Friday, April 29, 2011

"Hurtin' Swamp Dawg"

April's almost over, and boy, has it sucked.  Training through Chuckanut without resting was tough; it sapped my legs and my energy, making me take a significant rest week in early April.

Then AR50 happened. 

After Chuckanut I had pretty severe right heel pain, but I determined it to be an ankle joint issue that quickly went away.  Good news, right?  Not quite.  The joint was irritated because my stride was off; I had simply dodged a bullet when it dissipated so quickly.

At AR I was not so lucky.

My knee hurt a lot during the race.  If my gut (and, at times, my spirit) hadn't been so prominently disturbed, perhaps I would've taken greater notice.  Post-race, my "legs" (e.g. muscles) felt fine; but I was hobbling because of the left knee and, once again, the right heel.  Walking about afterwards and that night, I hoped I'd dodge another bullet -- take a day off or two and be fine.  I was bummed about missing the Sunday WS recovery run, but that would soon become the least of my worries.

It hurt like hell, just sleeping, both Saturday and Sunday nights afterwards.  I couldn't keep it bent on the drive home.  Nevertheless, I was hopeful it would clear up; or, that it would simply be a "really tight muscle". 

It has not.

The week after AR50, I ran 16 miles over seven days -- two days off, an the rest in varying degrees of knee pain -- as I traveled home for a long weekend.  The following week -- April 18-24 -- I got to believing it's "just muscle" again, so I gave another go:  48 miles on 5 days running with varying degrees of pain -- from "It feels fine!" to "It's a little sore", to, "Am I gonna break something?".  However, I was encouraged by a terrific 62-mile cycle last Saturday where it barely hurt at all.

The last straw was the Sunday run: I was determined to get back to running long, so I drove with Olmstead out to the 'hills to run Hardesty and Eagle's Rest.  I was a mile from the top of Hardesty -- only four uphill miles in -- when I knew I was done.  I told Dan that I had to pull the plug, thus ruining his double.  We drove back to Eugene and dropped him off at his house, where he departed stiffly to finish his run.  I joked, "This is good practice for a 45-minute aid-station stop!"

Correction: that was the second to last straw.  Still in denial, I thought maybe if i just corrected my form, I'd be good.  On Monday I hopped on the treadmill and ran three pain-free miles, only to then step outside, onto "The Pain Train" once again.  However, it took yet another failed run -- this time on Tuesday -- to get it to sink in that I'm in trouble.

The final, final, final death knell was an unofficial (house-call) PT evaluation by my boss, who declared it a bonafide medial joint issue.  He knows my history.  He knows I also had this same pain back in 2009, and I consulted my online running logs to confirm this.  Damn.

That's the bad news.  But it's bad: because even cycling is now painful.  And here we are: 8 weeks out from, as "Fast Ed" calls it, "The Big Juan". 

The good news:  I finally, finally, finally! know why this is going on; and not only that, but how to fix it! 

In 2002, I had a significant right foot issue: first Achilles, then plantar foot pain.  Near as I can tell, ever since that time I've run with my foot rotated out.  On the rare occasions I would see it, I'd try to fix it, then forget about it.  And the rule of thumb with running mechanics for most is, "If it ain't broke (or causing pain), don't fix it".  So that was my attitude.

That was until last year, when I went on my running mechanics crusade.  Since that time, I've been nearly obsessive about my mechanics, going out of my way to find store front windows to assess my form.  My mission with mechanics has been to learn how to maximize speed and efficiency -- not only for me, but for my patients.  Also, I wanted to address several chronic issues I've had, including:

- Right referred leg pain -- both during running and with prolonged sitting
- Right heel pain -- not Achilles, but stiffness in the subtalar and talocrural joints
- A funky and extremely irritating "left lean".

Below is some evidence, with pictures going back to 2008:

Craters of the Moon NP - May 2008.  The earliest (and worst?) evidence I've got.  Severe left trunk with externally-rotated/whipped R foot.
Twin Cities Marathon - October 2010.  Mile 22.  Left trunk, "ER'd" right foot.

Finish of Twin Cities Marathon - October 2010.  Really?  This is a stride that can run 2:32?
Autumn Leaves 50M - October 2010.  ER'd right foot. OK trunk lean because I remember "trying to have upright form" for the photographer.

Chuckanut - March 2011.  Subtle, but note the zipper on my coat: bowed to the left.
 (Here is a video of my sprint mechanics.  Tough to see fully, but now that you're "looking for it", the ER'd right foot is obvious)

I've tried various things to improve it: the "Don't Do That Approach", of trying to "lean right".  This was very effective on the short term during Autumn Leaves, when I began to experience left-legged cramping.  However, it is always temporary; I worked with my boss to correct my arm swing (as my left arm swings out wide to compensate), but this, too, did not correct it.

It took until last week's treadmill run for me to realize: it's the damn right foot!

