Brooklyn Half

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It’s Brooklyn Half time again! Last year I volunteered at the event, which got me guaranteed entry into this year’s race. I was excited to sign up because I was leading the New York Running Company Half Marathon Training Program for the race.

Training was going well, until about five before the race, when I started to have intense knee pain on my right leg. This has been a bit of a lingering injury; sometime in the fall, I tweaked my knee taking off too quickly at a November Project Destination Deck workout (City Hall, to be exact). That specific moment made me say ouch, and there was a bit of difference in my knee through my winter training. This year, it was feeling better, even through my Spartan Race on Saturday, where I did a lot of stairs without pain.

This might have done me in. Early in the week I was fine, but Wednesday I started to have high calf pain in my right side (not a spot I typically have pain) and then pain above my knee at my quad. I picked up my bib anyway, thinking I might be able to feel better by the weekend. The pain moved to the outside and then under my knee, and there was a popping that happened each time I moved my knee. Stairs were out of the question both up and down.

I saw Brynn on Thursday and decided to rest. This is not my A-race and I want to be able to really push it there, so I skipped Brooklyn Half.

My athletes did great, with new PRs for our NY Running Co participants and people I’m coaching privately. Real race day is 3 weeks away, so I’m resting until it feels better.

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One Year Follow Up

So much of my writing recently has been about my nagging leg injuries, but today I have news about my upper body! May 15 was one year since I fractured my left clavicle, and May 22 was one year since the surgery to repair it. I went to Dr. Frank Cordasco‘s office at the Hospital for Special Surgery (#1 in orthopedics in the nation!) to get a one year xray and follow up to make sure everything is okay.Image

First, the accident: May 15, 2013, I was riding my commuter fixed gear bike home from work. One and a half blocks away from my apartment, I flew over the handlebars unexpectedly. I landed on my left shoulder and helmet, rolled onto my back, skid for 10 or so feet, and then rolled toward the sidewalk in a panic. I was in the bus lane and I wasn’t sure why I flew over my handlebars, but I thought I might get run over by a car or bus. When I stopped sliding and rolling, I lifted my head and saw two bikes. And a person. With no helmet on. He lifted his face off the ground, spit out teeth, and oozed blood from his nose. I was in much better shape than he was after the crash; I walked my bike to the curb and locked it, I waited while people collected my keys and items that flew from the pockets of my bag, and I watched the EMTs treat the other guy. I knew my collarbone was broken and my season was over. Then I was sad. I had a weird interaction with the EMTs, and then I Googled specialists for athletes and found Dr. Cordasco. I was in surgery one week later.

On September 6 I was cleared for take off and I started training for HITS Naples. Cue my triumphant comeback! You know the rest. So today was to make sure healing was fine and the hardware was okay. The scar looks great, and my strength in my arm and shoulder is back to normal. My swimming is fine, and I never experience range of motion issues. I do, however, know when it’s going to rain by the pain in my bone. I also have pain when I wear a back pack or bag, or anything touches my left shoulder. Massage on my shoulders even sucks. You can see the hardware through my skin, so I brought this up. 

I did a quick few xrays, and then saw Dr. Cordasco. He said the ridge I can feel and see probably isn’t a screw head, but is the edge of the plate. If it were a screw, it would be easier to deal with – a quick incision, drill it out, and don’t sweat for a week. But removing the plate would leave one plate (the front plate is fine) on the bone, but would leave five Imagescrew holes like swiss cheese through the top of my bone (the screws stick all the way through), making the bone more susceptible to fracture should I ever crash. It would also be a few weeks of recovery time and not training, and I’m in the middle of training for my season right now, so this is not ideal.

I said it’s something I can live with for the time being, and he suggested removing it in the off season (“if there is such a thing”) or whenever it bothers me too much. He said the goal is not to have to “live with it,” but to have it be as good as possible. 

I chose to leave it for now, and revisit it later. 

My favorite part was at the end of the visit, standing with my shirt off, when he enthusiastically said, “you look fantastic!”

I believe that is surgeon code for, “I did a damn good job on that scar!” (and he did!)

