Showing posts with label Recovery. Show all posts
Showing posts with label Recovery. Show all posts

February 3, 2015

Andrea: Long Overdue Update

This is a long overdue update on my progress from Surgery #2 back in September of 2014. The last time I posted here I was only 6 weeks out from surgery - now I'm nearly 4.5 months out! It's been a while, but I really didn't feel like posting anything until I had finally made some progress.

The roller coaster of rehab that I talked about last time - "(I feel like I am on a never-ending cycle: pain ("I'm never going to get better") - some relief / not too bad ("I'm getting better!") - aggravated / pain ("this is never going to end")... repeat X a million times)" continued on for over two months (~4 weeks post-op to ~3 months post-op).  I didn't see any improvement for a long time. This was incredibly frustrating and disheartening. Danny became as much of a psychologist as he was a physical therapist, the poor guy had to deal with my breakdowns every week for quite a while. I tried to keep positive, but my hopes were definitely dwindling.

The corner turned (a little) in December. The swelling in my abdomen finally went away and I felt good enough to walk for 30 minutes every day. I was also able to bike with Jake on some of his runs. The bilateral was still there, but much more manageable. After the holidays, I was able to increase my activity level: longer walks, longer bike rides, a little elliptical, backcountry skiing / SkiMo, strength training, and yoga.

Jake made me an awesome chart of all my different activities :)


Right now, I would say I'm at about 60% of full health. That is a good amount of improvement, but it is definitely taking a lot longer than anticipated to get totally back to normal. Dr. Meyers gave me a 6-week recovery plan... that was completely unrealistic. For someone that discovers their core injury immediately or has a minor injury, maybe 6 weeks is possible... but for someone like me that has been injured for 2.5 years - there's no way that time frame is realistic. I have set my own goal of 6 months to feel "almost-normal".

Currently, I don't have much (if any pain) during rest... maybe 2/10 on average. After exercise I feel some discomfort/pulling on the right side between my right adductor and abdominal scars, and left pubic/adductor pain + abdominal tightness. Recently, my left side has been the limiting factor on activity.

I still have a long way to go. I don't know if I will keep getting better from here or if I will have another stall-out period of no improvement (I hope not). Ideally you'll see another update from me soon because that will mean things are looking up :)

October 1, 2013

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 3: 3 - 4.5 months

The two previous post-surgery recovery blogs are located here and here. At three months post-surgery I really started seeing some results. I spent most of August running about 30 miles per week and then was able to increase my mileage up to 40 mpw for the month of September. What a huge relief to be able to run regularly again!

Here is a general summary -

August: The first week of August I got roped into the Corporate Games 5K for work. The grass was significantly harder for me to run on than the road because of the uneven terrain and my weakness with lifting my leg.
Corporate Games 5K
Throughout the rest of the month, I increased my longer runs from 5 to 7.5 miles. I was able to run outside of a one mile radius of home since I was gaining confidence in my ability to run further without pain. I did get overly excited and tried to do a few faster workouts, but it was too soon. My physical therapy was similar to what it had been but with a few adjustments/modifications.

- Psoas inhibition
- Psoas activate then heel slide
- Step downs (2x more on right side)
- Lateral step up/step down
- Clam shells
- Hip abduction (while laying and side step monster walks)
- Hip adduction

- Glute activations

The second week of August, I started having a lot of upper abdominal cramping when running. It would slowly build until it was a very painful cramp and would remain until I finished running. I was told that this is common for people whose psoas muscle is not functioning, so there was still a lot of work to do there.

September: Over Labor Day weekend, some friends and I went to Silverton, CO for fun in the San Juans Mountains. I was able to do some long hikes and felt great. I even went on a 9 mile (hard) trail run up at Molas Pass!

Hiking Highland Mary Lakes Loop
I jumped into two races the next couple weekends - the Alta Peruvian 8K as a fun run and then the Flat as a Pancake 5K, which I ran in 19:13. This was a 2.5 minute improvement over Draper Days 8 weeks before - a great indication that I am in fact coming back. I began running one mini-workout and one longer run a week while keeping my mileage steady. I started getting some compensation in my IT band/hamstring so I really need to work on strengthening my hips more before I try to increase my workload any more. I found that going to the hot tub every day really reduces the amount of discomfort I had in my groin the following day.

