Mental adjustment

The MacPherson Forest loop was my last long trail run

It is a challenging (character-building?) time for me.  I find myself constantly re-evaluating my situation, looking for plausible positive scenarios (while trying not to fool myself), and fending off the darker morbid thoughts that must come to anybody who suddenly finds they have a potentially life-threatening medical condition.  I always assumed that my serious running career would be brought to an end by some major joint failure.  I did not expect it to be threatened by a cardio-vascular event, and it's taking time to get my head around the consequences.  With joint failure, there were always going to be alternative forms of endurance exercise such as cycling, hiking or kayaking to fill the running void, but a cardiac problem will be just as much of an issue for those activities.

MacPherson State Forest trail run

It's amazing how quickly your perspective changes, especially with the resources of the Web and Google to inform you.  I'm already thinking about changing the title of this blog to "The Futile Pursuit of a Last Sub-3 Hour Marathon" as it's hard for me to believe that I will ever be able to subject my heart to the stress necessary to run that fast again.  New goals are formulating.

Of most importance to me is the ability to exercise most days and feel good about my health, well-being, and quality of life.  It would be great to include occasional long "no pressure" trail runs, and be able to go for extended hikes/rides in remote places.  Compromises will be needed, along with patience.

MacPherson State Forest trail run

I have already decided I'm willing to reduce daily and weekly distances, give up the pursuit of age-group podiums, and even walk up hills.  If it seems likely to reduce the risks, I'll cut out caffeine (despite my well-known penchant for Diet Coke and Pepsi Max) and stop using my asthma inhalant, Symbicort.  All of these things - too much endurance/hard running, caffeine, steroid-based asthma medications - are statistically correlated with Atrial Fibrillation and cited as possible risk factors.  Age (I'm 63) is another significant risk factor, but I can't do much about that.

There will be more tests and doctor consultations to come, and there are still plenty of "unknowns", but it will help me deal with the situation if I've started mentally adjusting to the life-style compromises that may be required.

Trotters

Terrigal

Last night was the monthly Terrigal Trotters Committee Meeting at the Terrigal Surf Life Saving Club.  I always get a sense of privilege rocking up to the Surf Club on a Monday evening during holiday season.  Terrigal is a very popular holiday destination and during the summer you have to make your way through throngs of holiday makers knowing that by next month's meeting they will all be back at work or school and you will still be here, continuing to enjoy the delightful beach, hinterland and weather that have attracted them for their vacation.

Terrigal Surf Life Saving Club

Over my athletic career, I have belonged to a succession of running clubs - Melbourne High School Old Boys (defunct), Kew Camberwell District (defunct), Croydon Harriers (UK), Colchester & Tendring (UK), Watford Harriers (UK), St Louis Track (US) - and now Terrigal Trotters.  Along the way I have served in various Committee positions in some of these clubs and Terrigal Trotters stands out as unique.  Most Clubs seem to rely on two or three people to do much of the work assisted occasionally by other club members.  At Terrigal Trotters, without counting the numbers, I would guess that there are 20 people who make a very significant contribution to the Club's activities and many more who are willing to help out with particular events.

Terrigal Trotters Santa Run

The Committee is energetic and the Club inclusive.  Membership is growing and there are new people showing up for every Saturday's run, many of whom soon become hooked on the format and camaraderie.  It's fun to be a part of and volunteers enjoy involvement in professional and successful events.  Such success feeds on itself, drawing in more volunteers and participants.

Each month, one of the Committee Meeting agenda items is to nominate people who have made an exceptional contribution to the Club in the previous month and then select a Club Person of the month.  It is illustrative that there were 30 members nominated for their efforts in the past month.  Surely a sign of a vibrant club doing it's bit to promote fitness, health and fun.

Terrigal Trotters Christmas Party

My exercise today was another 5km walk around Copa.  I felt good and really wanted to be running.  Unfortunately, resumption still seems to be some way off.  My Echocardiogram this morning revealed significant Atrial Fibrillation in my heart and the specialist immediately sent me off for an Electrocardiogram (ECG) which confirmed his diagnosis.  The results still have to be reviewed by a Cardiologist, so I don't have a detailed report, but Googling the condition makes it plain that I have been lucky, will remain on Warfarin to reduce the risk of Stroke, and will need to consult some specialists before daring to run again.

