More importantly though, we did hash out exactly when I will be able to start incorporating different training components.

• In 2 weeks: I will be able to run my first few stride.
• 3 weeks: First workouts. That puts me right around Christmas time.
• 4 weeks: Heavy plyometrics.

After our meeting though, I did do one thing a little aggressively. I hit up the Albemarle track and ran 1 mile at 5:30 pace. I just really needed to get that under my belt for psychological reasons. It kind of acted like a checkpoint of sorts. Could have been a mistake but I was confident to take the risk. The end result was that my pelvis felt perfect, my legs felt heavy, and my heart felt like it was going to explode out of my chest… Exactly the feedback I was looking for. Brings some closure to my question about what kind of shape I’m in.

Coming up I have a meeting with Jay at the Gait Lab to make sure my mechanics haven’t gone to efficiency hell, and I’m also going to be heading back to the frozen tundras of Chagrin Falls, OH, where the skies are gray, the slush is abounding, and the sports teams are awful.

Bring on the 30 mile week! I’m off to do my 6 mile long run.

Today I glided through my first 4+ miler, and to my jubilation, my calves were actually the achiest part of my body! When I made the realization that I was mentally focusing on how my calves felt and not my pelvis, I literally smiled mid-stride. Didn’t stop me from whining about them to everyone I know though. Some things never change… Actually, I got some experiential advice that it could be low magnesium levels. I haven’t been diligent recently about multivitamins… Might be a side affect of that, or just natural atrophy from months off land-based training.

To recap my training for the last 3 weeks it’s been:

• Week 1 — 4 days, 1 mile each. Walk/jogging.
• Week 2 — 5 days, 2-3 miles each day. Walk/jogging.
• Week 3 — 5 days 3-4 miles each day. Running. hellll yeah

Coming up this week I have an appointment with Dr Wilder (Friday I believe). I plan on doing my first tempo the day before. Stretching out a little bit to see if I can handle something faster than 6minute pace. My runs this week will be in 25-30min range and I’ll take days off as I see fit.

I’m incredibly encouraged though and 30 minutes is long enough to feel like a runner again.

Yes, that’s a smiley face bitches.

1 mile run (super excited)
Off (cold/rainy)
Off (cold/rainy)
Off (very cold)
1 mile true walk/jog
1.5 miles true walk/jog
1.5 miles true walk/jog

Not too bad. The past two days the runs have been broken up. 3/4 mile to the gym. lift/swim/stretch. 3/4 mile back. I’ve kept up with normal levels of aquajogging/lifting and added in hurdle drills for the first time in a while.

As I sit here right now, my bones are doing alright. They still aren’t any worse for wear. The awkwardness and stiffness and general weakness is still there but they are not painful, which I am taking to be an amazing sign.

My quads, however, are on fire!… What the heck? It always amazes me how quickly my body adapts to different exercises (aquajogging) but also how quickly it adapts AWAY (running). I feel like i just ran down Mt Greylock at full speed. Sheesh.

One last side note: today was an amazing 68 degrees. Love it!

The run felt almost as good as feeling sun on my skin. For far too long I’ve been splashing in the pool looking up at blue sky through the AFC facility windows.

Getting down to business though, my stride felt great. I’ve done a really good job of doing balancing drills and getting in a lot of lower body/leg lifts. I can deep squat about twice as much as when I started (but still less than my body weight…) and I’ve done a lot to improve my lower back strength as well (these two areas have been embarrassingly weak in the past). Everything muscularly felt great, and I had the urge to sprint when I got to the little hill.

However, the running motion definitely put stress on my pubic bone. I felt no pain, but the two sides of my pubic bone were distinctly different. The left side felt tight and awkward. Things didn’t feel like they were moving naturally or smoothly. The fact that I felt no pain is great! But I’m 100% sold on the fact that I need to keep these “runs” to under a mile this week. And only bump it to two miles next week. It will take several weeks or even a couple months before that area of adema is sorted out through the repetitive stress and rebuild cycle.

