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?

Too Many Doctors, but Some Running, Too

On Friday, I ran for 40 minutes! It's the first time since March that I've run more than four miles at once. A little boost from sea level air helped, though I like to think the massive humidity in Missouri, where I'd flown to collect my kids and see my parents (too briefly), cancelled some of the "thick air" advantage out.


Boy, my hat is off to all of you who contend with that kind of heat and dampness on a regular basis. It was like running with a wet washcloth over my mouth and nose. I'll take less oxygen any day if it means cool dry mornings.


Before leaving Colorado, I had two key doctor appointments. Here's a summary (since all of this medical stuff is starting to seem downright self-absorbed):


Last Tuesday, I returned to Jim, the physician's assistant in the orthopedic practice. He reviewed my MRI with me. It didn't show nothing, which was my greatest fear. I do have some disc degeneration in my lumbar spine, and as expected, they are recommending a steroid injection for the pain. Jim thinks with good core maintenance I should be able to be pain-free for a while after the shot, so I made an appointment for it. The downside: many people my age, especially those of us with a history of sedentary jobs involving a lot of sitting at a desk, have disc degeneration in the exact spot I'm showing it. My pain may or may not be related to it.


Sigh.


The next day, I visited Dr. Hansen, the chiropractor Darren wanted me to see about my tweaky right hamstring. I told him the boring story of my back and my return to running, and he ran me through several diagnostic tests (toe touching, twisting my legs around to see where the stiff places are, etc.). He feels that I may not need the shot but recommends that I keep the appointment for now and consider cancelling it if working with him mitigates my pain. He then gave me some active release therapy (ART) for my hips, back, stomach and the hamstring.


I liked Dr. Hansen. He's a longtime runner and high-school cross country coach himself, and he has a good sense of humor. He does his homework, and I trust him, even though I come from a background that's decidedly unfriendly to chiropractors (my dad's work resolving insurance lawsuits really biased him against them). The only thing he's suggesting that I'm unsure about is the Graston technique. I could find no real science backing this up online. Any Graston stories out there?


Anyway.....


The situation right now is this: I have an appointment for a steroid shot on Aug. 22. The good news is everyone agrees I can run and train, that running hasn't and won't make whatever the underlying problem is worse (whether it's the discs or something else).  Dr. Hansen recommends keeping any speed work at tempo pace or slower for now until the hamstring completely resolves, and he's given me another routine of post-run moves to loosen my back.


I'd love to have enough of a reduction in my pain before Aug. 22 to be able to cancel the shot, largely because I'll have to cut back on anything strenuous the week following--cutting back is the last thing I want to do right now. But I'm dubious that I'll really be able to do that. The pain has been there for so long that it's hard for me to imagine any set of exercises or therapies will cut into it that quickly. I'll do my best to stay optimistic about it. Honestly, the only thing that's keeping me going to these doctors is the fact that I don't EVER want to go through this again, that I need to fix this now, or at least determine what can make it something I can live with and still run reasonably well.


Quitting running? Not something I'll ever consider.

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!

New Challenges (Good Ones)

Last month, I had hoped to improve my sleep habits and even set up a little challenge to get myself there. Well, I outright failed that challenge, not only not improving my own sleep habits but also failing to help out the others who signed on to this with me (some of them did just fine without me--good for them!--and I apologize for being so little help).

This month will be different. I've set up some new challenges...and I hope not to fail at them.

1. The first challenge: to run again....for real....outside....before midnight on July 1. I believe I'm close. My back has been feeling (dare I say it?) good. I haven't had a pain-free day yet, but the pain I have has been much less. The Pilates exercises that I learned last week are the first that consistently make my back feel better immediately after I do them, and this effect seems to linger. I'm still VERY stiff when I wake up in the morning, but I'm trying to mitigate that with some yoga poses (child's pose and cat/cow) before I even climb out of bed. I've also eliminated the glute exercise that seemed to make things worse (the standing side leg swing) and am trying to hit only the ones that do no harm.

So fingers crossed!

2. The second challenge I signed up for is a formal one. Amanda at Run to the Finish has been leading a healthy challenge every month this year. I haven't been able to do the exercise-specific ones, but June's Green Smoothie Challenge is right up my alley.

