Executive Decision: No Injection

I'll admit: the warning that the injection for my back, originally scheduled for tomorrow, would cost more than $600 out of pocket played a role. But mostly, it's that I'm happy with my running right now, I'm convinced that running isn't making my back worse--and I want to keep my modest little momentum going.

So I did the math. It looked something like this:

[(Don't want to take a week off running; marathon 14 weeks away) + $600] - (Back still not pain-free) =

I Cancelled the Shot

It wasn't an open and shut choice. I still have a lot of pain first thing in the morning and overnight (trying to turn over in bed when I've been in one place for a while....yeah, it hurts). Getting into and out of certain positions that should flow easily in Pilates can cause me to catch my breath. And sitting too long (which I have to do at my job sometimes) doesn't agree with my back and glutes at all.

But my core is clearly stronger. I was able to go across some monkey bars on a playground with much more ease than the last time I tried (it's always fun to impress your kids). And today Kate, my fantastic massage therapist, said she thought my back and hamstrings were the loosest and happiest she'd seen them since she started working on me last December. This is despite the fact that I am down to just one session per week on the recumbent bike. All the rest of my cardio is.....running!

I can always reschedule the shot if it turns out I really do need it. But first I want to try to get to the California International Marathon as well-trained as possible given the four-month lay-off I had between March and June.

This injury isn't gone. I'm not going to pretend it is. I do wonder if it will ever completely go away. But though my running base has undoubtedly eroded, I do know that my core is far stronger than it was last year for Top of Utah or Houston, and that has to count for something. I figure I'm at least as safe training for this marathon as I was for those. This was never really a running injury, as much as it turned out that it interfered with running.

So I'm going for it. I'm going to train as hard as I safely can to run as fast as I can in Sacramento on December 2.

All I can do is, as they say in Russia, "Go with God." Isn't that all I could ever do anyway?

Physical Therapy Ch. 10: Headed for an MRI

It looks like I will be getting a shot.

 

Cathy (my physical therapist) yesterday referred me to a physiatrist. I had never heard of this medical specialty before; it's an orthopedic MD who specializes in non-surgical solutions to bone and joint issues. Today, I had an appointment with the physiatrist's physician's assistant, Jim. He listened to my long boring tale of back woe, looked me over and said I had done all the right things by trying PT, core work, ice, and ibuprofen courses--but that at this point I am definitely a candidate for a steroid injection. What started out as a sacro-iliac joint issue, he says, has caused chronic inflammation around my lumbar vertebrae. The injection should bring that down.

 

First, though, I have to have an MRI to confirm his diagnosis, rule out cancer and other unlikely problems that a shot wouldn't help, and also to reveal exactly where my inflammation is. That MRI is scheduled for Friday. The physiatrist, who will be the one to administer the shot, is on vacation for two weeks, so we're looking into August for the shot itself. (I shared all this info with Darren, and once again felt so glad I had hired him.I'll apparently have to take a week off of intense exercise after the shot. I'm hoping Darren can bring me back fast from that. I hate the idea of taking even seven days off!!)

Jim, the physician's assistant, happily, is pro running. He says running is actually not bad at all on its own for my kind of back problem. And he thinks as long as I keep my core strong (and you can bet I'm committed to that--Pilates forever!), I'm likely to be one of those people who doesn't show up again in five months needing another shot.

 

Fingers crossed that he's right!

 

On Darren's advice, I'm also going to see an ART (active release therapy) guy next week to deal with my recalcitrant right hamstring, which has been needling at me just a tiny bit for a couple of weeks now. Darren wants NO hamstring issues as we move into real training. And now that I know the prognosis for my back, I'm ready to deal with the hamstring, too.

 

Though I'm SO grateful to live in a place like Boulder, where sports injuries are taken seriously and there are plenty of skilled doctors, PTs and alternative practitioners around, I will say I'll be glad to move on to a few months with no doctor visits, no co-pays, no trying to fit appointments in between my job and my family obligations. I just want to work, raise my kids, enjoy my husband....and run.

 

It's time to get healthy!

Oh, Our Aching Backs--Part II

My high-tech system for tracking my physical therapy and other exercise.

Two posts ago, I detailed how two strong runners came back from sacro-iliac joint dysfunction, the injury I'm currently working through. In this post, I'm going to detail my own ongoing program, which I hope will result in my own successful comeback. All of these things, big or small, were either prescribed by Cathy, my therapist, or discussed with her.