But at least I get to do something outside.

Also, I never included images of the stress fracture itself. So here they are. I had to crop it pretty tight in order to keep it G rated (well… Might still be PG). These are the two best slides. one is a slice going right through the middle of the bone and the other captures the actual slightly-fractured part on the surface.

And the results are in. The Osteitis Pubis is still hanging around but the stress fracture certainly isn’t showing up. I’ll have more instructions as to what to do about that (if anything) soon. However, I’m moving forward with the rehab plan outlined by Dr Wilder. It follows:

Week 1: Stay in the pool. This is the 6th week anyways of the original 6-8.
Week 2: Stay in the pool. This we’re calling a buffer week.
Week 3: 5/7 days: walk/jog 1 mile. Wooo!
Week 4: 6/7 days: walk/jog 2 miles.
Week 5: 6/7 days: run 3 miles. Reassess from there.

This puts me at about christmas break. So if all goes well I should be running like a 40 mile week come january. Building to 70 by Feb. The important thing is that I keep up the pool intensity until I’m running at least 4 miles at a time. I don’t feel like I get any real benefit from anything shorter than that other than just redjusting to land based training.

Projected date of complete recovery: Valentines day, 2012.

Cold Hard Facts

The MRI showed 2 stress fractures. One is just inflammation (the first stage of a stress fracture) in an area on my sacrum. The second one is on my left pubic bone and is actually showing some splitting of the bone (stage 2 of a fracture). I’m sure I’ve been feeling this and mistaking it for just muscular stiffness/tenderness/weakness. This is surely the reason I favor that area.

I also had a small tear on my left groin/adductor, the muscle/tendon that attaches to the pubic symphysis and the femur. I believe this was larger at one time and one of the initial symptoms along with a tear in my lower left ab muscle. However, I think Eric and I have been doing a great job rehabbing these. The ab tear didn’t even show up and I feel back to 100% up there.

Last, the Osteitis pubis was still showing up. It was actually kind of grotesque to look at on the the image (Dr Wilder was AMAZINGLY helpful by making 15 minutes for me to go over the MRI images. That was a HUGE psychological help for me since I’m so visual). The pubic symphysis is supposed to be smooth and round. Mine was all lumpy.

What This Means

So the first thing the stress fractures mean is that I’m taking 6-8 weeks off anything impact related (running). I also want to be a LOT more careful about what kind of pain I subject myself to in the groin area. It’s important to let that bone just heal. That’s really all I can do for it.

However, I DO need to keep working on rehabbing that groin, which requires stressing and massaging it (removing scar tissue). So there’s a fine line between enough and too much. Once again, different types of pain. I am getting into the water quite a bit these days. Aquajogging is becoming a routine. Up to 55 minutes at a time in the pool. I just need to be doing something. I also felt like I had JUST gotten to the point where I was feeling a bit of fitness returning and I don’t really want to have to got through that 2 to 3 miles at a time thing again. That was frustrating.

The Conclusion

So the whole thing just came at a bad time. And that made it a bit worse. I was up to 42 minutes on a run the day before I got the news and not feeling too bad. However, I can admit that probably wouldn’t have stayed the case in the long run. I would have regressed.

It is VERY nice to know what I’m dealing with though. I’m incredibly grateful to be allowed to take that MRI. I’ll emerge from the water in 6-8 weeks (well 5-7 now), get a followup x-ray, and hopefully get the green light to go run.

Adios til then

Man, I really messed myself up though huh?

I decided this past weekend that it was time to start focusing on getting my aerobic endurance back. My legs really aren’t able to handle much more than 4 miles right now so I’m looking to the pool to get my hour-plus-high-heart-rate fix.

