Tendon surgery

I was doing some research on tendon surgery today and came across this, which is a good description of the surgery I'll be having on the 14th:

"Surgery should include diagnostic arthroscopy to exclude any intra-articular pathology. If arthroscopy reveals no intra-articular derangement, then an incision is made directly over the direct head insertion of the semimebranosus tendon. The semimembranosus tendon is dissected free from surrounding tissue and the sheath is opened. Any areas of necrosis or degenerative tissue should be excised. Several longitudinal tenotomies are performed. In addition, the insertion site is drilled with a small Kirschner wire to promote a healing vascular response. Tendon rerouting or suturing the semimembranosus to the posterior aspect of the medial collateral ligament has also been proposed if friction between the tendon and the tibial plateau exists. In one report, the results of surgery were good in 9 of 10 patients, and allowed return to sporting activities at an average of 12 months postoperatively."

Source: Tendon injuries: basic science and clinical medicine, by Nicola Maffulli, et al.

December 14th

I am having surgery to remove the medial plica from my right knee (arthroscopically) and to repair the semimembranosus tendon (non-arthroscopically, as it's outside of the joint) on December 14th. The plica gets sucked out with a vacuum. The procedure for the tendon is a bit more complicated. In order to determine the extent of the injury to the tendon, the surgeon must pull the tendon away from the bone and then reattach it after he's done his business. Tendon injuries are usually to the inside of the tendon, so any injury is not immediately apparent until the tendon has been cut open. If there's damage to the tendon, then that part of the tendon must be removed. If it's just scar tissue, then it will be debrided. I hope it's the latter, obviously.

I can expect to be on crutches, partially weight-bearing, for 8 weeks. No splint, cast, etc. required. Only band-aids and a compression sleeve over the wounds. Showers are ok. This is all much easier than the recovery from my foot surgery. For that, I was on crutches for 12 weeks and couldn't get the wounds wet. Over 2 1/2 years later, I ran my second marathon. A long road, to say the least--hoping for an easier recovery this time around.

Surgery

I'll never forget it. It was February 7, 2011, and I was running on the treadmill at NHHR--a follow-up to a 17-mile long-run in Central Park the previous day--when I started experiencing severe pain on the inside of my right knee. I was tempted to stop, but I stubbornly pushed through the pain.

Fast forward 10 months, and I'm still dealing with the same pain. It has all but shut down my running. I've tried everything from RICE to prolotherapy, but nothing has worked. So, if all goes well with my appointments on December 5th, I'm going under the knife on December 14th. I'm not yet entirely sure what the surgeon has planned, but we'll discuss that on the 5th. All I know at this point is that there are two problems, one with the semimembranosus tendon, and one with the medial plica. Both light up quite well on the enhanced MRI.

What is most unbelievable about this injury--aside from the fact that it has sidelined me for 10 months--is that I pretty much predicted it would come to this back in February. I can remember thinking to myself on the treadmill that night that this is not good. But I just couldn't bring myself to abort the final few weeks of training and forgo running the Austin Marathon. The training went so well that I just couldn't do it, despite realizing that I was headed for trouble.

If the surgery works, which I believe it will, for I would not do it otherwise, I will have to make some major changes in my training. Those changes include, first and foremost, devising and sticking to a stretching routine. I am the world's most inflexible human being, and I believe that this has contributed to my injury. Secondly, cross-training and strength training are a must for me.

Another opinion

I saw Dr. Michael Medvecky at Yale today, because my ailing right knee seems to have stopped responding to prolotherapy. As previously reported, there had been some improvement, but I feel that it has leveled off, unfortunately. I was hoping to avoid surgery on the knee, but that seems unlikely now. The first two docs that I saw (orthopedists) told me that I have hamstring tendonitis. The third doc that I saw (osteopathist) told me that I have some stretching of my MCL and the medial coronary ligaments of the knee. The fourth doc, Medvecky, told me that I have a partial hamstring tendon avulsion--if I understood him correctly--which is the tearing away of the tendon from the bone. I'm scheduled to have a contrast MRI (big bucks) on Tuesday, Nov. 22nd, and I will follow-up with Medvecky on Monday, Nov. 28th. He said that if it is, in fact, an avulsion, he would need to surgically reattach the tendon to the bone and debride any scar tissue that has formed at the site of the injury. Fine. Do what you you gotta do.

