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Wednesday, May 29, 2013

Five things that almost ruined my running.

Since in a year I went from "invincible" (marathons back to back weekends, one of which was actually 27 miles; speedwork the day after a half marathon PR; 20 minutes off my marathon time in a year) to an injury-prone, decrepit specimen of a former runner, I decided it was time to review how I got off track.

1. Just run! I had so many winter races on my calendar that I actually put off strength training until the spring.I felt like all I had time for were long runs and speedwork.
The result: Weak core and repeated circles around the park in one direction led to a cycle of SIJ and adductor issues that precipitated chronic osteitis pubis.
The fix: I put the strength training back in, replacing one day of running with a day of strength only, plus I have another day with running plus core.

2. Flexibility? Huh? I just ran. I stretched if I thought it would feel good.
The result: Tightness that could have led to a stress fracture, and nearly ruined my hips.
The fix: I don't think static stretching makes sense, but I now foam-roll before and after every run to keep things loose, and I schedule a short session of yoga for runners once a week.

The result: Not enough recovery time led to fatigue, poor race times, and damaged soft tissue.
The fix: I will try to scale back the distance races but keep shorter distances as workouts.

4. I never respond to my body's cues. Sore? Run it out! Tired? Run it out! Pain in the right calf? Run it out!
The result: I worsened two injuries.
The fix: Now I'm taking my doctor's advice: If there is any discomfort when I run, I will stop immediately, walk home, and take off until it goes away. I'm just not good enough at recognizing pain!

5. I overestimated my fitness and abilities last fall. I came back from injury to a tough marathon training plan and dove right in. I felt fine at the beginning, but in a month or two I was slowing down at races, feeling tired during the day, and missing workout paces.
The result: Major injury and a few bad races.
The fix: I need to make sure that I do three things: ease into training slowly, keep my mileage on the low side (65 max, better at 45 MPW), and keep easy runs easy.

Friday, May 24, 2013

Foody Friday: Bagels for Breafast

No running = enough free time to make my own household staples.

Those are some really crappy pictures. 

Finally worked out a recipe I like, with the right stretchy bagel texture (not pillowy like bread). The secret here is two-fold: one is working the dough hard enough to really develop the gluten, and the other is extra-long boiling time.

1 and 1/4 C warm water
1 TBS yeast
2 and 1/2 C white flour
2 C whole wheat flour
2 tsp salt
2 TBS olive oil
3 TBS sugar

Dissolve yeast in warm water. When foamed, add remaining ingredients. Stir to combine. When dough forms, knead for at least 5 minutes. You want very stretchy, developed dough. Work it to death. It should squeak when you knead it.
Put it in an oiled bowl, cover with a damp towel, and let rise for 2 hours in a warm place.
Punch down dough, knead lightly, and divide into 12 pieces. Roll into ropes and form bagels. Let them rest/rise for about 20 minutes.
Meanwhile, preheat oven to 475 and start boiling a large pot of water. Add 1/4 C sugar to the water. Drop bagels into boiling water carefully. Boil for 1 - 2 minutes per side (I like to boil mine on the longer side for a very chewy crust). Place on a greased cookie sheet and bake for 15-20 mintes.

Wednesday, May 22, 2013

Guess what I ran in today?

As a Brooks ambassador, I am happy to announce that I RAN HAPPY five miles in my brand new free shoes!!!!!!

I kid. I paid $109 for these, and that's with my club runner's discount from Varsity (and 9% sales tax, thanks New Orleans). And I'm not wildly in love with the marketing for Brooks (I would like less emphasis on how amazing these shoes will make my soul feel and more emphasis on how they will cure all running ills and immediately heal or prevent injury).