Five days into June, I've found this surprisingly painless given how disorganized with eating I usually am. I acquired some greens-enhanced protein powder, a bag of pre-washed spinach, some bananas, some almond milk.....and that's all I've needed. The protein powder I'm using is called Vega One, and it's working for me because it tastes good and has all the needed nutrients but contains no artificial sweeteners. I tried a different brand on the first day and felt terrible; I discovered later that it contained both maltitol and xylitol, which work like laxatives. Sugar alcohols are the reason I can't drink Nuun before or during runs (it has another sugar alcohol, sorbitol).

This is a helpful challenge to me because I start off the day ahead of the game on getting enough vegetables into my diet. Throw in a glass of low-sodium V8 and/or a salad for lunch, and I'm truly good to go. For an indifferent cook (sometimes you could say I'm even hostile to cooking!), it's a lifesaver.

Tomorrow is National Running Day and I'm planning to celebrate with 30 minutes on the Alter-G, hopefully at 90% body weight. I'm glad to be able to celebrate at all! What are your plans for National Running Day?

Pilates

When I last left you riveted by the Chinese water torture that is the story of rehabbing my back, I was feeling down in the dumps because it still hurts, more than I think it should after almost three months of physical therapy, no outdoor running or spin class and lots of strengthening exercises for my abs and glutes.

It's like one of those never-ending video games, where you achieve a new level or find a new token....only to learn that the ultimate Holy Grail remains elusive.You start to wonder if you'll ever get there, or if you should even be bothering.

Well, no video game addict would ever stop looking....and neither will this running addict. Yesterday I received a new token, a new tool in the quest: a one-on-one Pilates lesson with Patty at Boulder Center for Sports Medicine, who is also one of the physiotherapists who supervises me on the Alter-G. I don't want to be overly optimistic (that's not really in my nature anyway), but I'm feeling good about this for two reasons:

1) Patty is not only the only Pilates instructor that Cathy, my physical therapist, wants me to see, but she is also a Boston Marathon qualified runner, a mom and a recovering sacro-iliac joint issue survivor herself. She understands this problem not only academically, but personally (in fact, she says hers still bugs her if she overdoes it working in her garden). She also has a good sense of humor and hung up my kid's picture of a train at her desk at work.

2) Jessica of Pace of Me and Dimity of Another Mother Runner both say Pilates done right was THE magic spell that freed them from the curse of their own back and hip issues. First-hand endorsements from athletes I respect....you can't beat that.

Patty had me warm up with some Kegals. Pregnant and formerly pregnant ladies will remember those. Apparently, not only do they help with incontinence issues (thankfully I don't have those, though I know some runners do), but they improve pelvic floor strength and thus support the back. I need to be doing them all the time, boosting them as I go by imagining my sit bones moving closer to each other with each squeeze.

As I lay on my back doing Kegals, we talked about which exercises in my current routine seem to exacerbate my pain. This was easy for me to answer: the standing glute exercises and the seated-on-a-Swiss-ball leg raises. Patty counseled me to do only one of the standing glute exercises per day until I identify the one that truly makes my pain worse. She suspects it's the one where I swing my leg out to the side--but time will tell.

She then modified one of the exercises Cathy had given me for my abs. For the "laying on my back marching" one I am supposed to slow down and really concentrate on two things: 1) using my abs to lower the leg as well as raise it (this already makes a HUGE difference in how this feels to my back) and 2) exhaling on the raise and inhaling on the lowering. I'm supposed to do the Swiss ball lifts (carefully) with the same focus. She said to think of there being a puppet string from my lower abdomen to my knee. I have to really concentrate on this--my quads really wanted to help.

Patty also suggested I do this exercise lying length-wise on a foam roller. This makes it harder, but also more obvious when I arch my back.

I also have one new ab exercise: the Pilates Hundreds. If you Google this exercise, you'll see the more advanced "real" version, done with legs straight and elevated. That's not the one I'll be doing. My version has me on my back, knees bent in sit-up position and feet on the floor. I then raise my torso to about bra level and do the pulses. I'm also not doing a hundred pulses. Right now, I'm to do four sets of five inhales and five exhales.

