PRP - Round 2

At the beginning of February I had a PRP (platelet-rich plasma) injection to heal high hamstring tendonopathy/tendonosis.  (You can read about the procedure here.)  My hamstring had gotten so bad due to overtraining and failure to listen to not only my body but also professionals who were telling me to take a break.  That overtraining and continued running through pain ultimately led to 12 weeks off running, at which point I had the PRP injection, which required another 4 weeks off.  Was all the overtraining worth it?  I think you know the answer.  

Even now, 9 months post-PRP, I am still not fully healed.  I am running stronger and faster, have greater mobility and better form, but I still have a niggling pain in the top of my hamstring.  It has always been there.  I'd say at best I was 95%.  At worst I was probably 20% (pre-PRP) so that was a huge improvement!

Because I never fully healed, there was always the chance I would have a second injection.  Many people have PRP done twice and are very successful after the second time.  The plan was to get through my training, run NYC, and then reassess.  Coach Terra was helping me to make sure I was training smartly, getting massages, activating pre-run, and stretching/foam rolling post-run.  She was keeping tabs on how my hamstring was feeling and adjusting my weekly plans as needed.  The niggling was up and down but it was all manageable.

Then I tripped on a construction sign in the dark 7 weeks pre-marathon and strained my MCL.  KT Tape kept me running without knee pain but gradually the hamstring started to feel worse.  By the time I ran the American Home Fitness 5K it had gone from niggling to painful.  

As for the marathon, I didn't do much to prep for it hill-wise, fearful that I would ruin my hamstring in the training before I even got to the race.  Whether that I was smart or not, I won't know and can't worry about it now.  That course is filled with hills so I might have been underprepared no matter how well I trained here.  What I can say is that by the time I hit the Queensborough Bridge around mile 15, my hamstring was sore.  And by the time I came off that bridge at mile 16, my hamstring was just about done.  But I still had 10 more miles and the rest of the course only got harder.  After the marathon it hurt to sit or bend down to tie my shoes.

Up until this recent marathon, things were going relatively well.  Most of my runs were pain-free or with minimal pain.  However, if there is a chance I can be healed 100% I want to go for it.  If it doesn't work then I will cross that bridge when I come to it.

My procedure is scheduled for tomorrow morning.  I'll let you know how it goes!

Finding Strength

12 days post-PRP.  12 days of not being being able to bike or swim.  Those were my saving graces in the 13 weeks that I wasn't able to run.  I spent the first three days after my injection trying to be as immobile as possible.  According to my doctor and what I read online, those days are most critical for healing to occur.  It wasn't easy to be still but I knew it was important.  I used the time to rest, cuddle with the kitties, and finally get back to reading Born to Run, which I started reading about 4 years ago.  Now that I know a lot more about running, I'm finding it much more interesting and enjoyable than when I started reading it.

I knew I was healing and tried to remain positive; however, sitting around for 3 days with little movement started to mentally wear on me.  I started to panic.  If I was going this stir-crazy after only three days, what was I going to do for two weeks?  Sure I could use weights for my upper body but I was craving some heart-pumping cardio.  That's when I remembered the machine at the gym that is rarely used but would be perfect for me: the arm bike!

My spirits lifted when I thought of this!  It isn't the cardio I'm used to but it's something.  Since last Saturday, I've been at the gym every day, pedaling away for 30 minutes on the arm bike.  It's harder than it looks!  I get some cardio benefit while working my chest, shoulders, back, arms and core.  I increase the watts to make it more challenging and sometimes try one arm at a time for variety.  I found an article about arm bike benefits here.

I've also been working on strength training.  At home I use my dumbbells for biceps, triceps, and shoulders.  I have to be careful with core moves but can do crunches and Russian twists (feet on floor).  Yesterday I went to Mechanics at Detroit Tough and Coach Terra put me through a rigorous arm workout.  I did 4 circuits of biceps, triceps, chest, wall pushups, crunches, Russian twists, and shoulders (Y and T raises). My warm-up was 5 minutes of wall angels.  I'm feeling those today!

I know a lot of people get injured and can't run.  When that happens there are cross-training options - bike, swim, elliptical.  I never imagined I'd see the day when I couldn't do any of the above.  Instead of feeling sorry for myself (even though it was tempting to do so) I chose to embrace this opportunity to focus on strengthening my upper body.  

I may not get to run.  I may not get to bike or swim.  But I get to use to arm bike!  

Embrace your strength.  Focus on what you get to do.

