Friday, April 26, 2013

Still no better, still no answers.

It has been over eight weeks since this initial injury.  I have run a sum total of 5 times, and never over 2 and a half miles.  I've been getting ART massage.  I've been going to physical therapy three times a week.  I do my strength homework every day, at least twice a day.

And I don't seem to be getting any better.  In fact, it seems to be getting worse.  In the beginning, I couldn't sit for long periods of time without radiating pain down my right leg, and this eventually spread to my left leg. Then standing began to cause pain.  Last night I couldn't sleep because my right side hurt so much.

The spinal MRI was "not remarkable."  There wasn't anything revealing a source of pain.

When I first visited my chiropractor, she mentioned possibilities including impingement, a labral tear, stress fractures, and strained muscles.  I didn't think much of what she said, but after six weeks of treatment and the same symptoms, I spent quite a bit of time researching them.  Here's what I have come up with.

-Strained muscles?  Possibly but eight weeks would provide significant healing time.  They aren't healed.  At all.

-Pelvic stress fracture?  Possibly.  But again, there would be SOME healing that would have taken place in the past eight weeks, and I actually feel pain now in the very first few minutes of running as opposed to after a mile or two.  Pelvic stress fractures take a long time to heal, but they don't require surgery.

- Impingement.  My chiropractor performed manual tests for this at my first visit and it was a possibility.  I had to do a lot of research on this one, and it seems to match my symptoms pretty closely. Here they are (and I have all of these), stolen from an Irish website:

  • FAI often presents as hip and groin pain with restricted range of hip movements.
  • Symptom onset can be acute, following injury, or insidious after prolonged exertion. It is generally not disabling, except in sporting activity. 
  • ‘Payback pain’ after participating in sporting activity is common
  • Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be on the side of the hip or the buttock.
  • Movements can be restricted particularly high flexing and trying to cross the legs.
  • Pain is often provoked by these manoeuvres, by exercise, or by attempted return to sport and relieved by rest and inactivity.
  • FAI may occasionally present as groin pain after prolonged sitting. There is no rest or night pain.

- Labral Tear.  Initially my visit with the chiropractor presented this as a possibility but subsequent manual tests have been negative.  This really is the worst case scenario.  The symptoms are basically the same as FAI except for an addition:
  • Groin pain
  • Clicking and snapping sensations in the hip
  • Limited motion of the hip joint
My hip clicks and snaps, and pops.  Only on the right side.  Right at the hip joint.  The first doctor I saw on March 7 diagnosed me as having "snapping hip syndrome", which is a symptom of an underlying problem. Possibly this.

I never thought I'd be wishing for a stress fracture or muscle tear.... but bones and muscles heal.  Joints don't.  They get worse.  You ignore FAI or labral tears (or quite possibly, both) and you can end up with a hip replacement down the road.

Recovery time for just the FAI procedure without a labral tear?  Optimistically looking at a couple weeks on crutches, then slowly returning to swimming, biking and finally running by 3-4 months post op.  If it is the worst case scenario (well, the worst case I'll even allow myself to imagine at this point) -- FAI and a significant labral tear -- it could be 6-8 months before I can return to "normal" activities.  If I'm one of the lucky 95% of patients who can return to "normal."

The good news is that although the FAI or FAI with labral tear surgical procedure is relatively new, the DC area has some very skilled doctors with this specialized training.  I've spent hours researching them, reading their online reviews, and asking around the PT, Chiropractic, and triathlete community.  

So what's next?  On Monday I have an MRI with IV-contrast.  This will hopefully get to the root of the pain.   At this point, I want it to show SOMETHING.  For the past 8 weeks I've had no idea what is wrong with me.  Whatever it is, let's just figure it out and get on with it.   If I need surgery, let's just do it.  Let's get the bed rest part over with, start the aqua therapy, get back on the bike, and be running by late fall.

I was reading forums of other triathletes who have been through the surgery, and one of them mentioned the handicapped hang tag for your car.

Wow.  From a 3:31 marathon, to a few months in the handicapped car space.  

And how does a mother of two little people with a job that demands playing classroom instruments, folk dancing, and sitting on the floor with kindergartners find the "right" time for hip surgery?

Maybe the MRI will show something completely different.  Maybe it will be something that they didn't see, but has a much easier fix.

Realistically, though, I know where my symptoms are pointing.

I have an appointment scheduled with one of those top hip surgeons a week from Monday.  My MRI results will be back in a few days.  Until then, my mind is swimming. 

Friday, April 19, 2013


It's MRI time. Six weeks with no improvement... Let's hope this at least gives me some answers.

Thursday, April 11, 2013

This Injury

It's unbelievable how one week your biggest exercise consideration is how you are going to manage to fit in 70 miles despite your busy schedule of working full time and caring for your family, and then four days later you wonder if you'll ever be able to run even one mile without pain.  But let's back up.