The Prom

The boardwalk through Sealers Swamp on
Wilsons Promontory

Not unexpectedly, I was unable to get my Echocardiogram done today.  The first day back at work for the clinic after the Christmas/New Year break was always going to be busy.  I was lucky enough, however, to receive a call from the clinic later in the morning to say they had a cancellation and I'm now booked for the test tomorrow.  The chest X-Ray last week found that my heart was "borderline enlarged" but it seems reasonable that it would be in an endurance athlete.  If I did an hour of chin-ups most days for 45 years, my biceps would be "borderline enlarged" as well.  There is a condition called Athletic Heart Syndrome (AHS) that would explain the size, but it's hard not to be a bit anxious about what they will find.

Refuge Cove, Wilsons Promontory

My exercise today consisted of a walk around my usual 5km in Copa listening to an audio version of "The Economist", one of my favourite reads/listens.  Walking by the beach on a nice sunny morning, it was easy to think about better things and I recalled one of my favourite long training runs that included some great beaches.  I have only done it a handful of times, because it is on the remote Wilsons Promontory, the most southerly point of Australia's mainland, and one of Australia's best National Parks.

Oberon Bay, Wilsons Promontory

There are a number of running routes available on The Prom, short and long, and over the years I have spent weekends and weeks camping there with family and friends.  All of the runs are worth doing, but my favourite is a 43km loop that includes beaches on the western and eastern side of The Prom and two climbs over the spine that provide views and some quintessential Australian bush trails.

Tidal River, Wilsons Promontory

Going in a clockwise direction the run starts with a steady climb up to the Oberon Car Park along a tarred road for 4km before joining the walking track to Sealers Cove that starts with some hillside running, crosses Windy Saddle, and then descends to boardwalks across an eerie swampy world behind the spectacular Sealers Cove.  From there the trail follows the coast southwards past Refuge Cove to Waterloo Bay, offering some fabulous views over the pristine coast before turning westwards, back across The Prom to Oberon Bay.  It's easy to imagine that nothing has changed here for thousands of years as you run along the flat hard Oberon beach with the breakers to your left and the imposing Mount Oberon ahead.  The last section of the run returns to the starting point at the Tidal River campground around a rocky cape and you can finish along the beach or along a trail through the ti-tree.

I have run the course quite quickly in days gone by, but it is just as enjoyable at my slower pace of today, and I look forward to my next visit.

Mixed feelings

Ultra-running legend, Pat Farmer, running
with friend, Dina, near the end of the
"Round the Bay"

Today was Terrigal Trotters' "Round the Bay" run, which is traditionally held on the first Sunday in the New Year.  At just over 37km of roads and concrete bike paths, and usually in humid conditions, this a tough run.  Three weeks ago, I had been planning to use it as a long training run, but the Pulmonary Embolism diagnosis a week ago changed all that.

The event, which circumnavigates Brisbane Water, and is followed by a picnic breakfast, has become increasingly popular within the running club, and today was no exception.  Fifty-five people completed the circuit, including one group of walkers who began at 2:00am!  Some slower runners started at 4:00am while the main bunch set out at 5:00am.

Despite injury, Wayne nears the end of
his 13th consecutive "Round the Bay"

To get some exercise, I drove down to the start in Gosford and then walked 4km out and 4km back along the last section of the course with my camera, photographing the runners and walkers as I encountered them.  It was inspirational to see so many of my friends out testing themselves, including some suffering from injuries and/or a lack of preparation.  In just about every case, I managed to coax a smile out of them, despite their exhaustion.  My friend, Wayne, who is the only person to have run every one of the twelve editions so far, and has had a bad couple of years with various injuries, still found the determination to finish and preserve his record.  We have had a few good tussles on this course in past years.

