I’ve started this post many times and abandoned it out of frustration. But now it’s been far too long since I posted anything and something about the looming date of July 1st and the second half of 2018 has me ready to ship this thing.
2018 has not gone as planned to put it mildly. To get an accurate picture of why it’s been so hard, I have to back up to 2017.
2017 was da bomb. I accomplished almost everything I set my mind to. I started the year coming back from a slight hamstring/adductor injury and busted out a giant 10k PR in March, squeezing under my goal time of 39:30 by a little over 5 seconds.
Then I headed into track season and eked out an 800 meter PR without specifically training for it. I had a solid summer and ran a 5k in August that indicated I could actually meet my lifetime goal for the 5k in Macon next month.
Breaking 18 minutes for 5k has been my goal since 2008. It’s always been something that I mostly considered just out of my reach but would be really freaking cool if I accomplished. It wasn’t unrealistic, like trying to go to the Olympics, but it wasn’t so easy that I did it in college which is when I was in arguably the best shape of my life.
The Macon Labor Day 5k is a screaming fast 5k course, and I’ve been known to run the first mile of that course faster than a flat out mile on the track. It’s a certified 5k distance, but it’s much faster than any other courses, especially in hilly Atlanta. I know that running a sub-18 at Macon doesn’t make me a consistent sub-18 runner elsewhere, but I just want to cover the distance in under that amount of time.
Between my August race and Labor Day, training went full bore, and I was attempting some of the hardest workouts of my running career. I say attempting because I often fell off the assigned paces, but I was doing so with the full confidence that I was close and could get there.
Labor Day rolled around and I ran 18:01.93. Even though I missed my lifetime goal by less than 2 seconds, I was ECSTATIC with the PR. I haven’t had much of a breakthrough since college, and I was ready to celebrate my success rather than mourn the fact that I didn’t accomplish my goal.
Given the extremely fast nature of the course, I set my eyes on September of 2018 for my next realistic attempt at sub-18. I finished out my fall racing season despite the hamstring/adductor issues cropping up again, and then took some time off around the holidays to try to get that under control.
Ok now finally back to this year
2018 began with planning and goal setting for the year. I wanted to essentially repeat 2017, only do everything faster. I’ve learned to be more selective with races and wanted to pare it down even more for 2018. I even started researching a late fall marathon for after my Labor Day focus!
Hamstring/adductor issues continued. I diagnosed myself with high hamstring tendinopathy and started doing bridges every day. This gave me some relief, but honestly it became “normal” for my upper hamstrings to hurt when I run…or when I sit too long…especially in the car.
February 2018
At the end of the month I noticed my left knee was also hurting as I started to run. This plus both hamstrings made for some awkward, jolty steps to begin with before getting into a normal rhythm. I iced it and would foam roll/use the lacrosse ball on my lower quads, right above my knee cap, and kept on with my training. And my lifting! I was doing squats and grimacing through them because “no pain, no gain” right?
March 2018
Ok so both of my knees hurt now? And still having hamstring/adductor issues. At least my knees hurt differently. My left knee is swollen and hurts in a vertical pattern and is EXTREMELY painful with hyperextension, and my right knee feels like pretty normal patellar tendonitis, probably from overcompensating for my left knee.
It’s a weird pattern because there will be days when I finish running and feel fine and days where 30 minutes after I’m done, it feels like my knee is going to fall off.
I take it really easy the week of my 10k, wear KT tape, and run the race…about 75 seconds slower than last year. Feeling like you need to limp after a race is NOT worth it to run that slow, so I take some down time and go see a physical therapist at the end of the month.
Side note: I think physical therapists are the best and have only had really positive experiences with them. If you’ve ever had a bad experience at a doctor’s office (like 90% of the time when I go), imagine your ideal situation of someone listening to you and forming a long term plan of action for healing, and that is physical therapy.
