Long Lonely Walk of Loneliness

Where has May gone?  And April for that matter?

It's been a hectic, stressful -- and at times, demoralizing -- past two months.  To quickly summarize the past two months: Some knee pain, resting, then running, then resting, then walking, then resting; a cane, an MRI..."...Phyllis, a man, a map, and his penis - I believe you all know what I am referring to...".  As such, I had done basically zero training of any kind from mid-April until only days preceding Memorial Day weekend.

In short, a "pain grenade" went off in my left knee during AR50 -- affecting the knee joint, the knee cap, the MCL and anything else it its path -- that prevented any training.  Even pool running and walking was painful and irritating.  About two weeks ago, it ocurred to me that I may have a stress fracture in the medial tibial plateau -- pain was ongoing, exacerbated by walking and light hopping I'd been doing in hopes of progressing to jogging.  I promptly put myself on a cane for half a week while I investigated.


X-rays were ordered, and two days later an MRI -- while I typically scoff at unnecessary imaging tests, I desperately needed to know if there was any pathology in the joint.  A day later, the report:

FINDINGS: There is no knee joint effusion or Baker's cyst. The ACL and PCL show no tear. There is no meniscal tear. The collateral ligaments and posterolateral corner structures are intact. There is fluid within the layers of the tibial collateral ligament extending superomedially and to the region of the medial patellar retinaculum. There is no retinacular tear. The distal quadriceps and patellar tendons show no significant abnormality. There is no fracture or bone contusion. No focal cartilage defect is identified.

In short: ALL CLEAR*


(*short some "fluid in layers" on my MCL, which is insignificant)

There is a definite pyschological component to pain.  Pain is any stimulus the body perceives as a threat.  And since AR, my two threats:

1. Not being able to run WS and make that weekend an awesome experience for me, and my friends/family.
2. Not being able to run again -- or significantly -- if I had a serious knee pathology.

Returning to running required that I dispense of both those threats:

For #1, I had to break down in mid-May and announce to my crew that I very well may not run.  Having a walking tolerance of 5 minutes (and a cycling tolerance of 30 seconds) 6 weeks prior to a hundred-mile trail race does not bode well for success.  To finally let go of "my idea" of that weekend -- run fast and strong, and making it about my competition -- was liberating to me.  Rather than worry about racing 100 miles, I could finally begin to focus on simply getting better.

For #2, it was the imaging.  Duplicate orthopedic exams by my boss were equivocal, and my medial knee symptoms were suggestive of a joint or bone issue.  I was really worried. I needed that "clean bill of health".  As such, the cost for Peace of Mind was $625. 

Since my clean bill of health on May 25th, I went from 30 seconds to 30 minutes to 60 minutes a day cycling.  Then, I headed to Michigan Bluff for the annual training camp weekend with the Eugene Crew.  I brought along my bike, thinking I'd do primarily cycling and perhaps some hiking, if the knee allowed.  To summarize:

Friday: Britt and I picked up Sam at the airport and headed to MB.  We went on a hike on the WS trail west from MB towards Bath Rd.  1h50m total hike, which included 37 minutes of light jogging (mostly 1 minute on, 1-2 minutes walk rest).

Saturday: Sam and I went east on the WS trail from MB to Last Chance and a mile+ beyond.  We walked nearly the entire way out -- 13.3 miles in a leisurely 4:30 (with stops to check out Pacific Slab, Deadwood Cemetary, etc).  On the way back -- we ran nearly the whole thing, except for an exhausted/bonking hike up out of El Dorado Canyon to MB.  26.3 miles total, about 10 of which were run.  7h30m feet time!

Sunday: Training Run from Foresthill to Rucky Chucky.  Except Sam and I ran from MB, the 7 miles (except the last half-mile to FH).  We also ran at a normal pace, non-stop, the entire training run save the brutal 3 miles uphill to the bus.  22 miles run, 5h00m feet time!