MRI to come on Friday. Next big update shortly thereafter. But for now… Enter the POOL WORK

When I had a meeting on Thursday with Dr Wilder, I was on quite a low. I was feeling incredibly tight even just moving around. He patiently listened to my concerns and shared that, for him, PT did work on his sports hernia but it took 4.5 months. He also mentioned that focusing on contracting his pelvic floor was the key to his recovery. The medical result of that meeting was that did end up scheduling an MRI for Sept 23rd to get a better picture of what’s going on.

Since that meeting I’ve run every day at least 2 miles and been very diligent about my drills, icing, massage and stretching. The pain each morning has been no worse and now on day 4, I gotta see that as a good sign. I ALSO played a bunch of paintball this past weekend which had me doing a lot of squatting and shuffling (can’t quite call it running as I forced myself to wear moccasins as a running deterrent).

I saw Eric again on Monday and his massage was once again helpful. He agreed it was a really good sign that I could run and not be any worse the following day.

Then, finally, today, I’m pretty sure the pain was less! I took an ice bath yesterday and did hurdle drills for the first time. I think both of those helped maybe? But either way, I’m now riding a bit of a high. That said, I chose to follow Eric’s advice and take a bit of a down day, only running 1 mile to the gym, doing upper body work, and 1 mile home. Tomorrow, I’m going to try another 4 miler. Maybe 5.

But I’d say rehab is on the right track and hopefully it continues that way.

2
5
4
5
3
6
… or something like that. So far so good. Nothing’s getting worse as I expected would happen. I’ll just keep plugging along, stretching, massaging, drills in the morning and run in the PM. We’ll  see where this takes me but it was nice to break a solid sweat! I swear that was the first good sweat in 9 weeks..

So this time I describe my experience and outlined my thoughts for Eric. We went back and forth about the biology of the pelvic area, trying to draw conclusions about whether this pain was just “hurt” (a weak muscle working its way back to strength, like a sprained ankle/stress fracture) or a pain that indicated the muscle was being “harmed” . The end diagnosis was that we need to explicitly challenge the muscle in order to elicit a more exaggerated response.

Long story short, I got approval to go run 3 miles.

I came out of the meeting feeling much better both physically (thanks to a good massage/stretch) and mentally (thanks to the reaffirmation that it’s OK to feel pain). I think part of my problem was all the Google diagnosing I did of myself. I kept reading that you should only move to the next level of PT if you can do so free of pain. Good to know that I can push myself a bit.

So I ran.

19minutes later I was still feeling pretty good. And though I iced afterward I didn’t even really feel the need to take ibuprofen. We’ll see how I feel tomorrow but this whole thing is continuing to perplex me. I like the direction that its taking right now though. Hopefully I’ll wake up tomorrow feeling the same way.

Time for another mile! I figured this time I’d switch up the loop a little, keep it interesting. I picked a loop with some up and down in it and headed out.

I’m glad I went for the up and down run because I discovered that my ache was significantly worse going downhill compared to up. So it definitely has something to do with me leaning back.

Still not too painful before, during or after the run, but the ache was consistent with what I was experiencing months ago on a heightened level. I did get the impression that without ibuprofen it doesn’t seem like the muscle would be able to take a longish run. Running downhill at least is still harmful…

So I’m thinking I really need to do a 3 mile run to validate my suspicions. 1 mile just isn’t enough to really know if I can run or not. It is a bit tender afterward but I can’t be sure if this is to be expected and indicative of improvement or if its just the result of only running a mile (I had never run just a mile on it before so tough to compare the level of discomfort). I think I’m just going to continue to do my drills diligently. If Sunday I feel alright I’ll try 3 (with ibuprofen). Otherwise I’ll wait to see Eric and Dr Wilder on Tuesday.

1 hour prior to the run I did a bunch of stretches and some hip strengthening drills to test out the un-medicated muscles. Still a slight weakness/tenderness in the ab area, and actually groin area too. Like I wanted to guard it a little. But no pain.

