10/30/2011 The Icy Hot Experiment

88 days post injury, 55 days since last attempt to run

The deep ass pain has gotten worse over the last few days, presumably from the cortisone shot wearing off. The pain is slightly different, coming from the same area but different muscle movements eliciting the pain. I took Friday off to give it a rest, then returned to the gym on Saturday for a whopping 20 minutes on the bike. I decided to break up my hip and hamstring strengthening and save the hammy work for tomorrow. Another day's rest won't hurt. Today I did my hammy work, beginning the Icy Hot experiment.

I got the idea for the Icy Hot experiment from a bartender friend. I got to know this bartender because he works at the bar our running group meets at after the Wednesday night run. Since I am not running, I still meet up with the group but always manage to get to the bar earlier and start drinking. That is where I got to know Mike, the bartender.

Mike has a friend who runs and has chronic Achilles problems. His friend swears by Icy Hot. He puts the Icy Hot patch on his Achilles before running and it has miraculously cured his problem. Mike is not a runner, and he bought in to the story. When I returned to the bar the next week, he had a present waiting for me: Icy Hot patches.

While his heart was in the right place, I was very skeptical that Icy Hot could cure my problem. A little about the hamstring tendon: the hamstring tendon originates at the ischial tuberosity of the pelvis, which is deep in the butt. Genetically, this poses a problem as my family is known for carrying a little extra junk in the trunk, and I am not an exception. Thus, the Icy Hot has to penetrates layers of adipose and muscle tissue before it reaches the tendon. Also, the active ingredient in Icy Hot is menthol. I scanned the scientific literature and found that menthol has been shown to reduce pain and reduce blood flow. There is no evidence that menthol provides any other physiological benefit that would decrease recovery and healing time in muscle strains. Despite the lack of evidence that Icy Hot will help with my ailment, along with basic common sense, I decided to try the Icy Hot theory. Desperate times require desperate measures.

The Icy Hot Experiment

Methods: Apply Extra Strength Icy Hot Medicated Patch (8 cm x 12 cm, 5% menthol) to junction of right butt cheek and proximal upper leg. Conduct hamstring strengthening exercises as instructed by PT. Analyze pain levels before, during, and after exercise.

Results: Icy Hot patch provided cold and hot sensations, "Icy to dull the pain - hot to relax it away". Pain levels seemed to decrease slightly during and after exercise, but whether it was due to the Icy and Hot feeling on my skin distracting from the real problem is unknown.

Conclusions: Icy Hot may be useful in therapy when pain prevents normal range of motion exercises to be performed, and there is little tissue in between the skin and tendon/muscle. No evidence was provided that suggests Icy Hot may speed recovery. Sensation on skin suggests a bottle of Scotch may be as useful as Icy Hot patches. 

10/27/2011 Baring it all

85 days post injury, 52 days since last attempt to run

The runners' diet has finally caught up with me. To me, runners' diet means try to eat healthy, but indulge in junk food and beer every chance I get. When I used to run 40 miles a week, I burned a minimum of 4,000 extra calories a week. I could eat an entire pizza and not have to deal with the consequences. Now, I am intaking an extra 4,000 calories a week, which translates into 1 lb a week. Although I try to not use the scale as a measure of weight loss. Nevertheless, this is what I am dealing with:

OK, I kind of cheated. Here is a less flattering shot:

I know what you're thinking, but body image is relative. I looked better 3 months ago...

Today I made the resolve to abandon the runners' diet. No more indulging, except for good tasting beer.

I am now in my second week of hamstring eccentric strengthening exercises. Eccentric means the muscle is being worked when it is lengthened, vs concentric which is when the muscle is worked while it shortens. Here is an example: the bicep curl. When you lift the weight, bend your elbow and bring the weight towards your body, the muscle is shortening and thus is a concentric exercise. When you lower the weight and straighten your elbow, that is eccentric exercise.

Although I was turned off on my first PT visit, I have really started to like my PT. She wants me to get back to running asap, but her main concern is for me to return when my body is ready so that I can run for 20+ more years. Sensing my impatience several weeks into therapy, she sat me down and had a pep talk with me. She told me that if I wanted to run now, go for it but I wouldn't be able to run past the age of 40. If I fully rehabilitate before running again, I will be able to run for many, many years. She said, "It's your choice". I chose the latter. At that moment we sort of became a team, both working towards a common goal.

I started aerobic activity last Thursday. 20 min on the elliptical, alternating days and alternating with the bike. I completed 23 minutes on the elliptical last night. My right hamstring is super sore. Much to my pleasure, the soreness is not in the area of the injury. However, I am again able to elicit the deep ass pain that disappeared after the cortisone shot but it has lessened. I am not worried, these things take a long, long time to heal. I don't expect a miraculous recovery.

I am not putting a timeline on my return to running. I will let pain be my guide (and listen to it this time).

After eating lemon quinoa with chick peas and pesto all week for lunch, I just realized that I forgot to eat dinner. Where did this sudden optimism come from, you ask: It's a Golden Monkey night.