Some basics:

1. For the first eight weeks, I wore the Serola Sacroiliac Belt pretty much every waking hour of my day--exercising, sitting at my desk at work, hanging out with my kids, you name it. Its job was to fill in for the support my largely absent abdominal and glute muscles are supposed to render to my pelvis. Here it is modeled by someone much more attractive than I:

No heavy lifting for me!

As of two weeks ago, I am weaning myself off the belt. I find I really need it only first thing in the morning (my back is always stiffest then), when I'm doing my PT exercises and when I'm sitting for a long time in the car or at work. For walking and light work around the house or yard, it's actually nicer to have it off. I consider this a good sign.

2. In the last two months, I've adjusted two other habits that sound piddly, but have made a big difference in how my back feels. First, I have weaned myself off of being a stomach sleeper. This was not easy. I bought a *huge* body pillow (it's like having a third adult in the bed with Dan and me) and at first I couldn't stand it. But now I find I like sleeping on my side if I can wrap my arms around that sucker. I'm still not much at sleeping on my back, which would apparently be even better, but I'm getting there. In addition to my back being much less stiff in the morning, my neck and shoulders feel looser. Making this change has taken me about a month. I'd say it's only this week that I am sleeping well on my side.

The second change has to do with our cars. Dan and I are both standard-transmission people. I've been driving a stick since I learned on my grandparents' dark-blue '69 VW Beetle (God, I loved that car). Both of our current cars are standard, and I still much prefer this kind of driving. But driving a stick means lots of raising and lowering both legs, and that motion *should* be handled by your lower abs--exactly the muscles I had forgotten how to use, to the detriment of my back. Now, when I'm driving (which is far too much, but that's another issue), I pay close attention and engage my lower abs whenever I shift or adjust the pressure on the gas or brakes. I know it sounds miniscule, but believe me, it's helping.

The Exercises:

This list includes all the exercises I'm doing now. I didn't start out doing all of these. In fact, the first week, when my back was really bad, all she wanted me to do was wear the belt and get the inflammation down (more on how below). But gradually over the weeks we've added these, and this is my current program. More may come later, too, but I feel I'm in a good groove.

Equipment needed: Swiss ball, Theraband, Bosu ball (I don't own a Bosu ball--I use the ones at my rec center)

Abs (mainly targeting the transverse abdominus)

1. Knee lifts--I lie on my back with my knees bent and feet flat on the floor (traditional sit-up position). Engaging my lower abs (usually I put my hands on them so I can feel them contracting), I raise one foot off the ground, lower it and then raise the other, alternating legs, keeping my low back flat on the floor. I'm up to 50 of these now, and I feel the contraction in my abs quite strongly. When I began, getting 10 done without arching my back was very difficult, and the motion of my transverse was more like a twitch than a contraction. This was the very first exercise I was given.

I now also do some step-outs, one leg at a time, where I start from the same position, lift the knee in the same way, but step out with my heel three times, then step the leg back in. I still sometimes feel a back arch creeping in with this, but it's getting better.

2. Bicep curls & rowing on the Swiss ball with a Theraband--A Theraband is a stretchy piece of latex. I got one from my PT. For this exercise, I sit upright on the ball, feet flat on the floor, back straight, abs engaged. I hold each end of the Theraband, and my husband holds the middle so that it's stretched taut (if you have a stable pole or bannister, you can also wrap the band around that and pull it out). I then do baby bicep curls and rows. The object isn't arm strength. It's stabilizing with your abs while you do the exercises. I try to do 3 sets of 10 of each.

3. Kneeling twist--Do this one next to a wall or table in case you need some support. Kneel on the floor in genuflect position.

Tebowing works too, except you hold your torso straight instead of bowing over your leg.

Engage your lower abs, then put your front foot (the bend in the leg should be at about 90 degrees) more toward the mid-line of your body, deliberately making yourself unstable. You will wobble a bit (if you don't, move the leg further in toward your other side). Once you can stay upright, up the ante by lifting your arms straight overhead. And once you're stable with arms raised, slowly rotate your torso from side to side.