I set out for the run feeling good. About 100m in, it was apparent that there was a definite difference between the left and right side in the pubic bone area. It wasn’t painful. Just stiffness. As the run wore on, it got a little worse, to the point of ache, but this corresponded to also feeling a bit worse in every area of my pelvis (glutes, hip flexors, right side adductors). By the time I finished the run, everything was a bit achy.

So that sounds pretty pessimistic but I got to remember a few things.

1. I’m paying hyper-attention to the area.
2. I haven’t run in 8 weeks… I’m pretty sure I have felt the same achy/stiffness after 10milers back in the spring.
3. (Big Takeaway) I was also playing with my form on the run. It turns out that I could actually vary the degree of discomfort with my form. Leaning forward a bit and contracting my abs felt significantly better than relaxing and staying upright. This is a huge relief because it points to form issues being the source of the injury in the first place. However, the times I was running “wrong” probably aggravated the area a little more than if I had been running correctly the whole time.

Based on that feedback, I can’t say right now if the stiffness that I feel right now is due to the injury and would be worse if I had run further or just the fact that I haven’t been running that much and the area might still be pretty weak from being favored so much.

Either way, I popped 600mg of Ibuprofen and put frozen peas on the left groin area.

I now sit here 25min after the run, just got up and did some lunges stretches and everything feels good. Effect of Ibu & ice? or a successful rehab?…

I’ll update again in 6 hours…

I wanted to get this post out today as a look at what I’ve done to get to this point and review where I am mentally before tomorrow’s run either a) shatters my dreams and sends me back to rehab and maybe surgery or b) throws me into a state of euphoria that causes me to forget the road I took to get here. Either one is bound to alter my perspective. So here’s how it went down…

Week 1:

PT meeting with Carl. Great guy, young, the kind of dude I’d like to bump fists and get a beer with, and he seemed pretty knowledgeable too. However, I didn’t feel comfortable with him as my doctor… Upon analysis, turns out I like to put my doctors on a pedestal. Make them godly in my mind. It helps to trust in their advice. And while that might just be a placebo,.. placebo’s work. And I just can’t look at this guy barely older than myself and be like “yeah, he knows his stuff”. So I was happy to see Eric (who was on vaca for this first appointment) the next two times. More on that later.

Carl diagnosed the fact that I have weak outside glutes and gave me a bunch of good drills to work on that. Good start. I know those are weak anyways.

Also this week — Steroid pack. Methylpredatorinabox or something. The prescription started with 6 on the first day, 5 on the second, 4, 3, 2, 1… I was a little worried about how it would affect my mental outlook but in general the effects were subtle. I definitely felt more energized on days 2,3,4 (something I only realized was probably due to the meds by day 4) but in a kind of restless way. I felt super-social, which was awesome at first but I’m guessing to other it looked like I was a bit ditsy. I would describe myself as slightly schizophrenic. Glad I didn’t write a blog post then as it would have been far more disconnected and tangential than my usual ramblings. However, the meds were well worth it as it made my adductor feel GREAT. This was my first glimmer of hope. Since the Methylpred was just a strong anti-inflam it probably meant the injury was just due to scar tissue and swelling that wouldn’t flush out. I was hopeful.

Week 2

I came off the Methylpred and saw Eric who agreed with the diagnosis of weak outside glutes but connected all the symptoms with the fact that my pelvis moves a lot. And I mean A LOT. He was actually pretty impressed with my range of pelvic motion but much like a ganglar in comparison to a body builder, I was flexible due to lack of muscle. My core is decent. My major muscles are fine. The problem lies in my hip flexor and outside glute/hip. They’re both tight and weak. A terrible combination. I’ve already experienced tenderness in the hip flexor just from the drills I’ve been doing. So Eric gave me a new regime to add to the old one. These exercises focus more on pelvic stability and strength than specific muscle building. Neuromuscular in nature. He also massaged the area for 15minutes which felt really really good. He had a great balance of getting deep into my gut without causing pain. First time I could really feel the problem area being touched.

