Category Archives: injury

Week in Review: 10.1.18 to 10.7.18

First cutback week in a while, which was much needed. Per usual, I spent the first few days of my cutback week feeling awful. This was exacerbated by a flu shot that wiped me out (no regrets, better than the actual flu!). By the end of the week, however, I was feeling rested and ready to tackle a full volume week. Last push towards Savannah!

Monday: 25 minutes easy plus arms. (Still on the online video train, btw. This was the one I did this week.)

Tuesday: Hill workout. Warmed up for 20 minutes then 6 by 45 second hills hard. Cooldown after for total of 45 minutes. Legs after.

Wednesday: 25 minutes easy plus PT. Moving into the part of PT where I am recovered enough to remember how terrible my balance is…

Thursday: Planned rest day.

Friday: Early, early morning workout. Fridays are always pandemonium and I had a concert on Friday night, so figured 3:15 am was safer than pretending I’d get it in after work. Progression run on the treadmill ending with 10 minutes continuous at tempo pace. Kettlebell legs after with the curtsey lunges that always kill me.

Saturday: 25 minutes easy on sore, sore legs courtesy of above.

Sunday: Easy 60 minute run plus striders and core.

Total Miles: 25 

How DO You Get Back to Running After Injury?

Short Version: Slowly, methodically and with no glamour.

May: Almost no activity besides PT and surviving the day

Early June: Light recumbent biking, PT

Late June: Light elliptical, biking, and PT

July: Elliptical, Walk Jogging, and PT

August: Walk-Jog to Continuous Jog 3 to 4 days a week

September: Building up to 5 days a week, initiation of basic workouts

October: 5 to 6 days a week, building to 35 miles per week, base phase workouts

Longer Version:

Tearing my MCL was my first “surprise” running injury and as result, my recovery from my MCL was different from my fasciotomy and tarsal tunnel release. Because of the extent of damage to my knee and because the MCL is the “gatekeeper” of the knee joint, I was in a big, clunky immobilizer for almost 10 weeks. At first, I had to wear it any time I wasn’t sleeping or laying on the couch. This was because without an MCL, my knee was vulnerable to additional injury with any twisting or extension. After a few weeks, I graduated to only wearing it when I was going to be at work or walking around but could have it off for PT or around the house. Around this time, I started biking again with the immobilizer in place. This was essentially only to get blood flow through the knee. I assure you, there were minimal cardiovascular benefits. By the end of June (6 weeks out), I was on the elliptical for 30 minutes of very easy effort.

On July 3rd, I went for my very first “run.” The rules were strict: no pivoting, flat surface only, no more than a few seconds at a time. As this was my first walk without my brace with the exception of PT, suffice to say, I was very tentative. As I was starting to wean off my brace at work (12+ hours with stairs, elevators, standing and twisting), I took it easy with any additional exercise. Throughout the rest of July, I slowly built up my running with a run-walk approach. When I got to a point where I could run for 5 minutes before a break, I switched a continuous short run instead.

August was where I really started to run regularly again. I was still restricted to no pivoting so spent a huge amount of time on the bike path down by the river. I transitioned to slow, continuous running and built up to 20 minutes 3 to 4 times a week. By the end of August, I started adding drills back in. I started with just stretching drills first and finally added dynamic drills at the end of the month.

September was the first month where I felt like I might actually be able to recover from my injury, a full 4 months later. I built my runs to 30 minutes, added in a long run, started very simple workouts and finally, got back to 5 to 6 days of running a week. My last week in September was as follows:

Monday: Tempo Effort with 2 by mile at Tempo Pace, 5 miles total. Legs after.

Tuesday: 50 minute easy group run

Wednesday: Off day.

Thursday: 32 minute run

Friday: 30 minute run with 6 by 1 on, 1 off.

Saturday: 35 minute easy run

Sunday: 90 minute long run.

