Friday, 9 January 2015

Dealing with long-term injury

I am indebted to my loyal readers
for your ongoing support
Yet again, I have allowed far too much time to elapse between blogs. Bad news for me, since the idea is to get my thoughts down on a weekly basis so I have a handy record charting my running progress. Bad news for you, because potentially this could have been very long. Therefore I have decided to write two blogs – this one being concerned with my injury, which is finally on the verge of being diagnosed and treated. I have decided not to advertise this blog via Facebook as I would normally, since primarily I am writing it to help me get my thoughts in order, and although I am now feeling very positive about my treatment under a new consultant, the subject in general is not that upbeat. It also summarises events I have documented in more detail in earlier blogs. So in other words, if you happen to have stumbled across this and have decided to plough on, you only have yourselves to blame.

But please stop sending in pictures
showing yourselves enjoying my blog
That said, I would hope this may be of interest to those of you currently struggling with injury or ill-health, or perhaps those of you who have gone through problems in the past  – and let’s face it, most runners will pick up a problem at some point, given what we put our bodies through. I will write another blog, hopefully soon, charting my recent running – which has been extremely positive: I am currently in my best ever form, hitting PBs regularly and feeling very optimistic about what I am still yet to achieve. A lot of this positivity come from knowing that I am currently being looked after by an expert consultant who I know will sort me out: this then is a summary of what’s been happening recently.

Nerves. All in the mind?

I have bleated on about my groin problems for some time now – they have accompanied my running since May 2013. A few people I know have wondered if they are largely psychological, and I have never entirely discounted this theory myself, since I know how easily I am affected by this kind of thing. Particularly of concern is the difference that stress levels make to my physical well-being, and there is the danger of getting into a vicious circle of being stressed about potentially experiencing discomfort, and that stress affecting my stomach and adding to the problem.

Sometimes there just isn't time to join the toilet queue before the off
I have always suffered from pre-race nerves, and sometimes even pre-training nerves, particularly when I am preparing for a training session that I know is going to push me hard. I suspect I always will, and I am far from alone in this. However, throughout the last 20 months or so, I have been pretty certain that something else has been going on too. Although generally it is better described as discomfort, at times there has been tangible pain. This has been about more than nerves.

The Solution - Slower pace and target an Ultra?

Following confirmation that there is no underlying medical problem, through the process of elimination I have discovered that the problem only really occurs when I increase mileage. It is probably more than just coincidence that it first surfaced after I ran my first marathon. Because at the time it wasn’t being linked to my running, but was stopping me getting the kind of times I wanted, I made the decision that if I couldn’t set myself time targets, I should set myself distance targets – and so went through a period of high mileage training culminating in a 30 mile race.

Unbeknownst to me, (what a great word, never used that before!) this was no doubt actually making things worse. But it was also clouding the issue, since I did not see any particular correlation between the types of training runs I was doing and the level of discomfort, because I was permanently uncomfortable, due to the ongoing high weekly mileage (typically around 45-50miles per week.)


Training for London Marathon 2014

The Essex 20: a popular race used by many runners targeting a
Spring Marathon. 3 laps of an undulating course - a good
performance builds confidence but important not to overdo it
At the club AGM at the end of 2013, I was lucky enough to get a London Marathon club ballot place, which of course I was never going to turn down. Still not having really correlated the discomfort to the high mileage, and being in the process of undergoing physio for the condition, despite no-one having been able to diagnose what was actually going on, I pressed on – and to be fair, times started to get more promising, and my training for the big day went pretty well. The problem was always there, but often not in a particularly debilitating way. I was very encouraged by a couple of decent half marathons and my first two 20 mile races, all of which suggested I would do well in London. Some days the discomfort was bad, but most days it was manageable. I have no doubt I simply became better at dealing with it, and looking back now this probably was an important part of making me a stronger and more determined runner. Ibuprofen helped a fair bit too. Whilst London itself wasn’t great, I think this was more to do with other factors relating to the heat on the day, and getting my hydration and nutrition wrong, coupled possibly with racing my second 20 mile warm-up race too hard, when I probably should have slowed that one right down. 

