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”.

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.

 

First Aid on the Move

So I sustained a minor injury yesterday.  No I wasn’t out running on a remote trail in the wilds of Delaware (I prefer the roads and neighborhoods most of the time), but I was a scant .5 mile away from home in a neighboring development.  I was running on the sidewalk as there were cars parked along the road when I looked up and saw a tree branch I was going to need to get under.  I was about 1:40 into my long run and feeling really good so I went to duck under.  I made the first branch and never saw the second branch which must of been lower, and I smacked myself right on top of the head.

This is after I showered and cleaned up.  Nice and scabby now.

This is after I showered and cleaned up. Nice and scabby now.

So I saw stars for a moment, but quickly gathered myself.  I thought to myself, “Wow, now what do I do?”  Here’s was what I did, and while it might not be exactly as a medical professional may recommend, here’s my thought process…

(1) First thing, sit down and get low to the ground, because if you faint you have less distance to fall.  I also thought that the faster my HR is reduced, the better.

(2) I applied immediate pressure with my hand.  It hurt, but between the sweat and the blood I couldn’t tell how bad it was.

(3) I was on the lookout for light-headedness, nausea, and a headache.  I waited about 5 minutes and didn’t sense any of these things.  I also sensed that the bleeding was close to stopping.

(4) Call for help.  I debated calling my wife to come and pick me up, but decided to walk it back home.  I’m certain I looked ridiculous walking with my hand perched atop my noggin, but I wanted to walk slowly and still apply pressure.  I drank the remaining bit of water I head left.  Overall I felt more embarrassed than anything, and a little pissed to have such a great run derailed like this (I was gunning for 2 hours).

I got home and showed my wife.  It was a fairly large cut, but very much on the surface and not much to be stitched.  I jumped in the shower and cleaned up and the cut bled very slowly and very little.  I applied anti-bacterial cream and left it open to air out.

I usually run around town with my FuelBelt with one pouch which holds my iPhone, a tin of EnergyBits or a gel, and sometimes some cash.  It made my think of what I would’ve done if I were out on a remote trail somewhere.  I did a little research and gathered some resources concerning first aid.

Some Updates

I’ve been a bit lazy keeping things current, but I wanted to take a few moments to catch up with you…

  • I recently gave my little blog a place on Facebook.  I’m using that portal to be more of a “curator” of content and sharing what I think is the most useful or valuable to my small following.  It’s actually going to be different from what I post here, so you should pop on over ad “Like” my page – https://www.facebook.com/PersonalReboot
  • My next races are all Olympic Distances, so my focus for right now is (a) building power/speed/strength and then onto (b) distance and endurance.  This has been really evident in the pool as I’ve found that I can pretty much count on 100s coming at a 1:40ish pace when I’m going for distance.  In a set of sprint 100s (with rest intervals) I can get them down into the 1:20s, which is new for me.
  • Zone2 HR training is where its at!  For a long time over the winter and early spring I spent most (if not all) of my time below 148 bpm.  The result is that I can now go A LOT faster with a lower HR.  Case in point – I did a bike/run brick yesterday with a really short 2 mile run.  I kept my HR in Zone2 and was 2 minutes per mile FASTER than comparable runs last fall.
  • Diet – still working on it 🙂  Seriously, I am trying to work in green machine smoothies for breakfasts, some incorporating a scoop of Juvo Green Protein Powder.  It’s not cheap, but it really presents a full amino profile and actually makes a cup full of dirt taste a little better.  Also, bananas and pineapple helps that too.

I see the light at the end of the tunnel in terms of my schedule chaos.  I’ve been travelling almost weekly for work and it’s getting to the point where it drops out for the summer months.  It will pick back up in August/September, but the summertime will need to be focused on quality time and hard work.

My wife and I have stumbled upon some awesome recipes that I’ll be sharing soon.  The one that was one of the most surprising was Cauliflower Crust Pizza!  More on that later…

 

Breakthrough Swim

I wanted to share a quick post about how important it is to engage others, group up, and find mutual support in your training.  As triathletes, this sport is widely an individual endeavor, however the preparation for this individual pursuit can (and I would argue SHOULD) be undertaken with others.

There is safety in numbers, you know...

There is safety in numbers, you know…

Last summer, soon after my friend Derek inspired me to consider taking my running for fitness’ sake to a new level via triathlon, I learned that there was a Northern Delaware triathlon team locally called the Delaware Swim and Fitness TriDawgs.  While we have over 250 members, the team is really comprised of a smaller group of very active and dedicated age-group athletes.  Several members are 140.6 multi-time finishers, and some have qualified and raced Kona, in addition to shorter course distances as well.  I participated in some Open Water Swim sessions last summer in preparation for my September and October sprints – but this spring I’ve been taking part in some organized masters swim sessions with the team.  These sessions have been by “invite only”, since we only have 6 lanes and 90 minutes of time, but I’ve learned that not only can I hang with the team, but I’m also pretty fast – or faster than I thought I was anyway!

This past week, I pressed myself hard and did a speed/power session that was shared by one of my Twitter friends:

BluebTweet

I did this same workout, but I pushed HARD!  I maxxed it out, to the point where between the 3rd and 4th sprint I puked in the pool gutter, and then kept going.

Thursday and Friday were recovery days – my upper body really felt sore, especially with all the pulling with paddles.  One thing to know – be careful about technique when doing pull drills with paddles, since the added resistance could cause undue pressure on your shoulders.

When we show up for Saturday practice, we do not know what to expect specifically.  When I saw “XX x XXX on X:XX” I knew something was up.  Once I heard the “Aw crap” mutterings, I thought “This can’t be good…”

We did our warmup, then some drills, then the coach split us up evenly across all 6 lanes. When I say “evenly”, I immediately sensed that each lane had a balance of top, middle tier, and developing swimmers.  I was the low man on the proverbial totem pole in my lane.

Our mission – (10) 100 yard sprints FULL OUT – balls to the wall – on 5 minutes.  I initially thought “On five minutes – this shouldn’t be too bad”, but I was mistaken.  For the first couple of 100s, everything was fine – I was breathing hard coming into the last 25, but I was OK.  Then in the 3rd and 4th repeat, the wall smacked in the face.  My arms didn’t want to move, and my pace went from 1:20 to 1:32-ish.  I felt like quitting, but the swimmers were cheering each other on and making a big deal of it.  Every minute a new swimmer left, and when they came into the wall to turn for the back-50 we raised the roof.

At that point, all I could do is just go with it.  It hurt like a mother-effer, but it wasn’t going to get worse, I wasn’t going to die, and if I push through it, I’ll have accomplished something.

My 100s dropped back down into the low 1:20s.  I was suddenly swimming at a level and intensity I’ve never approached before, and I was in some pain and suffering but I was dealing.

The thought crossed my mind that if I can become comfortable with finding that limit, and pushing slightly beyond while living on the edge of the suffering, I might learn how to manage that pain and find it within myself to win.  When I mean “win” I mean just winning against myself.

So my average was 1:25 over the (10) 100s.  As a point of comparison, I averaged 1:36 in my last five intervals on Wednesday night (when I puked in the gutter).

Sad but a little true.

Sad but a little true.

This drives the point home to me – I need to start running and biking with others.  If my level is actually this much higher than I thought it was in the pool, then I’m assuming that similar gains in the other segments may be found.

When you have had the opportunity to work out with a team or group, have you found another level?  After going back “solo” were you able to maintain?