I also continued to take Naproxen, an anti-inflam.

As the week wore on, I discovered that my groin pain was completely gone (great because otherwise Eric and I would have both had to endure a very awkward massage… Adductor is low enough). So that was good, however my adductor was complaining a bit again during specific exercises like twisting lunge. The nice thing about this though was that it was a tight/stiff feeling rather than the ache that I felt 2 weeks ago.

Week 3

I had another session with Eric yesterday (Monday) in which we looked at some more sophisticated balancing and pelvic stability drills. I jogged 30m a couple times for him in which he critiqued the fact that I’m a little too upright as I run. Instead of trying to float along I want to maintain a more aggressive posture.

The final result of our meeting is we agreed that I should try running at this point.  The adductor problem isn’t gone but the idea is that I should now be able to run without aggravating it. I picked tomorrow, Wednesday, as the day to test drive this thing. I’m going to stop taking Naproxen for 24 hours before just to make sure I’m able to feel the problem areas if they exist.

I’m pretty excited and I feel almost 100%. Only issue still are those damn twisting lunges. The solution to that is simply not to twist while I’m running . In the mean time, I have some good hip-flexor stretches to loosen up that muscle group. Hopefully that’s the last tweak.

That’s the story so far. The most important chapter will come tomorrow. Hopefully I will once again become a runner.

Here’s my last month at a glance:

2 weeks off, just fooling around, living life, enjoying food and sleep.

first run back, 50 minutes, didn’t feel good to start and was quite achy in the lower ab area toward the end. for 48 hours afterwards though, my injured area (now identified as groin/lower-adductor) was really quite sore. This wasn’t an injury that was going away with rest.

I did a bunch of research and came up with “sports hernia” as a likely diagnosis. However, it was also the most pessimistic diagnosis as frequently, surgery is the only solution.

Rather than labor over that possibility I decided to review the facts:

• It started as a sneeze induced strain. That I’m positive of.
• I did no abs for 2 months because it irritated the area and I was in race season anyways.
• It was only a dull ache for 2 months before becoming more painful.

Well not too many facts there but I supposed that perhaps my strain had turned to muscle atrophy and that was causing problems when coupled with oversized runner hamstrings/glutes.

New plan was to stretch and do abs for the 3 weeks I was in Maine (not much else I could do). During that time I was able to enjoy almost every activity without pain except for running specific ones. lunges, jogging, high knees, squeezing-legs-together all hurt. I also went onto ibuprofen as a general solution.

After 3 weeks of that, I did a 15min run (man did it feel good to be running again) with little pain. However, once again, bad ache for 48 hours afterwards which was definitely going to be a problem. At this point I knew I had no hope of solving this on my own. Gonna need a good look from someone in c’ville.

3 days ago, I concluded my summer travels and moved into our new place. Wooo! First thing I did was go into the shop and ask for advice. Before I could blink Mark said he’d get in touch with Doc Wilder for me. A few minutes later I was scheduled to see a leading orthopedic MDs the following day.

In the appointment I found out that Dr Wilder has had 2 sports hernias himself and tons of experience treating them so i honestly couldn’t be in better hands.

It turns out “sports hernia” is more of a diagnosis by omission than something you can test for. So we went with step 1, an XRay. I traipsed right over to the UVA hospital and got my bones scanned within the hour.

Dr. Wilder called me back same day and turns out the results are positive for Osteitis Pubis. Interesting.

Plan is steroids, prescription strength anti-inflams and PT, the first session of which is Monday. I’m not out of the dark because OP is sometimes caused by a sports hernia but we’re going to attack that and see where we stand.

So this is all heavy news but I was kind of expecting it. At least I’m finally feeling like I have a plan of action and I’ve never been more thankful for anything than I am for how well Bob Wilder is taking care of me. Thank you RMR.

/Rave review!