4. Swiss-Ball Knee Lifts--I still can't do this one unassisted, but I'm a lot closer than I was. Sit on the ball as you did for the biceps/rows. Make sure your back is straight, and rest your hands on your thighs. Engage your lower abs and raise one knee straight up WITHOUT leaning to the opposite side (leaning even a bit means you're using your back, not your abs). Right now, I do this one next to a table or wall, using the pinkie of the hand on the same side as the lifting knee to give my abs a little help. I'm hoping this week that I'll finally get the knees up at least one time without the assist.

Glutes (baby needs back)

For the first seven weeks, I did side-lying leg raises and clamshells only. Once I could do these without increasing my back pain, I graduated to the following exercises.

1. Side kicks with support--Stand straight up, engaging your lower abs. Hold a tall ski pole or other pole in one hand for support. Plant the leg opposite that hand firmly into the ground--don't lean or hike the hip. Then take the leg on the same side as the pole hand and do side leg raises with it. Do not lean to the supporting leg side. You want that leg's glutes doing the work of keeping you straight. I do 50 of these on each side.

2. 45-degree kicks with support--Same set up as above, but instead of kicking out to the side, you kick behind you at a 45-degree angle. I like this one. You really "feel the burn" in the kicking glute as well as the stabilizing leg. Again, I do 50 on each side.

3. Running kicks with support--This is my favorite glute exercise because it's the one that gets as close as any of my exercises to actual running motion. Set up like in number one, but instead of kicking to the side you lift the pole-side knee in a high march motion, then swing it back behind you in a runner's kick. Be very careful with your back on this one. Your range of motion may not be great at the beginning. Remember NOT to hike the hip on the planted leg or lean that way--this strains your back (and is apparently what my body was doing when I was running because my glutes weren't doing their job). I'm supposed to do 50 of these, but that's hard. I often have to break it up to rest the supporting leg.

I see this exercise as super-important. Cathy (my therapist) told me she wants to see me to do 100 of these WITHOUT the supporting pole before I'll be able to run again. You can imagine how I attack this one.

4. Mini squats on a Bosu ball--Stand on the flat side of a Bosu ball. When you've got your balance, lift your arms in front of you so they are straight out and parallel to the ground. Then do mini squats. You don't have to go low (and at first you shouldn't). Squeeze your glutes on the up motion. I do 3x10 of these.

5. Supported mini lunges--Rest the ankle of one leg on a small step or other support behind you. Place the other leg in front of you. Do mini lunges with the front leg. Don't put that leg too far in front (you will be able to move it out later when you're stronger), and don't go down too low. Squeeze your glutes on the up motion. I do 3x10 of these, too.

Also in my repertoire for glutes are the leg press machine at the gym and step-downs (I don't use a step as high as the guy in this video--Cathy told me no larger than the Boulder phone book--nor do I use weights--yet). Again, when I do these, I do 3x10.

How often do I do these exercises? I try to alternate days so that one day I do all the ab ones and the other day I do all the glute ones. I also do the lying-down knee lifts and/or step-outs even on glute days, and I try to do at least one glute exercise on the ab days.

Cardio

I'm still doing the Pete Pfitzinger plan that I think I linked early on in this process. I'm currently on week seven. It's really for water running, but I apply the durations and intervals to the recumbent bike (hoping to graduate from that soon, too, maybe to a stair climber or elliptical-type thing, but I'm waiting for Cathy to suggest that). I watch my heart rate the whole time I'm on the bike, making sure it stays above 120 for as much of the time as possible (I prefer the 130s and 140s). My average HR at the end of a session on the bike seems to be around 130.

I freely admit I can't face the days when I'm supposed to just go steady for an hour or more on the recumbent bike. The intervals go fast, but I get really bored doing one pace or heart-rate range for that long. So on days when I don't ride the recumbent, I always take at least a 30-minute walk that incorporates hill climbing of some sort, and when it's possible I do an hour walk or at least one 30-minute walk while at work and then another after the kids go to bed in the evening.

Supplemental Therapies

My back is responding well to all of the above, but it still gets sore if my form slips during the exercises or if I tweak it bending down. And sometimes my glutes or legs feel tight for reasons I don't understand. So here's what I do when that happens:

Massage--At the beginning, when things were very sore, I saw Kate for a 45-minute massage every week. Now I'm spacing these out more. I'll probably do them on the weeks where I don't have PT with Cathy, and only when I need them.

Dry needling--Cathy didn't do this the last time I was in because I was feeling good and she didn't find any tight spots. But when needed, it really helps, especially my piriformis and my quadratus lumborums (QLs).