Then, of course, there was the bit about how we can try to get you back to where you were, but there are no guarantees. I don't need a surgeon to not guarantee me anything, I just need him to repair the injury, and my body will do the rest. If there's a will, there's a way. I learned that with my foot. Before learning of the injury to my foot, I was told by a podiatrist that I would have to limit my running to 8 miles per week if I wanted to do any running at all, and then I went on to average upwards of 55 miles per week and run four marathons without even the slightest protest from my foot.

In the meantime, I'll be mostly biking with some occasional running thrown in there. Just because I'm not in excruciating pain doesn't mean there's not a serious problem. Literally, the day before my foot surgery, I ran 7 miles with very little discomfort. Eventually, things quiet down, and one begins to question whether there is, in fact, a serious problem, but once one begins to ramp up, the problem rears its ugly face once again. And that's what's happened with the knee.

Nov. 7-14

Monday, Nov. 7
Treadmill: 0.5mi; 6min (Adrenaline)
Was very tight today. Perhaps pushed it too hard yesterday. I'm not too concerned, though. Biked for 10 minutes, then tried to do 10 minutes on the treadmill, but my legs weren't having it. Did lunges and tried deadlifts. Some core but still sore.

Tuesday, Nov. 8
Wilbur Cross H.S. track: 1.5mi; 16min (Adrenaline)
Still tight. Some discomfort down the front of leg. Biked over. 6 laps around (2:40, 2:42, 2:42, 2:40, 2:40, 2:39).

Wednesday, Nov. 9
Treadmill: 0.6mi; 6min (Minimus Trail)
I think I need to deemphasize running for the time being because I'm really tight and sore. To that end, I got on my bike and rode the 16 miles to and from NHHR. It looks like I'm going to stick to the bike and strength stuff mostly for a while until I feel comfortable running. The problem is that I'm growing quite impatient and if I continue to run I know that I'm going to overdo it, if I haven't already. God, this is getting old.

Ran out of motivation to continue reporting here but have been doing a fair amount of biking. Going in for surgery on the 14th of December. 12/11/11

Oct. 31-Nov. 6

Monday, Oct. 31
Treadmill: 1.9mi; 20min (Adrenaline)
Didn't have as much discomfort in the front of knee but tight in back. Otherwise, felt good. Core afterward with JB. Worried about bite on back of left leg.

Tuesday, Nov. 1
Wooster Sq.: 2mi; 20min (Minimus Trail)
Chilly. Felt pretty good except for still worrying about rash on back of leg. Some strength afterward but back sore from yesterday's introduction of new core exercises.

Wednesday, Nov. 2
Treadmill: 1.9mi; 20min (Adrenaline)
With the exception of some slight fatigue in my legs, felt good. Oh, and a little tight. Core and stretched out.

Thursday, Nov. 3
East Rock: 36min (Minimus Trail)
Had planned on the stationary bike and a short run at the gym tonight but instead hit up East Rock with Dan. Ran to the summit and back down the same way. Dark forced us onto the park roads for the last little bit. Biked the roundtrip to the trailhead. Strength stuff at home afterward.

Friday, Nov. 4
Treadmill: 1mi; 10min (Adrenaline)
Biked for 10 minutes, then moved over to the treadmill. Felt fine. New core routine and lots of strength stuff. Stepping it up.

Saturday, Nov. 5
Treadmill: ~15min (Adrenaline)
Treadmill turned off so don't know exact distance and time. Biked for 15 minutes, then moved over to the treadmill. Felt good. Had to cut the visit short because Jess had to get to work. Sore from yesterday.

Sunday, Nov. 6
West Rock: 37min (Minimus Trail)
Lovely day with Jess and Dan at West Rock. Started at the lake and headed east; came back on white trail and then did a loop around lake. Not sure of distance because I stopped somewhere around the lake (felt fine, but didn't want to push it). Legs at gym afterward. Core still sore so passed on that.

2hr 38min running

Oct. 24-30

Monday, Oct. 24
Wooster Sq.: 1mi; 10min (Adrenaline)
I was eager to get this run underway, but it didn't feel all that great. Definitely some soreness from yesterday. Strength and core.

Tuesday, Oct. 25
AM: Third prolotherapy session with Dr. Boyer. Not as bad as the first session, but not as good as the second--somewhere in between. The concentration of the solution injected into the MCL and coronary ligaments was 12.5% for the first two sessions. We decided to bump it up to 18% today, because I had very little discomfort after the second session. This could explain why today's session wasn't as pleasant as the second.
PM: East Rock: ~2mi (Minimus Trail)
After work, I biked out to East Rock and then hiked up to the summit and down the Giant Steps Trail. GPS showed 1.1mi to the summit. Probably should have kept to the bike, as I had some soreness on the downhills. Core.

