Following the heart

I've identified as a runner since returning home from college in 2005. Growing up, I was a baseball player but, for one reason or another, didn't have the drive to pursue the sport in college. After my freshman year of college, I took up running, inspired by a 7-mile road race held every summer in Litchfield, CT. My then-girlfriend had run it a few times, and we trained together in the nation's capital. I'll never forget my very first "fun" run on the trails behind my alma mater. It was just as miserable I had remembered running to be in high school for baseball. Something in me, however, craved more, and I continued to run--albeit only 5K, give or take, at a time--every other day. At the time, I had no knowledge, whatsoever, of the sport, mechanics, etc. I just ran, and it felt good.

When I returned home from college, I got serious. I started reading Runner's World, learned my foot type, and decided that it was time to invest in a better, more suitable pair of shoes; although, in hindsight, the New Balance 993 was a good pair of shoes. I decided on a motion control shoe. Within only a few weeks, I was injured. In reality, though, my foot had probably been injured long before I began experiencing pain that late-fall day 2005. I remember the pain like it was yesterday. It began on a 7-mile, out-and-back run on Winsted Road in Torrington. The run out felt great; the run back felt like shit. I pushed through it, nonetheless. It was the same pain that I feel today, nearly a decade later. At the time, I didn't think much of it and continued to run on it until I wound up in my first doctor's office. Diagnosis: posterior tibialis tendinitis. It would not be until another two years and about a half-dozen more doctors before I learned the real diagnosis: a spring ligament rupture and an osteochondral lesion of the talus. I still have the business card on which Dr. Reach scrawled the diagnosis. Despite the bad news, seemingly out of thin air, I found a long-lost freedom. A freedom from not knowing. When the body feels good, unlike when the body hurts, it doesn't matter why. It's easy to take for granted.

Dr. Reach performed surgery on my foot in 2008. Obviously, he did a good job and my foot healed, because I went on to run several thousand miles over the course of the next few years. There's now some question as to whether he succeeded in treating the cause of the injury, as opposed to just the injury itself. Dr. Johnson, here in Ashland, seems to think that an equinus contracture is not only the cause of my latest injury--most likely just posterior tibialis tendinitis and not a recurrent ligament rupture, per an MRI--but the first injury in 2005. Equinus contracture is simply the inability of the foot to dorsiflex. Few of us runners--probably doctors, too, given their track record--realize this, but sufficient dorsiflexion is part and parcel of the running gait cycle. Without it, the whole body gets thrown. It's a miracle to me that I've gotten this far in my running career without more serious injury to my body. To treat equinus contracture, the doctor must first determine whether it's the gastrocnemius muscle or achilles tendon at fault and lengthen the appropriate structure, accordingly. Dr. Johnson thinks it's the gastrocnemius muscle in me and has proposed a procedure named after the doctor who developed it (of course)--the Strayer Procedure. It involves cutting tendon to provide more slack in the muscle and, in turn, more dorsiflexion. It's fundamental biomechanics, but I'm apprehensive.

As it stands, I can barely get my foot past neutral--i.e., 90 degrees--without compensating by stressing the medial aspect of the foot. It's well settled that undue stress over time leads to injury. To run safely, one needs 115 degrees, at a minimum. Everything I've read has stated that stretching will get you only a few degrees. Strayer promises at least 15. At the suggestion of a friend, I began practicing Bikram yoga in early November 2013. I have found not a scintilla on the efficacy of Bikram yoga--or any yoga, for that matter--in treating equinus contracture, and I'm willing to bet that I've read every Bikram yoga success story on the Internet. While a success story or two might be nice, faith and trust in the yoga and the ability of the body to heal is all you really need.

Thus, I have two choices: 1) give my body more time to heal or 2) have surgery. Whether I've been active or not, I've felt injured for the good majority of the year. I hardly feel like a runner anymore. I feel more like I did before I became a runner, except now with an elusive yearning. It manifests in a different, more intense kind of pain that I don't wish on anyone. When I see someone running now, I want to run up to him/her and say, "if only you knew how lucky you are." I know I have my very own set of luck, injured or not, but it boils down to perspective. I think I'd be more willing to choose the former if I knew it would work, even if it took half of the rest of my life. The latter is the quicker path to becoming a runner again but not without risk, hence my apprehension. I've read that patients have reported permanent weakness and nerve damage post-op. And I'm not sold that it's my gastrocnemius muscle, as opposed to my achilles tendon, that needs lengthening.