Tuesday February 18, messing around on the floor with my family, my right leg gets bent in a funny position.  I was a little concerned, at first, but then no worries, the next day my slow easy run went just fine.

Sunday February 24, I ran a 10 mile race in hilly Columbia MD on very tired, already-ran-52-miles-that-week legs, set a PR (which I wasn't that thrilled with, as my goal was a couple minutes faster), then ran a slow 8 miles to finish off the day.  My legs felt pretty dead from the race the next morning, but I felt okay.  Sore Tuesday, so I skipped my speedwork and did an easy run instead.  I had a deep tissue massage that night, and my therapist noted that my right leg had really, really tight muscles, which he worked on for quite a bit.  After his intense session, I decided to keep the run easy on Wednesday morning.

And then came Thursday February 28.   I had a tempo run on the schedule, but my legs were still feeling pretty dead, so I decided to try a few intervals ladders instead.  When I got to my four minute ladder and saw I couldn't get my pace under an 8 minute mile for that length of time, I decided to scrap it and jog back to work.  I went to the restroom to change clothes and freshen up, then went to a meeting at 8:40.  When I stood up 50 minutes later, I couldn't walk.

Throughout that day, I had a visible limp in my right leg.  I couldn't figure it out.  I had felt okay during the run, though my legs were obviously not recovered from the race.  I was in terrible pain, even after three Advil.  I declared Friday a rest day, and did a long soak in an Epsom salt bath instead.

Saturday I felt fine, so I figured I'd start my long run by doing a 1.5 mile out and back, and if I was still feeling pain free, start the 14 mile loop with the DC Road Runners group.  3 miles, no pain, so we headed out.  At 4 I started to feel some discomfort.  At 5 it was pain.  I decided to turn around, but I still have two miles to go.  By 6 it was radiating further down my leg, and when I reached my car I had excruciating pain in my inner adductor.  This was not good.

Sunday in church I was hobbling.  Not just limping.  Hobbling.  People made comment after comment.  I was sure I'd broken something.

Monday I made an appointment with my GP.  She diagnosed it as IT Band Syndrome and told me to stop running.   Seriously?  First of all, I had IT Band Syndrome when I was 27, and it did not stop me from running.  It was a pain, but I could run through it.  Whatever I had now, there was no running through it.  And the pain was in completely different places.  Shooting pain in my hip, glute, and adductor.  Not my outer knee.

Tuesday I sought a second opinion with a Sports Injury Orthopedist.  He took x-rays and said he couldn't see any fractures, and he diagnosed it as Snapping Hip Syndrome and Piriformis Syndrome.  He said I could try to run and just cut my mileage down, and prescribed Physical Therapy.

I tried to get an appointment with the PTs at the office where I met this doctor, but they had nothing available for a month.  Really?  A month?

In the meantime, I made an appointment with a Sport Chiropractor who does Active Release Therapy, which I had heard good things about.  But I couldn't get in to see her until after the marathon, either.

I mentioned this previously, but on the Friday before the race, I attempted 3 miles.  And it hurt.  I went home and started googling stuff on recovering from running injuries, and read about this thing called the AlterG (antigravity) treadmill.  It allows you to run on a percentage of your body weight, resulting in much less impact.  I found out that two PT clinics in my area offer this, and one of them accepted my insurance.  I sent them an email, and got a response the next day that they have a fabulous therapist who is a runner, Ironman, and specializes in running injuries, AND she happened to have an appointment on Monday.

The day after the marathon DNF, I sadly walked into the PT office, where I met my therapist, Heather.  She spent about ten minutes poking and prodding my legs, and told me she was like a body detective and her job was to figure out what the root of the injury was. She agreed that I had "piriformis syndrome" and "snapping hip syndrome", but they were probably symptoms of the real problem.

And then she discovered that my SI joint was out of rotation.  She didn't seem surprised.  She said "Now I'm going to put it back into place."  She bent my knee, pushed a certain way, and I immediately felt some relief.  No more snapping hip.

That was almost a month ago.  In that time, I have seen Heather twice a week.  She begins our sessions with something called "Dry Needling", similar to accupuncture, where she sticks needles in my muscles and faschia.  I can't say it is comfortable, but it does seem to relax my angry muscles.  On Monday, after three weeks of absolute rest from running, I was allowed to try the AlterG Treadmill.  I didn't feel any pain during the actual 14 glorious minutes I was allowed to run, but the following day I could feel my SI joint and hips flare up.  Big time.  I had more knots on my right side then I'd ever known possible.  She spent a good 30 minutes doing the most painful dry needling session I'd had thus far, but it worked.  I could feel the trigger points release, and today (Thursday) the swelling is completely gone.  I was put on another week of running rest, and hopefully will be allowed to try the AlterG again on Monday.