Trotters gather for breakfast and a low-key presentation
after the "Round the Bay"

The inspiration provided by my friends this morning was, sadly, somewhat offset at frustration with my own situation.  It was only eighteen days ago that I ran the same course on my own without pressing the pace in quite a reasonable time.  I need to remind myself that eighteen days is not that long, and that I was still running up until a week ago.  Assuming next week's Echocardiogram is clear, I may be jogging in another week, and won't have lost much fitness.  Other people with my condition would just be thankful to still be vertical, and I need to remember that too.

Some cause for optimism

Near the start of the Dubbo Gully Run

As the early test results come back, I'm becoming more positive about a return to running.

So far, no evidence has been found of more sinister underlying conditions that could have led to a blood clot forming in my veins and migrating to my lungs.  However, I still need an Echocardiogram early next week to rule out any heart disease or other heart issues, so am not out of the woods.

On the other hand, an Ultrasound Doppler examination of my right leg yesterday, found a small clot just beneath my right knee and close to the site of severe knee pain I experienced following a 30km trail run on the Dubbo Gully course three weeks ago.  There is no pain there now, and there hasn't been for several weeks, so it seems reasonable to surmise that the clot may have been larger when the pain was greater.

Crossing Mangrove Creek on the Dubbo
Gully Run

What led to such a clot forming, and why didn't I pay more attention to it?

Firstly, I have had significant right knee pain for more than six years now (see Post titled "Adaptation"), so I expect it to be sore after a long run.  However, I recently switched from wearing Nike Pegasus shoes, a model I have worn for decades, to another brand that promised more cushioning.  I was wary about changing shoes because I know different brands and models can change the stresses and strains imposed on the legs making you potentially more vulnerable to injury.  However, I have also been struggling with a painful chronic right Achilles tendon injury and been stymied on several long runs, including the Melbourne Marathon, by lower back pain and associated sciatica.  A shoe offering a softer ride and different pressure on the heel was worth trying and I bought a pair.  After a couple of weeks and several long runs in the new shoes, positive signs were that my Achilles tendon was less painful and there had been no back trouble.  Offsetting this was a minor worsening of my knee pain, which seemed to have moved to just below the patella on the inside front of the leg.  Following the Dubbo Gully run, the pain was particularly intense, especially on the hour-long drive home, and was sufficiently painful to cause sleeplessness the next two nights.  It now seems likely this pain was associated with deep vein damage.

Part of the Dubbo Gully route

Three risk factors probably compounded the development of a clot in the vein.  I was dehydrated after the run, but drank sparingly in the next four or five hours, increasing the viscosity of my blood.  Unusually, I had a three hour nap (while still dehydrated) on my bed when I got home, during which my heart rate would have dropped to its usual low resting rate (~45 bpm).  Finally, I have low blood pressure anyway.

My guess is that the coincidence of the new shoes changing the stresses on an already damaged knee, dehydration, a post-run nap, and low blood pressure led to Deep Vein Thrombosis.  The next ten days saw parts of the clot break off and travel to my lungs and the development of Pulmonary Embolism.

Through gradually increasing the daily dosage of Warfarin, my International Normalized Ratio (INR), a measure of the clotting tendency of my blood, has reached 2.1 (the desirable range is 2.0 - 3.0) and the daily Clexane injections have ceased.  I'm still not allowed to run, but I played golf this morning and have been walking about 5km per day this week without ill-effects.  I haven't discussed it yet with the doctor, but I'm hoping I can resume unpressured jogging after a scheduled visit in a week's time, provided the Echocardiogram doesn't yield any concerns.  Fingers crossed!

A new challenge

Terrigal Trotters gather after their Santa Run

The New Year has brought some additional challenges in my quest to run a last sub-3 hour marathon.  When I started this blog, I thought my goal was possible rather than probable, and now it seems closer to impossible than possible.

Following my underwhelming Melbourne Marathon effort back in October 2013 (see post), my training was consistently around 100km per week up until Christmas and I could feel my fitness improving significantly.  Enough, in fact, to begin plotting my race calendar for 2014, culminating in another sub-3 hour marathon attempt at the Gold Coast Marathon in early July.  I entered races such as the Bogong to Hotham 64km in January and the Six Foot Track 45km in March, optimistic that, barring the unforeseen, I would do well in both.