My passion to be outside and moving will forever burn. My heart knows that. What it doesn't know, though, is how to realize that passion in the face of an injury. In time, I'll figure it out, as I always do. I just need to go to that place where it's just quiet you. Things are easier there.

Bikram progress

1 Standing Deep Breathing – This has become much easier, but I still need to work on exhale timing. I feel left hamstring/calf tightness quite a bit, not to mention left foot weakness, which tends to distract me.

2 Half Moon Pose – I've made great improvements on this posture. I've worked to lift more out of the hips--as opposed to folding at the hips--and, as a result, I feel much less pinching and discomfort in my lower back.

3 Awkward Pose – I've become much stronger in this posture, particularly my arms (no more shaking fingers). I've noticed that on the first variation, my left foot begins to collapse as I move deeper into the posture. Perhaps it makes sense to stop moving deeper into the posture just before the foot begins to collapse.

4 Eagle Pose – This posture puts a great deal of stress on the medial aspect of my feet, particularly the left. The deeper I move into the posture, the more I feel it, as if the insides of my feet will spill out onto the mat.

5 Standing Head to Knee – I noted last time that this is probably my favorite posture. I take that back--for now, anyway. My left side has become so tight that I feel a great pulling (and subtle pain) behind my knee, even while just balancing without the kick. Perhaps I should just forget about the kick for now.

6 Standing Bow Pose – I love this posture, but, again, I think that I have overdone it on the left side with these standing postures. Time to back off and embrace what I can do and enjoy the breath.

7 Balancing Stick – What can I say? This is a great posture once you figure out your limitations as to hamstring flexibility. It's too easy to push beyond your flexibility.

8 Standing Separate Leg Stretching Pose – In hindsight, I progressed too quickly to locked knees in this posture. I can barely engage my quads without feeling a great pulling behind the knees, which is probably an indication that I've taken it too far.

9 Triangle Pose – This is a difficult posture, but I've made good progress in getting the hips down and aligned with the high arm more overhead (thanks to ANB showing me where that arm really belongs).

10 Standing Separate Leg Head to Knee Pose – This posture is most likely the hardest on the left hamstring. I need to take more care in this posture, particularly on the left side. Things feel great on the right side. For whatever reason, it's easier to safely stretch the right side than it is the left side. I yearn for the day when my right and left sides are in harmony. Can it happen?

11 Tree Pose – This posture has helped markedly to open up my hips. My right hip is still the tighter of the two. It's clear that I have deficiencies/weaknesses on both sides of my body.

12 Toe Stand – I don't know that it makes sense to attempt this even on the more flexible left side, as I feel I have a lot more to gain in Tree Pose. Granted they are two separate postures, Tree Pose progresses into Toe Stand.

13 Dead Body Pose – As of late, believe it or not, I have a hard time letting my left leg relax on the mat, as things are so tight and bound up behind my knee.

14 Wind-Removing Pose – I feel a great pinching in my hip on the more flexible, left side. It's exacerbated by the follow-up, Turkey Pose (or whatever it's called).

15 Sit Up – Some days I can touch my toes, others I cannot. This is a testament to the fact that the body is ever-changing, even if that means regression when the goal is progression.

16 Cobra Pose – Quoted from my last report: "Not a huge fan of a lot of these floor series postures." This is interesting, because I have come to enjoy the floor series more than the standing series. The reason is two-fold: 1 my left side makes the standing series uncomfortable and 2 my back has gotten a lot stronger, allowing me to get deeper into these postures. This is a challenging posture, for sure, but I love the challenge and the strength that it's given my body.

17 Locust Pose – The contralateral leg has been able to more easily take a vacation, but it's quite difficult to allow it to relax completely. The second half of this posture, involving both legs, has become so much easier. It's definitely top 5 in quickest progression.

18 Full Locust Pose – Usually, I'm cashed for this posture, given that it's sort of a combo of the Cobra and Locust Poses. Also, the more space, the better.

19 Bow Pose – I've made great progress on this posture, from barely able to get knees off ground to kicking and lifting with ease of breath. I never thought I'd care much for this posture, but I do now.

