Sunday, April 10, 2011

Training Comes to A Close ...

   As you can tell from my last couple of blog entries, my marathon training has been winding down to a close.  I finally was able to put together a couple of strong workouts this week in order to finish my training strong.  I definitely think that I was helped by the fact that I knew these were really my last two workouts that I was going to be doing. 
   The first workout took place on Friday after work.  Once I finished up my day at (around 4:30p), I headed right over to the Y.  Despite the fact that the gym was packed with people, I was able to walk right up to my elliptical without a wait.  I decided that I would hit it pretty hard again, and started my workout at a good pace.  My legs, mostly my quads, were actually pretty tired from my earlier workouts because I had worked in a lot of periods of high resistance on Tuesday and Wednesday.  Again, with good music and the knowledge that this was going to be my second to last serious workout ... I was able to push through and complete a solid 45 minute workout. 
    As Sunday rolled around, I knew I was in for the last of my workouts.  If I were still able to run outside, it would have been a nice 10 mile run in perfect 50 degree sunny weather.  Instead, my last long workout took place on the second floor of the Wang YMCA, on my favorite elliptical, in a room that's only ventilation consisted of two wall mounted fans.  Needless to say, I would have much rather have been on the L Street run instead of in a hot, humid gym on an elliptical.  Its hard to imagine, but while I was in the middle of this elliptical workout, I actually cracked a few smiles.  The smiles came from the fact that this was the last hard workout I would be doing.  It doesn't seem like much, but honestly it was the end of a 5 month period of training.  I hit a couple of bumps in the workout, like when my iPod decided to stop working about 70 minutes into the workout.  On any other day, this would have been a devastating blow to the workout because being on an elliptical without music is pure torture.  Today though, it really didn't matter.  I was essentially counting down the minutes.  I actually started at 120 ... when the ipod broke I was at 50 ... and I just kept counting down from there.  When all was said and done, I finished  ~2 hrs worth of elliptical. 
    I can't describe how good I felt when this was done.  I guess at a point like this its good to look back at where you started, to help you appreciate how far you have come.  When I started this journey 5 months ago, I was able to run 2.5 miles outside.  When I first started on the elliptical, I could do 20 minutes ... and that was with taking a 1-2 minute break after about 12-14 minutes worth of working out.  I guess, when you look at things from that perspective I have surely come a long way. 
    Although I use the elliptical as a surrogate for running, it really doesn't come close.  If its one thing that I have come to appreciate during these months of training, its the ability to run outside.  Running honestly provides things that no other exercise or exercise machine can really come close to.  Roll into that the ability to do these runs on well organized group runs with an organization like L Street Running Club, and its truly unbeatable.  In hindsight, my training didn't follow the path I hoped it would when I started out back in November.  I guess it was slightly ignorant to think that I was going to train for my first marathon ever without suffering an injury.  I guess part of the journey was learning how to adapt to these curve balls, and also learning what I need to do in my training to avoid them in the future.  There's still a few unknowns left out there ... will the knee hold up, will I have to walk, what will the weather be like, etc.  I do know that I did everything I could with the cards that were dealt.  I didn't give up on the training when an overuse injury popped up ... I tried to adapt through PT and changing my training to the elliptical.  Hopefully it will be enough!  I guess in a week we will find out!!

Friday, April 8, 2011

More Physical Therapy

   Thursday was kind of an off day for me since I had done two pretty high intensity workouts in a row over the last two days.  In order to give the body a break, I decided not to do any cardiovascular training today and just relax until my physical therapy appointment.  Physical therapy went pretty much the way it has gone for the past couple of weeks.  It starts out with ultrasound therapy on the IT Band area, proceeds into the deep tissue therapy to try to break up any fibrous tissue that may have formed from the inflammation and then finishes with some stretches aimed at the legs and hips.  All in all, I think my flexibility has definitely increased over the past few weeks which is probably secondary to the fact that I have tried to be diligent in doing my stretches daily.  In addition, my hip / butt strength has also increased dramatically since I am able to do more reps / higher resistance on all of my exercises.  From what I have read in the medical literature, increasing the strength of the gluteus medius is really the key to curing ITB since it helps support the pelvis better and takes the strain off the band.  Hopefully these last two weeks of stretching / strengthening will start to pay off.
    At the end of the day, it was actually a pretty low key day today.  I will be back at the gym tomorrow for one of my last serious workouts. 