Wednesday, Oct. 26
Wooster Sq.: 1mi; 11min (Minimus Trail)
Didn't decide to do this run until the walk home from work. Two laps on the path and one on the road. The road lap is about 0.4mi. Felt fine but decided not to push behind three laps given yesterday's procedure. Knee soreness precluded any kind of strength exercises afterward. Some core at home.

Thursday, Oct. 27
AM: East Rock: 2mi; 23min (Minimus Trail)
Dark, rainy morning. Kept to the flat trails and came back on English. Slight ache on top of left foot. Tight right hip flexor. Felt fine otherwise, I guess. Knee still sore, so no strength exercises again. Not feeling too inspired after this one.
PM: Core.

Friday, Oct. 28
AM: Appointment with Dr. Zeitler.
PM: Wilbur Cross H.S. track: 2.5mi; 25min (Adrenaline)
Biked over. Felt pretty good. Did some strength exercises on the football field post-run.

Saturday, Oct. 29
Branford Trolley Trail: 1mi; 14min (Minimus Trail)
Felt ready to roll but knee was tight so decided not to push it beyond the railroad tracks. Core.

Sunday, Oct. 30
Treadmill: 1.8mi; 20min (Adrenaline)
Not too thrilled about the treadmill, but felt pretty good actually. Only some slight discomfort in the front of my knee. Probably going to keep next week's running to 20-25min per outing, as my knee protests a bit if I try to go any longer. Strength stuff post-run.

1hr 43min running

Oct. 17-23

I finally feel that I'm engaging in sufficient physical activity to call it training again, so here's my first weekly training report in a long time:

Monday, Oct. 17
Bear Canyon Trail: ~4 miles; 22 minutes of running (Minimus Trail)
This was mostly a hike, as all of my outings in the Bozeman area were while I was there for 6 days. Bear Cyn was a nice, double-track trail with a modest climb. I ran about half up and half down. My breathing was labored on the up, but I felt fine on the down, except for some minor aches in my knee. Aches are fine; pain is not. No Grizzlies :(

Tuesday, Oct. 18
Sypes Canyon Trail: ~6 miles; 3-5 minutes of running (Minimus Trail)
I mostly hiked this trail purposely. This was a pretty stout hike with 1600' of vert. The views from the top were stunning. I felt fine, except for perhaps some slight dehydration on the way down. Too much wine; not enough water.

Wednesday, Oct. 19
Wooster Sq.: 2 miles; 21 minutes (Minimus Trail)
Rainy afternoon. Some slight twinges in my knee. Different than what I'm used to, though. Not sure what it could be. Probably nothing. Some minor tightness. Right foot needs a bit more support, so I'm going to have to be careful about running too much in the Minimus Trail, even though it's a pretty sweet shoe. Strength, drills, core, and push-ups.

Thursday, Oct. 20
Wilbur Cross H.S. track: 2 miles; 21 minutes (Adrenaline)
Biked the two or so miles over to the track at Wilbur Cross H.S. and managed eight laps around, albeit painfully slow (2:39, 2:42, 2:41, 2:39, 2:37, 2:36, 2:37, 2:39). Long gone are the days when I could run a lap about a minute faster than that. For now. Strength and drills.

Friday, Oct. 21
Wilbur Cross H.S. track: 1 mile; 10 minutes (Minimus Trail)
Dr. Z. appt.; got new excercises; biked up East Rock for a round-trip grand total of about eight miles; run felt good; strength, drills, core, and push-ups

Saturday, Oct. 22
Wooster Sq.: 1 mile; 10 minutes (Minimus Trail)
Beautiful fall morning; ran at a bit faster pace; felt fine; didn't have much time to do anything else, as we had to hit the road to West Hartford

Sunday, Oct. 23
East Rock: 32 minutes (Minimus Trail)
Biked the four-mile round-trip to the East Rock trailhead at the end of Orange Street. Summited East Rock in 14 minutes flat. Running the whole time. Felt pretty good. Some minor twinges here and there. Longest run since April! Longest pain- and awkward-free run since January! I'll take it. Strength and drills at Wooster Sq. Nice day.

2hr 1min running

Bear Canyon double-track.

Endless trails back there.

View atop Sypes Canyon Trail.

