Wednesday, August 2, 2017

Not dead yet

It's been quite some time since I last blogged. Much has happened in that time, but none of it involved running (or cycling). However, it is now time to attempt another 'come back' to see what direction the hammies would like to take. I'm on a comprehensive exercise programme focusing on hammies, glutes and back. Craig Purdam, my current physio, has put a lot of thought into this programme and we remain hopeful. Returning to exercise is currently very limited. There is a walk/jog/walk session for 20 mins (after warm up) once per week and cycling 30-40 mins twice a week. All well spaced apart to ensure adequate rest and adaptation. The first couple of walk/jog/walk sessions went well with no discomfort during the jogging phase. However, the hammies still niggle at the walk and at times when sitting. Only one cycling session so far and the right hammies did not like the bike seat on the mountain bike. It may be seat/bike specific, so the various bikes will each get a session to determine if one is better than the others.
Photo taken at Lac du Bourget
This will all be revisted in 4 weeks time. If progress is good, then hopefully some more frequent walk/jog/walk sessions will be added into the mix. The 2nd walk/jog/walk session felt amazing. It was so nice getting the heart rate up again (and it didn't take much to do that!). I'm now counting down the days to the next W/J/W session 😃.

Saturday, April 22, 2017

The hamstring conundrum

The corticosteroid injection made no difference and another attempt at a walk/jog programme resulted in increased irritation in the hamstrings. The Doctor then sent me off for an MRI to better assess the situation. Alas, as expected the hamstrings looked pretty crappola on the MRI. After that news I was ready to 'accept' my fate. After all, I'm in my 50s and seem to have genetic predisposition to tendon problems (I still have medial epidocondylitis after 6 months and have had other arm tendon niggles in the past). However, my doctor was not going to let me get off that lightly. She was adamant that if I take a rest, it may settle down, but it would flare up as soon as I increased the load on the tendons. Next step, a referral to see Craig Purdam, a physio with much experience with tendinopathies. I have read a number of his publications and he has been at the forefront of tendon research for some time. I was lucky to get an appointment with him as he is reducing his caseload as he heads towards retirement. It's been a bit of a wait and I will be seeing him at the end of April.
In the meantime a few things have seen me re-evaluate the situation. After taking a (complete) rest period, the hammies did seem to settle down, BUT going for some walks set them off again. The rest has resulted in them becoming even less tolerant of load than before! How frustrating! However, I did a bit more research and discovered that this apparently is a common finding. Jill Cook, a research colleague of Craig Purdam, strongly advises that exercise is the best treatment for tendinopathy. That is, the right programme of exercise. Of particular interest to me was Cook's recommendation that there should be at least 2 minutes rest between any tendon exercise repetitions. Well heck, I have not been doing that, it was not pointed out to me that I should be. I have been suspicious that my exercise programme has not been allowing for sufficient recovery, but I did not realise it was at such a microlevel. Oddly this gives me some hope. I know I can settle the hammies down again with isometric exercises, but this time with appropriate rest between repetitions. From there I am hoping Craig Purdam can help me with staging an exercise programme in a way that allows for sufficient recovery and forward progress. Now I'm just waiting for that appointment at the end of April.

Saturday, February 25, 2017

My hammies are trashed

Yep, trashed they are. Despite all the appropriate rehabilitation and taking it easy, they continue to niggle. Because of this and my continuing frustration, I consulted with another specialist sports medicine doctor to see what else, if anything can be done. She did a full assessment and found that strength-wise the hammies are good, the glutes are firing well (they often don't in runners), but the lower back is still far too stiff (admittedly back loosening exercises haven't been a high priority in recent times).

She is a strong advocate of progressive loading of the hamstrings, regardless of my age and other risk factors. I indicated I have had several attempts at doing this only to have the hammies get more niggly. So we then discussed the big 'C' word, yep corticosteroids. CSs are commonly used to control inflammation and the associated pain in joints, ligaments and tendons. The downside is they can mask damage and interfere with healing as inflammation is part of the healing process. Of course, it is also possible that the pathology in my tendons is due to an abnormal inflammatory response and switching it off for a while may be of benefit. So despite my distrust of CS injections I opted to go ahead and get it done. I have two focal areas in my right hammies that continue to niggle and these were the areas to target.

The procedure is done using ultrasound guidance by a specialist medical imaging doctor. The preliminary ultrasound confirmed the presence of ongoing inflammation (not much change from seven months ago 😞). When injecting the solution (in this case Celestone - active ingredient betamethasone) it helps better visualise the tendons and the doctor commented that there are some big holes in my tendons. So yep they are trashed. Prognosis is pretty poor. The imaging doctor commented that he had not treated a lot of people with hamstring tendinopathy as it is not a common problem. He did mention one person with a big defect in a tendon that responded well to CS injection. He said that given the size of the holes, PRP would likely have limited effect given the inability to adequately immobilise the area post-injection. The PRP I had last year certainly hasn't helped.
I hope I enjoy pool walking as much as this woman 😉
So next step is the exercise rehabilitation prescribed by the sports doctor after resting for one week post-CS injection. The CS injection can take anywhere from two days to two weeks or more to have an effect (if it does). At less than 24 hours post-injection, there is no notable improvement, with a bit of 'injection' soreness. Payback karma perhaps from all my days as a horse vet and all the injections I gave my patients in the rump 😉! The exercise rehabilitation will involve some pool walking as this will load the hamstrings more gently and have the added beneficial effect of working the lower back to improve its mobility. Cycling is okay, recommence the walk/jog programme and keep doing all the gym work I've been doing. Then return to the sports doctor in five weeks time for a follow up and progress report.

I'd like to say I'm optimistic, but based on the ultrasound findings I'm not. However, now that I know the opinion of the specialist sports medicine doctor, I'll just figure out a way to manage this so I can stay somewhat active.