As you’ll notice, essentially all of my runs are time based. I did that intentionally to avoid any comparison trap for myself as I come back. Prior to my injury, I certainly wasn’t in peak shape but my mile pace was my usual 8:00 to 8:15 for easy runs. Afterwards, it took me anywhere from 10 to 11 minutes to run a mile and I wanted to avoid the temptation to push myself before I was ready.

I am a long way from where I want/need to be but I am also feeling well and have no knee pain. Even better, I have an endpoint to my MCL which means that things are coming back together. I still can’t pivot or run on other surfaces but I am slowly, slowly making forward progress.

Hey.

When I finally figured out my password to this site and was trying to figure out a way to start up again, all I could think about was that I feel like a terrible ex who ghosted someone and is coming back 12 months later to see how they are. So, in homage to everyone who has ever been ghosted or done the ghosting, let’s just call this blog post, “Hey.”

In many ways, a lot and nothing has happened since I last wrote after RDC. I’m not an intern anymore, I’m not even a brand new PGY2 at this point. I let all my sponsorships go in December of last year. I tore my MCL in May and took most of the summer off (more on that later). I’m just barely back to training semi-normally. So what prompted me to write again? A few things.

First, I tried to break up with running last winter. At the time, I was blaming running for all the stress in my life. So I stopped. Sure, I plodded along a bit and I even ran a decent enough 8K. But I really wasn’t into it and I didn’t even think I missed running. Then I met Dave, who happened to be one of my Attendings, but who also happens to be a runner and talking with him about running and racing made me have the smallest inkling of missing IT. Dave connected me with Ellen, who became my first real running friend here and those miles with her made me admit out loud that I missed it. And then I tore my knee.

May was actually a decent running month for me. I built back up to 30 miles a week, which was a LOT on an intern schedule, and my long runs were moving along. I was starting to daydream about a fall race and even had a great workout on a trip home in May. The purpose of that trip? Seeing one of my dearest friends (and running buddies) from medical school get married. She and her husband are going to have a lot of luck because their wedding day was RAINY. Anyway, flash forward to the reception and me dancing in heels on a rain soaked floor and…twisted knee, instant inability to bear weight, shit. I hobbled back to North Carolina, saw an amazing Orthopedic Surgeon, got an MRI and sure enough, Grade III MCL plus a bonus avulsion of my gastroc. Not optimal. I spent the remainder of May, June and July in an immobilizer and in intensive PT. I was exceedingly lucky to find (through my awesome Orthopedist) a phenomenal physical therapist in Sean, who spent a huge amount of time rehabbing my knee with cool technologies like BFR (blood flow restriction) therapy (which Heather Kampf just used during an injury and came back to win the Navy Mile last week).

Anyway, it was a long, suboptimal summer of training but all of my work with Sean has paid off and not only am I back to running 30 miles a week, my SPARK for training is back. I am day dreaming on runs again when three weeks ago, I was having pity parties. I babbled at Will for 10 miles on Sunday about my hopes and dreams and goals. He and I can both assure you that hasn’t happened in a very long time.

What prompted me to write, however, was the fact that this blog has always been a place to process what running means to me, to think aloud as it were about training, running, and racing. It has captured the heartbreak of bad races (still not over Philly) and celebrated great ones. It has forced me to evaluate my rehabilitation and recovery through two surgeries. It has followed me through the entire process of becoming a physician. So even if, after a year of silence, no one reads it anymore, this blog is the best way I know to figure out who I am as a runner at whatever stage of life I find myself.

So what’s next? Up first is the RockNRoll Savannah Half. I am doing this with friends and quite legitimately, don’t have any big goals besides finish. In my head, I’d like to try to challenge myself to get of sense of my fitness but if I finish and my knee doesn’t hurt, it will be successful. Beyond that, my next big goal is the San Diego Half in March. I’ll be completely honest – I have a lot of hope for this race. If I can get back down into the mid 1:20s for this, then I’ll look at aiming for the Trials Qualifier or at the very least, a marathon PR for the fall of 2019.