But marketing aside, I have heard nothing but good things about the Brooks Pure line, and they seemed like a safe way to move to a slightly more supportive shoe. I got the men's Cadence because:

1. I have osteitis pubis. This means that my pubic bone is hurt and inflamed all the time. It is worsened by adductors pulling on the bone; if I can reduce that load the pain should lessen. Pronating leads to aductor shortening and tightness. I'm trying to work on this by strengthening my hips, too, but maybe a little control at the foot will assist.
2. When I got the left femoral stress fracture, my gait was off from some MTSS in the right leg. I've had that before in my right leg, and it is also a result of pronation.
3. The Cadence is probably a safe, light level of control and I don't want to go full stability. I tried that before and I was chronically injured: knees, hips, groin, etc. My runner's knee vanished immediately when I got out of my motion control shoes and into neutral. The Cadence seems to be halfway between monster motion control and cushy Kinvara freedom.

So this is a big experiment, and I thought I might as well try it while my mileage was low and slow. I ran in them once and didn't have any terribly ill effects, although there isn't as much cushion underfoot compared to the Kinvaras. I'll report back on the results after a few weeks.

Anyone else in the Pure line? Love them? Hate them? Do they really wear out in 300 miles?!

Tuesday, May 21, 2013

We're poster people: Crescent City Classic top 500 poster

We're officially runners in the New Orleans sense of the word:

We have a Crescent City Classic poster!
I ended up putting it in my kitchen, under the blinding glare of our absurdly bright fluorescents, because we have limited wall space: we can't put holes in our lath-and-plaster walls and have to hang art from our picture rails or prop it on ledges. I took down a pear still life in the kitchen and replaced it with this years' poster.

David likes the poster in the kitchen because he remembers a friend on his street with "weird" parents who ran, and they always had the current CCC poster in their breakfast nook. He gets so nostalgic about this that he's mentioned it, oh, every time we eat breakfast.

The dark blue kind of dominates my yellow kitchen, but oh, well.
This is our only shrine to running. Do you display medals, bibs, posters, trophies, etc? I threw all mine out last year but I took a photo to preserve the memory!

Sunday, May 19, 2013

Running again!

A week ago Saturday morning I tied my Kinvaras - they felt so strange on my feet! - and headed out the door for a test run. I was supposed to walk ten minutes to warm up, then begin 5 minute running and walking intervals. But I was so nervous that I'd be in pain when I started running that I walked for about 20 minutes before finally breaking into a jog.
Five minutes ticked by with no pain, and I started to breathe more easily. I finished my run pain-free and a week later, I'm still feeling just fine. Thank goodness! I'd really forgotten what it felt like to run without sharp pain behind my knee at every step.
...And the humidity is back! After a sweaty run.

I did about 20 miles the first week, but only about half of that was actually running: at least time-wise. I didn't want to over do it, so I stuck to walking intervals.

My assessment after a week:
- Pain at bone is no longer there. Oh my gosh this is so strange to me. Even after 6 weeks off I expected to wince every time my left foot pushed off.
- However, left leg still feels "off" - like my VMO is working harder on that side. The hamstring feels strong to me, but it is visibly smaller. I think it atrophied from sparing that leg for so long.
- Osteitis pubis: still there, darn it. It's always worse after a running break, though, then improves in a few weeks, so I will see how that feels later.
- My calves were so sore at first! There is nothing like running to really work your calves.
- I didn't lose much cardiovascular fitness (although I AM going slowly and walking too)

I'm asking for your advice again, since I am waiting on a return call from my doctor. My lovely lab charged me $1100 (seriously) and never sent my labwork to my doctor's office, so he needs to see that before he calls me back. In the meantime, anyone have any idea what to do about the weak left leg/sore VMO? I think the VMO is doing some of the work my pathetic shriveled little hamstring should be doing.

Wednesday, May 15, 2013

Femoral stress fracture versus hamstring tear

If you remember way, way back in November, I was convinced that I had a hamstring tear. It wasn't until May that I was diagnosed with, instead, a distal femoral stress fracture! Why the confusion?

1. I was confused:
- The pain began as very diffuse pain and even numbness. I couldn't even point to where it hurt. From my hip to my knee was numb, mostly at the back of the leg.
- I had bruising in striations on the back of my thigh. I still can't explain this. It was definitely there. Did I have two injuries at once? Did a hamstring strain lead to a fracture?
This is someone else's hamstring. But my bruising looked almost exactly like this. 
- Graston - a soft-tissue treatment - brought relief. After my first session of Graston I could finally walk down stairs.

