Tuesday, March 6, 2012

Love the One You're With

On the way to the first physical therapy appointment designed to deal with my unhappy back, glutes and upper hamstrings this morning, I heard the song that's the title of this post. It didn't occur to me that the one I'm "with" for the next six to eight weeks won't be these:

Nope, instead I'm looking at all this all the time:

Yes, it's true. I got the prescription all of us dread: no running. Also no elliptical, no rowing machine, no stair machine, no swimming, no lower-body weight training. Only biking is allowed (but no standing on the bike).

I have sacro-iliac joint instability. According to a good explanation I found online, "under ideal conditions the sacrum is positioned somewhat diagonally between the pelvic bones. With this relationship in place there is maximum stability. With a swayback posture (hyperlordosis) the sacrum tilts downward and forward and becomes more horizontal. The ligaments...are stretched and the sacroiliac joints become unstable and the self-locking mechanism is impaired. The ligaments undergo further stretching, firing the pain receptors. Alternatively, the unstable sacroiliac joints may become locked in an abnormal alignment, maintained that way by resultant muscle spasm producing pain."

The pain described is exactly what I've experienced, on and off, for five years now: "Sometimes the pain goes into my butt and the back of my thigh, but never past my knee.....The pain may involve either or both sides, radiate into either or both legs, usually not past the knee, at the same or different times."

In my case, says Cathy, physical therapist and my new best friend/taskmaster, it goes back to my twin pregnancy--the ultimate time of "swayback posture" for me--and an incomplete period of recovery after it. As you all know, I've mostly ignored my pain because I thought it was just weakness in my core, and that if I could get my stomach muscles back to where they were pre-pregnancy, the back pain would vanish. It was frustrating that core work seemed to make it worse rather than better, but hey! I was running, and the running was going OK, so I just lived with it.

For some reason, it makes me feel better to know that it's not a running injury, that it has nothing to do with bad form or my shoes or how my foot strikes the ground.

But regardless it's not something that I can run through. Running, Cathy tells me, isn't going to help the irritated joint stabilize. Nor can the problem be solved by a cortisone shot or PT exercises. I will probably still have some dry needling done (at next week's appointment) and I will be getting some of that coveted insurance-sponsored massage.

The main tool for this week is this:
The Serola Sacroiliac Belt
During all of my waking hours (and my sleeping ones, too, if I can stand it), I have to wear this little item. I'm wearing it as I type. I'm not going to lie: as soon as Cathy put it on me, my lower half felt about ten pounds lighter. The hamstring pain went away entirely, and the glute and back pain, while not gone, feel much better. It actually takes me back to pregnancy, when I purchased one of those belly support bands and could suddenly walk again without pain.

This isn't to say I felt completely happy when I walked out of the clinic. In fact, I had a good messy bawling session in the car, decided to go to spin class right then and, when I got to the gym where I thought the class was happening and found out it wasn't, broke down crying again at the front desk. I managed to put on my big girl pants and get on the bike for 40 minutes on my own (the equivalent of the 40-minute recovery run I would have been doing today).

Afterwards, feeling sweaty and therefore much better, I apologized to Matt, the guy at the front desk, for breaking down in front of him. Matt is one of those chiseled Boulder types, a coach, triathlete and runner who spends his summers in Kona. He told me he totally understood, that he was sidelined recently himself for a couple of weeks with a freak back injury and had his own breakdown the weekend that happened.

While on the bike getting sweaty, I had decided that my plan for this period of being sidelined will be to stick as close as possible to the workouts in my running plan--but do them on the bike. So, for example, this weekend's 90-minute progression run (first third easy pace, second third medium pace, third third medium-hard) I'll mimic on the bike in both duration and intensity.

I shared this idea with Matt. He said it sounded good. He said the key thing about running is the superior aerobic fitness it builds. "That will be the hardest thing to get back," he said, "so do whatever you can on the bike to get your heart rate into the zone where it's working as close to as hard as it does when you're running. When you come back to running, your legs will feel weak--that muscle strength comes back fast. But the aerobic fitness can take a really long time once you start running again if you don't work hard on it."