Unfortunately, "the unforeseen" has arrived.  At the Terrigal Trotters Santa Run, on the Saturday preceding Christmas, I struggled around the 10km course for no apparent reason, breathing particularly hard on the hills.  It was warm and humid, I was wearing an Elf costume, and I had run 37km (comfortably) in training three days earlier, so I wrote it off to a combination of those factors.  Over the next three days, I ran just 10-15km daily, and didn't push the pace, but still felt fatigued and short of breath.  I even walked up a couple of steeper hills, a rarity, and quite demoralising.  I survived a long-planned 35km Boxing Day trail run with friends by running conservatively the whole way, and hoped that successful completion might have signalled some kind of recovery.

Me (centre) getting ready for the Trotters Santa Run,
unaware of my Pulmonary Embolism and how hard I
was going to find the run.

Sadly, two days later, I could only shuffle around the monthly Trotters 10km Hill Time Trial in 56 minutes, some 13 minutes slower than I should have been able to manage.  This convinced me something was wrong, and not getting better.  On returning home, I spent some time Googling my symptoms.  The most likely explanation seemed to be Pulmonary Embolism (PE) a condition that can quickly become fatal and requires urgent medical attention.  I didn't feel "on the edge" so resolved to visit my local Medical Centre the next morning.  The duty doctor thought PE unlikely, since I had no symptoms of Deep Vein Thrombosis (DVT),  but alarmingly, thought some kind of heart condition probable.  Nevertheless, she took my concerns seriously and prescribed a series of tests to check for heart and lung issues.

Being the Sunday between Christmas and New Year, I had to wait until the next day to get the first tests done and a Pulmonary Angiogram found evidence of PE in both lungs.  Often this would lead to immediate hospitalisation, but since I seemed otherwise healthy and stable, I was sent directly back to the doctor where I was given an injection of the anti-coagulant Clexane in the stomach and prescribed another anti-coagulant, Warfarin.  More tests were prescribed to try and determine the source of the original clotting, which I gather could include cancer, heart problems or injury.

Now, three days later, I'm still trying to come to terms with how this is going to change my life.  After more extensive Googling, it seems the best case scenario is that the clots are resolved by the anti-coagulant and I cease taking the Warfarin in three months and return to my pre-PE life.  The worst case scenario is that the PE is symptomatic of a more serious condition.  I feel healthy, when not running up hills, and have a sort of instinctive confidence that there is nothing seriously wrong.  On the other hand, I strive to be a rational being and know I'm getting older, I frequently test my body to its limits, and some time, barring accidents, a medical condition will lead to my demise.

I'm restarting this blog with the intention of tracking my progress through treatment and towards the Gold Coast Marathon in July.  At this stage, I really have no idea whether I will be running.  Chances are that I won't bother unless I feel fit enough to threaten 3 hours.  Right now, this seems a very slim chance, but I'm keen to try.

Strategising

Crossing Austria as part of my 2012 Via Alpina hike

I did manage to run 5km this morning, but I felt slow and heavy-legged.  I took care to minimise the strain on my injured right knee and it survived the distance without getting worse, but my right Achilles tendon was sore and I didn't feel like I was moving well.  With an Achilles tendon injury, my body subconsciously responds to the pain signals by shortening my stride length and avoiding pushing off too hard from that leg.  The consequence is an inefficient gait, more effort to run at the same speed, and premature fatigue.

Crossing a river on the Old Telegraph Track in Far North
Queensland during my ride between the southernmost and
northernmost tips of the Australian mainland in 2006

Even accounting for the Achilles and knee problems, running has been a chore of late.  Apart from a very modest performance at the Woodford to Glenbrook 25km a few weeks ago, satisfying runs have been scarce for three months.  It's enough to make me wonder whether I need some kind of circuit breaker, a period where my body can get back on an even keel.  In the last ten years, such a circuit breaker has been provided by the annual hiking or biking adventures I have been lucky enough to enjoy in retirement.  In almost every case, I have finished the adventure feeling fit, strong, refreshed and ready to resume my running career.  Maybe it's been one of the reasons my running career has lasted through these last ten years.