Hey. I missed you. Love Sarah.

Week in Review 10.26.15 to 11.1.15

Monday am: 15 miles with 8 at marathon pace. Ended up being 6:23 pace, so I was psyched with the effort.

Monday pm: Drills, 1 mile warmup then legs in the weight room.

Tuesday: 6.5 mile recovery run.

Wednesday am: 9 mile recovery run in what turned out to be miserable weather.

Wednesday pm: Drills, 1 mile warmup then striders.

Thursday: 400s on the track. Given the crazy wind on the home stretch, rotated start points around the track. Goal was 85, result was pretty dependent on Mother Nature. 84, 83, 84, 83, 82, 85, 82, 83, 85, 84, 85, 85, 86, 85. Legs felt totally awesome but it was admittedly frustrating in the wind. Legs afterward.

Friday: Unplanned rest day (I planned to take it on Saturday) courtesy of the dogs, who accidentally knocked me down in the driveway. Knocked the wind right out of me and banged me up pretty good but after laying there for a few minutes panicking that they had broken my leg, I determined that I was mostly okay.

Saturday: 4 miles in the early morning before we headed out then another 4 around the States Course. Amazing day for us, with some great teamwork and some stellar individual performances too. We beat Burlington by 1 point to qualify for the New England Championships, which was our team goal for the year. Doesn’t get better than that!

Sunday: 8.9 miles with striders.

Total Miles: 65

Total Miles for October: 282

The upside of a flexible schedule is that I can push my long run to tomorrow since my legs (and body and soul) are tired from yesterday. The downside is that it makes me feel like I’m messing up my training because I’m not following some arbitrary schedule. This downside is obviously all mental – my body doesn’t care that tomorrow is Monday. Still, it irks me!

Besides my fall on Friday, this week was actually a great week of training. I’m starting to feel really strong and am continuing to improve in workouts. I don’t have a lot of “big” work left before taper, which will start the week after next. My long run tomorrow will be long: 2 hours 15 minutes with 5 by mile at tempo pace and 8 by 200 hard at the beginning. With the tempo miles, this will be about a 17 mile effort. Later in the week, I’ll do my long run on Friday because I’m headed to DC this weekend to see my best friends for our Friendsgiving. I’ll be running while I’m there but it’s much less stressful when I don’t have to get a 2+ hour long run in.

Move That Ass

Since starting 3rd year, I’ve been living some great combination of standing, sitting and running all over the hospital in heels, clogs and on rare days sneakers. Thanks to this, my a** has been killing me since about March. Right on cue, another blogger friend sent me a great followup post about how to fix butt pain when all you do is sit. This applies to almost all of us, regardless of profession. In our culture, we sit. All the time.

Since getting his email and getting fed up with constant pain, I’ve been much more diligent about taking care of my rear. I get up when I sit for a few hours, try to use good posture when I have to stand (in the OR, on Rounds, in the ED etc) and stretch whenever appropriate, especially focusing on my hamstrings and hip flexors. It’s hard to stay on top of it but I’m much happier when I do.

How do you handle sitting all the time?

Week in Review: 12.15.14 to 12.21.14

Winter running is in full effect, including stutter step runs across ice and so many layers that one looks a bit like the kid in the Christmas Story.

Monday: 6.8 miles.

Tuesday: Workout! Ran to gym then 2 by 10 minutes on the treadmill at 170 bpm (T Pace) which turned out to be 6:40 pace. A little slower than in cycle but that’s to be expected. Lifted arms after.

Wednesday: Cross training, skied with the team.

Thursday: 4.25 mile recovery run plus hour ski with the team afterward.

Friday: 7 mile run. Legs wiped from a week of doubling.

Saturday: Hour of skiing at Sleepy then with Will. Scar and FHL bugging me.

Sunday: 9 mile run.