I think this graph of my weekly running mileage pretty much sums up the level of activity I was able to handle since surgery on May 8th.



I definitely am not completely healed yet and have a few more months of limitations, but I can see the end of the tunnel now. I WILL GET BETTER! I can only hope that I have enough time to train and get fit enough to go after that Olympic Trials time standard in 2014-2015! :-)

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 2: Weeks 7 - 12

The first six weeks post-surgery blog is located here. The next six weeks were slow but steady improvement. I was still very limited by groin and compensating pain, but those became a little less overwhelming by the week. Here is a weekly recap -

Week 7: Started running a little more. I went to Duluth with Jake for the Half Marathon Champs and I needed to run. I would stop as soon as I started to hurt (usually 1 mile or so). Lots of compensation still, adductor soreness, and groin discomfort. But better! Same PT exercises.

Week 8: Added some biking and got up to 2.5 miles of running about every other day. The biking and running added some stress on my groin area, so I started doing PT on the alternate days from running. My groin and adductor got quite sore and my right knee felt slightly unstable but had to start somewhere!

Week 9: 4th of July week. We went up to Hebgen Lake, MT with some friends. I was having sporadic periods of feeling terrible then feeling great. I ran my first race - Sawtelle Stampede 5K. I paced my friend to a sub-25 and felt great for 2.5 miles (it's amazing what the racing atmosphere can do!) before my groin got weak and achy.

Week 10: My psoas hurts. I focused a lot on the psoas inhibition exercise and relaxation pose (see previous blog post). I was working really long hours and had a lot of stress which definitely contributed to the pain. I was able to run a little more than the previous week and got up to a 4 mile run this week. I went to PT and he added back extension exercises and more glute isolation exercises to my routine. 

Week 11: Starting to feel like I am really running again with several 4 milers. I ran my second race post-surgery as a test to see where I am. I ran 21:28 at the Draper Days 5K, and it was tough! I also went on my first hike since surgery and did well for 3.5 miles before my right leg got tired.

Week 12: We went up to Jackson, WY for the week. I didn't run much but was able to do a lot of hiking! It was a huge accomplishment to hike for 9.5 miles up to Ampitheatre Lake and back. I put my legs in the cold lakes as often as possible and iced with my feet up the rest of the time. It was very exciting have some fun adventures again.

September 30, 2013

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 1: Weeks 1-6

I am now 4 months out from athletic pubalgia surgery and feeling much, much better. I decided to summarize the progression for those that may have questions about the post-op of this surgery. Keep in mind that the healing time varies significantly depending on how long you have had the injury and how significant the injury was. I had problems for 8 months leading up to the surgery (and could not even walk without significant pain) and therefore my recovery has been pretty slow. In contrast, my friend Bret only had the injury for about a month and was running 4 miles without pain a mere 15 days after surgery (August 27, 2013). Jerk! :) I would bet that most people are somewhere in between Bret's recovery and mine. My surgeon said that my injury was the worst of this type he's ever seen in a female, and he's been doing these procedures for three decades.

Although there have been a few setbacks, I am making overall progress week to week. I'm not going to lie, the past few months have been very hard. BUT I do (finally) have confidence that there is an end to this injury!

I have been posting every day about my recovery on my Fast Running Blog if you want to see the daily ups and downs. On this site, I am breaking up the recovery into 3 blogs - First 6 weeks, 6 weeks - 12 weeks, and 3 months - 4 months.

Week 1: HARD. I had a difficult time just sitting up by myself because of the pain from the surgery. (Note: do not schedule a flight home the day after surgery). I began "walking" the day after surgery, starting with only 20 ft and progressing to about a half mile by the end of the week. There was a lot of hunching over and A LOT of laying around. I had discomfort with every movement and occasionally shooting pains from my groin to my back. I was only able to sleep for a couple hours at a time and with tons of pillows under my knees and ice packs.
Rock bottom - riding the scooter at the grocery store.

Week 2: Still in a lot of pain. I went off narcotics after a week, although I never felt like the drugs helped much. After moving around for a couple hours at a time, I had to lay down for several hours to recover. Overall pelvic pain dominated the week and ice was my savior. I walked every day and got up to a distance of 1 mile. I was only waking up 1-2 times a night needing a new ice pack.