9/26/2011 And now I have a bulging disc

54 days post injury, 3 weeks since last attempt to run

I blame my fucking job for this one; I didn't go to grad school to do manual labor on the job. The pain is now radiating down my left side. The pain in the ass is very sore. New plan: no cardio for one week, nothing that could aggravate my hamstring. I will stretch, do the core and hip exercises, lift upper body and that is it (probably calves too). Fuck, fuck, fuck. Troegs variety pack to get me through this week.

9/21/2011 It just keeps going downhill

49 days since injury, 16 days since last attempt to run

No running or biking. The elliptical just doesn't do it for me, and I apparently pushed myself too hard on the elliptical yesterday because the pain in my ass is worse. I had stopped drinking for a week, thinking that would help but that just made things worse. Oh yeah, I drink because I'm bored when I am injured. I also watch a lot of tv. I was late for the prediction run (I was going to help with timing) so I said screw it and ended up at Gullifty's. So tonight I treated myself to a pumpkin beer and La Fin de Monde, both 9% alcohol.

Job prospect does not look good. I haven't heard about the recent job I applied to. I should have jumped on the opportunity in May/June when I had it. I need a new game plan and I need to save money so I can get the hell out of here.

9/13/2011

41 days post injury, 8 days since last attempt to run

Excerpt from diary:
"It all started 6 weeks ago with a small pain in the ass. I ran through it for 10 days, running two 5K races and a 16 mile long run. That was the beginning of what spiraled out of control with my body.

2 days after the long run I ran 4 miles, and the run was cut short because of the severe pain. I rested for 4 days, got ART (active release therapy) on Saturday morning, and tried to run a flat 4 miles. A very painful 4 miles. So then I rested for 2 weeks (meaning no running or any aerobic activity). During that time the dull ache in my right hip/butt/side got worse. I finally went to the doctor. An MRI was done 9 days after my last attempt at running and showed absolutely nothing wrong with my hamstring, pelvis, femoral neck, etc. It did show DDD at L4-L5 but that's not new news to me. It also showed mild cartilage loss in the hip joint, but that is expected with age. Diagnosis: hamstring sprain at right ischium.

It has now been 3 weeks that I have had the dull ache. The sharp pain in my ass is still present. I have seen the PT twice, first was an evaluation and yesterday was the 'therapy'. Half of the time I waited around for her while she was working on other patients. I did simple core exercises that I could do anywhere on my own. After I left the PT yesterday, the dull ache worsened in the 5-10 min it took for me to get to the gym. While walking into the gym I noticed some relief, and after I was finished with 40 minutes on the elliptical I had no hip pain.

Today I have a slight ache. I took the heating pad to work to sit on (for the hamstring). I went to the gym and did 40 minutes on the elliptical and 5 minutes on the bike, noticing the return of the hip pain. In the shower at home after the gym, I bent over and experienced a sharp pain in my lower back, with a sudden sharp pain down my outer left hip and leg and also into the groin area. The dull ache on my right side was completely gone.

I am at my wit's end. I was in great shape 6 weeks ago. I am usually smart enough to back off when I feel pain. Well, I didn't back off enough or soon enough. And here I am, a bum hamstring and a shitty back.

A Racing Injury Timeline

12/2010 Philadelphia Marathon, 3:29:29 (7:59 pace) PR
2/2011 Feel the Love 5K 20:29 (6:35 pace) PR
3/2011 Gate River Run 15K 1:05:08 (6:58 pace) PR
3/2011 Adrenaline 5K 20:27 (6:34 pace) PR
4/2011 Elizabeth River Run 10K 44:24 (7:08 pace)
4/2011 Moorestown Rotary 8K 32:58 (6:37 pace)
5/2011 Broad Street 10 mile 1:08:10 (6:49 pace) PR
6/2011 MidSummer Series 5K #1 20:40 (6:49 pace)
7/2011 MidSummer Series 5K #2 19:53 (6:24 pace) PR
8/3/2011 Pain in rear began
8/6/2011 Fox Chase Away Cancer 5K 19:55 (6:25 pace), pain in rear slightly worse, numbness in pubic area
8/11/2011 MidSummer Series 5K #3 20:14 (6:30 pace)
8/13/2011 16 mile long run, made bareable with Advil, numbness in pubic area
8/15/2011 4 mile run, excruciating pain after 1 mile
8/26/2011 Appointment with Sports Medicine MD, femoral neck stress fracture suspected, dull ache now coming from hip
8/28/2011 MRI
8/30/2011 Follow-up appointment; stress fracture ruled out, given default diagnosis of hamstring sprain and degenerative disc disease; sent to PT for both diagnosis
9/7/2011 First appointment with PT for evaluation, suspect bulging disc in back
9/12/2011 Began therapy for bulging disc
10/10/2011 Ultrasound guided cortisone injection to rule out nerve related pain; ultrasound revealed degenerative changes in hamstring tendon; pain in rear disappeared after injection; ultrasound and disappearance of pain positive diagnosis for chronic high hamstring tendinopathy
10/11/2011 Therapy for hamstring set to begin but delayed due to vulnerability to injury after cortisone injection
10/19/2011 Began therapy for hamstring