I also feel I'm in good hands with the Sports Chiropractor team.  They have a certified athletic trainer who works with me on strengthening exercises, and the ART massage and adjustments seem to help.  Two weeks ago, I couldn't sit for more than 20 minutes without excruciating pain in my back or sciatic nerve.  Now, the only time I have pain is when I run.

Of course, all I really want to do is run.  It's hard for me to believe how much I was running six weeks ago, because right now even a half mile isn't possible.  I haven't signed up for any triathlons this summer because I am not convinced I'll be able to do the final leg.  I am swimming or cycling 6 days a week, and trying to stay positive.

Tuesday, April 2, 2013

Race Report - Shamrock Marathon - DNF, but BOSTON BOSTON BOSTON!

It's interesting how a week after I blogged about being addicted to exercise, everything came to a crashing halt.

I haven't written anything in awhile because I've been too frustrated, but here is a recap from where I left off.

Following my visit to the sports injury doctor, I tried to get a PT or ART chiro appointment but couldn't get anything scheduled until after the marathon date.  So I just took complete rest and hoped that I could heal and get through the race.  I was hoping for a miracle, I guess.  On the Wednesday, I ran a half a mile.  It felt okay. On Friday, I attempted two miles.  By 1.5, I was hurting a bit.  26.2 would be a long shot.

Brittany, Jamie and I arrived to Virginia Beach and I pretended like I was still going to race.  I went to the expo, picked up my packet, carbo loaded with them, and got into my awesome race attire.

There wasn't a 3:30 pacer, and I couldn't find my Garmin, so I was depending on Brittany -- I'd just have to stick with her.  The gun went off, and I was feeling pleasantly strong for the first two miles.  Then, just as we passed our hotel for the first time, I started to feel that niggling annoyance in my hip that I knew would probably turn to excruciating pain within another few miles.  We were heading away from the beach, and we wouldn't pass my hotel again until mile 13.  As soon as I stepped off the causeway bridge at mile 3, I felt a shooting pain up my thigh.  "I'm done, Brittany.  I'll see you at the finish." 

My first DNF.  Ever.

It was 41 degrees, and I was wearing next to no clothing (thank goodness I had the leg warmers!) so I ducked in the first hotel I saw and registered for text messages updating me on Brittany and Jamie's progress.  Then I walked back to our hotel and was thrilled to find they were still serving their amazing brunch until 10 a.m.  I sat down and had fresh waffles, coffee, and eggs, and started chatting to some of the other folks in the hotel.  I met a woman on crutches who was waiting for her husband to finish.  She also had trained for the marathon, and couldn't run.  She had torn her plantar faschia in January. Yikes.  

The first text came in and Jamie was running at a 7:24 pace.  He needed a 7:26 to qualify for Boston, so that was a good sign.  I finished breakfast and went to the lobby.  

There I met a man who had done the half marathon earlier that morning as a tune-up race for Boston.  He said he'd qualified for Boston three times, and still hadn't run, because he'd never made it to the start without an injury.  

Text #2 -- Jamie crossed the halfway mark at a 7:22 pace.  Looking good.

I sat down in front of the fireplace and started talking to a woman who was tracking her husband as well, and also had registered to run the race.  She had a pelvic stress fracture.  Sheesh.  My hotel was like injury central for running spouses.  

Text #3 -- Jamie crossed the 18 mile mark at a 7:21 pace.  Time to head to the 26th mile and wait.  

The finish clock read 3:08 when I passed it.  I walked a little further, and waited for Jamie.  I saw a couple people from his running team, and then was a little surprised to see him, all by himself on the boardwalk, at the 26 mile marker just around the time the finish clock hit 3:10.  I wasn't sure if I could keep up with him, but I'd try.  

And there you have it.  3:11:29.  Average pace of 7:19, negative splitter, my husband, new Boston Qualifier.  How did we ever qualify in the same year?  Well, as much as I hated to be injured, and as stupid as it probably was to run the last .2 miles with him at under a 7 minute pace (he did the last mile at 6:45!), that moment was priceless.  Had I run, I wouldn't have gotten to see him cross the finish line.  

This was my third Shamrock marathon, and I don't even remember the post race party at the first one, I was so out of it from the run, and in 2010 I broke my foot somewhere along the 17th mile (my only other significant running injury to date... apparently Shamrocks do not bring me much luck...) and skipped the festivities altogether.  This time, I figured I paid $110 for the Irish Stew and beverages, and I was going to enjoy it.

So that was two and a half weeks ago.  I saw my PT the following day, and found out my hip was out of rotation.  Probably a good thing I stopped at 3 miles.  I haven't run since.  More on the injury later, but for now, I just wanted to share that BOSTON 2014, WATCH OUT!  THE LYNCHES ARE COMING!