Testing

Since May 18, I’ve been allowed to run outside with the conditions of 4 miles or less, slow, pain-free, and every other day at max. I cheated on the 4 miles part a bit. 

– Sunday, May 18: 3.9 miles. Good!
– Tuesday, May 20: 2.6 miles. Stopped because of pain. Not good! Didn’t count this.
– Wednesday, May 21: 4.1 miles (to and from November Project, but didn’t do workout. Just a LOT of planks). Okay.
– Thursday, May 22: 5.6 miles easy to and from Empire speed work workout. Okay. Didn’t do workout.
– Friday, May 23: ride
– Saturday: swim
– Sunday: ride
– Monday: run 4 miles. Good.
-Tuesday: ride
– Wednesday: 6.9 miles (to and from November Project, did not do the workout). Leg did not hurt, but was annoyed. 

Here’s today’s surprise distance: Image

 

Friday I’m back at Finish Line for a follow up on this. Slow progress, but I’m feeling slightly better. I’ve been off and on with the Aleve, and I’ve been experimenting a bit with pace through running by feel. It feels a little better to run faster than at a slower pace.

So, progress! I’m forcing myself to not get too excited and do too much too soon, but I did sign up for a June race, which made me feel a little better.

Cleared for outdoor running

Last week I ran twice on the AlterG treadmill at Finish Line PT. The first session on Wednesday was 35 minutes at 75% bodyweight, which was a slow go but still pain-free. After, my back hurt a bit.

Thursday I went to my general doctor and gave the whole story about my leg and back. He said it would be overkill to do any scans or imaging of my back just yet, and suggested taking Naproxen for two weeks to reduce the inflammation of the back and leg, suggesting that it might be muscle spasms that haven’t been able to sort themselves out. My leg has been feeling better since it’s ocean soak last weekend, so I agreed with his overall assessment and have been taking Naproxen 3x daily. 

Friday I returned to Finish Line and did another 4 mile run on the AlterG, this time at 85%, which then cleared me to run outside. What a relief! The specifics are:
– 4 miles max
– slowly and PAIN FREE
– rest at least one day between runs
– no speedwork, no hills, nothing crazy 
– be attentive to terrain
– after two weeks of this, I’ll be cleared to integrate running back into my training

It is awesome to be back outside on the run. Yesterday I ran four pain-free miles uptown. And then immediately went home and signed up for a race. 🙂

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Progress

Yesterday (5/14) I ran for 35 minutes on the AlterG treadmill – PAIN FREE! I did a 9 minute pace at 75% of my body weight – better to start slowly than to risk jumping in too quickly. I felt good while running, and then did a series of hip flexor stretches and calf rolling/trigger point after. Following this, my lower back started to hurt again. 

The injury report card has been updated to reflect new progress and issues for my doctor appointment today with my GP:

4/30 rest, saw orthopedic, got x-ray (negative)
5/1 rest, did MRI (negative)
5/2 rest
5/3 rest, did ultrasound of leg (negative), back hurt
5/4 rode 81.8 miles, leg hurt slightly when pulling up on pedals, back hurt going up hills
5/5 rode 36 miles, back hurt slightly
5/6 rest
5/7 saw PT, did exercises & light soft tissue work. Recommended seeing GP
5/8 calf hurt
5/9 vacation! spent time in salt water which seemed to help. 
5/10 calf hurt walking in sand, back hurt sitting at dinner
5/11 back hurt sitting at dinner
5/12 back hurt, leg felt great
5/13 leg hurt walking home. rode 25 miles. felt back pain
5/14 35 min on AlterG. Felt mostly good after, some back pain
 
Tonight I see the doctor with a long list of complaints, although I do feel like I’m on the mend. The key, I think, is to take it slowly. 