Post-PRP

I'm sitting here with a whole day stretching out ahead of me.  My plans include sitting or lying on the couch most of the day and moving slowly around when necessary.  The pain isn't too bad but I'm definitely uncomfortable.  Squatting, bending, sitting down, and getting in and out of the car is hard.  I'm not going upstairs until I go to bed.  Basically once I get into a position I'm okay but the actual getting there isn't easy.  

The PRP (platelet-rich plasma) procedure went very well.  First I had an ultrasound, performed by Dr. Bouffard, a DMC diagnostic radiologist.  This gave a more detailed picture of what is going on with my injury than the MRI did.  My injury is on the right side so the radiologist took images of my right IT band, piriformis, glute medius and minimus.  Although it's my hamstring that is actually injured, due to compensation I sometimes have pain in my hip and he was able to see thickening/inflammation in these other areas, as well.  

Next he moved onto the hamstrings.  For comparison, he took images of both the left (healthy) and right (injured) hams.  Dr. Bouffard kept marveling at what he saw, telling me I was "textbook!"  I'm guessing he must not see runners too often!  My left side looked great but on the right he saw a problem at the the tuberosity (insertion point where I have pain) and definite thickening of the tendon.  Even though I was confident I'd made the right choice before this, I was relieved to hear Dr. Bouffard tell me there was a reason for my pain and that PRP was the right choice for me.  

After the ultrasound I moved to another room where a nurse drew my blood.  It was a pretty big syringe/plunger she took.  I should have asked how much but it was a good amount.  Next she spun it in a centrifuge for 15 minutes to extract the platelet-rich plasma. which ended up being a relatively small vial.

When my doctor - Dr. Haque, DMC sports medicine - was ready, he and Dr. Bouffard came in with the ultrasound machine again.  They used that to guide the needle to the right spot before injecting the PRP.  The needle had to be directly on the bone - on the ischial tuberosity - but it kept slipping off.  Dr. Haque said due to the tendinosis my hamstring is thickened, which was making it difficult for the needle to get through to the bone.  It was a lot of poking and moving the needle around while Dr. Bouffard monitored it's placement and positioning with the ultrasound.  It took a while but I was grateful that the doctors took all the time needed to make sure it was in the exact right spot.  Once it was on the tuberosity, Dr. Haque injected the PRP and that was that.  

I should expect to be sore for a while.  I'm hoping in a few days I'll be a lot less sore.  I have a follow-up appointment with Dr. Haque on February 16th.  No lower body work until then.  As I said in my last post, that's going to be hard but I'm thinking about the big picture.  I was reminded of these words that you often see at construction sites and roll your eyes at, wondering what "short-term" really means.  

This time, I know that short-term means only 2 weeks and that the relief at the end is going to be oh so sweet.

Read previous injury posts here: 

Injury Update - Hope in Sight

Injury Update - 7.5 Weeks

Injury Update - Still a Pain in the Butt

Injury Update - On the Run Again!

Video Analysis - Taking a Closer Look at My Injury 

Injury Update: Hope in Sight

This hamstring injury of mine has been a long, drawn out process.  The onset of pain was May 2nd and it has never gone away.  I've had better days and worse but the pain has been there for 9 months.  Running, walking, sitting, bending over to put on my shoes.  It's become one of the constants in my life.  

Just as stressful as the pain have been the appointments to try and get a clear diagnosis and proper treatment. First was my family doctor who finally referred me out to an orthopedic.  I had video analysis done with a physical therapist to check for weakness and imbalances.  Then there were the three rounds of physical therapy.  I took three cortisone dose packs.  Other anti-inflammatories.  I tried massage, yoga, and acupuncture.

Somewhere in there I took a 2-week break from running.  I still trained for the Detroit Free Press Marathon, albeit on reduced mileage and speed.  And I ran that damn race, even though it about killed me to do so.  After that I really scaled back, running one last 5k a few weeks later for fun, until I stopped running altogether.  For 12 weeks.

The first day I didn't run I had a meltdown.  It felt like my world was crumbling around me and I burst into tears.  My whole body shook as I grieved the loss of what is so much more than exercise - it's my release, my joy, my freedom, my peace.  I didn't know how I would live without it for an indeterminate amount of time.

Getting through the first week was the hardest but it got easier.  It helped that I could bike.  I rode that damn stationary bike every day, challenging myself to up the resistance and ride more miles (whatever that even means on those things).  

I also started going to Detroit Tough, where Coach Terra helped me gain strength and balance in her Mechanics class.  Thanks to her I can do solid pistol squats, real sit-ups, and a seriously good bird dog.  More importantly, she helped me remember to look at the big picture and got me through the tough days when I missed running the most.  