Total: 33.4 miles of running, 4 hours of skiing.

Happy to get some longer runs in this week and my first workout back. My foot is struggling with skiing right now (just hasn’t had to push off like that in a year), but hoping some stretching and scar cross friction will help resolve that. Looking forward to a week with a less insane schedule so that I can keep getting longer runs in.

How Do I Get Ready for Speedwork Again?

A fellow runner is coming back from injury and asked for some input on how to get back into workouts after a bit of a layoff. It’s a great question and one that I face as an athlete at the end of the off-season and as a coach when we transition from summer mileage to in-season workouts. I don’t know how others feel, but there is little more daunting about those first workouts back. Despite the fact that an underwhelming workout doesn’t mean anything, there can be SO MUCH PRESSURE. These two workouts are designed to take the pressure off. One has no prescribed recovery time; you go when you’re ready to go. The other is just time based; when time is up, you’re done running hard and jogging back down the hill.

Caveat: If you are coming off of a long layoff, your first step should be to add striders back in to the end of your run. Aim for 4 to 6 at 90% pace and good form. Once you’ve done those for a week or two, you’re ready for the next step back towards the following workouts.

3,2,1 Rust Buster

Packard Repeats: This is named after the workout we do on the First Day of School every fall on a hill near the high school. Find a hill that is about a quarter mile long and after a warmup, alternate between 30 seconds, 60 seconds and 90 seconds hard up with a jogging return. Aim to do three sets (9 minutes of hard work). The benefits of this workout? Because you’re running uphill, it encourages good leg turnover and begins to strengthen your quads, two key elements for successful speedwork.

What workouts do you use to get back into the swing of things? Do you do strides regularly? (Hint, you should!)

P.S. Welcome back Fox!

I Walk The Line

I’m quite confident that Johnny Cash wasn’t talking about running when he penned “I Walk the Line” but he nailed it when he sang I’ll admit that I’m a fool for (running). I’m currently walking the line between fitness and foolish with a foot that just doesn’t quite want to get on board with this training cycle.

My general rule for aches and pains is to ask myself three questions:

  1. Have I had this pain before?
  2. Does it get better or worse with running?
  3. Is it changing my form?

With exception of broken bones or some serious injury, if a pain is new, goes away as I warm up and lets me run almost normally (as normally as I run with a post-op foot), I assume it’s volume related discomfort and carry on. Sometimes I’ll do an extra recovery day or tone down a workout but this has worked well for me over the years.

My current “niggle” is giving my injury approach a run for its money, however. When it started, it was just a little soreness across the top of my foot. As I’ve learned to run again after surgery, I’ve had some assorted foot pain as I got back up to mileage and figured out how to carry my foot. Given this, I assumed this too would pass. However, in the last week, the top of my foot has gone from a little uncomfortable to really fucking painful (that’s official doctor speak for 8/10 pain) on occasion, especially after hard efforts. Just when I’ve gotten to a point where I am thinking I need to take a day or two off, I’ll have a totally pain free run. For example, on Saturday, my foot was sore doing an hour of recovery running and I wasn’t hopeful about my Sunday long run. Naturally, I did 18 completely pain free miles on Sunday. Yesterday I could barely walk. Today it’s much better but still a little tender.

I’m pretty confident it’s a touch of tenosynovitis of the extensor tendons, the little guys who help lift your toes. With high arches and some hesitation on my surgery side that leaves me in dorsiflexion a little longer than desired, it’s not surprising that they got inflamed. They seem to be happier when I add an extra recovery day between efforts, tie my shoes loosely, add a little KT tape to help them out and ice after my runs.

I have some unhappy tendons...

I have some unhappy tendons…

Dealing with little injuries like this is always a thin line. As I said to a running partner this morning, if I had any suspicion that this was something more serious, I’d take time off. If I took an off day every time I felt sore or tweaky, however, I’d never get my mileage in. That’s the cruel fate of the distance runner; it’s a rare day when something doesn’t hurt or ache. In our house, the first few minutes of the day are spent creaking around, hanging on to the railing on the stairs while we warm up. I’m sure my neighbors who see me warm up and cool down would be surprised that I can run faster than 10 minute miles.

