Old Man Still running

Just three more days.  Pool workout including a 1+ mile swim.  Been trying to keep the weight down.  Tough when I'm not training as much.  I'm about 4-5 pounds over my usual race weight.

Leg, about the same.  What can I say?  It will be painful, but I hope it decreases.  I believe there has been some good improvement.   When I walk with a mid-sole or toe strke, there is very little pain.  That is why there is less pain running faster.  With a heel strike, there is pain down on the tibia.  It just won't go away.  I suspect those are just nerve endings.  Hopefully they will go numb.  Also underside knee cap pain that shifts around.  That shouldn't be a big deal.

Evening.  No pain at all in leg.  Go figure.  There is hope.

Leg is feeling pretty good this morning.  The next worry is the weather.  My flight goes through Denver and there is a big storm there tomorrow.  I have a morning flight so hopefully with just delays I will be fine getting there.  Last year there was a big storm in Texas and probably about 100 runners never made it.   If they cancel the flight, there are alternatives through Phoenix with different airlines.

Finished my 5th RR100 and got the 500-mile jacket.  Barely finished.  I went into the race with an injured leg, hoping it wasn't too injured and would calm down after about ten miles.  It did, but later got terrible.  Today I can't bare any weight on it and am making a trip to the doctor.  I almost quit at mile 60, but there still wasn't any swelling so I decided to try at least another 4 miles with my pacer, flatlander.  Felt a little better, so kept going.  I couldn't really run anymore.  If I tried to run faster than 12-minute pace, the pain would be terrible.  By mile 80, I couldn't go faster than 15-minute pace and needed to do the last 20 miles with trekking poles.   At mile 93, the knee started to swell up a little so I slowed way down to be very careful, probably doing 30-minute miles.   I did a little better for the last seven miles with my pacer Wade who kept my mind off the pain.   I crossed the finish line in a very slow 28:23, by far my slowest RR100, but I got it done.

A terrible thunderstorm hit about an hour before the start and lasted for two hours dumping at least two inches of rain on the course.  During Loop 1 at about mile 14, I took a face plant in a mud bog....head to toe in mud including face.   I couldn't clean up until mile 20.  It was pretty funny.  I still had hopes for a 20-hour finish at mile 40, but then the leg got worse and by mile 55 I was in rough shape.   Had to run the last 5 miles of that loop by moon-light because I forgot to take a light with me on that loop, I was going too slow.   At mile 60, I was about ten miles behind my pace last year.  Matt Watts caught up to me around mile 70 and it was fun to run with him for about 10 miles.  He ended up finishing more than three hours before me.

Anyway, great crazy fun.   I'm hoping that won't be the last 100-miler I will run.  We shall see.   I suspect I have at least two months of healing ahead of me.

Really bad pain in the leg getting into work this morning.

Well, here is the current dianosis from the doctor after x-rays.  Well actually first he asked tons of running questions.  He wasn't my regular doctor but he has read Born to Run.  He was nice and said I looked like I was in my 30s and had lots of compliments about my active lifestyle.

1. My bad knee is not yet bone-on-bone.  The cartilage layer looks like it is about half the thickness it should be with a normal knee.   Good news.

2. No stress fracture showed up.  Good news.

3. But, there is an unusual small bump showing up in the layer next to the bone.  This layer is called the Periosteum.  This is a membrane the lines the bone and can do corrective repair to the bone and cause some calcium build-up over time that can be seen on x-rays.  This layer is rich in nerves and if irritated can be very painful.  I believe I have at least a couple spots on my upper shin about two inches below the knee that are giving me great pain.

If you explore this area of your shin (upper, inner), there is no muscle there, but there are muscle attachments from the hamstring and shin muscles.  Something has irritated the periosteum by pulling it or lifting it.  The end-result is something like a shin splint, but the pain is in the bone, not the muscle.

So, it appears that treating it similar to a shin split will work.  Rest and in this case heat treatments.  The doctor recommended that I go see my orotho doctor who could perhaps figure out what is pulling on that area.  He knows that not running 100-milers would certainly solve things but he wants me to continue and so do I.   I'll wait a month so they can compare x-rays and also check out my knee after it recovers some.  My bad knee REALLY got pounded.  The worst I've ever felt by far, but it isn't swollen.  I can feel a little fluid build-up inside, but the pain is on the tibia platform, all weight-baring pain.  I bruised it pretty bad.

