December I'll be able to maintain any gains through cross training and come back 100% healthy and ready to go...preferably sooner rather than later.

Initial Diagnosis - NOT a Stress Fracture

Allegedly!

The black dot indicates roughly where the pain is, but the radiologist was able to rule out a stress fracture. I initially looked at this image and was worried by what appears to be the "dreaded black line." But as I looked through the other x-ray images, I noticed some similar areas, and those areas have no tenderness or acute sensitivity. I also googled a number of other x-ray images to compare my x-ray to other tibial stress fractures and there were no similarities. Typically an x-ray is not the most accurate imaging to determine if there is a stress fracture, but resources dictated care in this case.

Even with that fairly positive news, it's still concerning that it hurt to walk and put weight on my right leg. So this morning I went for a previously scheduled sports massage with the hope that there would be a corresponding trouble spot contributing to these issues. Thankfully - there was! The massage therapist found a fantastically painful  knot deep in my calf, and kneading that out hurt like a mutha. And while that was less than eight hours ago, I'm enormously encouraged by the significantly reduced pain that I have while walking.

I'll try to temper expectations and continue my recent routine of cross training/myrtle routine/stretching, but it's a huge relief to think I could be out running again.


Here's some stuff....

Sunday

30-Dec

17.0

17.0

Long Run

0.00

Travel day. Shin.

Monday

31-Dec

-

-

Rest

0:08:59

12.29

Ran Battle Road. The loop was entirely covered in snow, and I had zero traction so the going was slow. Shin felt ok during the run (w/ibuprofen), then hurt later on.

Tuesday

1-Jan

5.0

10.0

Hills/Tempo

0.00

Rest. Shin.

Wednesday

2-Jan

4.0

8.0

Recovery

0.00

Sports massage. Foot & towel plus some other exercises.

Thursday

3-Jan

7.0

10.0

Intervals

12.45

400/600/200 x 4 - I took 2 ibuprofen an hour before leaving, then another 2 right before heading out the door. Shin held up ok and the workout felt tough, but fast.

Friday

4-Jan

4.0

6.0

Tempo

0:08:11

4.05

Foot exercises/golf ball/ice in the morning and afternoon.

Saturday

5-Jan

4.0

6.0

Recovery

0:08:11

6.02

Battle Road with Fanning - running in the snow is slow and tough.

Sunday

6-Jan

18.0

18.0

Long Run

0:07:38

14.54

CSU run w/breakfast. Fun, but my right shin and knee are pretty unhappy with me.

Monday

7-Jan

-

-

Rest

0:07:56

4.02

Easy recovery run - shin and knee were hurting my stride at the end. Gotta rest. Also, this was a cold night for shorts.

Tuesday

8-Jan

5.0

10.0

Hills

0.00

Felt sick - took the afternoon off from work, and shin was bothering my just walking.

Wednesday

9-Jan

4.0

8.0

Recovery

0.00

Still sick. Awesome. Shin, also awesome, but not really.

Thursday

10-Jan

7.0

10.0

Intervals

11.62

400/600/800/1200/800/600/400 - shin was tender the entire time. I should not have done this workout.

Friday

11-Jan

2.0

4.0

Tempo

Shin feels terrible. Hurts to walk. Bad sign.

Saturday

12-Jan

2.0

4.0

Recovery

10 miles on the bike, 15 minute row machine. Back workout  & 3 sets of the Myrtl routine.

Thursday 1/3 Splits:	Thursday 1/10 Splits:
400 - 1:17	400 - 1:19
600 - 2:03	600 - 1:59
200 - 36.68	800 - 2:44
400 - 1:17	1200 - 4:16
600 - 2:02	800 - 2:51
200 - 36.1	600 - 2:04
400 - 1:17	400 - 1:14
600 - 2:02
200 - 35.92
400 - 1:18
600 - 2:02
200 - 30.1

Continued Training and Shin Splints

I don't think I can read any more articles or watch any more youtube clips on how to treat and recover from shin splints. I've read about 20 different descriptions for what I supposedly have, but it seems likely that it's Posterior Tibial Stress Syndrome. Or maybe it isn't, I don't know. But I do know that the inside of my right shin has proved to be a major bump in the road recently. 

I've been able to maintain a reasonable training routine, as I'm too stubborn and stupid to totally stop, but it obviously hasn't been the 60+ miles per week that I was hoping to build upon. And the doubles that I was hoping to continue at an increasing intensity have stopped completely. Assuming I can continue to get in two to three solid workouts a week, and do some lower leg/stability/core exercises on the off days - I'm hopeful that this will be a minor bump in the road. I also plan on doing this exercise at work probably twice a day of the next week+.