This makes total sense to me. So I'm going to dig out my old Polar heart rate strip and wear it on the bike, and work to keep the heart rate above 115-120 (Matt said that's where the benefit will arise, that you don't gain that much more by pushing it higher). I'm also going to stay indoors for this. Biking outside is more fun, but I can't afford any "coasting downhill." Staying inside will assure I'm working hard the whole time I'm at it.

Which brings me to my other issue with the stationary bike: boredom. A 40-minute run outside? Paradise. Too short. But the 40 minutes on the bike today felt like it would never end. So I'm going to do as much of it as possible in spin classes. For the first time, I'm glad that the longest runs planned for the next few weeks never topped two hours.

So, yeah. Add me to the DL list. The half-marathon on April 15 isn't likely to happen.

A good attitude will be really important. I'm cultivating that in two ways. One, by trying to see this six- to eight-week period from the perspective of my 65-year-old self, who of course will be fit and running races and doing all this with a nice, steady sacro-iliac joint. It's best for the long term.

The second attitude adjustment is this: On the drive out from the clinic, I saw a guy running in a Boston Marathon shirt. Cathy agrees with my doctor that fixing this will make me faster. Solid back=solid running. That's what I'm hanging on to.


  1. Ugh...this stinks for you, but I'm glad you're getting it taken care of. Also, it strikes me that your husband's "please no marathon BQ attempt" request means that you don't have to have the ADDITIONAL stress of not being able to train for your big race.

    Although I'm not injured, I totally get the frustration of being stuck with something that isn't your joy. Ironic that we have twin posts with opposite frustrations. :) Hang in there!

    1. Thanks, Kate. Yes, you are so right that it's good I'm not training for a marathon right now. I didn't get the chance to ask the PT about my fall marathon, but Matt (the guy) at the gym seems to think that will be no problem. Fingers crossed that he's right!

    2. Terz, sorry to hear this but you know what your mother said. Glad you are fixing. Ma

    3. Terz, sorry to hear this but you know what your mother said. Glad you are fixing. Ma

    4. Terz, sorry to hear this but you know what your mother said. Glad you are fixing. Ma

    5. Terz, sorry to hear this but you know what your mother said. Glad you are fixing. Ma

  2. Oh man! I am sorry about the no running, BUT, it sounds like you have a great plan in place and I have NO doubt that you are going to come back better, stronger, and faster than ever. Good luck and stay positive. Hugs!

  3. oh NO!!!  I totally wasn't expecting that!  I figured since you have been running that you'd be able to continue.  I'm really sorry that you have to take time off :(

    I do think the good news is that Cathy was able to pinpoint the problem and there are solutions to fix it.  So much better than a vague answer - now you know what you have to work on.

    Your bike plan is a good one.  I think the reason I did so well on my first 5k only 6 weeks after I started running is because I was coming off the 6 day bike race and my cardio fitness was the best it had ever been.  The biking fitness has carried me a long way and since you are already a runner - I think you'll bounce back *very* quickly.

    And yes - riding the bike inside is TORTURE.  Actually, I have an indoor trainer ride today and as of yet - I haven't been able to get on my bike while it's so beautiful outside.   One thing that helps me is break up the workout in 5 -10 minute increments.  10 warmup - 5x1 min sprints w/30sec rest - 5 min rest - 5 min steady state - 5 min rest - 5x1 min sprints w/30sec rest - 19 min cool down.  something along those lines and I listen to Radio Lab podcasts.

    no shame in have a meltdown - I think it helps process the disappointment. 

    btw - you come up with the BEST phrases "coveted insurance-sponsored massage." 

    hopefully the next 6-8 weeks will fly by and you'll be back to running better than ever!!! 

    let me know if you need anything.  :)

  4. BostonboundbrunetteMarch 6, 2012 at 2:44 PM

    I feel your pain!  I am in the same boat right now!!  It is tough when you are used to running and all of a sudden you have to completely stop!!  Hang in there and have fun cycling!  Spinning is a great work out too!