This entire problem probably started at ATY around mile 120.  My upper calves became very, very tight and I suspect have some insertion points in that area.  On the other side of the leg my shin muscles also got sore.  During RR100, my lower shin muscle tore a little and swelled up during the first 20 miles. (The pain was nothing compared to my other problems, so I just ignored it.)  So that tells me all those muscles were still too tight and probably pulling on that area big-time.

The doctor assured me that I will run again and felt confident that I will be healed up by Northcoast 24-hour in May.  So, I'll go ahead and put my name in the lottery for Cascade Crest 100.  I will likely pass on Buffalo 100 this year and just run with my son in the 50

Worked from home so I could ice the leg.

Improvements today.  To benchmark my progress, I went out for a "run".  I took my Garmin to measure my speed.   I had to keep the pain under about a "5".   My peak pace was 27:00.  The good news is that is about three times faster than yesterday afternoon.   I was able to "run" 0.2 miles in 7:45.  Good stuff!

The biggest source of pain now is in front of my knee behind the patella, I believe on the Tibia platform.  That is odd because I should have more cartilage there.   I would think that will calm down pretty fast, but I do recall pain near there before running RR100.  

As I was "running" two women came running toward me.  I could not deal with that sight.  I turned my back and headed back in. Little did they know that the old slow-moving cripple is actually the fastest long-distance runner in the city.

I put this on facebook, a Tiny Tim reference. 

Feeling like a cripple today. Someday when I'm gone, I will be sadly remembered by one lone trekking pole by the fireplace (near my belt buckles). God bless us everyone.

p.m. walk with the dog. She was pretty annoyed that I was only going 45:00 pace.  Cut it short as the shin started to complain.

Entered the lottery for Cascade Crest 100.  If I don't get in, I'll likely do Plain 100 again.  I just enjoy both of those more than Wasatch.  Plain is a lot tougher than Wasatch and CCC100 is both tough and amazing variations of trails. Wasatch course is getting somewhat boring after running it both racing, pacing, and training, probably about 6 times now.  I seems to get bored with a race after about six times.  That is probably why I'm not going back to Bighorn or Tahoe Rim this year either.

I've been researching medical papers about my problem.  My main source of worry is the shin pain.  It can be classified as a shin split, but it is unusually high on the shin and now pretty big.  Two muscles send attachments to those areas, both are calf muscles.  So the calf is likely doing the pulling.  Strange because I've had no calf soreness or tightness.  But my calves are probably over-developed and causing grief.  I don't rule out a stress fracture.  New stress fractures often don't show up on x-rays until several weeks later.  But it doesn't matter, the treatment for either a stress fracture and periosteum problems in that area are the same.  Rest and patience.   Cause seems to always point to over-pronation problems.  I know, I know.  That leg is a bother, swings from the hip wrong and seems to be shorter than the other leg. 

I'll start swimming again tomorrow.  Other than that leg, I feel totally recovered already from RR100.   Worst is probably upper body soreness from using the trekking poles for 9+ hours.

p.m.  A walk with the dog.  Top sustained pace today, keeping the pain the same was about 21:00 pace.   That is progress.   I needed to stop several times to bring down the pain.  Brought back memories of the last 40 miles of RR100.

Progress.  No longer a cripple.  Getting close to how I felt a few days after ATY.

I looked very closely at the x-rays again. The bump seen on the x-ray has nothing to do with the pain I have.  The bump is three inches lower, just some a calcified bump on my shin probably from dozens of bumps there.   So I examined the exact area closer for anything, but there is nothing in the four pictures.  Not a mark.   So I think that is good news.   At this point, just rest, let things heal and in a month if it still is bad, I'll seek more advise.  But no surgery would help, just PT.

Now the the pain is going down, I can try to figure out what is putting pressure on the problem area.  Sure enough, it goes up as the heel turns in, over-pronation.  So, I dusted off my prescription orthotics that I haven't used for five years.  I'll get used to using them again.  They will force that foot to pronate better and give some arch support.  Hopefully it will rest that area of the leg better and let it heal.  NO MORE BAREFOOT around the house.  Funny how my downfall has probably been going barefoot so much.

