Showing posts with label physical therapy. Show all posts
Showing posts with label physical therapy. Show all posts

Monday, February 2, 2015

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: 

Thursday, January 8, 2015

Detroit Tough - Why I Love My Gym

It's about time I get down to writing a post about my favorite gym - Detroit Tough.  Although these days, Detroit Tough isn't just my favorite gym.  It's pretty much my favorite place.  It's where I go to find inspiration, healing, and peace.  Yes, peace among the smashing weights, loud yelling, and Slayer music blaring in the background.  Somehow I feel calm there.  It's my happy place.  My home away from home.

I started going in November and working with Coach Terra Castro, a former professional Triathlete.  She is an all-around amazing person and came into my life at just the right time.  She launched the Detroit Tough Endurance Program in November, which includes Run, Bike, and Swim classes.  I haven't attended any of these classes yet but am looking forward to doing so in the coming months, once I'm healed up. 

Also part of the program is my favorite class - Detroit Tough Mechanics.  It's an injury prevention/rehab class that targets mobility, body mechanics, strength, and balance.  As Coach Terra says, "we need to focus on the little details to keep our engine running properly."  

For me, this class has been key with my hamstring injury - both mentally and physically.  It has been better than any PT I've received.  We do band work (clams, monster walks, squats).  We use balance balls (hamstring curls, leg extensions, Supermans).  We use medicine balls (wall ball, Russian twists.)  She has us using the TRX system, lifting kettle bells, and using boxes for mobility drills.  One day we even got to beat the crap out of a punching bag with a baseball bat.  It's never the same class twice and it's always awesome.  

Coach Terra is kind, gentle, and understanding of what it's like to be injured.  She's been a lifesaver!  She will, however, push you to your limit.  We've done 5-minute planks.  100 calf raises per leg.  100 sit ups.  No whining, no excuses.  And I love her for it.  Nothing ever hurts my hamstring when I'm there.  She makes sure of it.  

Here are a few of the exercises we do in Mechanics.  (Photos courtesy of Coaches Terra and Roger.)


 Strength - Wall ball.  Squat and throw against the wall. It's harder than it looks!


Mobility - Under and over.  Knock one down and it's a 5-minute plank penalty.


Balance - Bird dogs with PVC.  Keep the hips stable or the pipe falls (5 push-up penalty).

Movement prep - Great rehab for my hamstring; also great for non-injured runners too!

Therapy - I wrote "hammy" on the bag and beat the crap out of it.  It felt amazing.


I'm looking forward to my hamstring being healed so I can take advantage of the rest of the Detroit Endurance Program, along with more of the classes that the gym has to offer. I'm especially excited to do Coach Roger's Detroit Tough class.  I actually did it once when Coach Terra and Coach Roger teamed up and combined their classes.  It was the most challenging boot camp-style class I've ever taken - and it didn't even involve pushing football sleds, tractor tires, or climbing walls like it usually does.  We did, however, army-crawl through a human plank tunnel in the dark while getting ice cold water poured over our backs as we listened to the same Slayer song for an hour straight.  So there was that.

The gym offers tons of classes.  Besides Detroit Tough, I'm excited to try TRX, Bricktown Bodies, and Bodyweight Warrior.  Right now I've been doing drop-in for Mechanics but once I know what's going on with my hamstring I'm going to start a 1-month membership that my parents gave me for Christmas.  (They're the coolest parents!)  Hopefully next month I can check out some of these other classes.  It's time to shake things up!

Detroit Tough is located in Corktown, behind Brooklyn Street Local and PJ's Lager House. Read more about Detroit Tough and what Coach Roger is doing with the gym and for the community in the January Hour Detroit issue.  Good stuff is happening in Detroit, ladies and gentlemen.  I'm happy to be a part of it.   Amazing gym, incredible people - coaches and clients alike.  

Plus they have super sweet hoodies. 



Photo courtesy of Brian Wolski


What gym do you belong to and why do you love it?


Tuesday, December 30, 2014

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!




Monday, September 1, 2014

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.


Saturday, July 19, 2014

Injury Update - On the Run Again!

When my PT told me I couldn't run for 2 weeks, it sounded like forever.  What was I going to do without running for 2 whole weeks?!?  I managed to keep myself active with cardio, strength, and stretching.  This was my routine for my running break:

Stationary Bike*: 45 minutes (13 miles)/daily
Treadmill Walking (backwards): 10 minutes/2x weekly
Treadmill Walking (side-to-side): 2 minutes per side/2x weekly
Yoga: 1 hour/4x weekly
Strength/Core: 30 minutes/3x weekly
Stretching: Daily

*Some outdoor biking in addition to indoor (better aerobic workout indoors and less chance of falling off my bike so I tended toward the stationary bike!)

It was fine, especially once I got into my routine.  I would hit the gym at 5:30am and get it out of the way before I could talk myself out of it.  But it wasn't running.  Sure, I was sweating and getting a good aerobic workout but wasn't enjoying the same benefits that running offers me.

2 weeks was beginning to feel like 2 months.