Week 3: Definitely doing better. I was able to keep the pain in check after activity by laying for 30 minutes and letting the injury site relax. We traveled to Oregon for our friends' wedding and I was able to do some short walks to waterfalls along the Columbia River Gorge. The pool seemed to help with range of motion and loosening up muscles. Sleeping through the night now.

Week 4: Back to feeling pretty normal with daily living with just a general achy-ness. We got a cute, old foster dog for healing powers and a friend to walk with. I started walking for several miles every day and felt about the same as pre-surgery - groin discomfort, TFL and glute pain. Although I felt a little better, overall I couldn't tell if the surgery did anything yet. I started physical therapy with these exercises: 

- 5 min, 10s holds of light pelvic tilt 
- 3 x 15 glute activation - make sure glute fires first (http://goo.gl/jv4c84)
- 3 x 15 oblique cable exercisee 
- 1 x 10 core stability hip rotation (
http://goo.gl/BnycHq)
- 1 x 10 straight leg raise 
- Pelvic adjustment


Week 5: Lots more walking. I was still struggling with compensation patterns but am able to walk several miles a day. I tried running for a couple minutes and it caused my adductor and groin to be sore the following day. Continued the routine of physical therapy and made some progress. Increased the number of sets on other PT exercises and added these exercises as well:

- 90 second hold of strain-counterstrain position of iliopsoas
- 1 x 10s psoas inhibition exercise (patient lies supine in hook lying and is instructed to dorsiflex at the ankle and push through their quadriceps as if to gently slide up the mat. The challenge is to contract the quadriceps without activating the hamstrings. If done correctly, the tibialis anterior and quadriceps are activated, while the hamstrings and psoas are inhibited)

Week 6: I incorporated a tiny bit of running into my walks. I could only run for a minute or two before my right leg ran out of power or my groin started to hurt. I am still very diligent about the PT exercises every day.

January 4, 2013

Jake's Recovery Keys in Marathon Training

I used my Holiday Training Camp post earlier this week as a way to transition to a more important topic - recovery. I was asked: How do you maintain consistency - high mileage, quality workouts, races - over a long period of time without breaking down your body and mind? I don't claim to have all the answers, but its a fun topic to think about and discuss. When I started to make a list, I realized that I do a lot of things that I don't even think about... they become automatic after a while.

I actually used to be very injury prone - in college and for the couple years after. But I've made some adjustments over the years, and the results have been amazing. Andrea has helped me with a lot of it - especially the emphasis on sleep and protein. Of the items on this list, those very well could be the two most important.

Hopefully, some of my "keys" can be useful in your own approach. And so you know, I take a lot more stock in anecdotal evidence and personal experience than peer-reviewed research and what the "experts" say. These are listed in no particular order, except that I grouped the ones dealing with nutrition...

Consistent Volume / Mileage
Mileage can either build you up or break you down. To be consistent, you first have to be consistent. Talk about talking in circles! :-)

The fact that I already run a lot of miles allows me to recover a lot faster. How do you get to that point? That's a bigger (and very interesting) topic, and I'll post my thoughts next week.

Run Easy
Hard days hard, easy days easy. I never push the pace on my recovery runs, and do a lot of running at 7:30-8:30 pace on those days. A lot of mornings, the day after hard workouts, I'm not even cracking 9 minutes for the first mile or two (or three). Give your body a chance to loosen up. "Pressing" increases your injury risk and is downright silly on easy days. What do you really have to prove on those runs?

Live like a clock
The body loves routine. Exercising twice a day sort of becomes the easier thing to do. I do the majority of my running in the morning. I don't have to think about it - alarm goes off, get up and go. Then I run again after work. Automatic. Having a set time that you are going to run (assuming your job doesn't require you to work crazy, non-routine hours) helps you stay consistent. Same goes for sleeping... go to bed at the same time every night (or as close to that normal time as possible)... and while we're on that topic...