20 Fixed Firm Pose – Most days, I can get my ass down between my heels and even get a back-bend going; other days, I feel as if it's my first class. The good news, though, is that I feel a lot less tension in my right knee and ankles.

21 Half Tortoise Pose – Still, I'm having a difficult time getting my butt down on my heels because of the tight, right hip. If I were to fully relax in this posture, I'd fall over onto my left side, so my tendency is to sway right and get a solid stretch in the hip to balance things out.

22 Camel Pose – I've made great progress on this posture. Perhaps top 3? I love getting into that back-bend. It feels great but it probably doesn't appear that way. Anyway, ppearance is not the measure of quality.

23 Rabbit Pose – This is now one of my favorite postures. I feel strong and confident in it, particularly now that I've figured out how to get the weight off my head and onto my knees.

24 Head to Knee Pose and Stretching Pose – I feel that this is more of a hip opener than hamstring stretcher for me. One of these days, I'll remember my stretching strap.

25 Spine Twisting Pose – Between reports, I've learned that the goal is to get the sit bones down. The one I twist into likes to lift up.

26 Blowing in Firm Pose – I struggle to keep up on the second set.

In sum, I feel a bit defeated. My foot has been giving me fits for months and now my left hamstring is limiting my yoga practice. What gives?  This is OK, though, because I have the next 50 years to figure it all out.

Update on things

I completed my 21st Bikram yoga class last night. My strength and flexibility have improved markedly, but I think I might have overstretched my left hamstring/calf. Either that or I'm still feeling last Saturday's massage. I can't seem to find the right stretch in those posterior muscles. Now I can hardly fully extend my left leg without these muscles recoiling. No yoga tonight. We'll see what Thursday brings.

In other news, I received Dr. Reach's read on my MRI yesterday. Again, Dr. Reach was my orthopedist in Connecticut. He performed the spring ligament repair on my left foot in January 2008. According to Dr. Reach, the spring ligament and all other medial soft tissue structures look fine; however, there is some sort of foreign body in my ankle joint. Unfortunately, he could not identify this foreign body. I wish that I could give Dr. Reach and his assistant a big hug right now. They went above and beyond.

After receiving Dr. Reach's read on my MRI yesterday, I called Dr. Johnson here in Ashland. In light of Dr. Reach's findings, he promised to take another look at my MRI. I had to prod him again this morning to take another look. He finally did and, sure enough, found the same thing. His take on it was that it's not in the ankle joint itself but in the joint capsule near the ankle arthroscopy scar from 2008. And that it's not a foreign body or bone but perhaps scar tissue or something from the arthrogram. He promised to call the radiologist about it today.

6 in a row

Yesterday's Bikram class marked six in a row and ninth overall. After my first class on November 4th, I could not fathom returning the next day, much less four consecutive days after that. It was not until November 9th that I returned for class number two. I then started grooving. Today, I need a break, and it's timed perfectly, as there is not a regular Bikram class this evening.

My body does feel a bit stronger and more flexible, but, today, I'm aching all over and my right (proximal) hamstring is a touch tight. My left foot is also tight and tender in spots, as per usual. Certainly, it's no worse for the wear, but no better either. With time and patience, perhaps, one day, I'll think to myself, you know, maybe this foot does feel better. Alex concluded Monday's class with a few words of wisdom, which really resonate with me: One thing that will make this yoga easier is if you learn to be satisfied with what you have in this moment.

Bikram Yoga

At the suggestion of a friend, I started practicing Bikram yoga earlier this month. To date, I have completed 8 classes. Already, my body and mind are better for it. Albeit only slight, I notice a difference in my strength and flexibility during and even between classes. How can this be in only a few weeks? The body's ability to adapt is truly amazing.

My left foot still hurts off and on. Even something as simple as standing at the kitchen counter to prepare meals is uncomfortable six times out of seven. Bikram does, however, provide some relief during and immediately after class. At present, it's hard to see the light at end of the tunnel, which has prompted me to send a copy of my latest MRI to Dr. Reach--who performed the spring ligament reconstruction on my foot in January 2008--as a second opinion. I know that he will give it an honest look. To be clear, I'm not interested in surgery until I give this rehab a good honest effort. This injury first reared its ugly head in May/June 2012, when Jessica and I were on the Camino in Northern Spain. I then had a solid period of training from July-ish 2012 through early this year. Since about February, things have only gotten worse. I never did take more than two weeks off to let it calm down, which is why I need to make a better effort at trying to heal this conservatively through Bikram, massage, etc.

