The bumpy road of physical therapy and injury rehab

I’m now just about 4 weeks post-surgery, and the process of adequately rehabbing an injury is something I find both fascinating and frustrating.

At any given moment, you’ve got two sides of your brain chattering at you at the same time:

left-brain-right-brain

 

The left and more analytic side is warning you to not push too hard, stay safe, and asking “What do you think that little tiny ‘twinge’ means?”…  The left brain looks for reason, justification, and something in the DATA to prove that improvement is taking place.

The right and more emotional side is egging you on, getting wrapped up in the enthusiasm of FINALLY TRAINING AGAIN, and also lamenting your loss of fitness, your slow lumbering progress, and overall lameness.  The right brain also swells with delight when a session goes well, and the iso-lateral movements are getting easier on the weaker side.

 

It’s a push/pull with every day.  The one thing I’m attempting to keep in center-focus is that REST will never hurt, nor set you back.  Much of my time these last couple of weeks has been strengthening the left (affected) side, bringing it into balance with the stronger side.  Too much too soon will result in other injury as the pelvic imbalance is significant.  

It’s a mind game.  So often we view “mental toughness” as kicking in on mile 85 of the bike, or mile 20 of the run, when all the matches are just about gone.  I’m looking at mental toughness these days as the practice of staying positive, having fun throughout the process.  Mental toughness tells you that the discomfort you feel is normal, and that “Rome wasn’t build in a day”, and “Put down that cookie”.  So much of any rehab plan – or any RACE PLAN for that matter – is rooted in “trust the process”.  It has to be, as at the end of the day “the process” is the only thing that is proven to work over the long haul.

In short – “Trust the Process”.

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Quick Post-Surgery Update

So my initial PT visit went well.  My Physical Therapist (also a USAT Level 1 Tri coach) and I hit it off well and I did pretty well in my movement and strength assessments.  Apparently I’ve only got about 40% of the strength in the repaired hip, but the range of motion is pretty good.  I lack some range of motion in my hamstrings and glutes, and my hips are pretty tight to begin with, so this isn’t necessarily new news.

I was given some exercises for strengthening and stretching, which I’ve been doing religiously in the week since my first appointment.  I’ve also upped my time duration on both the stationary bike (not my tri bike on the trainer yet) as well as the elliptical.  I’ll be getting back in the pool this week as my incisions are almost 100% healed.

My wife and I are also doing the Plank-A-Day Challenge, and we’re up to 45 seconds so far on day 7.

Catching up – Ironman Arizona, Surgery, Recovery…

I’m surprised it’s been so long since my last post.  Things have been nuts all the way around and I didn’t even have a chance to throw together a post-IronmanArizona blog post.  The truth is that I returned from Arizona completely psyched but also staring down the barrel of a massive work schedule along with getting things ready for my December 18th surgery, so it fell by the wayside.  In a nutshell, here’s my thoughts:

On Ironman Arizona –

Some Sweet Rides

Some Sweet Rides

I arrived out in Arizona on the Friday of raceweek.  In addition to being out in AZ to volunteer (and thus solidify a spot in the 2014 race), I was looking forward to rooting on and supporting TinMen Endurance – a group of 5 heart-transplant recipients that were all racing together to raise awareness for organ donor programs.  My buddy Derek successfully finished Ironman Lake Placid in July becoming the first American to complete a full-Iron race.  We all went to dinner on Saturday evening and I had a chance to meet the guys and their families and learn about their stories.  Sadly, only two of the five were able to complete – one was jumped-on while entering the water pre-start and had to be pulled out before the gun at 7am, and another was swept off the run course late-night.  A third (Kyle Garlett) took a nasty spill on his bike a couple of weeks before the race and just couldn’t make the start.  Many of you might know Kyle from his previous Kona attempts and spotlight segments on the NBC Kona broadcasts.

The race was fantastic.  I was able to join some friends out on the bike course during the day before my volunteer shift at the finish line.  I saw a couple of nasty wipeouts – 3 loops causes WAY TOO MUCH CONGESTION and I sincerely hope the rumors of elongating it to 2 longer loops in 2014 becomes a reality.  At one intersection I saw a tri-teammate from Delaware dash into a porta-john, and shocked him when he emerged to find me holding his bike with a good luck cheer!  My time at the finish line was incredibly inspiring and while I was completely exhausted after a long day on my feet (woke at 3:30am) it’s impossible to NOT keep going while these competitors kept streaming across the finish line.  It was an honor to participate as a volunteer, regardless of my registration.