2. Medical professionals were confused:
- By the time I saw a chiropractor, pain had localized to a pretty small area on the back of my thigh (and the front if my thigh was unsupported, like dangling off a chair). I asked the chiropractor if he thought it could be a stress fracture, but he immediately wrote it off due to the location. The injury was still new, so I pressured him, and he did the "tuning fork test", which was negative - however, my thighs are muscular and fat, and I seriously doubt that fork got anywhere near my bone (plus the test is just 50% accurate!)
- When I saw a PT, he was already biased by my previous diagnosis. I brought up stress fracture again, because by now I could probe under the muscle and tendon and touch a spot the size of a quarter on the bone that hurt to pressure. But my PT very firmly told me there was "zero chance" of a stress fracture at that location.

3. I did not follow traditional treatment:
- I didn't completely rest.
- For some reason I decided to see a chiropractor first, hoping to discover an imbalance that caused the "hamstring tear". I did rest on my own, but the chiropractor actually urged me to return to running sooner than I had planned. He told me that it was the best way to get blood flow to an injured tendon, which he thought was the cause of the lingering pain.
- My PT also encouraged continued sport, as he does not advocate complete rest for any soft tissue injury.
- I didn't get any imaging done until five months from injury.

So there you have it. A lot of confusion contributing to a misdiagnosis. I learned two things from this injury:
1. See a doctor first. When my doctor walked into the exam room in May, 5 months after injury, he was reading my chief complaint. Before I finished my first sentence he was saying, "Stress fracture. Go get in that x-ray machine." I don't usually like doctor's jumping to conclusions, but he was right. What can I say? Go to the professional with the most experience and the ability to order imaging!
2. REST. Runners love to hear, "Oh, you can run through it" or "You need to use the muscle to get blood flow to the area" etc. But I think I learned my lesson here. Most injuries need rest and rehab and honestly a little rest never, ever hurts you! From now on, I rest my injuries! And then I rebuild.

Monday, May 13, 2013

Jazz at Galatoire's bar

I wore a pink silk mini I just bought and a navy lace turtleneck
David and I had a date night at Galatoire's bar in the French Quarter last week. Not only did I want a Sazerac on the rocks (who has heard of such a thing?! Yet Galatoire's does it, and does it well!), I wanted to listen to some good live music. Right now, the evening entertainment is Jep Epstein, whose music I love. And I'm pretty familiar with his piano playing: he's the pianist at my church! So I get to enjoy his phenomenal talent every Sunday morning. The Saturday night version was just as good, and if you are in the New Orleans area, I recommend you do an evening at Galatoire's bar. It's nice, clean, smoke-free, and a classy far cry from the grossness of the rest of Bourbon street. Jep is easy to listen to, remarkably good on the piano, and he takes requests. And I do suggest you try the Sazarac on the rocks!

Thursday, May 9, 2013

Almost ready to run

Five and a half weeks after seeing my doctor, I am almost ready to run again. I spent the last six weeks resting, then progressing to core and upper body work, then water jogging, then lower body work, then exercise bike, then mild plyometrics to test for pain.
Last real run: the Crescent City Classic! I'm in the front of the Varsity New Orleans Group, second from L.

So far, after the initial period of rest, the pain has not returned. I am allowed to progress to run/walk intervals this weekend. I will then work in more running over 2 weeks; after that I can basically pretend I am a newbie just learning to run.

I have a few concerns about this return.
- Is it too soon? I took off 6 weeks for a complete femoral stress fracture - as in, a broken bone. I mean, it did have five months of healing, but still...
- Why am I dealing with osteitis pubis? Just like the last time I took off running (last summer, to heal osteitis pubis) the condition was worse when I wasn't running/right after return to running. Does running help, or is the condition progressing (horrors!)?
- Will I re-injure? I don't know what caused this fracture to begin with, and I sense that my left leg is still weaker. Then, there is my crappy running form where my foot initially kicks out from my body, then crosses back over to the other side of my body. Too much movement, too much wasted energy. Should I invest in a running form lesson or two as I return to running, or is that asking for trouble?