My intention had been to dedicate myself to running the best marathon I possibly could in the period up until mid-2014, but I'm worried that my right Achilles tendon injury might be a show-stopper.  My favourite medico, Dr Jon, is away for a few weeks, but when he gets back, I intend to find out whether surgery is needed.  My expectation is that I have a calcification on the heel which is inflaming the tendon and will need to be removed.  An MRI will tell the tale.  If surgery is required, then it will almost certainly involve a lengthy rehabilitation period and the shelving of any short-to-medium term running ambitions.  It may be the right time to embark on another hiking expedition, once ankle function has been regained, and I'll be looking at the Pacific Crest Trail in the United States and the Te Araroa Trail in New Zealand (see Downtime post) as primary candidates.

For the time being, however, I'll soldier on as best I can, hoping that something turns up, and continue the blog.

Acclimatisation

Jack Foster winning the
1975 Honolulu Marathon

It was unseasonably warm overnight, with the temperature staying above 20°C.  Blustery northerly winds had raised the temperature to near 30°C by the time I headed out for an easy 10km at mid-morning.  Although the heat made the run harder work, I welcomed it.  I have a theory that you need to run in hot weather for about a week before your body adapts to make the running easier.  So the early days of heat in any summer will initially be hard work.  It's very hard to go from cold weather to warm weather and run well straight away.  A period of acclimatisation is needed.  This morning's run should have started that process for the coming summer.

The heat reminded me of a story I had been told about Jack Foster, a great New Zealand marathon runner, famous for the world record times he ran in his 40s (2:11:18) and 50s (2:20:28).  He only started running at the age of 32.  In early 1978, Jack was keen to get a place on the New Zealand team for the Commonwealth Games to be held in Edmonton, Canada, in August of that year.  For whatever reason, maybe injury, Jack hadn't run a qualifying time and was desperately looking for a certified marathon somewhere in Australasia to record a good time.  The only marathon he could find was in April in Whyalla, a remote steel town in South Australia, so he wrote to them and they invited him to run as their guest.  It was a new marathon and they were keen to get the publicity.  I heard this story the next year, when I was fortunate enough to be invited by the organisers to be their guest runner.

At least I managed to get on the same poster
as Jack Foster

Anyway, Jack needed to run a time of something like 2:16 to qualify and was optimistic that the flat Whyalla course would give him every chance.  Unfortunately for Jack, Whyalla can get hot, even in autumn, and during the race the temperature rose to 34°C.  The organisers had a huge barrel of water at about the 20 mile mark which they were intending to use as a source of water to douse passing runners.  By 20 miles, Jack's hopes of a qualifying time had evaporated in the heat, and the organisers told me that Jack actually jumped in the barrel of water to cool off before continuing to the finish in 2:26:52.  A year later, without the heat, I won in 2:27:43, so I have an appreciation for Jack's talents.  Sadly he was killed in a collision with a car while out training on his bike at the age of 72.

My right Achilles tendon was still quite sore when I set out for today's run, and I did wonder whether I was wise running at all.  But this injury has been with me for some years, and comes and goes in intensity, so I'm hoping careful management will help it settle down.  Part of that careful management is not forcing it, so I wasn't able to stretch out.  My running style felt awkward, which it was, and I'm sure I looked like an old man going out for a jog, which I was.  I hoped it might loosen up on the one kilometre climb out of Copa, but if it did, it was only a little.  I felt less fatigued than expected, given the 25km trail race on Sunday, but it got harder in the last kilometres as the hills and heat took their toll.

My time for my regular 10km loop was slow, 58 minutes, but that was of no consequence today.  The weather conditions were bad for anybody with breathing issues and the run was accompanied by lots of coughing and spluttering.  The mailman brought the new Sorbothane heel raises I had ordered today, so I'm hoping that will give my Achilles tendon some relief, and a visit to the doctor later resulted in a reversion to the former asthma medication which my body seemed to handle better.  I may risk a longer run tomorrow.