The breathing is key for all of this--and I'm very bad at it. Patty says learning breathing control will help my running, too. That makes me more likely to stick with these latest modifications. I've gotten really good at visualizing finishing a strong marathon, or crossing the finish line in Boston with my new abs and buns of steel. It's still a fantasy, but with each squeeze I feel a tiny bit closer.

The Latest from Alter-G and Recumbent Bike Land

My time crunch continued on Thursday, which is one of the days I'm home with the kids. My Alter-G appointment was at 5:15 p.m., but Dan didn't want to leave work early again (I don't blame him).

So, being a flexible mom of twins, I assembled a Boredom Bag (crayons, paper, books and some graham crackers)--and took Will and Ruthie with me. I figured, how bad could it be? It's only 30 minutes.

Happily, they were so fascinated with the Alter-G that they barely cracked the Boredom Bag (they did eat all the graham crackers; I mean, these are MY children). And fortunately Patty, the physiologist, proved good with kids. She joked with them. She let them circle the machine and put their hands inside the bag when I was finished. Will made a drawing of a train for her. Turns out her son went to the same preschool that Will and Ruth attend. He's now 17, but apparently the director and the cook are the same people who were working there when he was there.

I don't expect this to work every time. Familiarity breeds contempt with little kids. But I got it done, and much more easily than I had on Monday. My kids, it turns out, are more forgiving than my job.

The session itself went well. I got closer to 3 miles for the total (sweet-talking Patty into letting me cut the cool-down short) and stayed no lower than 85% body weight the whole time.

Yesterday I took it easy, with a 30-minute walk (featuring some good break-up music--thanks to everyone for your excellent suggestions) and PT exercises. Then this morning I went to the gym and knocked out a 1-hour bike session with 55 minutes of intervals, followed by a 30-minute hill walk on the treadmill and then more PT exercises.

I'm not going to lie to you. My back is still unhappy. It's definitely not where I need it to be to start really running again. I've been trying to track when it bugs me the most, and it appears to be the leg raises on the stability ball and the glute exercises that irritate it. This doesn't surprise me, because attempts to do core work (and doing it poorly, I guess) are what sent me into PT in the first place. It IS frustrating that this still happens after nearly three months of work. It's also frustrating that most mornings getting out of bed I am still painfully stiff. Sometimes I want to run because, well, why not suffer AND run instead of....just suffer?

Patty, to whom I told all this, still seems to think I'm doing well. She's a runner herself, a Pilates instructor and has had SI issues. She said the move she recommends for glutes is more subtle than some of the ones I'm doing. It involves (when sitting, though she says you can try it walking or running, too) contracting the muscles that you imagine could bring your sit bones closer together. She says this brings not only the glutes but also the pelvic floor muscles into play for back support. I've been trying this any time I'm sitting down (and under her watchful eye also on the Alter-G), and I will say that while I'm concentrating on it, it does immediately reduce my back pain. The problem is.....it's hard to concentrate that hard all the time.

My next plan of action will be to get permission from Cathy, my physical therapist, to make a Pilates consultation appointment with Patty. I'm not due to see Cathy again until the middle of June, so I'm going to call and ask. It may not happen right away, as Patty has a vacation planned too. But I like Patty and I feel like she will be careful, so if I can get in and get a new exercise routine from her this week, I'll feel like I'm still making progress while not ignoring the plain sad fact that I still have too much back pain.

The Angry Break-Up Playlist

I am happily married. I want to say that before I get into the meat of this post.

Dan with his second-biggest fans after the race. They ate more pizza than he did.

Last night the kids and I watched Dan do his second Dash n' Dine 5K. It was hot and windy, that dry oven-like wind we often get here in the summer, and he didn't feel great. In fact, he was a minute slower than he was on the same course last month. But we all still had lots of fun. Now this series is over, so I have to find some other races for him to do, so I can continue to live through him.

That's what husbands are for, right?

So now that I've established that what I'm about to say has nothing to do with Dan or our marriage.....

I'm really into angry break-up songs lately.

