Monday, September 3, 2012

Weekly Training Wrap - 8/27 - 9/2

Before the Leadville 100, my knee started acting up. I was fortunate enough to get through the race with the help of my friends and several doctors. In hindsight, I don't believe any of the help did much for me other than moral and mental support. It has now been two weeks since the race and I have zero improvement. While I have been contemplating taking some serious rest after Leadville for a long time, I didn't want to have to do it this way.

On Sunday, I spent some time playing Internet doctor and talking with Tony and have diagnosed my knee with Patellar Tendinosis. This injury is frequently confused with and misdiagnosed as tendonitis. While many of the symptoms are the same, the injury treatment is very different. Tendinosis is called a degenerative condition, which makes it sound really bad. But that just means that there is a real injury there and it is more than a simple case of inflammation. The patellar tendon area needs time to regenerate and recover. The theoretical worst case scenario is something like 100 days, though that depends on a ton of individual factors. This is a very common injury for runners of all ages.

There are a variety of things that people have tried, but here are the factors most likely to assist in healing are (in order of importance):

Not surprisingly, the number one factor for recovery is rest. This seems obvious, but we sometimes get caught up in having to actively do something to heal (particularly me). This reminds me of a great quote I recently came across: "God heals and the doctor sends the bills". I hope it doesn't take 100 days, but I will be need to be patient.

Eccentric exercises
It is somewhat ironic that I was told by a doctor that my "big built up quads" are a potential source of problem and the treatment is to work them even more! Eccentric exercises like squats have been shown to encourage the regeneration of tissue in the knee. The key is go very slow on the eccentric portion (down) of the exercise. And, obviously, don't push through anything beyond mild discomfort.

In particular, stretching of the quads, hips, and calves has been shown to have mild success in helping patients. However, working these stretches is really only helpful after workout when the muscles are loose.

Fixing Imbalances
No concrete evidence has been found on what causes this injury, though it is considered an "overuse" injury. However, there is a suspicion that any imbalances that exist in a runner -- particularly hip stiffness, leg length discrepancy, and weak gluteus -- could put a runner more at risk. I plan to spend time working on things like my IT Band, core, and lower back to improve any existing imbalances.

Things that don't help
Runners commonly do the following things to treat injuries, but none have been shown to help with tendinosis:
- anti-inflammatory medication (since this is not an inflammatory injury)
- Ultrasounds or other "electrical modalities"
- Ice: ice may provide relief from symptoms, but it is not useful in healing

The long and the short of all this is that I have a long road back to health, possibly months. The good news is that I can now get to all the cross training I have been neglecting for sometime. And, it appears I can still power hike without aggravating the area. Thus, I have something besides the bike that I can do to keep a reasonable level of fitness while I perform my PT and wait.

Day Miles Notes
Monday 1 Treadmill Powerhike at 15%
Monday 0 Cross Training - Weights
Tuesday 0 Cross Training - Yoga & Push ups
Wednesday1 Failed attempt to run
Thursday0Push-ups, Sit-ups, Crunches
Saturday Rest
Sunday .5 Failed attempt to run, followed
Sunday 0 Followed run with Cross Training
Total 2.5

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