A straight-ahead foot, when you push/PULL with it, will result in an equal and opposite force: straight forward propulsive.  A right foot angled outward to the rigth, will do what?  PUSH YOU LEFT.


I've done three treadmill runs in the past week, working on "turning in" the foot.  It works.  Without surprise, my trunk "shift" vanishes, and I even caught myself drifting to the right, as I've for so long been used to overloading the left side. 

It's taken a maximal effort to "turn in" might right leg to make it normal, but even then, the foot still whips outwardly.  I showed it to Dan at the end of the run, and even when I was correcting it, he said, "It wiggles!"

While frustrated to no end about the injury, I'm relieved that I know the solution.  The "coolest" thing?  This gait fault explains all of my symptoms.  Everything"EV-ER-AH-THENG-UH!":

- The left knee pain, from sheer overloading.
- The right heel pain, from the outward-twisted right foot (resulting in poor motion at the ankle)
- The right thigh pain (from the SI joint not moving enough or normally.

Now, I'm hopeful that those chronic issues, as well as any future left leg pain, should be minimal.  But I'm double (fartedly) frustrated that I'm just now figuring this out

So, I am officially out, indefinitely -- or until I can do non-impact things (e.g. cycling and elliptical) without left knee pain.  I have no choice.  I have to get this healed before WS, even if it means running only 100 miles, or 10, or 1, between now and June 25.  This also means the coveted "Bichigan Muff Training Camp Week" is in jeopardy. 

As for my mental affect?  I'm doing well.  Deep Survival has taught me several things, several of which I mentioned in the AR50 report.  Most importantly: the notion of "Surrender without giving up.".  To survive is to grieve, and the most effective survivors blow through The Five Stages rapidly and progress to working on things they can control: in my case, to make healing the top priority, and to prepare for WS day in any other way that I can.

However, it's hard not to be bummed.  And to pretend it doesn't bother me, with potentially the biggest race of my life less than two months away, immediately brings this classic case of denial to mind.  Ha!  That's not me.  But I'm not freaking out.  But I may just have to let go of any notions of a competitive performance on 6-25 if my recovery drags far into May and beyond. 

All that being said, send positive healing vibes my way -- or "ask JoBu to come, to take fear from knee" -- so that I can give my mom a birthday present deserving of a trip to Auburn!


  1. Joe,

    My name is Josh Katzman - I'm friends with Sam Jurek (he and I have been running together for around a year now). He's told me about your WS venture - impressive. I came across this post, and, as I have lost a bunch of training due to a right knee issue (flared last summer, and am taking it easy before it happens again). Turns out I have a significant right foot, external rotation (my dad remembers it from when I was a kid and I just had my wife video my stride on a walk with the kids). Are you doing any specific strengthening exercises to fix this? At this point it is something I've had, essentially, for my entire life, and have logged tens of thousands of miles with it, but, like you, think it is at the core of my knee issue. Any suggestions you have are appreciated.

    Sending good vibes your way, and I'll be rooting for you at WS!

    Josh Katzman

  2. Josh-

    Thanks for the post. Like nearly ALL running injuries, it is an issue of Mechanics. And to chance mechanics, you have to "do something different".

    The "game plan" for addressing any pathology involves 3 elements:

    Mechanical - Do joints and soft tissues have the ability to move through the required range? (e.g. "stretching" or "massaging")

    Neuromuscular - Does the person have the strength or motor activation (the latter being far more commonly deficient) to move their joint/body through the required motion? (e.g. strengthening, neuromuscular faciilitation)

    Motor Control - Can the person "put it together", to coordinate all the systems to consistently and efficiently make the required motor behavior?

    The last element - Motor Control - is by far the most important element. And too often, sports med folk think they can change motor behavior simply be "strengthening" or "stretching". False. The brain wants do what it always does; as such, you need to make real change, to feel a different motion.

    SPECIFICALLY: I am doing two things:

    1.) "Proprioceptive Neuromuscular Faciliation" (PNF) D1 Diagonal strength.

    Very briefly: the discipline of PNF was developed to rehabilitate patients with severe neurological deficits. Scientists discovered that the human body does not move in isolated motions (think: weight machines). Instead, there are a handful of key PATTERNS of motion, wherein multiple muscles coordinate with one another to create fluid, if not angular/spiral patterns of motion.

    Here is one in particular:

    Specifically, when the leg extends in this pattern, it's supposed to:

    Extend/Abduct/Interally rotate at the HIP
    Extend at the KNEE
    Plantarflex/Evert at the ANKLE
    Flex at the toes

    Look familiar? That's RUNNING!

    For those of us that have a foot "sticking out", we're not finishing the pattern. For me: I don't plantarflex or evert enough. That's because of that old foot injury, where I hurt my plantarflexors!

    So my exercise is doing this pattern, using a band, on my side.

    2. Push off the ball of the foot! So if I'm not plantarflexing, I simply have to THINK about doing that more: to push off using the calf muscles more prominently...

    More on this later...