Anyone have some good advice for me about returning to running? Especially if you had a stress fracture? I definitely do not want to re-injure myself!

Wednesday, May 8, 2013

Poor little car

Last week I went to the gym before work, walked out, and found that someone had stolen one of my hubcaps while I was in the gym.
This week I went to the gym before work, walked out, and found that someone had viciously side-swiped my car, gouging deep into the back side panel and door.

My poor little car! The hubcap robbery baffled me until I realized that they don't make my hubcaps anymore (I drive a Scion Xa - they don't even make my car anymore!). Someone surely stole it to replace one of theirs...although I'd like to think better of Scion drivers. I was lucky enough to find a replacement on Ebay. The theft itself isn't shocking since the parking lot I use is in the ghetto. Yes, my gym is incredibly beautiful and fancy (and it has a BAR and a LIBRARY), but like most of New Orleans, nice stuff touches ugly stuff all the time. The lot spans the block between the gym and the housing projects.

The side-swipe has to be fixed: it isn't just a scrape. This is the THIRD time my car has been hit while parked. I think it's so small no one can see it. But I'll be paying my deductible again.

Monday, May 6, 2013

Locks of Love wouldn't even take it.

I finally cut the stringy mass that was my hair. I severed eight inches of pathetic split ends.

Now it's short and wavy. As soon as I hit mid-back, the weight of my hair pulls it completely straight. The shorter it is, the more wave it has.
Sorry for the creepy expression. I'm bad at self-portraits. Good thing I don't post a million pictures of myself every single day.

This was a particularly puffy day at the office right after I cut it. My allergies are killing me this year. I think it's much nicer without the silly hair clip, but then it gets in my eyes. And in everyone's pill bottles.

Friday, May 3, 2013

I can cycle!

This week I got to add in cycling! It's slightly closer to running, and a nice change from the pool. The first time I biked (stationary bike) I felt some muscular soreness, but it was bilateral so I don't think it is related to the stress fracture. More related to my out-of-shapeness. The next time I biked I had no pain or soreness at all. Two weeks of this, then I can work in running!

In other news. I finally went to collect my labwork from several weeks ago. My results were generally fine. There were some low-normal-range results, and guess what? News flash: that's still normal. It annoys me when people are all, "My calcium is low! It's 8.6 and normal is 8.4 so like it's a little low!" No, it isn't. The range is 8.4 - 10.4, so you're fine. You're practically in the middle. Quit being a hypochondriac.

There were two actual low results, though.
1. My vitamin D is 26.6, so in the fuzzy "insufficiency" range. Whatever, I'll take a vitamin D capsule. Can't hurt to increase it while I'm trying to heal my bones. Sheesh, if I could go running and get out in the sun I'm sure I could fix my vitamin D in no time!
2. My alkaline phosphatase was low. I assume my doctor got an alk phos to make sure it wasn't HIGH, which could indicate bone cancer, but as it turns out it's low. That's a sign of hypothyroidism. No big surprise there; I am hypothyroid secondary to a thyroidectomy when I was a teenager. But I'm the world's worst patient, so I stopped taking thyroid hormone replacement a while ago. This is a reminder to get back to the doctor and get that regulated.

Stuff that really matters, like PTH and calcium, were all fine. I'll call my doctor back to discuss the results and see if he wants me on some vitamin D, then I suppose I had better find a PCP to follow up on the ol' thyroid.

Wednesday, May 1, 2013

Buying running shoes for bunions: an updated list of recommendations

One of my most-viewed posts is one I did years ago about buying running shoes. This is a particularly hard task for runners who, like me, suffer from bunions. Since I wrote that post, new shoes have hit the market and new technologies are available to help us make the shoe choice, so here goes an update!