Monday: Britt and I ran from the HS to Robie Pt and back.  Extremely sore everywhere, only mildly so (relative) in the left knee.

One word: astonishing.  In my wildest dreams I thought I'd shuffle a half hour per day that weekend; instead, I ran nearly 40 miles and put another 15 in hiking, for a total of 15+ hours of feet time in 4 days.

Besides the psychological component, I also believe there was some physiological component.  Scar tissue needs remodeling.  And that remodeling in and of itself can cause symptoms.  Interestingly: the more I did (hiking 4h30m, for example), the better if felt -- as if scar tissue was being mobilized and remodeled -- similarly to my "breakaway" snowshoe hike (5hr+) that effectively healed my achilles pain back in January.

This past week: pretty good but still tenuous.  I was extremely sore from doing nothing to hammering down the WS canyons.  I also had some collateral issues: a strained posterior R knee (overdoing the powerhiking and R leg emphasis) and the L foot arch.  The left knee has also been sore on and off, but overall better than the previous week. 

Yesterday I had a breakthrough run: a solo excursion to Rooster Rock, in the Menagerie Wilderness of west-central Oregon.  Per the Eugene crew, this is the closest topography in the States to the WS conditions: the >3600' Rooster Rock peak with two access trails, both starting around 1500': the Trout Creek Trail and the Rooster Rock trail.  One "loop" consists of running up Trout, down Rooster, up Rooster, and down Trout -- each time summitting Rooster. 

Yesterday I did 1.5 of these (x2 of the smoother, less severe Trout and x1 Rooster) and, besides some general knee soreness, I felt terrific.  It was also hot, so it was a good heat training session, as well.


With every day I feel more and more confident in my ability to run and survive the 2011 Western States.  It may not be the peak performance that I had fantasized about, but -- this two month "blip" in preparation makes the upcoming June 25th all the more interesting.


In the mean time, my focus is on the following:

1. "Seasoning the Quads" -- doing everything I can to prepare my legs (namely quads) for 20-24 hours of ambulation.
2. Ongoing health and recovery of the body -- not just the left knee, but all the other aches and pains -- this and the former will be a tantalizing balancing act the next 3 weeks
3. Experience -- seeing some more of the WS course.

Important upcoming dates:

• 6-5-11.  Scheduled "last long training run" with the Eugene Crew.  Not sure where exactly -- perhaps the foothills off OR58.  I have yet to do a true long run with the Crew, so I'm hoping to take part, and get in a good, long run.

• 6-10 and 6-11-11.  I'm returning to the WS trail on my own for 1-2 final "crash-courses" on the trail:  one run along the canyons + some Cal St, then a slog/walk from Robie Pt to Green Gate and back.  That makes for an extremely long weekend, but the focus is on "feet time" and experience.

That's all for now.  Wish me luck, please!  I'm just so happy and relieved to be feeling "OK".  Send your good vibes, such that this string may continue through 6-25 and 6-26!

Run Gait: Before & After

Did some major troubleshooting on Saturday, and I was able to normalize the stride (albeit with focus):

Here's the "before shot":

As you can see, major externally rotated foot.  What you see in "the wiggle" (as Dan O put it), was me trying to correct it by simply "turning in" the.  That doesn't work, and it's unnatural (and likely to cause another injury).

Here's the corrected shot:

This was accomplished by focusing on "PNF extension" -- or a global extension pattern beginning at the pelvis and extending all the way down -- I didn't even think about the foot or turning/pushing off, and it was 80% corrected.

I've also, with great reluctance, started an aggressive course of anti-inflammatory meds: a whole mess of ibuprofen.  I'm taking 800mg x3-4/day; the pain is 99% gone, and I was even able to elliptical train for an hour yesterday, which was promising.  However, the point of the NSAID is the blast away inflammation and to return to running ASAP.

"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.

DOUBLE-FARTS! 

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!