Coach Terra also taught me to be BOLD.  I never learned to swim as a child so I took 5 lessons and practiced on my own every Sunday morning.  I moved from the kick board to a buoy and flotation belt to finally swimming full laps across the pool with only the aid of fins.  They help my hamstring in a huge way, giving me a stronger kick and allowing me to glide through the water more easily.  I can swim without them but not nearly as well.

After 9 months my orthopedic doctor finally ordered an MRI for me.  It showed small tears in my hamstring, which is consistent with an overuse injury - high hamstring tendinopathy or tendinosis.  Because it is not tendonitis (inflammation), traditional therapies haven't worked for me.  Instead of being a nice smooth tendon, mine is grisled and gnarly.  It isn't getting good blood flow to the area and healing time is very slow.  Because this is been going on for so long, I need to speed up the healing process.  

Tomorrow I am going to have a procedure done called Platelet-Rich Plasma (PRP). Basically, the doctor will take my own blood, spin it in a centrifuge, and extract the platelet-rich plasma.  That will then be injected into my hamstring using ultrasound imaging to ensure it goes into just the right spot.  

This is still not exactly a quick fix.  After the procedure I have to rest completely from any activity involving the hamstring (other than walking).  Shut it down.  I'll have a 2-week follow-up and if all looks good I should be able to slowly start up again.  There will be 6-week and 3-month follow-up appointments.  The whole healing process should be complete by the end of 3 months but I'll be able to run before that.  Yes you read that correctly!  Barring any unforeseen circumstances I'll be running again!

To be honest, 2 weeks without any cardio scares the crap out of me.  Although riding that bike day after day got old, it was something.  But when I look back, I never thought I'd make it 2 days without running, let alone 12 weeks and counting.  If I could do that, I can do this too.  It's all about the big picture, which is getting healthy so I can be back out there doing what I love most - running.   

Read previous injury posts here: 

Injury Update - 7.5 Weeks

Injury Update - Still a Pain in the Butt

Injury Update - On the Run Again!

Video Analysis - Taking a Closer Look at My Injury 

Injury Update - 7.5 Weeks

It's been so long since I've run.  51 days to be exact.  It feels like forever!  High hamstring tendinopathy is a real b*tch.  Thankfully, I've been able to keep up my fitness in other ways.  I've been going to the gym and riding the stationary bike just about every day for 45 minutes.  At first the seat aggravated my butt; however, as my hamstring improved a bit that did, as well.  I tried spinning class a couple of times but found that getting in and out of the saddle, as well as hovering over the seat, left me in pain the next day.  Back to solo rides.

I've also been learning to swim.  Today will be my last of 5 lessons.  When I first started I only knew how to doggy paddle and had never worn goggles or a swim cap.  Now I can swim one full-length of the pool in a somewhat respectable manner.  I have a lot of practice to do and I don't love it yet but I'm getting there.

What I've worked the most on during these past 51 days is strength.  I've been going to Detroit Tough for a Mechanics class.  Coach Terra helps me with balance, mobility, and strength.  I've made a lot of gains from my work with her - both mentally and physically!  (Detroit Tough post to follow shortly.)

Along with my work at Detroit Tough, I'm also finishing up another 4 weeks of physical therapy.  This time I'm going to to Advanced Physical Therapy in Dearborn.  It's been a good experience.  Previous PT was done at Henry Ford Fairlane (not a great experience) and ATI Ann Arbor (good experience).  I've been going 3 days a week for 1-1.5 hours and completing exercises/stretches at home most days that I'm not there.  The exercises all work to strengthen the hips, glutes, and hamstrings.  I'll finish on Friday but continue my home program until I see my orthopedic on January 14th.  He has an option he's considering to speed the healing process, but that would also have recovery time in and of itself.  I will keep you updated on that.

Here are a few of my exercises from physical therapy (all photos courtesy of Brian Wolski):

Straight leg lift 1 of 4 ways (holding 3 seconds): I use leg weights at PT

Straight leg lift 1 of 4 ways (holding 3 seconds): I use leg weights at PT

Clams (holding 3-5 seconds)

Ball Bridge: part 1 (hold 3 seconds)

Ball Bridge: part 2 (hold 3 seconds)

People are starting to ask when I'll run again.  The only answer to that question is that I'll run when I'm pain-free.  After running in pain for 7 months, I'm finally doing recovery right.  

Boston 2015 is probably not going to happen after all.  It would take a miracle.  But I've made my peace with it and set my sights on fall marathons - New York and Chicago.  New year, new races, new cities to see on foot.  And more time to heal.