April 2018
I’m in PT twice a week getting dry needled and doing exercises with the blood flow restriction cuff (BFR). I now have an elaborate warm up routine to do before I run every morning, and I’m restricted to 4-5 miles at a time as we try to get everything calmed down.
Near the end of the month, the PTs evaluate my running form again by filming me on the treadmill and suggest I try to lean forward just a bit and/or engage my lower core. I run very upright and heel strike, and apparently this prevents the glutes from firing at all, meaning my hamstrings and adductors have to work overtime and get irritated.
I tried my new running form a couple of days later and found out that leaning forward makes me go super fast which was pretty fun! I also started having 90% pain free runs (for hamstrings/adductors) and could sit in the car without squirming around. It was like magic! Engage your glutes, and the rest of your muscles are happy. Got it.
Side note: leaning forward while running also led to me taking a tumble and skinning my right knee which was almost funny but mostly annoying. 😉
May 2018
For the first half of the month, I’m on cloud 9. I graduate to only 1 PT appointment each week, and I’m cleared to increase my mileage a little bit. The swelling in my left knee and pain with hyperextension has never improved, but it doesn’t actively hurt while I run, so I focus on the positives like that I drove over an hour in the car and didn’t want to scream about my hamstrings when I got out.
I also incorporated a little speed back into my life. Strides had been a major point of pain with my hamstrings/adductors, and now I could do them without that wrenching, resistance to changing speed. I even did “long” runs of 8 and 9 miles!
And then I relapsed. That’s what I’m calling it at least. While my knee had never seen much improvement, I went from pain free hamstring/adductors back to how I felt in March before I even started PT. Running with my leaned over form, working my glutes with rehab exercises, nothing helped. I would get a slight relief from dry needling at PT every week, but I was back to laying on my stomach instead of sitting and wincing through my jolted first steps of a run.
I was incredibly frustrated. Renewed pain plus the fact that my knee was still a little puff ball led me to make an appointment with a sports medicine doctor.
June 2018
At the doctor’s office I had X-rays which were normal and performed some tests for the doctor. The he had me lay on the exam table and felt both of my knees. He had the great quote, “Your right knee clicks a little bit, but the left one just grinds!”
He recommended an MRI since I had swelling for so long and had already been in PT for 8-10 weeks.
Luckily with all of the PT I’ve done, I already hit my deductible for the year, so the MRI was cheap. I got in 2 days later and then had to wait until the following Monday for him to give me the results (because MRI techs can’t tell you anything).
The results were:
These findings are consistent with a partial tear of the origin of the patellar tendon. This is most pronounced on the medial aspect. Edema is seen in the adjacent superior aspect of Hoffa’s infrapatellar fat pad.
I was convinced I had fat pad impingement, so I was happy to hear I was partially right. But not actually happy because that sucks! He said if I didn’t have a traumatic moment of knowing I tore my tendon, it could also be tendinosis, which reads very similar on an MRI.
I was highly irritated at the results being “tendinosis” because I thought it was just a fancy word for tendonitis which is (in my mind) not serious at all. But after some Googling and calming down, I learned that tendinosis is the advanced stage of tendonitis, where there isn’t an inflammatory response anymore, and you’re actually doing damage (that is my unscientific take).
The recommended treatment is the same whether it’s a partial tear or tendinosis – an injection. I had the choice between Amniofix and PRP, 2 types of regenerative medicines.
Amniofix
Amniofix had a full recovery time of 4-6 weeks with a warning that the 2-3 days following the injection are “extremely painful.” Like, prescription pain meds painful. It comes from donated placentas, and the growth factors get to work inside your body to repair your tendon.
PRP
Platelet rich plasma had a full recovery time of 6-12 weeks and an easy immediate recovery from the injection. They draw blood from your arm, spin it down to separate the plasma, and then inject that for the growth factors to work on repairing your tendon.
I went with the Amniofix. I loved the idea of my body working to repair itself from my own plasma, but I thought the “extreme pain” was probably overhyped and wanted that faster recovery time.