Not Many Workouts Left

   With the marathon fast approaching, this week seems like it has bee flying by.  Literally, April 18th is almost in the 10 day forecast on my weather channel iphone app.  I have been trying to finish my training strong with some good cardio workouts this week.   After a solid workout Tuesday, I was determined to follow it up with another good one on Wednesday.  After work got finished, I headed straight over the YMCA and took up my usual spot on my elliptical.  By now I am thoroughly convinced that nobody else in the world uses this elliptical because it is so mind numbingly boring.  Regardless, it has worked out well for me because in all of the times that I have been to the YMCA in the past 4 months I have never once had to wait to get on it.
   After a little bit of light stretching, I hopped on the elliptical.  I punched in the normal information it asks for ... Program - "Manual", Weight - "200", Time "40".  Like I said yesterday, my goal for today was to have a shorter but high intensity workout that incorporated a lot of periods of increased resistance.  While I don't think there is any good preparation for running the hills of Newton (other than running 20 miles and then trying to run up them), I am hoping that high resistance on the elliptical will get my legs used to increase work load.  Like most of my training, this again seems to be a big theoretical extrapolation that I am hoping will hold true.   Once my workout started, I was off.  I felt good and the fact that I was down to my last few high intensity workouts really helped motivate me.  Cardiovascularly I felt great and was able to do the 40 minutes no problem.  The "hills" that I through in definitely worked well to wear me down, but I was able to push through and keep up a good pace.  All in all, I finished the 40 minute workout and covered a distance of 4.25 "elliptical miles" which is actually a pretty good pace for me.
    It definitely helps motivate me to know that I really only have two more legitamite workouts left before the race.  My goal is to do a 60 minute workout on Friday and a 90-100 minute workout on Sunday.  After that, next week will basically consist of a couple of low intensity workouts to get the heart rate up and keep the muscles loose. Hopefully the last few workouts will continue to go well and I will be ready on the 18th. 

Wednesday, April 6, 2011

Back to the Basics

   I have to say that the knee has been feeling great since I saw the orthopedic surgeon last week.  That being said, I was taking it easy for a few days as per doctors orders.  The early part of this week was spent doing what appears to have become my normal marathon training routine ... physical therapy and the elliptical.  I went to physical therapy and got the usual treatment ... ultrasound on the IT Band, a crushing "massage" to try to break up any of the fibrous tissue that may have formed from being inflamed and stretching of the hips / legs.  Although I haven't seen to many clinical result yet (since I was still having pain with running), I am starting to see a huge increase in my flexibility and strength.  When I first started doing physical therapy I was barely able to do 20 "clam shells" and now I have gone through three different strengths of resistance bands and can still do 2 sets of 25.  In addition, the "bridge" exercise which used to be the hardest of them all, is now a piece of cake.  Although they haven't come through for me quite yet, I am hoping that two more weeks of solid physical therapy will pay off come April 18th.
    In addition to physical therapy, I have also been trying to keep with my ultimate plan of "elliptical-ing" my way into the finish.  I figure my best chance of running the majority of this race will be to have the knee as close to 100% as I can get it.  In order to do that I decided that my last two weeks of training, which is normally the tapering phase in which workout durations become shorter, will consist only of elliptical work.  This worked for me a month ago when I did three weeks of elliptical work to cool the knee down and then was able to go out and have a great run on my 15 miler.  My hope is that with minimizing the impact / strain on the ITB, following my physical therapy stretches / strengthening exercises and continuing to ice the area ... that I should hopefully be near 100% come race day. 
    My workout on Tuesday was probably one of the first good workouts I have had in two weeks.  The 20 miler that I didn't finished really seemed to take its toll on my psyche last week and because of that my maintenance workouts suffered a little bit.  It was hard to get my head right and get motivated after I performed so poorly on such an important workout.  Nonetheless, I came back strong and re-focused this week.  I headed over to the YMCA yesterday after work and had a great 6 mile workout on the elliptical.  Despite the fact that it was about 80 degrees in the Y since apparently they don't have AC, I pushed through and really nailed it.  Its hard to even imagine this, but I really only have about 5-6 workouts left before race day.  I will be back there later today and am going to plan on doing a 45 minute workout that incorporates a lot of high resistance periods which will hopefully mimic what its like to run hills.
     With the race drawing so close, I have definitely started to feel a little bit nervous.  I think the nervousness has to do a lot with the fact that I want to do well on this run.  Everytime this thought comes up, I always have to remind myself of what my goal was for this whole experience ... To finish the Boston Marathon.  As this was my first marathon, I didn't want to include a time in that goal and this is what I have to keep reminding myself.  The goal was to dedicate myself and train to finish the Boston Marathon.  If its 4 ... 5 ... or 6 hours ... it really doesn't matter as long as I finish.  I just need to keep reminding myself of that. 
    Hopefully the last few workouts will be as good as yesterdays.  In the words of Renee ... Time to Finish Strong. 