Sunday		16-Dec		18.0		18.0		LR/Recovery		0:07:28		18.43		Battle Road w/CSU. Really tight glut and hip during the last couple miles, but this was a solid run in general.
Monday		17-Dec		-		6.0		Recovery				0.00		Knee and shin want to become an issue. Gotta avoid that.
Tuesday		18-Dec		5.0		10.0		Hills/Tempo				11.04		11 repeats on Heartbreak. 5m warm up didn't feel great, but the repeats went well.
Wednesday		19-Dec		4.0		6.0		Recovery		0:08:17		2.11		Warm up w/Raleigh then 3x10 of lunges, calf raises, and squat jumps.
Thursday		20-Dec		8.0		10.0		Intervals-not at BU				12.25		600x6/400x3 - never felt great until the final 400 where I opened it up a bit for the last 100m.
Friday		21-Dec		4.0		6.0		Recovery				0.00		Lunges, calf raises, jumping squat, 10x3 - shin is an issue.
Saturday		22-Dec		4.0		8.0		Recovery/Tempo				0.00		Lunges, calf raises, jumping squat, 10x3 - damn shin. Also did some single leg squats while holding a golf ball w/my toes.
Sunday		23-Dec		18.0		18.0		Long Run		0:07:22		16.36		I was really hoping for 20 today, but my legs felt like crap the entire time. Good pace though.
Monday		24-Dec		-		-		Rest				0.00		Lunges, calf raises, etc. - damn shin.
Tuesday		25-Dec		5.0		7.0		Tempo		0:07:01		5.51		Four mile progression finishing at 6:09, then a 1.5m cooldown. Shin…
Wednesday		26-Dec		6.0		10.0		Hills		0:07:46		10.00		Hill repeats on heartbreak.
Thursday		27-Dec		6.0		10.0		Intervals-not at BU				8.05		Jog to Harvard track, 800x4, jog home.
Friday		28-Dec		4.0		6.0		Recovery				0.00		First day on Long Island, did some leg exercises, but no running.
Saturday		29-Dec		4.0		6.0		Recovery				2.20		Tried and easy couple with no ibuprofen. Raleigh enjoyed the jog, I did not.

Total mileage of 43.8 and 42.1 for the past two weeks. I expect this week and early next week to be easy mileage before I hope to get back into it.

60+ Continues

This week started really well...The long run on Battle Road was extremely comfortable - and being able to handle 16+ at a 7:4x pace comfortably is something that has me really excited for the new year. I've given myself plenty of time to prepare for Boston and Big Sur, which is probably a wise choice, and so far I'm feeling pretty darn good about my start.

I also ran a handful of doubles to start this week. After the Sunday long run, I went for a 4 mile shakeout in the evening with the dog. Then on Monday I had an active-recovery-double of 4 in the afternoon and 6 in the evening.  Both runs at a very easy pace.

Tuesday was the company holiday party, and I would have preferred to get in my normal hill workout - but I had to adjust and so I ran a handful of repeats during lunch, then took the pooch out after work to get him some exercise...which also served as a good shakeout for me.

I've yet to write out my full training schedule, but so far I'm enjoying the Tuesday/Thursday/Sunday routine I have going. At some point I'll start alternating tempo runs and hill workouts, but for now I think the hills are serving me well.

Sunday

9-Dec

14.0

18.0

Long Run

0:07:42

20.31

16.28m on Battle Road w/CSU in the morning - a little sluggish to get started, otherwise a good run. 4.03m shakeout in the evening.

Monday

10-Dec

6.0

6.0

Recovery Double

0:08:10

10.17

4m in the afternoon, 6m in the evening. Shins were a little tight - iced post run.

Tuesday

11-Dec

5.0

10.0

Hills/Tempo

0:07:44

10.18

Three hill route at lunch w/repeats on heartbreak, ~7m tot. 3+ w/Raleigh after work. Left knee issue.

Wednesday

12-Dec

4.0

6.0

Recovery

0:08:18

4.00

Recovery. Left knee still an issue.

Thursday

13-Dec

10.0

10.0

Intervals

13.13

200/400/600/800x2/600x2/400x2/200x2 - tough workout, but I was just about where I wanted to be. Knee and shin are on the verge of being an issue.

Friday

14-Dec

4.0

4.0

Recovery

0:08:13

6.04

Three hill route during lunch. Heavy legs today.

Saturday

15-Dec

4.0

6.0

Tempo/Moderate

0.00

Shin was bothering me all day. A reluctant day off.

Thursday splits: 200-0:37, 400-1:17, 600-2:00, 800-2:48, 800-2:51, 600-2:06, 600-2:06, 400-1:15, 400-1:16, 200-0:35, 200-0:34

Total: 63.83 miles...stupid reluctant day off, I was so close to 70!!!!

It IS Marathon Training

"Dear Patrick Bugbee, This is to notify you that your entry into the 117th Boston Marathon on Monday, April 15, 2013 has been accepted..."

"Dear Patrick, Congratulations! You are now registered for Big Sur International Marathon. Please check the event's official website for updates: http://www.bsim.org/. You are now successfully registered for the 2013 Boston 2 Big Sur Challenge..."

Awesome.