Friday, July 22, 2016

A 12 to 18 month process .......

I've been patiently waiting for a follow up appointment with my physio since an ultrasound finally provided an explanation for 5 years of muscle fatigue/cranky muscles/tight upper hamstrings. Despite those ultrasound findings, 'pain' is not the term I would choose to describe my ongoing symptoms. I stick with 'tight and cranky' hammies. It is disappointing that an MRI in 2013 failed to detect the source of muscle fatigue, which I had localised to the hammies/glutes back in 2011. C'est la vie, 3 years later and 4 health professionals later, a diagnosis! It wasn't in my head after all! In the meantime I have totally trashed my proximal (high) hamstring tendons. The question is, what can be done at this point?
Location of proximal or high hamstring tendinopathy
The damage to the tendons cannot be reversed, it is a degenerative tendinopathy. However, the ongoing reactive tendinopathy (occurring in the remaining normal tendon tissue) can be restored back to normal. To manage the degenerative changes, the muscles that support the tendon need to be strengthened. It will be a balancing act of strengthening the hammies and then finding the right exercise program that does not stir up more episodes reactive tendinopathy. Despite the duration of this problem, the ultrasound suggests there is a reasonable amount of normal tendon tissue remaining and the sciatic nerves appear normal (no obvious adhesions or entrapment). So there is something to work with. The physio advises it will be a 12 to 18 month process! Once upon a time that would have sent me into a deep depression. However, this has been ongoing for 5! years, so 1 to 1.5 years doesn't seem that bad. It's all relative.
No more women's100 for a while

As for what that 12 to 18 months will involve, it's early days. The next 4 weeks are the starting point. Phase 1 will be LOTS of isometric exercises (e.g. the isometric bridge). These start the strengthening process and have been shown to reduce the discomfort associated with the condition when performed 3-4 times per day. There are also lots of things one should avoid doing. I really stirred up the reactive component of the tendinopathy recently with 'frustration intervals' (short, sharp speedy interval sessions), so running is something to be avoided. Gentle cycling is okay but no more Rapha Women's 100 for a while!  Other things to avoid include sitting for too long (avoid hard surfaces), too much walking (and walking up hills), hamstring stretches, deep squats, deadlifts, and hip flexion when standing (like when washing dishes and such). After the first 2 weeks of isometric exercises, if the hamstrings are more comfortable, then the next 2 weeks will include a mix of isotonic (e.g. swiss ball hamstring curls) and isometric exercises. Then it will only be 11 to 17 months to go!  

Friday, July 8, 2016

A 'bit of' bilateral proximal hamstring tendinopathy

Finally an explanation for the tight hammies that have been plaguing my running for the last few years! After messing around with various exercises and running form for the last few months, it was time to get some more imaging of the hamstrings. Sadly, back in 2013, an MRI failed to show up anything. Maybe because it is a bilateral problem and back then it was pretty similar on both sides, it wasn't obvious on the MRI (supposedly the gold standard imaging modality). Now days the right  side is always worse than the left and there continues to be a neural component mostly on the right side. An ultrasound today showed bilaterally inflamed proximal hamstring tendons, worse on the right. A shame for it to take this long to find an explanation. Thing is, I have never considered it to be 'painful' just tight and uncomfortable. Further, palpation of the affected region itself never hurt! I only feels tight with activity and gets irritated with prolonged sitting. Other people experience pain with exercise and palpation.
Unhappy inflamed hammies at their origin

Both side appear to be vascularised due to chronic inflammation
It is not a common condition, but there is plenty of information available on the internet. It is much discussed in various running and triathlon forums. Treatment usually involves rest (i.e. no running and limited cycling) and various physical therapy and exercise programs. I'm still to discuss what to do with my physio. But given the prolonged history, it won't be a quick fix if at all. Still nice to know what the problem is even if that means that's it for running. Time will tell.

Saturday, April 2, 2016

Less will have to be more

It's been a few months since the last post. That is because of recurring neural/muscle issues that negatively affect one's running. Efforts to amp up distance or pace consistently trigger the problem. While some people get back pain, I get extreme muscle tightness that is coming from irritated nerves, which get irritated as I try to run faster or if I try to run further. So essentially any of the things one needs to do to be a better runner are the very things that lead to becoming a worse runner! The question remains, how can this be managed so that it will allow some progression? Running form (when fatigued or trying too hard) is one consideration. Lex Anderson is trying to assist by providing some cues that are intended to reduce an exaggerated right to left thoracic twist evident when I run. It's not a dramatic twist, but with a rickety old back, it is probably enough to contribute to the problem. I've also already been through an array of exercise and stretching programmes that have not markedly assisted (focus was building gluteal strength was well as some specific running strength). This is being revisited looking at what can be done to reduce the stress on the nerves. It is a work in progress. That said running may well be THE stress, a reality that may have to be faced sooner rather than later.
What can be done training wise while working on running form and nerve stress? An article about veteran runners racing well with less mileage popped up in my Facebook news feed. It's about getting the right balance in the limited running you do. Don't do long runs every week. Be selective about the type of intervals you do. Don't get caught up in using weekly 5k races as part of your training. My programme has been pretty low mileage for a long time now. But I am guilty of doing intervals and parkruns and long runs all in the same week. I see others thriving on this type of programme. I also see others thriving on lots of long distance, like I once did (for a brief period). Time to play around with things. Slow down the intervals, space the hard sessions well apart and be more patient. There could be the right balance in there somewhere.


Sunday, January 3, 2016

2016 - what now?