Here's my take/progress on the 26 Bikram postures:

1 Standing Deep Breathing – love this posture; what a great warm-up; posterior neck has become a lot less tense and arms up/elbows together has become a lot easier on the exhale

2 Half Moon Pose – still trying to get the arms straight back by the ears, palms together, and shoulders and hips square; however, generally, it feels pretty good other than my tendency to over-bend and struggle with breath

3 Awkward Pose – love it; left fingers tremble sometimes so tend to make a fist or drop arm; much better at second and third of three variations of posture because on toes; dorsiflexion lacking, which is why I can’t sit all the way down and back on first variation (and why my foot is chronically injured)

4 Eagle Pose – once I get that foot wrapped around calf, I’m home free; I feel pretty strong in this posture despite my wobbly, floppy feet

5 Standing Head to Knee – probably my favorite of all the postures; love the challenge of balancing on that solid leg for a minute and progressing through extending the lifted leg; I imagine it’ll be some time before I can get that leg fully extended

6 Standing Bow Pose – another good one; love the balancing aspect, especially for the left foot, which I’m trying to rehab; can’t kick too far back yet without straining the anterior aspect of the hip and hamstrings (particularly behind knees)

7 Balancing Stick – still another good balancing posture; can’t quite achieve the T; I like the variation on this posture with the praying hands at the chest instead of over the head (probably because it's easier)

8 Standing Separate Leg Stretching Pose – good stretch for the hammies; no where near grabbing the feet; can barely straighten the pegs

9 Triangle Pose – probably the strongest posture for me (it feels that way, anyway); I can’t quite get the lower arm to the floor between big and second biggest toes, but I feel super strong in it

10 Standing Separate Leg Head to Knee Pose – not close to locking peg and can’t get trailing foot flat on mat

11 Tree Pose – much stronger on left side

12 Toe Stand – no where near this, especially on right side

13 Dead Body Pose – hard to screw this one up

14 Wind-Removing Pose – just love it; good for hip flexion; certainly less flexible in right hip

15 Sit Up – easy in theory but can’t touch toes with legs fully extended

16 Cobra Pose – not a huge fan of a lot of these floor series postures, but as my back gets stronger, I’m learning to enjoy them more

17 Locust Pose – hard to not give an assist from contralateral leg but good for glutes

18 Full Locust Pose – like a 747; other than never having enough room to fully extend arms at right angles from body, it’s a decent posture

19 Bow Pose – I suck at this one but the tip to soften shoulders was a good one; I kicked those legs out a bit more even if only a hair

20 Fixed Firm Pose – not really benefiting from this one yet, as I can’t get my ass down onto the mat comfortably without straining my right knee, where that medial plica was excised (I wonder if that’s scar tissue I feel in there or stress on a meniscus?)

21 Half Tortoise Pose – man, this is fantastic, especially when doubled up; having a hard time letting hips fall back on heels, though, because right hip is super tight from all the favoring due to left foot (years of standing on right peg in locked position)

22 Camel Pose – this one makes me dizzy but was feeling it last night!

23 Rabbit Pose – don’t quite get this one but I like the circular energy analogy; it helped last night

24 Head to Knee Pose and Stretching Pose – got the head to the knee but not with the knee fully extended; it’s pretty easy for me to overdo it here; the wet towel is not conducive to getting the heel to slide to achieve deeper stretch

25 Spine Twisting Pose – definitely not upright but can finally get hand on knee; i’ll get there in time

26 Blowing in Firm Pose – belly work out

MRI with arthrogram on left foot

So I had an MRI with arthrogram on my left foot on Friday. The first part of the process involved two iodine injections, one in the ankle joint and another in one of the joints of the foot. This was not fun. The purpose of the injections is 1) to get a better picture and 2) to determine whether there is any leakage through the spring ligament. The second part of the process was the MRI itself. I have not yet made a follow-up appointment with Dr. Johnson, but I hope to see him again early next week.