Read previous injury posts here: 

Injury Update - Still a Pain in the Butt

Injury Update - On the Run Again!

Video Analysis - Taking a Closer Look at My Injury

On the Run: Brooksie Way 1/2 Marathon 2014

*This is a long-overdue post from a race on September 28th.  Sorry for the delay!

The Brooksie Way Half Marathon fell on a day that I needed to run 22 miles.  My final long run before the Free Press Marathon.  While some might think it crazy to tack on an extra 9 miles to my race, I figured it would be a good training opportunity.  Plus the race would get me more than half of my long run, making the total miles pass more easily.  I did the same thing last year for Brooksie, with a successful result, so why not?

I got to the race super early.  There was a large contingent of RUNdetroit Flight Club members running so Justin and Alia had the store tent set up near the start line.  I was able to leave my bag there while I ran through the campus of Oakland University, trying my best to avoid hills.  (It's a hilly campus so I wasn't entirely successful.)  I took it slow, running those miles at a 7:59/mile pace.  

My hamstring was a little sore already so I was nervous.  I wasn't sure what to expect from that, plus Brooksie is a hilly course.  This year it was changed due to construction.  The first half is pretty flat and usually there are rolling hills throughout the second half.  Instead of rolling hills, however, there was one HUGE hill.  It looked pretty bad on an elevation chart.  I knew what to expect from rolling hills but had no idea what to expect from this new hell (yes hell not hill).  My hill training hasn't been up to snuff.  I was hoping to run the race in 1:30 but I would just have to see what happened once I got out there.  

Right from the get-go things were not looking good.  I was sore and people were passing me.  I felt like everyone was passing me!  Men, women, children.  Everyone.

By mile 4 I was ready to give up.  I wanted to hop on some kind of wagon and ride it to the end.  I managed to pass a girl on the Clinton River Trail but before I knew it she passed me again.  Doh!  Things were not going well.  Then around mile 5 I was heading around a curve, down a hill, into downtown Rochester, when I was suddenly closing in on 2 women.  And then I was passing them!  And then I chicked 2 dudes!  That gave me some motivation.  Maybe things would be okay after all.  I had a big smile on my face as I passed some spectators on a corner, turning toward the park that leads to Paint Creek Trail.  

What really gave me the boost I needed was when I passed the halfway point and one of the volunteers shouted to me, "3rd woman - and 2nd is just ahead!"  I'd had no clue I was that close.  In my mind I was 20 women back so to hear I was 3rd was shocking!  And I could actually see 2nd place.  I gradually picked up the pace over the next mile, took a CLIF Shot, and by mile 7 I had passed her.  

Things continued to go well from there.  Of course there was THE hill at mile 9.  It looked bad on the elevation chart.  In real life?  It was HORRENDOUS.  I felt like I was barely moving!  It had 3 false summits.  The worst part was actually when I got to the top and tried to get my legs moving again.  It felt like I would never pick up the pace again.  Eventually I did and ended up running the last mile of the race at 5K pace.  I think because I just wanted to be done!  

I held onto that 2nd place spot and finished in 1:30:41.  58th overall.  Then I hung out with the other RUNdetroit runners who had finished the 5K and 10K while we cheered on the half marathon finishers.  Here we are at the end!

RUNdetroit Flight Club members

After that I had 2 more miles to run, which were probably the most brutal 2 miles I've ever run.  I basically complained for every step of the way!  But then I was DONE!  And I was oh so happy to be finished running for the day!  Last long run?  DONE!  Last race before the marathon?  DONE!  I should be getting my award in a few weeks.  I'll post a pic when it arrives!  

Time
1:30:41 

Pace 

6:55/mile 

Fuel 

vanilla chia pudding, banana (pre-race)

Vanilla CLIF Shot (mile 6.5)

Tunes 

Dangerous / Big Data 
Water Fountain / tUnE-yArDs
Lazaretto / Jack White 
Lately / Soul Asylum 
Gotta Get Away / The Black Keys 
The Walker / Fitz & the Tantrums 
Shake It Off / Taylor Swift
Bitter Rivals / Sleigh Bells
Supermassive Black Hole / Muse 
Little Numbers / Boy 
Sixteen Saltines / Jack White 
The Innocent / Mayer Hawthorne
Machu Picchu / The Strokes
Mercy / Duffy
Dear Rosemary / Foo Fighters 
The Monster / Eminem ft. Rihanna
Can't Hold Us / Macklemore and Ryan Lewis

Kiss With a Fist / Florence + the Machine
Runaway Baby / Bruno Mars
Best Friend / Foster the People
Fast in My Car / Paramore
Get in My Way / Robin Thicke
Discipline / Nine Inch Nails
Blood for Poppies / Garbage
Brave / Sara Bareilles

Riptide / Vance Joy

Coming Soon: Detroit Free Press Marathon race recap!