Ice--The first couple of weeks I iced a lot. Now it's on an as-needed basis. I keep a bag of frozen peas just for icing my back. I stuff it in my pants right over the SI joint when needed. Sexy...and effective.

Heat--One of my wonderful co-workers, Lisa, made me a special pillow that I can throw in the microwave for two minutes. When it comes out, it's toasty warm but not burning to the touch. I can stuff it in my pants above the SI joint just like the ice bag. I often do this after needling or massage, and also right before I go to sleep at night to loosen up the back before rest.

Ibuprofen--The first week, when I was really inflamed, Cathy had me take 1,200 mg of ibuprofen for four days straight. Now I take it on an as-needed basis. I haven't needed it at all in recent weeks.

Tennis ball (for the piriformis) and foam roller--These implements will probably always be part of my post exercise stretching routine. They hurt so good.

Hamstring stretches--The hammies get tight with the glute exercises and the walking. I realize now I wasn't nice enough to them when I was training for races. I won't make this mistake again.

Where Will I Go From Here?

I've already mentioned I'll be doing some running on the Alter-G. I will also be doing Pilates! Cathy calls Pilates an "end of therapy modality." I'm not strong enough yet, but she says it's really great for people in my state once the necessary stability is in place (Jessica in the prior back post swears by it, too). When Cathy tells me I'm ready for Pilates (and she has a teacher in mind for me already), I'll know I've reached the end of this tunnel.

And now you've reached the end of this massive post. If you're still with me, your back must bug you often enough that you feel you need some help. My advice? Don't ignore it! See a therapist or other practitioner you trust! I wish I had done all of this before beginning my BQ quest. But better late than never.

Oh, Our Aching Backs--Part One

Congratulations to everyone who ran the Big Sur Marathon (especially Kathy!) and the Eugene Marathon yesterday. I was jealous (my second "did not start" since my injury diagnosis, a 15K, came and went on Saturday), but also very happy for all of you.

I also want to say GOOD LUCK to the four hearty (and sleepy) souls who signed up for the May Sleep Challenge with me. We have a tough road ahead of us. It's not May quite yet, but I tried to practice last night and therefore was "lights out" at 9:34 p.m. Instead of falling into blissful slumber until my alarm sounded at 5 a.m., I tossed and turned and got up to use the bathroom and adjusted my pillows until about 10:20, when I finally drifted off. Then I woke up three times in the night for no good reason, finally rising for good at 4:50. At least, given how tired I am right now, I don't think I'll have as much trouble falling asleep tonight.

This week, I have no physical therapy appointment. I'm just keeping my nose to the grindstone with my ab and glute exercises. So I asked some bloggers who I know have experienced my injury--to remind you, it's called sacro-iliac joint dysfunction and it affects your lower back, hips, bottom and hamstrings--and lived to run again to tell their stories via a Q&A.

Tara and Jessica were nice enough to get back to me. Their stories give me hope, so I'm sure they will help someone else with SI issues who might despair, thinking that once your lower back goes there's no return. Tara is now expecting her second child (she ran a half-marathon pregnant in January!) and is looking forward to a big return to PRs after he is born. Jessica, who has three small kids, just took third place in a 10K and in her most recent marathon qualified for the Boston Marathon for the first time with a huge PR.

1. What caused your SI joint issue? (If it was a combo of things, definitely share that too. My issue was mainly caused by pregnancy, but doing too much running too soon afterwards, carrying toddlers, driving a stick shift, sleeping on my stomach and doing the wrong core work exacerbated it over the ensuing five years.)


Tara: My SI issues were caused by having extremely weak, inflexible hips and weak glute muscles.  Now, if I were just sitting around all day, my weak hips and glutes probably wouldn't have been a burden to me, but I trained for three marathons in under a year and did absolutely NO strength work whatsoever.  No squats, no lunges, no hamstring work....nada.  All of that running and no strength work eventually caused my SI joint to become hyper-mobile and my glutes/hips couldn't hold the joint in place.  The joint pulled on my piriformis muscle, which caused me to have piriformis issues, which in turn pulled on my IT band and caused IT band pain. I finally had to pull out of the Chicago Marathon two weeks before.

Jessica: I think my issue was caused by two things: horrible posture habits which were made worse during pregnancy.  When I was a new mom I would carry my babies around on my hip and do a million other things at the same time (put groceries away, wash the dishes, carry the laundry basket etc) - never paying any attention to how I was holding my body.  As a result I had a weak core and my SI joint was completely out of whack.