I got my injection later that week.
They start my using an ultrasound to look at your tendon. He showed me the part of my patellar tendon that was thickened due to the injury, which I pretended to see because it looked exactly the same as the undamaged side to me. Then they spray your knee with cold spray and you get some numbing injections.
The numbing injections were pretty uncomfortable. The needle going in wasn’t so bad, but moving around to inject in all the areas for the Amniofix injection wasn’t great. But the good thing is that it starts to work quickly, and I didn’t feel the second needle with the Amniofix at all.
I was really achy and swollen for the rest of the day. They said I’d stay numb for 2-3 hours, but I had a deep ache in my knee by the time I was driving home. And I definitely laid on the couch for the rest of the day, only hobbling out to Publix to get my pain meds.
I took a pain pill before going to sleep and expected to wake up in “extreme pain” the next morning. To my pleasant surprise, I was FINE. I still had a lot of swelling (that’s what happens when you get needles jabbed in you), but the pain I felt pre-injection and yesterday was gone. The swelling only got better over the next few days as well.
The injection came with 10 days of no running. I thought this was a small price to pay for a hopeful quick recovery of my knee, so I went for walks, I cut the grass, I swam, etc. I kept myself busy and looked forward to Monday the 25th when I could run again. I planned to start with some run-walk to be careful.
Monday morning I did my pre-run routine and headed to the river for some soft surface running. Much to my absolute horror, my hamstring/adductors felt just as bad (worse actually) as before my 10 days off. 10 DAYS! I haven’t take that much time consecutively off in who knows how long. And to not feel any improvement at all???
My knee feels fine, by the way.
I’ve joked with some people who ask how I’m doing that “I’m fine! I just have a breakdown every 3 weeks or so.” My latest was on Tuesday, so hopefully I’m good for a bit.
After another attempt at running going slightly better than the day before but still bad, I’m taking a longer break. I love running, but it currently is only hating me, specifically my hamstrings/adductors, so we need some time apart.
I’m still going to run-walk Peachtree next week. My PT agreed that it’s not going to set me back and the mental/emotional toll of not being there could be worse than the physical toll, so I’m looking forward to trying again then and maybe seeing some slight improvement after another week.
Answers
The most frustrating part of my “relapse” is the lack of a clear answer. Everything made sense for a while:
Exercise the quads, knees feel better
Exercise the glutes, hamstrings feel better
Change your running form, everything feels better
And it’s an oversimplification that I just got back into running too fast. If that were the case, I would see improvement with the time off that I took.
I have a new theory, and since clinging to an answer seems to help my emotional state, I’m sticking with it.
Part of PT has been working on my thoracic spine mobility and my cross-body stabilization. I’ll never forget my appointment where I did an exercise of pulling across my body that I could only do on one side. When I switched directions, it’s like I was frozen, unable to will my body to pull the rope across.
I think the breakdown of my cross-body stabilization started with my knee. I’ve been sub consciously and consciously favoring my left side for months. When I engaged my glutes for the first time, my hamstrings and adductors felt the relief they’d been wanting, but when I upped my mileage, the relief didn’t last as my stabilization breaks down when I get tired. Then it was exacerbated by my knee getting worse and ultimately being heavily favored post-injection.
I have no idea if that’s true, but it’s what I’m sticking with for now. I have some killer core exercises now that work on my stabilization, and I’m continuing my long list of rehab exercises and well as new forms of cardio to keep me sane.
The Second Half of 2018
I don’t know what I have planned. This injury has been a long process of letting go of my goals and plans for the year. The marathon was the first to go, and as we’ve gotten closer and closer to September, I know that I won’t be in shape (heck, might not even be fully training then), and that has been hard.
“All frustration in this world comes from unmet expectations.” So what’s the plan for Q3 and Q4 of 2018? *shrug emoji*
Sara Morrison 