IMAZFinishLine

I headed back to my hotel and caught a couple hours of sleep, then checked out and headed to Athlete Village to get a place in line.  The word on the street was that there was an unprecedented number of volunteers gunning for slots, and the long winding line appeared to have way too many hopeful people in it.  Once the sun came up the line began to move about 7:40 am and I ended up finding my way to the front and registering for 2014.

I Guess This Makes It Real

I Guess This Makes It Real

Surgery –

My hip really felt a bit “blown up” in the days leading up to the surgery.  Just to refresh, over the past summer I felt more and more discomfort while running.  After a round of PT treating what we thought to perhaps be a “groin strain”, an arthrogram revealed a torn labrum in my left hip.  We tried a cortisone injection to no avail, so it was onto arthroscopic labrum repair.

I look calm here, but I'm totally freaking out.

I look calm here, but I’m totally freaking out.

I’m not exaggerating, I was completely losing it prior to going into the OR.  My wife was really comforting though, and before I knew it I was waking up and only wanted something to drink really bad.

So there was a little more damage than my doc thought:

Beforehip

Red and frayed = not good. This is the anterior, and more damage was seen on the other surfaces.

But, it all cleaned up nicely…

Afterhip

Nice and smooth…

So the first couple of days were tough.  I needed crutches almost all the time and the pain meds were my best friend.  I used the hell out of my 110% Compression shorts and ice – ice and compression might just be the best thing ever.  I kept up stretching and my isometric exercises, and 9 days after surgery my doc was amazed at my recovery.  I had much more range of motion than would be expected, and he cleared me for bike, elliptical, pool, and core strengthening and just about anything I felt up to EXCEPT running!

So off we go.  PT begins tomorrow, and I’ll be working with a tri-teammate who is an excellent PT as well as a Level 1 USAT coach!  I’ve already been on an exercise bike as well as an elliptical, and the crutches are no longer needed.

Ironman Arizona 2014 – you’ll be my bitch…

Eye on the ball

It’s been a while since I’ve updated on this here blog, so here’s what’s latest and greatest…

This will be a bit “stream-of-consciousness”, as that’s the way I tend to write most of the time!:

  • Completely psyched about the fact this in ONE WEEK I’ll be flying to Phoenix, Arizona for my first Ironman event.  I am volunteering at Ironman Arizona, and I am very much looking forward to absorbing the race atmosphere and learning everything I possibly can from those that are battling the 140.6 beast.
  • In Arizona, I’m looking forward to meeting/greeting with the pros and friends I’ve made on Twitter.  The Slowtwitch party at Tribe Multisports seems to be the place to be.
  • Injuries – Arthroscopic hip labrum surgery is scheduled for 12/18.  In addition I broke a tooth and that needs to be extracted ASAP.  It’s an old root canal job from 19 years ago and it fractured up at the root.  It hurts but its manageable and I’m getting by.  I should be able to get it done prior to my AZ trip.
  • I applied for Team Everyman Jack – these guys are one of my favorite personal product providers.  You may or may not know that I’m a bit particular when it comes to soap and shaving products – I’ve got pretty sensitive skin and the more chemicals a product has, the more I tend to break out.  I’ve moved to old-timey wet shaving rather than cartridge razors, and EMJ lotions and washes are a go-to for me.  Meredith Kessler tweeted that they have a triathlon team and are accepting applications for age-groupers.  While I’m not necessarily “elite”, I plan on racing lots in 2014 in some big places, and I do know quite a bit about marketing and positioning products well (it’s my day job, after all).  I went ahead and applied and we’ll see what happens.  I truly love their products and I hope I have a chance to represent them in 2014!

My fitness goals between now and my rehab (which would begin on 12/19) is to (a) lose some of my excess weight through better, cleaner eating and (b) increase activity focusing on aerobic base and flexibility.  My hip is feeling a little less angry than it has been, although I swam last night and it was very sore coming out of the water (too much flexion).  I’m going to begin using paddles and a pull-buoy to work my upper body a little more.  Anything I can do that’s as non-loading as possible so as not to aggravate the general area will be fine.