2. Did you see a practitioner (physical therapist, chiropractor, doctor or other) to help you alleviate the problem? (I'm seeing PTs referred to by my doctor, a sports medicine specialist.)

Tara: I went to see a sports medicine doctor for my IT band pain and he sent me to a physical therapist who eventually diagnosed the root cause of my problems, which was that stupid SI joint.

Jessica: The first time I tweaked it, I went to see a chiropractor.  He was more of a "back cracker" and just adjusted me, told me to stop eating gluten, and sent me on my way.  It was frustrating.  When I was pregnant with my third baby last year one day I just went to tie my shoe and - TWEAK - I was in so much pain.  After the baby was born I found a new chiropractor who has honestly been so incredibly helpful to me.  He takes a much more holistic approach with his care - ART, chiropractic adjustments and massage.  He figures out where the imbalances are in my body and gives me exercises to do to strengthen them.  He is really wonderful and I am so thankful.

3. What sorts of exercises/adjustments/other therapy was prescribed? (For me, an SI support belt, regular adjustments and dry needling, massage and various at-home exercises have been my mainstays for eight weeks now.)

Tara: My PT had me doing at home hip exercises, squats, lunges, core work, etc.  I never knew that I had such a weak butt!!!

Jessica: I work with a theraband, do pilates exercises and foam roll every single day.  I also do strength training twice a week.  When I see my doctor (about once a month during marathon training) he will do ART on my super tight spots, STIM [electrical stimulation] and massage along with whatever chiropractic adjustments he feels are necessary at the time.

4. What factor or combo of factors finally got you over the hump with your SI problem? (I, alas, am still not really over mine. Trying to be patient.)

Jessica: Honestly, mostly just becoming so much more self aware and intentional with how I move and use my body.  I became a Pilates teacher two years ago and those exercises have changed my life.  As a busy mom of three I can forget myself easily on a daily basis and try to do too much at one time.  My SI joint will get cranky if I do that and I feel tweaks as a result.  So if I am mindful and I practice Pilates every day, it really helps.

5. Does your problem still flare up? What do you do when it does?

Tara (answering 4 and 5): I find that if I lapse on my strength work, the SI joint pain comes back.  I have learned to recognize the symptoms, which can be pain in the lower back, glute, hamstring, groin pain or a combination of all. I am currently getting ready to enter my 6th month of pregnancy and with pregnancy comes the hormone relaxin, which basically relaxes our joints, including the SI joint.  I am working with a chiropractor to keep my back "healthy" and he initially gave me the Serola SI joint belt, which I used for awhile, but I have been diligent about keeping up my strength work during pregnancy and I haven't needed the belt in the last few months.  I have a feeling that I will forever deal with the hyper-mobile SI joint. I must be diligent about strength work.

Jessica: Yes, it does on occasion.  I have not had a flare up for a year though, which is so wonderful!  If I feel things get tweaky, I will ice, rest and go see my doctor.  I bring more awareness to how I am using my body and try to slow down and pay better attention.

6. Any other advice for people who may be dealing with this? Any advice on how to prevent it happening in the first place?

Jessica: Take Pilates!  I really think it helps so much.  We ALL have imbalances in our bodies, even the strongest most fit athletes in the world.  We have to become self aware and pay attention to how we are using our bodies.  I think this is what has helped me so much.  I used to have issues with my SI on a pretty regular basis, and it was so depressing.  I would be laying on the couch afraid to move as my kids played around me.  I hated it.  I did not want to go through that again and Pilates has really saved me.  Also, find a doctor you really trust - not someone who will just adjust you and tell you to take supplements.  Find someone who wants to help you improve your quality of life.  Someone who "gets" you.  Check in with yourself throughout the day - when you're standing in the line at the grocery store - are you slouching?  Are you jutting out a hip?  Is your core engaged.  Stand tall and breathe.  Relax.  Be mindful and intentional with how you are moving.  And move every day - movement heals!!  You do not have to move fast - just move.


-------------------


Thank you, Tara and Jessica! I also want to give a shout-out to Michael, who when I was initially diagnosed sent me a great article with a thorough explanation of this problem and some adjustments and exercises to help alleviate it. I've found these to be a big help in addition to my formal PT program.