I was still going for physical therapy.  A little over halfway through my running hiatus I had my re-evaluation.  When I initially started PT it was for Piriformis Syndrome and tight hamstrings.  I had made improvements with those but was still having a pain deep in my butt where my leg attaches.  Because I was still having pain, was still on my running break, and hadn't returned to my regular running activities (I'm a 40-mile/week runner when I'm not training), I was pretty sure that my PT would be extended (I had only had 8 sessions).  

I was wrong.  I was better but not healed and apparently that's good enough for ending PT.  I was told there was nothing more they could do with me.  Maybe I needed more rest.  Maybe continued strength/stretching would help.  Maybe it was actually tendonitis. Maybe I would never get better.  (That last one was the worst!)  So many maybes!  

Then the PT who evaluated me went on to say that I should try running, maybe a mile.  If it hurts, stop.  And if I can't run without pain then I should probably think about finding something other than running.  Like for good.  I wanted to cry.  Although I knew this wasn't true - nothing in my running form analysis indicated that I was a terminal case - nobody needs to hear this!

First I was upset.  Then I was just angry.  There are people with far worse injuries than a pain in the butt who don't have to give up running for life!  

That was Monday.  I biked for the rest of the week.  On Thursday I consulted with a PT from the DMC who suggested I use the elliptical to transition to running.  I went to my favorite cycle class on Thursday night, where we do a lot of standing (I liken that to the elliptical).  Then I used the elliptical Friday morning.

I went back to my doctor Friday to follow up from PT.  The plan we came up with was to get back into running.  Maybe alternate running with elliptical if necessary.  I'll take Naproxen 2x/day for 2 weeks, regardless of pain to fight inflammation.  After 10 days I can reassess how I feel.  If I want more PT, I can just call the office and ask for a prescription.  If it's just a matter of continuing the stretches and strength exercises, I can do those on my own.  Yoga is a big help, too.  So we shall see how things progress.  (And if I do have more PT it will be with the DMC, not with someone who left me high and dry!)

And today?  I ran!!  And it felt amazing!  

Photo credit: Brian Wolski
I did the 3 mile group run at RUNdetroit, which was awesome because there were people at just the right pace for my first run back.  (Man, I've missed my Saturday group runs!)  I could feel my butt just a little bit but not bad at all.  It's been a few hours since and so far so good!

What's next?  Time to start training for the Detroit Free Press Marathon.  Only 13 weeks away!  Let the countdown posts begin!  


Wednesday, July 16, 2014

Video Analysis - Taking a Closer Look at My Injury

Around the same time I realized it was time to see a doctor and start shopping around for a good PT, a friend at work handed me a flyer for something called Performance Enhancement Through Video Analysis.  She hadn't gone herself but had made an appointment for her daughter who was dealing with an achilles issue.  I have some odd quirks in my form (shuffle step, short stride) and although it works for me, I wondered if maybe something I was doing caused my injury.  Plus this wasn't the first time I'd dealt with piriformis pain - it was just the worst.

The program is called RunFast and is through the Henry Ford Health System Sports Medicine Department.  I spoke with Dave, the person who runs the program at the Novi location, on the phone.  He asked a few questions about my injury and we set up my appointment for my first week of summer vacation.  All I needed was to wear running shorts and take 2 pairs of shoes - old and current.  

I showed up with 4 pairs of shoes.  I wanted to be thorough.  (I left a couple at home.)

Dave started by gathering information to create a detailed portrait of me as a runner - how long I've been running, average pace (pre and post injury), daily/weekly mileage, usual running surfaces, which side of the road I run on, how much stretching I do, what other exercises I do besides running.  We talked about what I do with my legs when I sit and what my posture is like.  He looked at all my shoes and took notes.  

Next he looked over my legs and feet.  My arches checked out fine and my legs are the same length, which was good to hear.  (Not that I was worried.)  

After giving me the once-over, he did a variety of tests.  A lot of them were in the exam room and then we moved out into the hallway and gym area.  Those were videotaped using his iPad and later put into an app called "Coach's Eye."  The app allows you to watch the videos frame-by-frame to check form, draw lines and angles, and put two video clips side by side to compare.  It's very cool.  I didn't get my report and analysis until 2 weeks after my evaluation when I went back to see him.  Below I'll briefly describe what he tested and make note of some of his findings.


1. First Dave tested my mobility - ankles, feet, hips, and trunk rotation.  Then he checked strength, core, and postural control by having me do bridge, plank, side plank, and resistive testing.

Findingsmildly tight calves (both soleus and gastrocnemius), very tight hamstrings, weak hips/glutes - slightly weaker on right side, piriformis pain not reproduced with any testing of right hip (leading him to conclude piriformis isn't my problem - interesting)


2. Next Dave had me complete a variety of activities, such as squat, hop, jump, balance, step-down with medicine ball.  (This is when he started videotaping me.)