I'm not sure why. Maybe it's because I'm injured and starting to feel like running has broken up with me. Plus, reading all the great race reports lately makes me feel like the freaky girl who never gets invited to the school dances. Or maybe it's because, with the exception of my college boyfriend, a truly nice person, all the guys I dated before Dan were losers. Maybe it's because my sister went through a break-up recently, and while it wasn't particularly angry, she's sad and I've been trying to think of ways to buck her up (so far she's ignoring my suggestion that she take up running). Maybe it's because I find anger motivating when I'm trying to push myself. Maybe it's because I really like Gotye's "Somebody That I Used to Know." Maybe it's because I'm getting a little tired of my current recumbent bike playlist (music is an absolute must on the recumbent bike).

So I decided to put a list of songs together that are all about breaking up, hating the person you broke up with, getting stronger post-break-up. Here's what I came up with:

Somebody That I Used to Know
Don't Come Around Here No More
Better Man
Here's a Quarter (Call Someone Who Cares)
One More Minute
I Hate Myself for Loving You
These Boots are Made for Walking
I Will Survive
The One I Love
Goodbye to You
It's Not Right But It's OK
Far Behind

Anyone else find this kind of thing motivating? What are your favorite angry break-up songs?

Alter-G Part 2 & Other Updates

Yesterday was my second rehab session on the Alter-G anti-gravity treadmill.

I felt very lucky to be there at all, as 24 hours earlier I had been in the throes of a freak virus that sent my temperature up to 102.9 and made my head feel like some alien was trying to break through my skull. The sickness came on me at work Wednesday in the form of violent shivering and nausea. I managed to haul myself home and collapse in bed. At that point I thought there was no way I could make my 5:15 running date the next day.

But in the morning, after 14 hours of sleep interrupted only by a trip to the bathroom around midnight, I woke up with NO fever and only a slight headache that faded to nothing by noon. It was the briefest illness I think I remember having, if also one of the more intense. I took it easy in the morning, did a few of my physical therapy exercises in the afternoon, took Will and Ruth to the annual Art Show at their preschool and then Dan took over so I could make my appointment.

Fever aside, I was curious about how the session would go this time. My calves were SCREAMING on Tuesday and Wednesday after the first session. I think this was mostly a "Whoa, what is this running thing all about?" reaction (after all, they haven't had that kind of intensity asked of them for over two months), but my new Pure Flow shoes probably contributed too. I actually looked over old racing pictures of myself to make sure that, yes, I generally do have a mid- to forefoot strike. And I think I really do--even in the finish line pic of me in Houston last January (see the right-hand column), where I was doing what passes for sprinting for me at the end of a marathon, shows me landing neatly in the right place on my foot.

Yesterday's Alter-G session was apparently just what the doctor ordered for the calves. I wore the Pure Flows again, and while there's still some calf tightness, it's quite run-of-the-mill now, and fading--whereas on Tuesday and Wednesday they felt like I had just run a marathon on them.

And what about the back? My sacro-iliac support belt got in the way of the machine's calibration yesterday, so I did the run without it. My back's left side definitely bothered me more this time, but it wasn't alarming. In the end, I managed another good two miles of running, this time at 75% body weight (yay for the increase!). The exercise physiologist in charge this time was Patty, who will also likely be the person I'll go see about Pilates once Cathy (my physical therapist) thinks I'm strong enough for that. At the end, she loaded me up with a giant bag of ice for the back and on my way I went.

My back definitely hurt this morning, so I've been wearing the belt a lot today. But I did get my recumbent bike session in (I'll keep doing those until I can run a lot more than I'm allowed to right now), and I did a few stretches and some PT exercises afterwards. Things are definitely feeling more normal now.

My next Alter-G run is on Monday morning. This time I'm going to bring my Garmin to see how my heart rate looks at the various paces and percent body weights, and how that compares to what I'm used to seeing on the bike at this point.

Sleep Update: So this month was supposed to be the month where I got in the habit of getting eight hours a night on a regular basis. I even enlisted a handful of others to go along with me on it. Well, for me, it hasn't happened. The month's only half over, so I'm not giving up, but my bad habits in this area have proven much more deeply ingrained than I thought. I love sleep! So why is it so hard for me to get myself in bed when I should? Life's just too interesting, I guess.