How do you triage little aches and pains? What’s your niggle of the week?

It’s All About the Science. And Beer.

Admittedly, I didn’t do much outside reading this week. Neural Science is easily the hardest class in medical school thus far (at least for me, I have trouble imagining structures) and keeping up with school and mileage shrunk my average sleep by over an hour this week. Ooops. Regardless, what I did read seems to have centered on some great writing on the things we accept as “truth” in running. I’ve been a competitive runner since I was 14 and even I have seen quite a few trends come and go. I won’t touch the 5 Fingers news from the week because almost everyone else has and I didn’t need longitudinal data to tell me that those weren’t a good idea.

First, a fantastic post by Chris McClung on the Myth of Over-Pronation. I’ve run enough and coached enough to see lots of different kinds of form be successful. I’ve watched enough races to realize that there is no perfect. Why should we expect anything less from our feet and foot strike? I don’t totally agree with McClung that we should throw out everything but our neutral shoes but I do agree that maybe we should focus less on finding a shoe that makes us hit the ground perfectly and more on building a strong kinetic chain.

Second, an interesting culmination to a week-long conversation on training pace from Peter Larson and Caleb Masland. In the series, Larson, Masland and other athletes explore the idea of training pace. All three line up on the idea that faster is not always better for training. I couldn’t agree more. One of the biggest struggles I face as a coach is convincing athletes to slow down. When you are getting back in shape, it’s tempting to push the pace to try to accelerate fitness acquisition. When you are a hair’s length away from a PR, it’s tempting to push the pace to get there. By and large, the only place you’ll get in these scenarios is injured. Last year, Greg McMillan wrote an article on longevity that really resonated with me. For a long time, I wondered if my religiosity towards slow long runs and easy runs was holding me back. Although I’ve had two surgeries due to anatomical freakshow-ness, I’ve never struggled with injuries. I’ve never had a stress fracture. I haven’t had shin splints since 1998. I attribute much of this to the fact that I have no problem running 90 to 120 seconds slower on long runs and even slower on recovery runs. The paces that matter are race paces and workout paces.

As I’m coming back from surgery and dealing with the aches and pains associated from reminding my body that it can run, I’ve been careful to make sure the foundations matches the architect’s plans. This article is a simple but excellent summary of what systems need to be in place before real workouts can begin.

Moving on from science, the Kara Goucher sponsorship train keeps on rolling, this time with Nuun. I’ve never tried Nuun, mostly because I don’t worry about my electrolytes but I am interested in their new energy product. I find myself slumping in the afternoon but work hard not to have another cup of coffee. Adding a little zip to the water that I need to be drinking anyway appeals to me.

Finally, I’m really anxious to find out the date of the Beer Mile World Championships. I’m running a marathon on October 12th but if the Championships are later, I’m giving full thought to going for it. I’m a serviceable miler but I was an excellent beer drinker in college and feel strongly that this might be my event.

What did you read this week? Have you tried Nuun? Anyone done a beer mile and have advice?

4 Weeks (and a day)

It’s hard to believe that I’m a month out. With my first surgery, I was still in pain, just recovering from my DVT and on crutches with no weight bearing. By contrast, I spent my 4 week anniversary yesterday walking in real boots at practice, biking and lifting. Granted, the regular boots were an experiment and a failed one (so not ready) but it was good to push a little.

I did 60 minutes of aquajogging on Sunday, so I think I’m ready to step up the cardio a little. My other new focus is transitioning out of my walking boot. I’ve been walking around at home some but am still very unstable. Over the next week, I’ll be working on walking in a sneaker daily and on the stability pad to take the next step (literally) towards running.

20140128-100445.jpg