Grizzly Bears

While I was away in Bozeman for a few days recently, I learned quite a bit about Grizzly Bears. My fascination with Grizzlies stems from my first trip to Grizzly country in July 2011, when I first learned of the threat of Grizzlies in the western-third of Montana, as well as two recent fatal Grizzly attacks in Yellowstone National Park--one at a campground very close to where we stayed in Cooke City in July.

For me, the main appeal to Bozeman is its close proximity to thousands of miles of hiking/running trails in the Bridgers and the Greater Yellowstone Ecosystem. There are two-thousand miles of trails in the GYE alone. The only trouble with running in the area, however, is the threat of Grizzly encounters.

The closer you get to Yellowstone National Park, the better the threat. That is, anything south of I-90, in the GYE, which includes the Gallatin Range, is ripe for Grizzlies. North of I-90, in the Bridgers, is still safe, but it's believed that Grizzlies will eventually populate there.

Runners are cautioned not to run alone south of Big Sky and Pray in Paradise Valley. Jess and I didn't go that far south, but we definitely got deep into Gallatin when we hiked up to Emerald Lake. It would have been wise to carry bear spray, so we were told. Our wedding caterer, who bow hunts for elk and deer, now carries a sidearm, in addition to bear spray, after having been attacked by a mountain lion. I don't know that I feel the need to carry a sidearm. After all, I'll be running on the trails, not bushwhacking in camouflage.

While Grizzly encounters are rare, the threat certainly exists. Almost everyone that we met in Montana had something to say about Grizzlies, and they all emphasized that the threat is real. Most couldn't believe that we hiked without bear spray. We did a total of five hikes, three in the Gallatin Range (Bear Canyon Trail, Emerald Lake Trail, and Gallatin Riverside Trail) and two in the Bridgers (Sacajawea Peak Trail and Sypes Canyon Trail).

100 Year Old Marathoner

Holy shit!
http://www.npr.org/blogs/thetwo-way/2011/10/17/141414363/video-100-year-old-man-finishes-toronto-marathon

Bozeman, here we come!

On the eve of our second trip to Bozeman this year, I feel compelled to write about my knee, because I'll be asking a lot of it in the mountains come this weekend. In many ways, my knee is worlds better than it was in July, when we were first in Bozeman hiking/running in the area. In other ways, it feels just about the same. I'm still unable to string together more than several minutes of running, which is just about equally as frustrating as not being able to run at all. Lately, I've been mixing in running with hiking/walking. It's certainly better than doing nothing, but I've been saying that for far too long now.

The good news is that I was able to run pain-free for a total of 25 minutes on Sunday. I hadn't done that since May. The key, I've learned, is to keep the leg loose. Sitting at a computer all day long doesn't help matters, but once I get up and moving, the leg loosens up and things start to feel functional again. The tightness felt after having sat for 3 straight hours is quite discouraging, but I hope that a few trips to the chiropractor will help that. And maybe a new, non-desk job, too!

A few days ago, a colleague noticed that I was limping. I always notice that I'm limping, but sometimes it's not as apparent to other times. Concerned, he asked: "Your knees are already failing you at your age?" He was half-joking, but part of me wanted to go into how my knee is perfectly fine--just not quite ready for high-volume running again.

This is one of those injuries that wasn't directly caused by running. In other words, it wasn't the act of running that caused the injury. What caused the injury (ligament laxity), we think, was an old sprained knee that didn't fully heal. When it should have been healing, I was in the midst of hard training for a breakthrough marathon. My training had gone so well up to that point that abandoning it was out of the question. Eventually, the pain went away, but full ligament strength was not restored, due to the continuous trauma of hard training

Ever since Austin in February, I've been struggling with this injury. It's been hard. I've had many a meltdown. Just ask Jess! But I'm confident that things will only continue to improve.

East Rock

The knee seems to be coming around after a second prolotherpy session with Dr. Boyer. As a result, I've been doing some running on the East Rock trails (with some mixed in hiking on the ascents). Last night, I biked the two miles to the trailhead at the very end of Orange Street, where it intersects with English/Farnam Drive, and ran the trail along Farnam Drive to where it begins to climb to the top of East Rock. I zig-zagged my way up to the top, stretched out, and floated back down.

It's nice to finally feel somewhat normal again on the trails. The fitness definitely is not there yet, but the knee is feeling good. There are quite a few more East Rock trails that I'd like to explore, so if the knee cooperates like it has been, then that's probably where you'll find me.

On another note, the Bridger and Gallatin Mountains are calling our names. T-6 days!