Top speed today walking the dog was 17:30 on soft grass..  Didn't have to stop to let the pain down.  But there is constant pain in the shin.  The knee is improving nicely.  I've come a long way considering a couple days ago I could hardly move without a cane.

I still haven't brought myself to really write a race report.  I have no desire to relive that pain, even in my head.   It was by far the most painful race I ever ran.  And, it wasn't very fun.   The only bright spot is I really enjoyed the kindness and company of my pacers.  Those guys were amazing.

Pool workout.  Had to drag the leg, kicking hurt.  Sunrise was spectacular.  I should have brought my camera.  Did deep massage of the calf and shin muscles with a high-presssure water stream coming out a nozzle in the kiddy pool.  It pounds the calf to mush.  Amazing.  Should help.

Two mile walk with the dog.  Discouraging.  Top pace with a huge limp was 15:00.  Pace with no limp 25:00.  Had to stop to rest twice to let the pain go down below a 5. But there is slow progress each day.  Of course I have those thoughts that I will never run pain-free again, since it has been 41 days now.  My first goal is to walk pain-free again.  That is probably still a couple weeks away.

It has been a bad couple days but I think some healing is taking place, the pain is starting to feel like a healing type pain.  But the pain now is even felt while sitting.  Lying down for awhile in the right position makes it go away.

Just to document my findings for my future use.  I believe I have several problems and we shall see which take the longest to heal.  They are all connected with the knee and I suspect once the knee heals up, everything will heal up.  For the worst problem the cause is very likely the recovery of my stride, bringing the leg forward.  For that leg, my toes naturally rotate outward on recovery causing the leg to come forward from the side.  Lots of the pain can be felt by simply pushing the inside of the foot against something.

Anyway, one problem is with what is called the pes anserine.  This is a area where three muscles connect as well as the MCL below the knee on the side of the tibia.  I'm having continued swelling on the pes anserine. 

"This is a location vulnerable to repeated injury in athletes due to the fact that several ligaments, tendons, and muscles all meet in this same general knee area. This area of ‘high traffic’ can become aggravated with overuse."  "

Pes anserine bursitis is most common in long distance runners. Failing to properly stretch is a main cause but this condition also occurs in athletes who tend to contact the ground with their foot rotated outward. Even the slightest outward rotation of the lower limb during contact with the ground causes poor weight distribution and strains the inner thigh muscles and knee ligaments."

Also having trouble with a tendon that wraps around the knee, maybe the popliteus muscle.

Another painful problem is front of the knee, joint line, under the patella tendon.  I can't figure that one out, hopefully it calms down and isn't a piece of cartilage causing problems.

So, I'll give it another week and see what things get better before going in to the ortho.   It is easier to diagnose things after some things calm down.

More of the same, walking is really hard and painful. Improvements were felt last evening, but mornings always cause some swelling to come back.  I've even giving up trying to do some walking and swimming until things get better.  Trying to stay off my feet more.  I made an appointment with the ortho on Thursday.  I still don't think there is anything that needs to be repaired surgically, but it can't hurt going in and having him check things and probably getting an MRI.  

Lows and Highs.  Yesterday afternoon after being on my feet working on my car for a half hour my lower leg swelled up and the pain was terrible, I could hardly walk at all.  I was so discouraged, wondering if I would be a cripple forever.

So, I spent the evening with me leg up and with ice on the bad spots, and plenty of anti-inflamitories.  By late evening all the swelling was down and I could walk almost pain free.  That really gave me hope.

But, when I get up in the morning, just the time on the feet and getting into work gets the swelling and pain going again.  This is pretty amazing.

Hopefully I'll start getting some answers.  Tomorrow is a doctor day.  I'll go see the ortho about the leg, and then go upstairs to see about a new problem with my hand.

It sucks to be old.

Got an MRI on the knee today, will hear results tomorrow.  Pain is as bad as ever.  The doctor said the area causing me the most grief can be solved quickly with a cortozone shot to help it heal quickly, but usually that area is a signal that the meniscus is injured.  I did pass all the physical tests that he performed.  But the MRI will tell and help find a possible stress fracture if there is one.