 

Ruling out options

ImageI’ve been battling some injuries this month, and for longer than I think some of them should last, so this week was the week to rule things out. To briefly recap, I flew to Chicago for the Trans 100 event at the end of March (somewhat relevant). On April 2, I had pain in my right calf – a new spot, and never a previous source of pain – during a run. I ran on it twice more, thinking it was a tight muscle or that it would loosen up over time, but after April 6, I stopped running altogether and put it to rest. The pain in my calf persisted, it moved, and eventually was waking me up from sleep before my alarm.  On April 22, I started to get a pain in my lower left back, which started swelling. Last night it was more swollen than ever, with my wife saying it looked like “a little fist” was poking out of my back.

Gremlins!

On Wednesday, I had an appointment with an orthopedic specialist, who said he felt a bump in my bone with his hands. He showed me on the x-ray where the oddity was, but said it was inconclusive. He ordered an MRI. I did it at 6:15 am Thursday, and got the news Thursday afternoon: no stress fracture. (WHEW) I asked about the pain in my leg and other causes, and he said I need a “good PT and maybe run on the AlterG.” My thought was that a calf strain should have healed by now.

Somewhere in the middle of this – the day I woke up from leg pain – I had the thought of deep venous thrombosis (DVT) and got worried. My brother had a vein removed from his leg after two episodes. I also had two TIA episodes when I was 20, which made me concerned. I spoke with some runner friends who said DVT was common in endurance athletes, and the flying part just before the first pain was concerning. Another ambassador for Empire Tri Club is a doctor, and recommended I get it checked out; he sent me the exact tests to ask for at the doctor and urged me to do it sooner rather than later. I did mention all of this to the orthopedic, but he quickly dismissed it.

ImageLast night I set out my kit and nutrition for a long solo ride today. My club is doing a brick, and since I can’t run, I thought I’d get an easy 80-100 miles in and enjoy the weather. I woke up and felt the pain in my back and my leg, and thought about my shortness of breath in the past few days; I put on real clothes and went to the doctor to rule out DVT.

Being a generally healthy (although somewhat injury prone) person, no one there was too concerned about me, which was both comforting and unsettling at the same time. I got an EKG to start, and freaked everyone out with a resting heart rate of 39 BPM. A nurse practitioner did a physical exam of my leg and back and ordered an ultrasound. I got three tubes of blood drawn for a complete blood panel and D-Dimer test to rule out clots, and then got the ultrasound. Then I waited on a stretcher in the hallway.

I’ve been very good about tracking all of this. I’ve been getting antsy to run but to be honest, it hurts too badly to even try to push it. I’ve even been weary of the bike, which has hurt a bit when I pull up on the pedals. My Strava tells the full story of the amount of pure rest this calf has gotten:

4/2 first felt pain on run, stopped halfway through. 4.8 miles
4/3 easy jog to Empire run, did not do workout because of pain (thought maybe it would loosen up with easy run). 4.9 miles
4/4 rest
4/5 bike
4/6 ran to work, 5.4 miles. did not loosen up. 
4/7 saw PT, advised to rest
4/8 rest
4/9 rest
4/10 bike
4/11 bike
4/12 rest
4/13 bike
4/14 bike
4/15 rest
4/16 rest
4/17 rest
4/18 rest
4/19 bike
4/20 rest
4/21 rest
4/22 rest
4/23 saw PT, light soft tissue work, advised to see orthopedic
4/24 rest
4/25 rest
4/26 rest (ran half block for bus, hurt for 3 hours)
4/27 swim
4/28 bike (woke up before alarm because of pain)
4/29 rest
4/30 rest, saw orthopedic, got x-ray (negative)
5/1 rest, did MRI (negative)
5/2 rest

Four and a half hours after walking in, I walked out with a paper that says, “Myalgia, Adult: Myalgia is the medical term for muscle pain….” The tests ruled out blood clots, which is great; it is certainly good news that I don’t have a stress fracture or DVT, but I’m still not sure of the cause, which is concerning for my calf, but even more for my lower back, which has the swelling. They said to keep an eye on it, and if it gets red, warm, or worse, to come back.

So the plan is to ride my bike those 80-100 with friends tomorrow, still not run, and see my PT asap to try to work it out. I do feel relieved that it is not serious, but the frustration of having it still be a mystery is a bit upsetting.

Here is my official “no shit, Sherlock” diagnosis:

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