  5. I'm so sorry Terzah!  NO!!!!!!  It sounds like you really need to nip this in the bud once and for all.  It sounds like your PT knows exactly what you need.  Hang in there.  You will be back soon and faster :)

  6. Ah! No one likes to be benched, and not being able to run will be hard. ugh. It does sound like you have a plan though, and that's good.
    What's the stance on chiropractor? I have a displaced hip so the chiro is my friend a tweak once a month keeps everything back where it should be.
    hang in there!

  7. I'm so sorry we're in the same boat, but I"m so glad you got a diagnosis and a plan for recovery!!  We're both going to make it to Boston--hopefully the same year so we can enjoy the sweet victory together just as we've endured our injuries!!  Heal well!!

  8. Crap....well I was not expecting this.  This sucks.  You are allowed to have a meltdown...or 2 or 3.  it means you care and you take your running life seriously.  You are strong and you can do this.  You have a good plan.  You will come back FIERCE.  watch out BQ!!!! hang in there my friend

  9. Argh! How disappointing-- I know how frustrating it is to not be out there running... we can be injured buddies.  :)  I like your biking-training plans... and definitely get to as many spin classes as you can.  Like you, I die from boredom on the bike alone...except for the Expresso bike with the screen-- that one is fun and pretty challenging if you choose a hilly course. 
    I'm trying to keep the same perspective... I want to be running years from now, so this is just a blip in the road.

  10. Lacey Sue - N.Y.A.R.MMarch 6, 2012 at 5:55 PM

    OH MAN! My heart broke for you- I am so sorry about the running! When my doc put me on bed-rest with my 3rd pregnancy, and said "under no circumstances will running allowed" I thought I would completely lose it! I cried all the way home. But I do agree with Matt, I think your plan is the best alternative - allowing optimal healing and keeping up your cardio strength. Muscle memory is amazing, you will be back to running before you know it!

  11. I am so sorry to hear this.  I have dealt with this exact same issue for the last 6 years.  I knew when you posted about this earlier, it sounded exactly like an SI issue.  It sucks, but it does get better.  Chiropractic adjustment won't cure it, but can provide alot of pain relief.  Keeping your core strong is a huge benefit too.  Keeps everything more stable and in place.  

  12. Oh boy, big time bummer.  I am very familiar with not being able to do what you want - RUN - and prepare for races.  I also laughed (sorry) at your meltdowns - only because, I too, have had some ENORMOUS meltdowns this past year.  It's OK - we get it out of our system now and then and then move on.  The "up" side is that it's only for 6 - 8 weeks, your structure will serve you better in the long run (pun intended), your mind will be fresh and ready to train after the time off, and the bike WILL keep you fit if you are diligent.  A variety of interval training will be invaluable.  Carmichael Training Systems has some great DVD's you can get from your local library to use on the days when you want to train at home.  Keep your chin up - you will be able to come back in fine shape and then build more solidly than before!  :-)

  13. Oh man Terzah! that sucks! But I love your positive attitude! You will be faster! And for what it's worth since I've done nothing for the last 3 weeks that 1/2 isn't looking to good for me either. :) I'll go but it will be darn slow I'm sure. 

  14. I totally did not see that coming!!! Dang!!!
    Stick to the bike and you'll maintain very well. Like the Bionic Man ... we can build her stronger, we can build her better!!!
    I've got my trainer and the stationary in the basement - come on by anytime and we'll pedal and have a Lord of the Rings a-thon!!!

  15. You have such a great adjusted attitude and I know you will make sure you do all your workouts on the bike perfectly.  I figured you didn't care for the 2nd opinion suggestion I gave you when I didn't hear back from you, so I'm glad you're at peace with what you've been told.  Super bonus points: it'll make you faster!  