Findings: weak hips/glutes, mild pelvic drop - more on left side, collapsing in of right knee, turning out of right toe (jump, step-down, and squat)


Step-down with medicine ball
Single-leg squat, followed by single-leg hop


3. Then Dave had me complete a gait assessment, where he had me walk with one foot in front of the other, then toe-in, toe-out, and with big steps.

Findings: more pelvic drop and/or pelvic rotation on the right side in nearly all of them


4. Finally it was the moment I'd been waiting for - the running form assessment!  He only needed me to run on the treadmill for a few minutes at my usual pace and filmed me from the front, back, and both sides.  He also had me run a little in the hallway prior to the treadmill.  I hoped for immediate feedback but he just smiled and said I looked the same in both places. Ah well, I tried. When I did get the video analysis, however, it was quite interesting.

[I was not able to embed these on the blog but you can view my running videos by clicking on the following links: treadmill1, treadmill2, treadmill3, treadmill4, treadmill5]


Findingsmild heel strike but shins are vertical at contact (so okay), 192 cadence, right hip not extending, right toe out, more trunk rotation on the right side, more right side pelvic drop, possible trouble driving off left side

Are you noticing a trend here?  My right side is screwed.  Not a surprise considering the pain I've been in.  Then when I think about how long I've been sitting on the couch with my legs tucked to the side, how I only cross my right leg over my left, how when I stand I shift my weight onto my right leg.  When I used to do burpees I would always kick out my right left before my left.  I can't squat and keep my right foot on the ground.  How long has this been going on??

In video 3 (when watched in slow motion), I can clearly see my right arm cranking back, as if I'm trying to power myself forward.  My left arm isn't doing it quite so much but it's crossing over slightly, as well.  How long as THIS been going on??  Is this a new thing that started with my injury?  Or is this the CAUSE of my injury?  In any case, I need to get that ironed out stat!  I've been running along happily giving everyone the thumbs-up (which I learned about at my Good Form Running class), thinking my arms were in proper position.  But - gasp! - they weren't.  All that upper body twisting wrecks havoc on your hips which can cause everything else to collapse inward.  

I have a quick cadence which is a result of my short stride.  I've always just thought of myself as an efficient runner.  However, there are other runners who also have a quick cadence yet they have a much longer stride.  I'm not going to purposely try to lengthen my stride but is my stride short because of some of these issues I'm having?  My hamstrings are so incredibly tight that I feel like I couldn't lengthen my stride if I wanted to! Perhaps with increased flexibility, my stride will naturally lengthen.  

What to do, what to do?  Dave had a LOT of recommendations!  On my first visit he gave me a few stretches but when I went back the second time he spent about an hour with me going over both strength exercises and additional stretches to target the problem areas.  He made sure I was doing them correctly and that I understood why I needed to do them.

Recommendations

Stretches:
  • Hip flexor stride stretch
  • Pigeon pose
  • Soleus (toe against wall)
  • Gastrocnemius - using this calf stretcher
  • Hamstring

Exercises: 
  • Clams with band
  • 1-legged bridge
  • Side plank with leg raise
  • Single-leg step up on bench with overhead press
  • Single-leg squat with back leg on bench
  • Single-leg balance, hip abduction with band

Sitting/Standing: 
  • Use good posture to prevent weight from resting on my hips.
  • Do not sit cross legged, particularly with the right leg over the left.
  • Do not sit curled up with my knees shifted to the left (right knee on top).
  • Keep even distribution of weight on both legs when standing rather than shifting weight to right hip/foot.
  • Watch right foot when standing to be sure it's not turned outward.

Running Form:
  • Less upper body rotation
  • Eliminate the right arm "crank-back"
  • Pull-through (get my legs back behind me more) to use more power

Once I get back to running in a couple more days (fingers crossed!), I need to be very mindful of my arms upper body.  I've been so focused on my legs that my arms never crossed my mind!  I also need to be diligent about stretching and strengthening, something I've neglected for at least the past year.  

All in all, I was quite pleased with my video analysis and follow-up session.  Many of the things Dave said went along with what my PT had told me (weak hips and glutes) but having the video component was a nice added feature for me, especially for the running form.  I already had an idea about what my legs were doing but I never would have guessed I was cranking that right arm back until I saw it in slow motion!  Plus, I liked how comprehensive the assessment was, taking every aspect of your legs into account to put it all into one big picture.

I would definitely recommend this for anyone with a running-related injury.  You'll gain a lot of information and leave with ways to help yourself feel heal.  Even if you aren't injured it could be a cool thing too!  You might learn some good preventative tips to keep you running healthy.

The total for two sessions is $125.  I also downloaded the "Coach's Eye" app for $1.99 (it was on sale - I think it's usually $6.99) and had Dave send me the videos.  You can watch the videos online but without the app you won't be able to play around with them and use the additional features that the app offers.  

For more information about the RunFast program or to set up an appointment, you can call or email Dave.  

David Tomsich, certified strength & conditioning coach, physical therapist
Office: 248-344-2331
Email: dtomsic1@hfhs.org


Have you ever had a running form assessment done?  If so, please leave a comment to tell me about your experience.