Sleep
8 hours a night will do wonders. Your body repairs itself while you are asleep. All kinds of stuff is going on while you are laying inside your fleece sheets (yes, fleece sheets, its cold in the winter!) There is all kinds of science to back this up - but everyone knows how good you feel when you get enough sleep (and how bad you feel when you don't). This is an area where I have really improved. In 2012 I started logging my sleep hours, and it came out to an average of just over 8 hours per night. That might seem like a lot of wasted time, but the quality of the other 16 hours per day is a lot greater. During the week I go to bed at 9pm every night. I'll stay up later if I know I'm going to get to sleep in a bit on the weekends... but usually I'm bored by 9pm anyways! Now, this is not to say sleep is more important than the training itself. If I go to bed later, I'm not going to sleep through my morning workout... but you try not to make a habit of staying up too late. The rest allows you to absorb the workload.

The Stick
There are a million gadgets out there for stretching and massaging. I use the original stick that I got when I was in high school, and that's it. I do this for a couple minutes every night... get the kinks out of my hamstrings, quads, and calves. I also do some self-massage on my achilles tendons when I am feeling some tightness (which is often b/c I have a perpetual knot in my right achilles).


Alternate shoes - Different pairs, Different types
I brought 5 pairs of shoes with me to Arizona over Christmas. When Andrea and I go on vacation, we usually have a separate bag just for all of the footwear we haul along. I think one of the best ways to prevent injuries is to constantly be changing your footwear so you don't get used to doing the same thing all the time. Right now I am alternating between two different pairs of Kinvaras (a minimalist trainer), Rides (neutral cushion), Triumph (a super plush cushion shoe for shakeout runs), Mirages (neutral trainer), Fastwitch (marathon flat for tempo runs), Type As (flat for speed workouts). That's like 7 pairs in my usual weekly rotation. The added bonus is that the shoes all last longer as well, since you aren't beating down the same pair every day. Like the human body, shoes tend to perform better when you stress them, then let them recover.

Compression Socks / Sleeves
I wear compression socks or sleeves all day, every day at work. Since I am sitting at a desk most of the day, it helps my legs feel good for my afternoon run. I also always wear them while traveling (airplanes or long car rides). I used to think the compression garments were a gimmick... until I started actually using them. I became a believer very quickly. They make a difference.

Biomechanics
I don't have perfect mechanics, but I'm a natural midfoot striker and I think that alleviates a lot of the pounding my body would otherwise be taking.

Mental Attitude
I firmly believe there is a strong mind-body connection. I like to tell myself its not cold outside (even when it is), and that seems to make it seem less cold to me. The same goes for recovery - I assume that I am going to bounce back and feel better when I am tired. Usually my body will follow what my mind wants/expects to happen. Just be positive, that's mainly what I'm saying. A positive mental attitude (Andrea gets SICK of me using that term!) goes a long way!

Training by Feel / Listen to the Body
This is a subject for another long post (that I am working on), but I also strongly believe that you cannot write out a 12 week training schedule and expect to follow it even close to exactly. In fact, I think that would actually be somewhat stupid. I'm paraphrasing Renato Canova: athletes should not follow a training plan, but instead the training plan should follow the athlete. You have to make adjustments and tweak things all the time, you have to be very fluid and understand that no single workout matters all that much - the big picture does, the combination of all the individual pieces. That doesn't mean bailing on a hard interval session every time you feel fatigued and just lazily jogging around all the time. Sometimes the right thing to do is actually run a hard session when you are tired... especially in half-marathon / marathon training. The bottom line is that you have to find a way to be objective and honest with yourself (especially if you are self-coached). And if you can do that, I actually think its an advantage to be self-coached, because no one but you knows exactly how you feel and are responding to every workout session. But its not easy to be objective and I wouldn't necessarily recommend most athletes taking that approach. In additional to being able to hold yourself back, you also have to have the mental capacity to really push yourself hard even when you don't want to. You have to be accountable to yourself.

Be SUPER LAZY Sometimes
There's nothing wrong with coming back from a hard workout (especially on the weekends or a day off from work), plopping down on the couch, and watching movies for hours, only taking a break to make the short walk to the kitchen to get more food and drinks. You need those kinds of days when you are training hard!


Genetics
I'm not going to try and pretend to understand this aspect of it - other than I realize that I have the ability to recover quicker than most, and genetic predisposition obviously has something to do with it. So... thanks Mom and Dad!