Monday, April 4, 2011

Water Stop

  Nothing all that exciting to report over the last few days.  Since my visit to the orthopedist, I have been laying pretty low since she told me to take 3-5 days off from activity.  Basically, I have been in kind of a holding pattern for the last couple of days where I have focused predominantly on my physical therapy stretching and strengthening exercises. 
   In addition to doing my routine physical therapy exercises, Renee and I also had to pay our L Street dues by working a water stop this weekend on the organized run.  As I have mentioned before, L Street does a wonderful job of organizing long runs in which there are water stops every three miles.  In order to be part of the marathon training group that goes on these runs, everyone has to volunteer at one of the water stops on a Sunday long run.  Renee and I chose this weekend for two reasons - #1 It was a shorter run towards the end of the marathon training so we didn't think we would be missing out all that much, #2 We figured it would better working a stop in April since the weather would be a little bit warmer when compared to working one in the dead of winter.  
    To prepare for our water stop we made a trip BJ's to stock up on all the necessary supplies.  According to L Street, each water stop was required to have 8 gallons of gatorade, 6 gallons of water, 500 7oz cups, snacks (candy, fig newtons, jelly beans, etc), motrin and tissues.  After stocking up on all the needed supplies, we were good to go.  Since we were the first stop on the designated course, we had to get out to our location on Beacon Street bright and early.  We arrived to our stop at around 7:50 to get set up.  We poured cups and cups of gatorade and water in preparation for the rush of runners that we were sure we would experience.  Shortly after getting there, a few of the runners started to trickle in.  These were most likely the runners that like Renee and I probably left a little bit early since we run at a slower pace when compared to the marathon qualifiers in the group. 
     About 10 minutes after our first runner arrive, the flood of fast runners hit the stop.  It was pure chaos for about 5 minutes, during which time tons of runners were just grabbing at cups of gatorade and water.  I would probably relate it to a piranha feeding frenzy, and while it was happening Renee and I were pouring more and more cups of gatorade in a frantic effort to keep up.  All in all, the water stop went pretty well.  We met some nice people and also fulfilled our requirement for L Street. 

Picture of our L Street Water Stop at Fielder Footbridge off Beacon Street.
  