    Just think, you're going to be all caught up on the latest released movies!!  :)


  16. Oh man -- I'm so sorry to hear this.  And I totally sympathize and understand the crying.  You have such a good attitude though and a solid plan -- I need to model myself after that.  And thank god for spin class is all I've got to say!  

  17. Oh girl, I am so so sorry.  SI joint instability was the exact thing that knocked me out of the Chicago marathon two years ago and I was in PT for a very long time because of it.  I was finally running without any pain when I got pregnant and now because of the whole relaxin hormone, I am dealing with it again.  I have that exact same belt as you do, in fact, I was going to do a post on how much it has helped me.  :)

    One thing that my PT told me is that I have very weak hips and glutes, so we spent a VERY LONG time getting my strength back.  I do more squats and lunges than anyone I know and this seemed to really help.  Of course, I can't battle the relaxin hormone now, but I am still keeping up with strength and wearing that damn belt, so hopefully after pregnancy I will be ok.  

    The bike isn't all that bad, you'll see.  Maybe you'll find you really like it and we'll see a triathlete out of you soon. Hmmm?  :)  

    Hang in there and let me know if you want any advice on the SI joint!  Totally been there done that. 

  18. I have SI joint "issues" and I have to agree that pregnancy made it much worse. It feels so much better already, though.  I guess cause I didn't carry twins?

    Unrelated, but I was wondering what week you delivered your twins?  How long were they in the NICU?  I hope you don't mind me asking, but I don't know anyone else who had kids in the NICU.

  19. OH my goodness, I'm so sorry to hear.  It sounds like you are tackling this head on and have the right attitude about it all.  NO doubts that you will be back strong and reading to run!!

  20. Oh no! I did not see this coming. I am so sorry. You are the third person I know in as many weeks to come up with SI issues. WTH? The good part is you got an answer and are on the mend with PT and the magic belt. This too shall pass. Hang in there girl.

  21. SO, so sorry! I like your attitude adjustments though. I'm sure this is an awful thing to hear from your PT, but I know you'll make it through and come back better and more ready to BQ than ever. Thinking of you! 

  22. I wish you the best.  I know that being injured is no fun.  When I am injured I always have a breakdown moment!  You will get over this one and come back stronger especially with the support you have from others right now!

  23. Belated sorry to hear the news. I also developed an injury last last summer due to basically running all the time and never giving my knees a break, and was reduced to biking for months. I particularly hated that i missed the great fall weather during this time. And yea, really boring. And also weatching my body soften a bit over the months of recoup was even less fun. The injury has healed and now i can resume running, but i am much more cautious about it and still cross train most of my workout days. In the most positive sense, it does remind you of the value of cross training. As my injury healed i wad able to add more workouts which helped.

  24. First I have to say that this is a REALLY well-written post! You explained a very complicated medical situation in a way that I could understand, so bravo! (and I learned something...thanks Matt!) Second, I am SO sorry to hear about your injury. It makes me sad to read about so many injured runners lately. But it seems like you have a really good attitude about it and at least you can bike! It could be worse, if they said do nothing, right?! AND at least you aren't in the midst of full-blown marathon training. Sounds like you will heal better than you were before and then we get to watch you get the success that you have worked so hard for!! Keep your head up!!

  25. Oh my goodness!  I've been so behind on blogs this week, this is the first time I saw this!  I'm so sorry this is happening...but you are right.  One day, looking back, you will look at this time as the time you took to get stronger and faster.  Hang in there!   

  26. Thanks, Corey! I'm banking on it that you're right.

  27. Yeah, I dread the softening body thing. Ugh. Oh well. If it means better running long-term, it will be worth it.

  28. What a bummer Terzah!  Good job to focus on how you will be faster (and pain free) when this is over!  I think anything stationary is BORING.  Even spin class.  Are you like me and can't read while on a machine?   I hope this heals on schedule and you're running before you know it!