Support system
Friends, family, training partners. I have an amazing group of people that believe in me and challenge me. Their encouragement helps me get out the door when its minus 10 or positive 110 degrees outside. I want to make these people proud of me - I want to inspire them like they inspire me. We're all a part of something that is much bigger than ourselves in this sport, and its important to realize that.

Calories
Get enough of them. Yes, being light is advantageous. But when you get down to what some would call "ideal race weight", you are walking a fine line... a razor's edge. You can do some amazing running, but you can also fall apart very easily. And its tough to bounce back once you start to lose your strength. I believe having a small buffer zone, staying just a tad above your ideal weight, allows you to recover quicker on a day to day basis. And you can still run fast. In October 2011, I panicked because my weight shot up a couple pounds before the Long Beach Half Marathon. Andrea told me to shut up and get over it. I went out and ran 1:05:45, probably my best race to date. Plus, food is absolutely delicious, so eat it. I put down an embarrassing amount of ice cream. But the engine needs fuel if you are going to run nearly 6000 miles a year. Other high-mileage runners agree.


Protein
The most important food group for recovery (yes, even more important than ice cream). Instead of summarizing 8th grade health class and how amino acids work, lets just agree that your muscles cannot repair themselves without adequate protein. Anyone who thinks otherwise its nuts. And speaking of nuts, I believe (like Ron Swanson) that the best forms of protein come from meat. So I eat lots of animals - cows, chickens, turkeys, deer, fish. I also like to eat a lot of egg whites - another great source (but low on cholesterol, which is good because high cholesterol runs in my family).


Iron Rich Foods / Vitamin Supplements
Iron deficiency is so common among endurance athletes, especially skinny distance runners. I eat tons of spinach, occasional red meat, and other iron-rich food sources. I also take a daily multivitamin and an iron supplement a few times per week during cycles of harder training. I don't have a perfect diet, but I think its pretty good. I eat a wide variety of vegetables everyday, although I could be better about fruit consumption. The multivitamin is just "insurance" to make sure I never get low on anything. I've had my iron tested twice during the past year and both times the results were very good...


The three supplements I would recommend taking are Iron (fatigue), Vitamin D (stress fractures), and Fish Oil (joint health)... or really pay attention to making sure you get enough of those things in your diet.

Diet Mountain Dew
You're just going to have to trust me on this one. Like I said above, I'm not using science to back up all of these claims. I'm using personal experience. If you don't believe me, take HER word for it...


Love It
Sometimes getting up early for a hard workout is tough, the day to day grind can be exhausting... but if you love the sport and find meaning in it (yes, I'm paraphrasing Without Limits), it's worth it 100% of the time. Being passionate about what you are doing ties into that mind-body connection... when you want something, you'll find a way to get it. And that isn't just going to make you a better runner, its going to make you a better PERSON.

SUMMARY
I think you should keep things simple. Stick to things that you'll actually do without expending excess mental / physical energy. You can wear yourself out simply reading about all the recovery "secrets" (let alone doing them), and the information is changing all the time. "The Stick" that came out decades ago still works today just fine, and I've had success with it, so I just go with what I know works. None of the things I listed really take any additional time out of my day... they are all pretty easy to do. Eat a balanced diet, do some sort of massage, get enough sleep, alternate your shoes, stay mentally engaged. Not rocket science.

I definitely have room for improvement. I need to extend the duration of my "down" periods of training after hard cycles and peak races. I also can clean some things up with my diet. Those are some of my goals for the upcoming year.

I don't pretend to run 140 miles a week and feel good all the time. That's why I run slow on easy days... I take what my body gives me. On hard days, the tables turn. I've found the balance that I can handle... I've found a system that works for me, and that's what everyone should strive to do. Make it fit into your life, make it your own routine. If you take recovery seriously, you'll enjoy training even more, and you'll run faster! But don't obsess about it either...


I'll finish with a quote I really like from Vern Gambetta's "Lessons from 2012" -
We must take a giant step back and look at what we are doing with recovery. I think we need to learn to use recovery methods more judiciously. Not necessary to ice bath after every workout. We need to understand that the inflammatory cascade is part of the adaptation process. Must educate the body to take advantage of this not interfere with this all the time.