I think the sheer gravity and inspiration that I’ll witness at Ironman Arizona will get me back to a better mental place – focusing on the positive and keeping my eye on the ball.  It’s about OUTCOMES here, and my primary goal will be to get to a level that allows for a 70.3 in June and a 140.6 in November.  The byproducts of those efforts will be practically endless, and I’ll have that journey for the rest of my life!

 

The Waiting is the Hardest Part

I’m certain Tom Petty would agree…

I met with my new Orthopedist last week – he came very highly recommended by some of my teammates and specializes in sports medicine and arthroscopic hip surgery.  One of my concerns was the old adage – “If all you have is a hammer, every problem looks like a nail”, but after our conversation I’m convinced he would only recommend a hip scope if he was absolutely convinced it was the best option.  Among his first questions was “So tell me about your race goals for 2014.”  This tells me that he’s pretty outcomes-focused.

He believes that we’re looking at a small hip abnormality, possibly caused by a small spur, and that my elevated training caused a tear in my labrum.  The fact that my hip hurt A LOT in the first 15 minutes of a run session and then subsided is most likely due to compensation – I simply adjusted my gait and stride to make it hurt less.  This caused all of the strain/pain in my abs, adductor, flexor, rectus, etc.

This is what an arthrogram MRI looks like - they shoot dye into the hip.

This is what an arthrogram MRI looks like – they shoot dye into the hip.

So mainly we need to identify if there is labrum damage, and then deal with it.  After 8 weeks of rest and guided PT there was negligible improvement, and that typically indicates that things won’t improve long term without surgical intervention.  The good news – my doc is one of the ONLY guys in the mid-Atlantic that performs arthroscopic hip procedures.  It’s done all the time on shoulders and knees, but less so on hips.  I’ll be on crutches for a week, but I’ll be walking unassisted by the end of week one, on a bike in week two, and then in the pool as soon as my stitches heal.  Running is out for 3 months, but PT will begin the day after the procedure.

My MRI is Wednesday, and of course there is always the possibility that this is all wrong and we pursue another path, but something is telling me we’re finally on the right track!  If I need surgery, I’ll try to schedule after Ironman AZ so I can still attend and volunteer.  According to my doc, I could definitely do a June 70.3 and a November 140.6 in 2014, as long as I do my part – so that’s about the best news I can hope for…

Getting Better – Resuming Activities Soon

So as I type this, my house is asleep.  I’d normally be out for a long run or big brick, as weekends are the perfect time to exploit my family’s love of late sleep while I go log some hours.  Also, most of my team is gearing up to race – either locally at our little “Top of Delaware” sprint or at Mount Tremblant or Timberman.  Normally I’d be at the local race as a “tune-up” for my intended A race of the Diamondman 70.3 in September, but the Triathlon Gods had different plans.

PT has been going well.  I’m now being pushed pretty hard, and we’ve added stationary bike and elliptical into the mix in small controlled doses.  Most of the work is actually stretching, strengthening, and stability.  My typical PT session looks like:

  • 10 minutes of ultrasound on the affected area
  • Sometimes – my PT does a little bit of “active release therapy” here  – if you’ve never had, it’s like a slightly more violent deep tissue massage designed to break up scar tissue
  • Stationary bike – 10 minute warm up (get a bit of a sweat going)
  • Calf Stretch 4 x 30 sec
  • Lying Hamstring Stretch – 4 x 30 sec (each leg with a strap)
  • Lying Quad/Flexor Stretch – 4 x 30 sec (each leg with a strap – facedown)
  • Using Flexi- bands (black = high resistance) – 4×12 reps straight leg standing lifts all 4 ways (flexion, extension, abduction, adduction)
  • Lying Knee Squeeze playground ball (adduction/groin) – 4 x 10 sec
  • Standard Planks – 3 x 30 sec to start (these kick my ass, and are part of the reason I’m injured in the first place)
  • Abdominal Bridges – 4 x 10 feet on bosu ball
  • Electro-Stim Therapy w/heavy ice pack – 15 minutes

This whole sequence ends up taking about 90 minutes or so.  We’re getting more aggressive with the intensity and the pace of the session, which is a good thing.  I’ve also noticed that injury recovery often involves days where you think “Wow, this stuff is working” and other days where you believe “Aww crap this sucks and I’m hurt again”).  It’s just difficult to know how you’re going to feel the next day or two after you work the injured area, but lots of my day to day functional pain is gone.  It hurt like hell to get out into my car and out of my bed, but those small daily reminders have vanished.