2015 is done and dusted. The IRONic jogger continued to jog for most of the year bar some minor injuries and illness. Total distance run was 1940km, which included approximately 29600 metres of climbing. Best 5km time was 22:31 and it wasn't long after that best time (run in April) that things went backwards and never really improved. A similar theme to previous years, but probably slightly better overall in 2015. The start of 2016 has included my longest run since 2010, a slow lap of 25km around the Cotter. Some dodgy navigation made for a slightly longer run than planned.
Wading through Vanitys crossing on the Cotter loop
Current goal is to work on 5km times with some interval training, providing the neural/muscle problems are manageable.  Long runs (of over 15 km) will be less frequent for now, having achieved the 25km. Once the weather cools down new goals will be set depending on how well interval training has been tolerated. Intervals (1km reps or 400m reps) have been in the programme for the last 5 weeks and so far so good. 

Sunday, December 20, 2015

Touring some of Canberra's ridges

There have been lots of events on my wish list this year that have passed me by due to injury and illness. The final one in the calendar for 2016 was Tour de Ridges - a half marathon that covers several ridges in Canberra's south including Farrer Ridge, Mount Wanniassa and Isaccs Ridge. All up somewhere between 550 and 650m of climbing, depending on who's Garmin you believe. The weather report for this weekend was for super hot conditions, and with a history of poor heat tolerance I was rather anxious about whether it would be wise to attempt this run. Therefore a back up plan was in place that included switching to the 15km event if I was struggling at the 10km mark and having Gregg out on the course with ice water and high power water sprayer in his Bob trailer. As it turned out the early start made for a pleasant temperature for most of the run and there was much more shade than expected. The water spray and ice water were much appreciated, but ended up not being critical for staying cool on course. The legs don't have a lot of training for this distance, so it was always going to be a long run at a comfortable pace rather than an attempt to race.

Jen Bright doing it easy out on the course

Finish line in sight!
Given the conditions, all the water stations were frequented and many steep sections on the course were walked. I made it to the finish line in pretty good shape (feeling much better than in the Bush Capital HM), but it was at a pretty casual pace. Happy to finish feeling pretty fresh. Also grateful the ankle roll in the first 500m was only minor so I could keep running! Time to plan the wish list for 2016, hopefully sneaking in parkrun #50 before the end of 2015.

Sunday, December 6, 2015

Dogged in December

Things are moving along in the right direction on the Kikka front. She has showed up for the last couple of runs as promised and she is starting to really enjoy the routine, yay! I am fortunate to have some inside help to enable me to stay ahead in 'the Kikka challenge'. That help is in the form of a 'ball of fluff' on four legs. Kikka's venture to Gungahlin parkrun, where a sub 42 should have been a piece of cake, was all too exciting for Yogi Bear (aka ball of fluff number 1). Yogi managed to slip his halter at the start and as I was starting the run with all the other runners, I spotted this massive ball of fluff out of the corner of my right eye running along side. This was quickly followed by a loud yell of "Yogi!" as Kikka quickly controlled the situation. A good thing he is an obedient ball of fluff! However, this meant Kikka had a delayed start. I ran super tired and did not have a good run. But with the ball of fluff shenanigans it meant my jog back to Kikka had a good head start and our meet up point was around the 3.5 km point. That would have been a win for me if at Gindy. Instead another target has been set for the 'Kikka challenge'.  Our next run was back on the Gindy course. I was not feeling at all confident given my run the previous week. However, a new ball of fluff entered the equation. Nala (aka ball of fluff number 2) was to tag along with Yogi bear, Kikka and Leah. Nala had some 'equipment issues' just before the start, so another head start for me. As it turns out I did not need the head start as my run was much better than last week. Jogging back to Kikka she was a few hundred metres behind the previously set mark, a win for me! Woot!
Kikka, Leah and my secret helpers - balls of fluff 1 and 2

Kikka now has the opportunity to set herself up for a 'Kikka challenge' win. I have work travel coming up and will miss the next parkrun. She has the opportunity get in some secret training while I'm away. I wonder if I will be able to continue to count on 'ball of fluff' assistance? The plot thickens.

Sunday, November 22, 2015

Moving forward

We are making some progress with Kikka, but it isn't always easy. She didn't get to parkrun last week and was without any good reason for not being there. She still isn't at the 'newly formed habit' phase, so it takes a much bigger effort. However, after another pep talk she made the effort to get to parkrun on Saturday, with faithful Yogi Bear by her side. Lou and Gregg also joined us to form Team Kikka for the morning. I am leading the 'Kikka challenge' due to her defaulting last week. However, this time around it was a draw, with Kikka making it to about the 3.5km mark around the same time as my jog back (with Lou) to run with her to the finish. We all made an improvement on our recent performances, with Lou really smashing her Gindy PB to finish in 19:03, oh so close to a sub 19. I managed a sub 24 - 23:43 and Kikka finished in 42:17 a 1:38 improvement on her run 2 weeks ago. Gregg is not a runner, but still managed a respectable 46:22 for his first ever 'park walk'. Kikka now has the challenge to get up a bit earlier next week so she can make it in time for Gunners parkrun.
Team Kikka and the faithful Yogi Bear
No sign of my purple patch yet, but things are moving in the right direction. Lou is in her own purple patch setting PBs in the Mt Ainslie run up, the Black Mountain run up, Gindy parkrun, as well as some pretty impressive running in the Triple Tri. I have managed a couple of 1km interval sessions in the last couple of weeks, trying to improve fitness and pace. The positive is that there have been no neural/muscle problems. Long runs are pretty slow and hills are harder work at the moment. But distance is back up to 19km, so hopefully pace and hills will improve with better fitness. Here's hoping Kikka easily cracks the 42:00 at Gunners next week.