No news today. The doctor was in surgery all day.  I'm trying to stay off my feet and will do so all weekend....just getting lazy and fat.   Where's the channel changer?

Actually, I can tell that some of the problems are healing up.  I have some sore lower leg muscles, probably from the limping.  But those are getting better too.

A guy stopped by my office today who does casual running with others at work during lunch.  He made the comment that this is great, that now they can keep up with me. 

p.m.  Progress.  When swelling spot down, walking pain down to a 2 or less, but can only really stay on my feet about ten minutes or the bad spot will start swelling again. 

A zero-mile week!   I don't know how long it has been since I have acheived that milestone.  Good job, nice lack of work.   I'm a hero for all those slackers out there.

Swam two miles dragging the leg.  Slow going.  Looks like since 2002, I've swam about 500 miles.   I pretty much quit swimming in 2006, only a few miles here and there since then.  7.5 miles in the past few weeks.  So boring.

Massaged the leg muscles with a high-powered jet in the kiddy hot tub.  Seemed to help.   When into the rec room and discovered that one of the eliptical machines keeps the feet closer together and I felt very little pain using it.  I hate those machines with a passion, but it looks like it may be the only thing to get some sort of leg workout for the next several weeks.

I'll find out Monday if I have to go under the knife again.  Hopefully not.  It is just 13 days since I tortured myself.  Patience, that isn't very long.

More of the same.  Pain about as bad as ever or worse.  Still can hardly walk.  Main problem is bursitis, two bursae are badly irritated, the worst right now is the infrapatellar bursa.  Boy, it really is painful, about an inch below the knee cap on the inner side.  It sites near a ligament and the patella tendon.  The tendon isn't sore, thank goodness.  But I can just tap on the area of the bursa and it creates big-time pain.

I'm sure other problems are joint pain, but they are so much lower than this bursitis.  I need a shot there, but the office is closed for the holiday, so no news or help.  Putting an ice pack on that area numbs things up for a little while.  Laying on the back with the leg up also makes the pain go away.

Well, believe it or not, the MRI came back fine.  Great news!  My ortho mostly laughed as he listened and talked to me about what I do.  After he discovered that I have run 23,000 miles since he fixed up my knee in 2003, he bragged to his receptionists.  I asked him specifically if I've damaged the knee at all from my running.  He said the MRI just shows what he did with the surgery, no new problems.   So what have I done?  "Overuse."  He couldn't rule out a stress fracture, but didn't seem very concerned about doing anything more to find it.  He did say that he should have ordered a brain exam.

He prescribed a steriod to be taken this week which should bring down all the swelling and solve the bursitus.   As we walked down the hall to the front desk, he yelled out and pointed to me limping, "I didn't do this to him!  He did it to himself."   He got me crutches for the next few days.   Hopefully I'll start mending now.

Some progress. Mornings are always the worst for some reason.  At least with the crutches I didn't have to endure the severe pain walking into the office from the parking lot.  Yesterday it was bad enough that the tear ducts started to flow.

Looks like the steriod is helping some of the problems.  I really don't feel much joint pain anymore which is pretty normal after a 100 within 2-3 weeks.   The main thing remaining is the worst problem going into RR100 and coming out of it:   The pes anserine area. below the knee.  This is where the MCL attaches and three other muscles including the semitendinosis hamstring muscle who's tendon had been sore.  The shin muscle on the other side of the leg also pulls somewhat on that area and that muscle is still tight and sore at times.

The pes anserine area is still swollen bad and when I walk feels like a knife digging in.  Crutches will help avoid that because that pain is only when it bears weight.  Its like a very high shin split.  I think the possibilities are: 1. Just continued pressure on that area.  2. a tear in that area.   3. a stress fracture in that area.   Either way from what I read it will likely be 6-7 weeks.   If things don't improve significantly in two weeks, I'll be back at the doctor and he'll help further....he told me to come back if it doesn't improve.

Improvements seen (I list these for my benefit so I won't doubt that I'm getting better.)

1. No longer much pain on the medial side (inside) of the knee when I rotate the leg in.  The MCL or semitendinosis would sting before and start aching very badly.