Detroit Free Press Marathon - 1 More Day!

I haven't been updating you about tomorrow's race like I have for my last two marathons, mainly because of my hamstring injury. I started training late, wondering if I was even going to run the race.  I very loosely followed my training plan. I ran through a lot of pain. I was in PT and on anti-inflammatories for much of training.  My motivation dwindled. Due to these factors I adjusted my goal from a 3:05 finish (7:03 pace) to a 3:10 finish (7:15 pace).  This would put me ahead of Freep last year (3:14:49) but it wouldn't be a PR (Boston - 3:07:38).  

Things have improved.  I've had some good solid races in the past month, placing me at the top in several of them.  I ran the courses faster than the previous years' races, even if I didn't PR.  I kicked butt at Brooksie Way a few weeks ago (post will eventually be up!), which was the second part of my 22-mile training run.  So that got me thinking that maybe I could run this thing in 3:05.  So this week I had a mini freak-out about pace. Justin from RUNdetroit helped work out a good plan for me that will allow me to start out slower, pick up the pace after I'm good and warmed up, put in a good kick at the end (fingers crossed!), and still meet my goal.  

Anyway, whatever I end up running, I'm just hoping for nice weather and that my hamstring holds out.  I need the wheels to stay on until I cross the finish line.  Then I will rest.  

If you want to track me on your phone or desktop, you can do so by following these directions from the race Web site (www.freepmarathon.com):

• Follow on your iPhone/Android app store by searching "Detroit Free Press", download the free app, and then access our 'Track Your Runner' link starting TOMORROW MORNING on race day (note: link will NOT appear on the app until Sunday AM). 
• Desktop users can alternatively visit this link on race day morning to also track their runner: http://live.xacte.com/detroitmarathon

I'll post on my Vegan Road Runner Facebook page after the race.  Blog post will be later. I still owe you one on Brooksie Way so don't hold your breath!  haha!

Event: Detroit Free Press/Talmer Bank Marathon

Website: http://www.freepmarathon.com/

Start Time: 7:00 a.m.

Injury Update - Still a Pain in the Butt

It's been 4 months since the pain in my butt started and unfortunately, it's still there.  It's a persistent bugger.  My diagnosis started as piriformis syndrome but now we know it's actually high hamstring tendinopathy.  Here are the things I've done to try to heal the injury:

• 8 sessions of PT at Henry Ford Fairlane (30 min each, not very aggressive)
• 10 sessions of PT at ATI - Ann Arbor (60+ min each, aggressive therapy)
• 2 week complete break from running
• Yoga 3-4 times per week
• Deep tissue massage
• Thai yoga massage
• Acupuncture and cupping therapy
• Daily stretches for hamstring
• Strength training for accessory areas - hips and glutes in particular

While at ATI (which, by the way, is an amazing place to go for PT), the physical therapists used a few different machines - ultrasound, E-stim, and something they called "The Hammer" - all to help speed up the healing process.  They had me working hard while I was there and closely monitored my progress.  I had the chance to work with Tim Broe, who filmed me running and gave me exercises to help correct my form (posture, stride) so that I can prevent this injury from happening again.

The therapists at ATI did everything they could for me.  I had made progress but not enough.  It was time to see an orthopedic doctor.  Thankfully I was able to get an appointment right away at Dearborn Orthopedics & Sports Medicine.  I saw Dr. Plagens, the team doctor for the Detroit Red Wings.  He concurred with the inflammation diagnosis and put me on an oral Cortisone taper for 6 days (6 pills on day 1, 5 pills on day 2, etc), followed by an anti-inflammatory drug.  I am supposed to be stretching several times throughout the day.  He also advised to "take it easy" with running - whatever that means. I see him again 2 weeks from today.

It's hard to say how much better I'm feeling.  The pain is less intense when running - more of a dull aching than a stabbing - but it's still there.  I can drive for longer periods of time before it becomes excruciating but it's still uncomfortable.  My legs are seemingly always tired and my speed just isn't there.  Am I better than a month ago?  Yes.  But I am far from "better."  It's frustrating.  

So I will continue with the stretching and anti-inflammatory until I see Dr. Plagens again.  He said if things are not improved he will look into other options for me, including an MRI to see if there is more going on.  

I will keep you posted.