Problem management

The path followed around the edge of Cockrone Lagoon at
McMasters Beach during this morning's run.

My right Achilles was still stiff and painful this morning as I headed out for an easy and flat 7km across the Cockrone Lagoon sandbar and through McMasters Beach.  I'm still wheezing and coughing a lot, but there is a very high pollen count on these warm spring days, and allergies may be exacerbating the problem.  Despite these two significant problems, I did feel like I was moving a bit better this morning, but I need to get these issues to a manageable level.

In the past, prior to surgery, I have managed chronic Achilles problems through the use of heel raises.  I recently purchased some at a sports store, but they are softish and more designed to cushion the heel strike.  I wonder if they make the problem worse, because there seems to be greater friction between the heel and the shoe as the pad compresses.  Thirty years ago, I used more rigid heel raises and often wore them for years on end.  The theory behind these heel raises is that the heel is higher relative to the front of the foot and therefore, with each step, the angle defined between the lower leg and foot is less acute.  We are talking millimetres, but it does make a difference.  I used to make my own heel raises by carving up the heels of old thongs (flip flops) and velcroing them to the inside base of my shoes.  Sadly, the thongs of these days seem to be made of softer and thicker material, and making my own heel raises hasn't been practicable.  An alternative I once used were Sorbothane heel pads and I've found they are still available on the web, so have ordered some.  If they don't work, I think I'll be visiting Dr Jon and getting an MRI.  I suspect there is a heel spur that needs to be removed, and that will put me out of running for months.

Cockrone Lagoon from the Copa side

The breathing difficulties I have been dealing with recently may be a consequence from ceasing use of the asthma medication I have been on for the last few years.  I stopped taking Seretide because it was giving me headaches, and before that, the doctor recommended I stop taking Symbicort which has had some adverse findings concerning long-term use.  Ventolin seems to help a bit, but I'm only taking it on days when I race.  I'm not sure that it is wise to be taking it before every run although a web search hasn't revealed evidence of any long-term use side-effects.  Two other major considerations for me are that I don't like the idea of taking anything long-term, and I don't want to take anything that is prohibited by the World Anti-Doping Agency (WADA) or the Australian Sports Anti-Doping Authority (ASADA).  The latter has a "Check your Substances" facility that allows you to make sure you are not contravening the rules and the FAQ on the Australian Sports Drug Medical Advisory Committee (ASDMAC) also provides good information.  Both of these websites show the medications I have been using comply with the rules, but that leaves the problem of avoiding long-term use.  I've made an appointment with my doctor next week to discuss the best option.

Can't take a trick

Better days......leading in the 1983
Stawell Marathon (1st, 2:29)

Another bad day at the office.  After last evening's abortive Six at Six race, I slept badly, waking up sweating several times, and rose early this morning feeling tired and unmotivated.

I journeyed to Terrigal Haven for the regular 6:00am track session and afterwards set out for my own planned run of 16km.  It didn't go well.  The two steep hills in the first kilometre are always a hard way to start a run, but usually, once I reach the ridge above Terrigal I start to feel warmed up and begin to move better.  That didn't happen this morning, when every step seemed a struggle and every breath an effort.  After a couple of kilometres, I began to question the wisdom of completing 16km, especially on the planned hilly course, and after 3km I made the decision to return to The Haven via the shortest route.

The last 3km, run at a very slow pace, were tough.  I was short of breath, heavy-legged and sweating profusely, especially round the head, and very glad I had chosen the short route back.  It took me about 37 minutes to run the 6km and I'm now convinced I have some kind of bug.  My chest feels weak and I lack energy.  Hopefully, it's just a short-term thing.  I can't really be bothered going to see the doctor.  My right Achilles tendon was also quite sore for the whole run, and I just don't feel like I can take a trick at the moment.  I would like to have just one day where I feel like I am running well and it seems like months (and is months) since that happened.

From experience, I know that I must keep running through this period, perhaps taking it a bit easier until I feel healthier, but generally sticking to my training regime, and eventually things will stabilise and running will become more enjoyable.  I also need to remind myself how unhappy I was when I couldn't run at all, and count my blessings.  I'm a believer in the body sorting itself out if you give it time and am hopeful that, in another month, the current period will be just a bad memory.