1. First and foremost, look for a wide toe box. The best new tool to help you find a shoe that fits nice and wide in the toe box is Shoefitr. It allows you to compare models, so if one model worked for you, you can find a similar fit in a different shoe. The technology is also used in shoe reviews; when I read Running Times' shoe reviews I always look for the nice "roomy" blue or green over the bunion area!
OUCH! This is the Adidas adiZero Aegis 2: super tight over the bunion! 
Brands that typically have wider toe boxes (please add comments to this - I'm always looking for truly wide toe boxes!):
- Brooks, especially Pure Project
- Saucony: consistently wider forefoot styles
- Mizuno: Some styles
2. Find a shoe with a mesh or soft fabric upper and minimal overlay at the bunion area. This is key. You want only material that can stretch and conform to your foot's shape over the bunion. Any stiff or non-stretchy fabric or plastic there will create prohibitive rigidity. There have been some fantastic additions to the market with flexible uppers with minimal overlay.
Altra Instinct: minimal overlay; the strip near the bunion doesn't cross over the foot so doesn't cause narrowing.
Karhu still makes some of the best shoes if you want no overlays: this is the  Flow trainer

The Hoka One's debatable for many reasons but it does limit overlay in the bunion
Mizuno Evo Cursoris: wide open!

Even the Mizuno Wave Rider keeps the widest area of the toe box free from overlay
Saucony's type A isn't overlaid; it's printed.
The Saucony spectrum, if you don't want a racing flat
The Sketchers GOrun doesn't have overlay, but the stitching might pose a problem

Obviously there are plenty of other shoes out there to choose from and I'm not endorsing any of these shoes: just using them for demonstration.
3. Go for men's styles if you're a lady. I've been wearing a men's 8.5 for years now and it's the only way I can find a shoe wide enough. Just lace up all the way to make the ankles snug enough.
4. Try a larger size. Maybe you need to go up a half-size. As long as you are not over a thumb-nail length from the front of the shoe, you should be ok and it's worth a try for a wider fit. You can also wear a larger size, and lace it carefully for a better fit: leave the laces loose at the toe, so the shoe can conform to your foot, and tighten as you go up.
Tight to loose

5. Look for depth. Even shoes with wide toe boxes can be restrictive if they are not deep enough. After the 2012 Olympics, everyone wanted a pair of Nike Flyknits on their feet. Not me: look at how shallow that forefoot is! Deep shoes give you more wiggle room and more flexibility. Plus, although we tend to think of feet with bunions as just being wider, the bunion also extends down lower than the rest of your foot, so you need a deeper shoe (If you have bunions, look at the profile of your foot and notice how the first MTP joint extends lower than any other part of your foot).
Look how little depth at the toe! 

6. Buy the right kind of cushioning to protect your bunions. If you have bunions, chances are good that they either hit the ground first as you strike (mid or forefoot strike) or as you transition to toe-off (heel strike). Basically, you are running with the whole weight of your body on one joint! Ease the pressure with a well-cushioned shoe. In my experience, foam seems to be best for this, since your swollen joint can sink down into it: something it can't do in, say, a grid. A word of caution here regarding minimalist shoes: if you want to go zero drop, it's probably best to still buy a shoe with enough cushion. Otherwise, you are slamming an inflamed, painful joint into the ground over and over again with every run.
7. Consider a shoe that promotes a mid-foot strike. In my opinion, going from heel-to-toe is tougher on the bunion than going from mid-foot-to-toe. If you land on your mid-foot, yeah, your bunion probably still strikes first, but then the rest of your forefoot makes contact with the ground, providing a stable base to absorb impact and sharing the work of push-off. When you heel strike you transition from heel to forefoot (your larger bunion striking first, of course) then immediately toe off, putting the full force of that action on your bunion alone. Just a thought. Don't change your form lightly though!
8. Pick the right sock. Everyone's got their favorite sock, and my particular favorite is a lightly padded cotton sock. I don't want any thick terry cloth socks to add bulk to the bunion area!
9. Avoid shoes with pointed toes. The shape not only promotes bunion formation/continuation, it places undue stress on the bunion as you strike and toe-off. Plus, the pointier the toe, the larger a size you'll have to buy to accomodate your width, and going too large can create other problems like black toenails and blisters.
Altras with flat, broad toes.
In case you are wondering, I am currently wearing Saucony Kinvaras and Mizuno Mushas. Both fit my bunions well, although the Kinvaras always split over the area after about 500 miles. What shoe do you wear?