2. Much less pain when I try to push aside something with the inside of the foot.

3. Much less pain in the infrapetellar region.  Still pain when I tap there, but much less than the last couple days.

4. Lower leg muscles better, probably from not limping.

More of the same, no real improvement seen.  Yesterday after work was very bad, crippling pain.  But elevation, ice, and Advil calmed everything down quickly for the evening.  No pain when sleeping. Then mornings it all starts over again.  Bad in the mornings, elevation and ice doesn't help much.  Not nearly as bad this morning as yesterday.

Seeing some reaction to the prednisone, not bad, but noticed.  I don't know if it has really helped much yet.

Really bad morning.  Seems like the Tibialis anterior muscle, the shin muscle on the other side of the shin is causing grief.  When it seems to be swolen and sore, everything hurts a ton more.   That muscle strained a little during the first 20 of RR100 and swelled up during the race.  It could be that everything is just swolen more this morning....didn't take Advil, tired of taking drugs.  Tried to walk in from the parking lot without crutches, sick of those things.  Bad decision...could barely move as I approached my office.   Really no improvement this week, so I suspect I'll be back at the ortho next week.  19 days of very slow recovery.  I think there are some good corners downtown where I could bring my crutch, find a tin cup, and get seomething good out of this.

p.m. much better.   However, the drugs caused or triggered what I think is a kidney stone.  When it rains it pours.   Great fun.

Improvement today.  Not sure what helped, compression over night, deep massage, or short workout on the elipitcal and bike.  I suspect the workout helped tighten up the knee getting some pressure off the problem areas.

It is strange that after three weeks, I still have swelling that rotates around. It went down into my lower leg this morning. It really makes me think there is a bad tear or stress fracture somewhere.  That is a long time for swelling to remain.

Best, is no kidney pain for past 12 hours.  Friday morning it was so bad I almost threw up.  Great stuff.  Builds character.

Added up the meager miles this week, about four.  Some on my extended trekking poles (actually crutches).   Gotta have some miles on the board!

Rough weekend.  Saturday night had terrible kidney pain that lasted two hours.  I had my shoes on to get to the hospital, but it finally calmed down.  Pain was a 10 at times.  Threw up.  Amazing.   I was really worn out after that workout.   Last night about 31 hours later, another one, but milder, pain 8, only lasted 15 minutes.   I'm hoping that this is just a reaction to Prednisone which I am now off of.   But, if it is a kidney stone, I have lots more fun ahead.  The pattern seems to be every 30 hours or so.

Leg?  What can I say?  At times it starts feeling great, but later not.  I can only walk about 100 yards or be on it about ten minutes before it starts aching down the bone.  The pain is always weight-bearing.   If I am sitting or laying down if I bend the knee or foot this way or that, no pain.

I tried sleeping in "the boot" in hopes to keep the leg in rested position.  Could have helped, not sure.   Still on crutches this morning.   Its been 21 days.

I've got another appointment to go in on Thursday.  Let's hope there are significant improvements before then.

Progress.   I keep trying new things hoping they will help.  This morning I got up bright and early and went to the rec center at 4:30 to try using an eliptical.  I had to go early because two are busted and the ones that work get filled starting 5.   I spent about 45 minutes on the eliptical and a bike.  The theory doing this is to tighten up the quads which will help tighen up the knee, the ligaments, and tendons.  Also start using the other lower leg muscles that keep swelling up.  Looks like it may have helped....or just getting an anti-inflamitory in my system helped.  But the knee does feel more together this morning and perhaps that takes the pressure off the points right below it.

For the first time in days, I could walk into my office from the parking lot without crutches and without a huge limp.  It was slow....half pace, but I still made it.  A small victory.

No kidney attack in past 30 hours.  Fingers crossed that no more will come.

More improvement.  Same routine today.  The pes anserine area (area below the knee, medial side) still gets inflamed but at least it isn't causing as much aching down the leg anymore as long as I only walk about 100 yards.  Lower leg muscles are no longer swelling up.  Walking into work from the car was at 3/4th speed without big limping.  No crutches.

I'll still go into the doctor tomorrow.  Healing is still way to slow.   But I'm beginning to hope within two weeks that I will be able to walk without pain.  I think running is still 6-8 weeks away.