Running with a cold

The last part of the Cape Three Points Road climb
out of Avoca

I'm trying to gradually increase my training intensity, while taking care not to overtrain as I come back from the right arch injury.  This makes me reluctant to step back when something such as a minor cold comes along.  Since Sunday, my nose has been running, my sinuses are blocked and I'm coughing a lot.  Like most runners, I believe that running with a head cold is unpleasant but not such a big deal.  However, I also believe that it can risk bronchitis, or worse, if the congestion goes to your chest or you get too run down.  The rational thing would be to back off for a few days and avoid hard running and breathing, but that also means less mileage and a slower comeback when the cold may just pass by anyway.

I have never been very good at backing off for illness (or injury).  For many years, my personal rule was that, if I was too ill to run, then I was too ill to work, and because I always wanted to run, I was rarely sick enough to miss work (in fact, I can't ever recall missing a day through illness, though there were probably a few early in my career).  Of course, I was lucky to never suffer a serious illness, though I did run a few times with a high temperature and flu symptoms, and occasionally against medical advice.  It's hard to draw the line.  There's no point in ending up in hospital or worse, but none of us feel 100% every day and I don't want to miss training unnecessarily.

Copa beach

In recent years, I have modified my illness rule to be no running with a temperature.  I have heard a few horror stories of runners collapsing when training or racing with temperatures, and have no desire to join them.

With just a cold to worry about, I set off for this morning's 14.5km road run knowing that it might not be pleasant.  I ran a regular course, but in the opposite direction to usual, making it easier for the early kilometres and back-loading the toughest hill - Avoca's Cape Three Points Road.  It was yet another beautiful warm sunny morning as I crossed the lagoon sand bar to McMasters Beach and cruised along the shaded Scenic Highway.  After a few kilometres, I spied another runner up ahead and thought I might catch them, but wasn't running fast enough and suddenly they had disappeared.  The first hill elevated my cold symptoms, and I was soon coughing, hawking and wheezing as I struggled up the climb.  My head felt stuffed up and I was sweating profusely around the eyes, a tell-tale sign of sinus problems for me.

Despite all that, I was moving better than a week ago, and it really was a beautiful morning for a run.  Even the first part of the Cape Three Points Road hill wasn't too bad, but the hill has a concave shape, meaning it gets steeper as you get higher, and I really struggled up the last part, spluttering all the way.  The reward, of course, was the run down the other side into Copa with it's magnificent coastal views, and the icing on the cake was a brief stop on the beachfront to watch a whale wallowing just beyond the surf break a hundred metres from shore.  I finished in 1:17, which was an acceptable time, two days after a hard long run, and the good news was that  my right arch injury was barely noticeable (though my right calf muscle had a tender spot).

Adaptation

The use of trekking poles has made a big difference to the
ability of my knees to deal with long hiking expeditions.

I'm in a bit of a quandary about my new insoles, bought to alleviate the pain in my right arch.  As you would expect, wearing these orthotics feels a bit strange in my shoes when running, and although they have certainly eased the arch pain, they have also affected me in other ways.  Normally, after resuming very easy running for a week, I wouldn't expect to have the aches and pains I'm currently experiencing in my feet, ankles and legs.  This morning, I couldn't even manage a quadriceps stretch in my right leg because of the pain it generated in my right knee.  This is unusual, and a bit of a worry.  My right knee has been very troublesome in recent years and I don't want to aggravate it.  It is the same knee on which I had surgery in 1980 (see previous "Lack of patience" post).

On two occasions in the last seven years I have had to stop running for extended periods because of pain in this knee, and on both occasions, scans revealed significant damage.

"Large chondral crater of the lateral patellar facet"

"Marked patellofemoral joint arthrosis, particularly laterally. Subchondral
bone change. Patellar tendinopathy. Torn medial meniscus."