I wrote about my experiences running in London in an earlier blog improbably entitled CAMELS, TAPERING and THE VIRGIN LONDON MARATHON

Post Marathon

And so after London, with lots of changes in my personal life, and with no high mileage race on the horizon, my training regime returned to what should have been a more comfortable level, doing regular shorter runs of around the 5 mile distance. But of course, I then began to push the training pace again, and to chase PBs and, whilst I got a couple (improving my 10k time at the Haver10 and a new 5mile PB at the Bury 5) my primary aim – to improve my 5k times – remained elusive. 

Throughout my whole running “career” I have regularly competed in parkruns – now up to 57 in total, across a few different courses. These are sociable occasions, but also offer a good regular gauge as to how my running is going. A particularly bad run at Nowton Park back in August led to me finally deciding I had had enough of pushing myself through the discomfort and sometimes pain barrier race after race, with no tangible rewards. I didn't quite throw all my toys out of the pram, but I did decide I was going to have a break from running - although I did have a few more races booked as part of the Kevin Henry series and the Suffolk Grand Prix, that I wanted to compete in so that I could represent the club. My performances were very hit and miss, with some days (such as the Framlingham 10k) proving a disaster. And after a promising start to the Kevin Henry 5k series at Impington, the remaining 4 races were all disappointing too, with Kedington 5k being the low point.

I blogged about this earlier in a blog entitled RETHINKING MY RUNNING. 

But these performances were to be expected since by this stage I had practically stopped training outside altogether. Knowing I would miss the mental boost that exercise has always given me, I knew I would need to replace the running with another activity, and so, having already rejoined the gym, I decided to throw myself into a different type of exercise regime, concentrating almost entirely on gym work.

And it seems this was exactly the right thing to do. I couldn’t stop running completely, so I would throw in a treadmill session at the end of each workout, and found that I could still get a buzz from, for example, setting myself a 3km or 2mile target. But the majority of each workout, after a 10min exercise bike warm-up, would be using the machines to work on the various muscle groups. In particular, I was keen to strengthen my core, something that my physio Becky  had always suggested would help me, not just with my ongoing issue but with my running in general. And because on a weekly basis I was doing very little mileage, the discomfort, whilst not disappearing entirely, was noticeably less. 

Returning for Medical Advice

In the meantime, I had registered with a new doctor’s surgery, and decided it was time to try again to see if the problem could be diagnosed. I was immediately referred to the surgery’s visiting physiotherapist, who gave me a likely diagnosis, (which doesn’t in fact now appear to be accurate although at the time the symptoms seemed to match it entirely) – but more importantly, he referred me to a consultant who he told me was the best around – based at a private hospital in Cambridge, but bookable through the NHS too. I have now been to this hospital four times in a short space of time, and finally things are moving quickly.

Visit one, to meet Mr Khanduja for the first time. He runs a hip and knee clinic, effectively specialising in maintaining mobility, and he has experience dealing with a lot of sports-related injuries. Whilst waiting to see him, I was asked to go for an X-ray on my hips and pelvis -  this was all done at the same visit – and he then chatted with me to get a brief history of what’s been going on. The X-ray gave him an idea of what the problem may be, but he wanted me to book in for an ultrasound and MRI scan before he would confirm diagnosis and proceed with treatment.

Visit two was for the ultrasound. This was effectively to rule out various things which an MRI wouldn’t pick up. I was told at the time that nothing untoward had been found – in some ways this was disappointing since I just want a diagnosis, but it’s obviously just as important to rule potential problems out, which this did.

Visit three was for the MRI – booked as one scan for each hip, but all done in one go, meaning about one hour of lying motionless inside the scanner. Boring, but obviously very necessary, and I am some grateful that the NHS has been prepared to do all this for me.