I’ve just entered into a period of heavy travel for my job.  The fall season is chock full of industry events and functions, and since my company’s primary marketing tactic is to exhibit and present/speak at these events, off I go.  I’m on the road and speaking 12 out of 14 weeks, but a lot of those trips are just 2-3 days in duration.  It’s going to be a stressful 3 months, and my biggest challenge is not blowing up like a fat balloon while grabbing fod on the road.  Salads and oatmeal will be my friend, and if I can begin some very light easy running soon I’d be a happy guy.

I just purchased a new heart rate monitor that will be compatible with my iPhone5.  I am going to play around with a Heart Rate Variability app called SweetBeat.  A Twitter buddy of mine is a big believer of using HRV to guide day-to-day intensity and monitor the body’s changes, and it’s been proving very effective especially in guarding against over-training.  I believe that I’ve been pushing the envelope here, and that over-training at least contributed indirectly to my injury.  I’ll explore this app and it’s benefits in some future posts, but you can read about my friend Brian’s experiences here – http://bri-tri.com/tag/heart-rate-variability/

 

 

Meet my new coach, sort of…

So being injured, I’m trying to keep this time both productive and positive.  Unfortunately my mood has been a little dark, as I am truly one of those sick, demented people that feels like a slacker when the workout gets cancelled!  Not “Jack-from-Shining” or anything, but just a little “off”…

"Did you do your BRICK yet?"

“Did you do your BRICK yet?”

 

Back in the summer of 2011 is when I began to take my fitness and body seriously – so I became compelled to start running.  You can read about my backstory here, but once upon a time if you took away my ability to train, I’d say “So what?  Bring me a beer.”  Now it’s an entirely different ballgame.

 

So I’ve been mildly bummed that I can’t do anything, and as I’m sometimes wont to do I have been eating very poorly.  I had been viewing my clean(er) eating as a way to fuel workouts, but take away those workouts and – why bother? – right?

Of course not, but we’re not always rational and logical beings.

So I arrived at a point where I needed to SNAP out of it, and I did.  Rather than focus on what I can’t do, I am making the choice to focus on my goals.  So two things were accomplished this week:

  1. I’m hiring a swim coach locally to get me more efficient.  He’s actually a teammate that happens to be a tremendous high school swim coach with about 20 years of experience.
  2. I’ve made a deal with myself that once I get down to goal racing weight I will make a gear acquisition – CARBON WHEELS!
Not my bike, but these would look great on my Cannondale Slice5!

Not my bike, but these would look great on my Cannondale Slice5!

 

As for program coaching, I’ve decided to go with BeginnerTriathlete.com and their online coaching program.  I’ve joined as a GOLD member, and mapped out my 2014 season back to front.  The phases look like a little like this:

  1. 16 weeks of sport-focused training on my two areas of improvement (8 for swim, 8 for bike) focusing on technique and power/speed.
  2. “70.3 and beyond”  16-week program that brings me to my first 70.3 the EAGLEMAN in early June 2014.
  3. 20 week program to build to Ironman Arizona 2014.

These 3 (actually 4) programs all dovetail from one to the other with at least a week of rest as well as a taper into the milepost race.  I’ll be adding a couple of shorter tuneup races early-season locally, but for the most part its going to be about training and less about race shirts and swag next year.

As for BeginnerTriathlete, the online training and program layout is very solid, and I like what I see.  I’ve imported in all of my Garmin data and it was shockingly simple.  I like what I see, and once I am cleared to ramp back up into training mode I’ll be activating the online coaching function.  All in all it seems like a great value for an organized, geek data-driven athlete that has some clue as to what they’re doing.  If things do not go well, I can always move to a more traditional coach, but I’ve got ample resources at my disposal so I might as well save the money.