Extended rest allowed the painful inflammation generated by these problems to abate and then careful resumption of walking and running enabled my gait to adapt, but I'm keen to avoid a recurrence.

That's not me, but I spent many hours hanging in
inversion boots to alleviate a lower back problem.

Similarly, thirty years ago, the stress fracture of a small bone in my lower back (left minor pars articularis) led to the displacement of a vertebra and years of significant sciatic pain that severely impacted my running.  Time has stultified the tissue around the vertebra, providing local support, and my posture and muscle strength have adapted, to gradually take pressure off the sciatic nerve.

For both injuries, doctors and specialists said surgery was an option, but might not improve my ability to run and might cause future complications.  It was suggested, explicitly and implicitly, that my running career was over.  Yet, I'm still running!

I don't put this down to a tolerance of pain, or to single-minded determination.  I suspect that most people my age, if they had their knees or lower back scanned, would get a scary picture.  However, I believe that our bodies adapt, we consciously and subconsciously change our gait, and we take more care in situations likely to aggravate the injury.  Pain is still present, but we know what it means and how to manage it.

I toyed with the idea of walking instead of running this morning, and also thought about removing the new insoles to see if that made a difference to my niggles.  However, in the end, I decided an easy 5km wearing the insoles was the best course.  My thinking is that my body needs time to adapt to the insoles and gentle running is likely to aid that process.  There were lots of twinges in the first kilometre, but none crippling, and I persevered.

I remain keen to ditch the insoles as soon as I can and get back to the running form I'm confident my knee can handle.

Massage, or not

Flexibility was never one of my strong points.  Here I'm
comparing capabilities with friend, Bill, after a long run.

An accomplished marathoner, and fellow Trotter, Melanie, has suggested on several occasions that massage might help my arch problem.  She has been suffering from a similar injury and found that deep massage of the arch has made a difference.

I have had mixed experiences with massages over the course of my running career.  The earliest experience I can remember was a positive one.  I had developed a painful knee while living and running in London in the mid-70s and a visit to Ted Chapple (sp?), a well-known sports masseur, was recommended.  He manipulated the knee, and had me adopt various positions to test the pain levels.  He then asked whether I had been doing any slow running. In fact, I had been encouraging my then wife, Barb, to tackle some longer distances in her running and we had been jogging up to 25km together on some evenings.  Ted worked on my quadriceps for a while and suggested I increase the pace of my running.  I did, and the pain disappeared almost immediately and didn't come back.

My next experience of massage was less positive.  I had been trying to manage chronic Achilles tendon pain in my left heel and was getting desperate.  Friends suggested I make an appointment with a well-known sports masseur, which I did.  It turned out to be one of the most memorable experiences of my life.  The masseur located the most painful spot on my heel and proceeded to vigorously massage it with his thumbs and fingers, telling me that he had discovered a knot which needed to be broken down.  I almost had tears in my eyes by the time he finished and I later learned that there was a calcification on my heel which was rubbing on the tendon, inflaming it and the bursa.  The masseur had been pressing on the calcification, and there's little doubt in my mind that he made the injury worse rather than better.  I later heard that the same masseur had been working hard on the site of another runner's injury, causing him excruciating pain.  The runner begged him several times to stop, which he didn't, and the runner finally sat up and punched the masseur!

Since that time, I have tended to avoid therapeutic massage unless recommended by a doctor.  My view is that any injury that appears to be chronic or structural needs to be assessed by a doctor, probably with the use of appropriate scans, before enlisting the aid of other health professionals.  This is the course I have followed with injuries over many years.  I have benefited from the services of masseurs on a number of occasions, but rarely make them my first port of call for injuries.

On the other hand, I don't have any problem with massages designed to relax muscles and tendons as part of a training program or post-race recovery.  It's more the use of massage to promote the repair of specific injuries that I avoid without first getting a doctor's recommendation.  This is just my personal opinion, and I have many athlete friends who happily rely on masseurs or physiotherapists for the treatment of injuries and tightness and are pleased with the results.

I walked about 3km this morning, wearing my new insoles, and did feel less discomfort and a little more positive that I could continue walking for exercise while waiting for the injury to heal.