Visit four then was yesterday evening, and has prompted this blog – since we have definitely got somewhere. The MRI flagged up some potential causes of the problem. Now unfortunately I am not medically trained, so the following may be slightly woolly, since I can’t honestly say I completely understood what he told me. The gist of it was though, that there were three potential causes, and he now wants me to undergo a procedure to help narrow it down further. I need to go into hospital for a day, where I will be injected with anesthetic in both hips, and then over the next 48 hours, in Mr Khanduja’s exact words, I need to “give my hips a good bashing!”  In other words, he wants me to run, and to try to replicate the problem. This is exactly what I have done prior to seeing him previously – gone out for a long run, which I know will cause the discomfort, so that I am suffering with it when we meet, in the hope this will help him identify the problem. This time, however, I will be doing so with my hip joints having been anaesthetised.  

The plan is to discover where the pain is coming from – if I can do these long runs without any discomfort, it will suggest that the pain is originating in the area that has been dulled. This will mean it is related to a thickening of the cartiledge in the area (that showed up in the MRI scan,) and the treatment will involve key-hole surgery. In many ways, although this sounds drastic, and would undoubtedly mean having to pull out of London, I am hoping this is the outcome, because surgery will permanently fix the problem, and I am happy to take some time out of running if it means that going forward all will be fine.

If, however, the pain still occurs, it will mean the problem originates with one of two muscles he identified that are showing inflammation, one of which sits in front of the left hip, and one which is coming from my backside (stop me if I'm getting too technical for you!) If either of these is deemed to be causing the problem (and I am unsure exactly how he will discover which one it is, or whether he will assume both) – then the likely treatment will be some form of rehabilitative exercise.
I suspect this is the most likely outcome, especially since the gym work I did will have been working these muscles already, and there has been such an improvement in my condition over the last few months. Indeed, in October, November and December I have been back out training on the roads again, clocking up 100 miles each month, and it has only been very occasionally that I have suffered with any problems – again, just when doing longer runs. In this time I have been smashing PBs and really enjoying my running – and this will form the bulk of my next blog, which will be a summary of my running and races over the last part of last year.

Future Plans?

I think there is a strong possibility that I will be pulling out of London irrespective of the treatment recommended. Undeniably at the moment, it’s only when I tackle higher-mileage runs that the problem becomes obvious. I am really enjoying being able to train hard, push myself pace-wise, and rediscover that great feeling of running quickly again, and improving times regularly. I want to get what I consider a decent marathon time, but I don’t believe that I will ever “specialise” in this distance, much preferring the short sharp races, 5ks in particular. Since my recent races have included good results at 10mile distance, I suspect I can probably race up to half marathon distance without any issues, and if the outcome of all this is that 13.1miles proves to be my limit, then I’m actually fine with that. I would like to get a sub 4hr marathon, but not if it means going through another 3 months of discomfort to get there, and especially not if it means all my other race times will suffer in the process. 

Of course, if Mr Khanduja can come up with a treatment that completely resolves the issue, I can continue to consider all distances – who know, I may even join some of my running friends in their slightly mad ultra events – but for the time being, I am just happy that I am in the hands of an expert, that a resolution is in sight, and that I will know moving forward what I can and can’t do.

I am aware whilst writing this blog that I am fortunate in some respects in that I can still continue to run and exercise. Whilst I have often felt that a specific injury, for example a broken bone, might be preferable – in that there would be a specific diagnosis, a specific treatment, and a set recovery time – I have never actually had to go through a prolonged period of being unable to run at all, and I can’t quite imagine how difficult this might be to deal with – I suspect it might drive me nuts, and I feel for anyone going through this. In many other cases of injury, the problem is less clear-cut, particularly when it comes to muscle problems, and I know that these too can stop people running altogether, and often with no clear end in sight to the problem. All I would say relating to my own experience is – don’t give up pressing if you feel something is wrong. I am fortunate that a change of doctor’s surgery has led to a referral to a brilliant specialist who is going to get me sorted. But I lost time for a while by not pushing my previous doctor harder when things weren’t getting sorted.

To all of my running friends experiencing injuries at present, I wish you the very best of luck in getting diagnosed, treated and then in your subsequent recovery. 


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