Thursday, March 31, 2011

Orthopedic Consult

  To say that it was desperation time would be a bit of an understatement.  I am about 19 days away from the Boston Marathon and I was barely able to run 9 miles on my last run.  Yeah, that's right ... 9 miles.  Let's try to put that out there a few different ways ... - 9 miles = 1/3 of a marathon ... 9 miles = 15 km while a marathon = 42 km  ... - 9 miles from Hopkinton put me in Natick, which is actually a 20 minute drive from Boston on the Mass Pike.   When you start to put it that way, it is definitely desperation time.
  Like I said in some of the earlier posts, I definitely went back to the drawing board earlier in the week.  While the ultimately answer for IT Band Syndrome is to rest, there are a few other things out there that can help.  Unfortunately, I have actually tried most of them.   Physical therapy, Foam Rollers, Stretching, Hip Strengthening, IT Band Brace, Kinesio Tape ... you name it and I have tried it!  Well, all except for one thing, and it was that one last thing that I was going to try today.
  Earlier in the week I finally bit the bullet and made an appointment at our Orthopedic Clinic at Tufts.  My appointment was with Dr. Matzkin, a nice orthopedic surgeon who specializes in sports medicine & sports injuries (I actually saw her a few years ago when I had my stress fracture).  I got there at 9:30 am, got some xrays of my knee and then got put in the exam room.
   As is the case in all doctors' offices, I ended up waiting in the room until about 10 am before she made it in.  Those 30 minutes were tough because my mind was racing.  What happens if this wasn't really IT Band Syndrome and was something else?  What happened if I had another stress fracture and I am officially done with no chance of running?  Ultimately, Dr. Matzkin made her way into the room.  Thankfully, she is a marathon runner herself and could totally empathize with the position I was in.  She was actually really surprised that I was even able to get an official number for Boston at all because it was so difficult this year.   After taking my history, doing a quick physical and reviewing the xrays, she ultimately confirmed the diagnosis I had made about 8 weeks ago - IT Band Syndrome.  The rest of the knee exam was totally normal.  She was actually really impressed that I had sough physical therapy so early on in the course.
  So now it was the official moment of truth.  My last shot at actually having a chance to run a majority of this race.  The therapy that I am speaking of is the only thing I hadn't tried yet for my IT symptoms.  It actually tends to be a last resort because it functions as a "band aid" that only treats symptoms and doesn't help with any of the mechanical issues that led to the problem in the first place.  Yep, it was a cortisone shot.  From all my reading, many runners have been in similar situations as myself where their IT Band flares up days before the race that they have been training for.  Since most of the inflammation is located in the bursa (fluid filled sac that helps tendons glide easily over bone) a well placed cortisone shot is normally effective at temporarily relieving the pain / inflammation and generally buys people enough time to get through the race.  Thankfully, Dr. Matzkin agreed that we should try it since it would give me my best chance of completing the race without serious inflammation or pain.  There isn't a guarantee, but normally its effective.   The mentality I had with this was is summed up by what one of my coworkers said this week "This is basically Game 7 of the World Series, do what you have to do and then you can rest in the off season".
   So after a little hurricane numbing spray on the outside of my leg, a tiny pinch and a little burn ... the steroids were in.  Honestly, it was kind of like a flu shot ... tiny pinch and burn and then in about an hour it feels like someone punched you there because it is pretty sore.
    So for now, as per doctor's orders, I need to lay low for 3-4 days.  She did advise me to continue the stretches as many times a day as I can fit them in since my IT Band was extremely tight when she examined it.  Now ... as they have been for the last several weeks ... my fingers are crossed that this will be buy me a few more miles on April 18th. 

XRAY (PA View) of my knees.  Thankfully, the xray is totally normal from this view.  There are good joint spaces in the knee which means that the cartilage cushion in both my knees is intact. 

XRAY (Sunrise View).  This is a dedicated xray that looks at the patella (aka kneecap).  It helps show that there aren't any fractures of the knee cap and that the cartilage under it (black space) is also intact.

XRAY (Lateral View).  This is an xray across my knee.  This one doesn't show any recent injuries but randomly enough shows a remote fracture of my tibia (about half an inch up from the bottom circle).  Guess I had an evulsion fracture a while back and never knew it.  Regardless, it was an insignificant finding.

The Workouts

   So it took me a little bit of time to recover from this weekends 9 miles.  The knee was definitely a little bit inflammed for the early portion of the week, but I was back to normal late on Tuesday.  I have decided that the last three weeks of working out is all going to be on the elliptical.  This should give me a solid 3 weeks to get down the inflammation in the knee and be as close to 100% as possible for the big day. 
   Thus, my workouts this week put me back in a familiar place ... a place where I have now spent hours upon hours over the past 3 months ... the elliptical at the Wang YMCA.  I have to admit that the two workouts I did this week were no where near my best.  My workout on Tuesday wasn't that great because I was still in an emotional hangover from my botched run on Sunday.  I was able to power through and do a 45 min (4.5 mile) workout on the elliptical.  It wasn't my best, but I was happen with the time and intensity of the workout.  
   Tuesday was a long day though because I had a moonlighting shift scheduled.  As always, this means I went into work around 7 am on Tuesday and didn't come home until around noon on Wednesday.  This essentially meant Wednesday was a wash.  Unfortunately, the fatigue that I felt on Wednesday seemed to carry over into Thursday morning ... which is when I had my next workout planned.  I got to the gym early, around 6:40 am.  For me, its tough to get the legs working that early in the morning when I am not pumped in anticipation (like is the case for those Sunday long runs).  I hopped on the same elliptical as always and started pedaling away.  For some reason, I couldn't get the legs to wake up and I ended out starting the elliptical at a pace of 132-136 ... which is way below my normal pace of 144 or so.  After about 5 minutes, the legs warmed up and I started getting into it.  By the end of the workout, I had completed about 30 minutes and just didn't have it in the legs to keep going.  Again, I think this Sunday's workout was still hanging heavy on my confidence because I didn't know what the deal was going to be with my knee (although I knew I would soon find out). 
   I finished the workout by doing all my physical therapy stretches and exercises.  Then, I showered and went to work!