First post of 2013

This blog was all but dead, but, tonight, I'm compelled to write here. The year started out well but has gotten progressively worse. It's not my knee but my left foot again. I cannot run. I cannot ride. I cannot even walk to work. All I can do is built shit in my garage.

I've tried everything to heal this injury. Cycle only. Run only. Hike only. Rest. Stretch. Strengthen. Yoga. Drink heavily. Diet. Etc., etc.

A few weeks ago, I caved and visited a chiropractor here in Ashland. He massaged; gapped my sub-talar joint; taped. He had no clue. On Friday, I saw a podiatrist (also in Ashland). He shed (a lot) of light on my injury. It turns out that my foot surgery was flawed. According to Dr. Johnson, whenever utilizing an arthrodesis and/or repairing the spring ligament/posterior tibialis tendon complex (which I had done in 2008), the gastrocnemius muscle must be lengthened (which I did not have done), as a short one is almost always the underlying cause of blowing out the spring ligament and/or posterior tibialis tendon. To make a long story short, Dr. Reach did not address the underlying issue, which is, per the doc, borderline malpractice but perhaps an East Coast/West Coast thing. And I was this close to flying to CT to see Dr. Reach. It turns out that I have an unusually short calf muscle, which prevents full dorsiflexion of the ankle and over-stresses the medial aspect of the foot.

The next step is an MRI with arthrogram to see the degree of injury to my foot. Dr. Johnson suspects I'm back in the same boat with a spring ligament rupture and osteochondral lesion.

Shoe Review

I bought two new pairs of running shoes.  Deal was too good to pass up.  Sierra Trading Post has some good deals.  I got a pair of Saucony Hattori's and NB MT00 Minimus for $30 and $45 respectively.

The Saucony's are excellent.  Good for road running and not bad on the trail.  Super light and still a offer more cushion than the Minimus.  I also like the velcro strap, no laces.  My foot did slide around a bit in the shoe when going down steep hills.  That was the only drawback. Probably going to go back on STPost and buy another pair for when they wear out.

The MT00 Miniumus was a bit disappointing, but still good.  The toe box felt too big, kind of like I was wearing clown shoes.  The MT10s I have fit like a glove and feel like they are part of my foot.  I didn't get the same feeling with the MT00.  Nice grip/traction and a bit more cushion in the toe than the MT10s.

Chiropractor

Just went to visit Dr. Steve, chiropractor in New Haven. Very nice guy and we spoke for 5 minutes and then got right into some myofascial release. Fancy word for massage as far as I can tell. He thinks it is an IT band issue and perhaps also related to my quad and/or hip muscles. He had a roller bar he went pretty hard on my outside leg where the pain stems from. At this point I was thinking I could probably do this with the foam roller, then he took to the inside of my leg and found a particular point that hurt like a motherfer when he pressed it with his thumb. I was impressed with this as I hadn't identified that spot as a problem. This all took about 10 minutes. Now my leg feels like I just did a bunch of serious squats. Back next week same time and place to see if this fixes it. $80 for the first visit, and $50 each visit after. He recommends at least 6 visits so this will be a $330 attempt. I'd pay twice that if this fixes it.

3rd Annual Southern Oregon Beer Mile

After receiving a Facebook invite from Rogue Valley Runners about the beer mile here in Ashland yesterday, I decided what the hell. After class, I hurried home and jogged over to the Southern Oregon University track, where it was held. It was dark and rainy. I had tasked Jess with procuring an at least 5% beer with low carbonation, and she showed up just as we were about to start with a 24-pack of Budweiser! Unbelievable! Long story short, I got through three beers and three laps. Hal Koerner won in 6:30. Erik Skaggs was second; Timothy Olson third.

Michael Arnstein

200 miles/week on fruit?

A MUST-listen: http://ultrarunnerpodcast.com/archives/2010

MDI

MDI Marathon didn't go so well. Made it about 18-19 miles and my knee/leg/IT band, whatever it is, became too painful to continue. Legs felt pretty good otherwise though. Weather was horrible. Rain and in the 40s. I tried walking and running for a bit and then got really really cold. Shaking uncontrollably and couldn't find any help from race organizers. Had to jump in a guys truck and get a ride. I don't see much road running in my future. Gonna stick to the trails. Sounds like I need to move to Ashland. Karolina finished strong in 3:43. Very good time for a super hilly course.