In "Part II" I will give you a detailed description of my PT program as it stands right now.

Why I'm Just Now Doing Something About My Back

First, a quick Friday hike update.

Thanks to the City of Boulder's Web site for the photo. As usual, I forgot my camera.

Will, Ruthie and I went to Coot Lake today. This is the same runner-friendly spot where the Boulder-area run for Sherry Arnold was held. Today's weather was the polar opposite of that cold winter morning: warm, dry, breezy. As seems to be our M.O., we didn't really walk very far, but we made up for it in the amount of fun had. This time the fun came in the form of a Golden Lab whose energy matched that of the kids. They took turns throwing his tennis ball into the lake so he could do that lab-otter thing and fetch it. I chatted with his human mom and tried not to notice the fleets of runners out enjoying the day.

I will run a lot--a lot--at Coot Lake and the nearby Boulder Reservoir again when my back is better.

Speaking of my back, I thought it was time to tell you what had gone on with it leading up to last January's spasm that finally sent me to the doc and physical therapy. I know it seemed to come out of the blue and so I wanted to explain why I just started dealing with it.

My back has been hurting since a few weeks before my twins were born. Here's what I looked like then (if very pregnant belly pictures turn you off, look away, scroll down, whatever):

November 2006

My arm is in the way, but just behind it my poor lower back is painfully arched from the forward momentum of that belly. By December 8, 2006, when I delivered Will and Ruth by C-section five and a half weeks early, I was regularly sleeping with two body pillows and weighed 50 pounds more than my usual 125.

Once I'd had the kids, the back felt much better. But I never really got to pain-free. Think about it. My lower abs were shot, not only from stretching during the pregnancy but also from being under-used then and afterwards. My body had grown used to this state of affairs, and my back was now routinely relied on to support the functions the lower abs are supposed to perform. I didn't do anything about this because....who had time? I had two infants and a job. I barely had time to get out and walk or run, much less rehab my abs.

Moreover, as those infants got bigger, there was more carrying them on my left hip so my right arm could do its thing (whether that thing was dealing with the other toddler or holding the phone or punching buttons on the microwave or folding laundry). As the months and years wore on, it became clear that my LEFT lower back was where most of the pain originated.

I didn't completely ignore this state of affairs. Dan and I, thinking it might be the aging mattress on our bed that caused my ongoing issues (some mornings my back hurt so much I had to roll out of bed), bought a new one in 2009. I attended a class called "Lose Your Mummy Tummy" and went to a holistic massage lady, who said all my problems stemmed from scar tissue where my C-section had happened. (Needless to say, I do NOT believe this.)

None of it did any lasting good. And since no one told me running was bad for a back like mine, and since I love running, which at that time was mostly done to keep me sane, I soldiered on with it. My first post-pregnancy race was a 5K when Will and Ruthie were 9 months old. It took me 29 minutes and change. I was disappointed (my 5K PR, set two years before, is 22:34), but not greatly so. At least I was IN a race.

As the years wound on, I kept running like this and ignoring the pain in my back. I did register that it seemed to hurt more with certain strength training moves (100s, a Pilates move, was particularly spasm-provoking), so I avoided doing a lot of core work (a mistake). But I kept entering races and, as I got more sleep with the kids getting older, my results improved despite the ongoing back pain. I even ran a half marathon in 2008, getting it done in 2:06.

But the race times didn't improve as fast as I wanted, and I found myself regressing. In the spring of 2010 I ran the Bolder Boulder 10K almost a minute slower than I had the prior year. This sent me into a depressed spiral. Could it be that my early 30s were really my fastest epoch? Surely not! There are tons of stories of women setting PRs well into their 40s. So I decided it was time to train again for real.

And my back? Well, running wasn't the thing that really aggravated it. Needing a big goal, I decided to go for a Boston qualifying time, started this blog and began training for marathons again. I didn't even consider my back, except to vaguely hope it would just....get better on its own.

I did pretty well until late January, when once again I tried to focus on my core. And you know the rest.

What's the moral of this story? Don't ignore pain. It WILL slow you down, if not right away, then eventually. There are things you can do about it. Yes, these things may take longer than you want and may involve some pain themselves (not being able to run IS painful).

But what we all want is to be able to run until our race is truly over. That's what I'm aiming for now, even if it means BQing by 41 or 42 instead of 40. (I'm still hoping it won't come to that, though. :^) )

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.