Weight/Eating Update: At least I'm still doing well on this front! My weight this morning was 128.4, and I'm still going strong (stronger every day, in fact!) on having no processed sugar of any kind any day but Sunday. I've found not only am I no longer craving sugar during the week or wanting to graze from treat trays brought into work, but that when I do have my Sunday treat, I appreciate and enjoy it much more. Last Sunday, I rode my bike over to the Dairy Queen on Main Street and picked up a chocolate dip cone for myself and a plain vanilla one for Dan, then rode home where we enjoyed our little treat together. That cone tasted awesome! That might be what I have to do this Sunday too.....

Could I still eat better? Definitely! I've found myself dipping into the tortilla chips I buy for our Friday night taco dinners much more often than I should. I don't eat regular potato chips at all--but corn chips....they've got my number. So I feel like they might be the next thing I eliminate, or at least bracket into just one day of the week.

That's it for now! I'm thinking of my friends Cynthia and Kathy, both of whom have big races this weekend!

The Best Day in a While

Really, I don't have a lot of bad days...but today was damn good.

Wanna know why?

Well, it started out as Mondays usually do: a 5 a.m. alarm, some 50 minutes on the recumbent bike and some glute exercises. When I got home, I got the kids their breakfast and took them to school.

But after that, things were different. I went straight from preschool to.....

This wasn't my first experience on the Alter-G. It wasn't my fastest. But it was much more meaningful. I warmed up walking at 100% body weight for five minutes. Then my exercise physiologist, Jaclyn, ratcheted me down to 70% body weight (the 50% prescription Cathy had suggested apparently isn't a good idea). And then I ratcheted the speed up until I was running. Yes, running!

How was it? The first few steps were, as my daughter says, "Ouchie." I felt them instantly in my tailbone. But as I got accustomed to the motion and warmed up to the speed, the pain disappeared (this took about 20 seconds). Soon I was able to increase the speed. In the end, I ran for 20 minutes, starting at 12 minute miles, working up to 10 minute miles and doing the last five minutes at 8:27 minute miles. At no time was I out of breath (thank you recumbent bike!) and though I had some tightness in my right hamstring and hips by the end, I felt no pain apart from those first few steps. At the end, I walked another five minutes at 100% body weight.

I estimate I ran a grand total of two miles (total miles with the walking amounted to 2.52). This brings my sad little annual grand total for 2012 up to 252 miles (it's been sitting at 250 since March 6). They weren't real miles, in a way, because of the anti-gravity boost. But trotting along at the end of them I felt that old joy, the old pull at my sternum to try to go faster and harder. I can't tell you the bliss of being able to push that speed button higher at last. Tonight my back is definitely stiff. I've given it a good foam rolling (along with that hamstring) and a good icing. I'm going to take it easy tomorrow, doing only my PT exercises and a short walk. My next date with the Alter-G is Thursday and I'm feeling optimistic.

Another fun thing: I debuted some new shoes with this little return to running.

The Pure Flows in my favorite color! The shirt was a gift from Kathy late last year. I wore it today for my modest return.

I decided that since I can't run very far anyway, I'd use the chance to get used to some lower-profile shoes. After trying a whole bunch on over the last few weeks (wishful running retailing!), I settled on the Brooks Pure Flows. It took me a while to find a place that had my size in stock (we had a little overnight with Kathy and her family on Friday, and a Saturday trip to one of her running stores finally resulted in a purchase--thank you, Kathy!). They just feel good--not too narrow for my bunion-y feet, cushioning in the right place under my forefoot, light as a feather. And on today's run they and I agreed nicely with each other (at least at 70% body weight).

My fun day wasn't over yet, though. After showering and running some errands, I drove down to Denver and met up with Jill and Kathleen for lunch. These two ladies--both of whom are seriously generous people and admirable runners, with one being a road goddess and the other a trail goddess--had run together down in the south suburbs but kindly drove a ways north afterwards to hook up with me.

Jill, Kathleen and me.

Between my night hanging out with Kathy over the weekend and this lunch today (and thanks to a comp day off work that allowed me to do all of these things!), I had a really nice Mothers' Day weekend "girl talk about running" fix, something that's too rare for me.

Am I "back"? I can't really say that yet. I need to have pain-free running, and have it with full gravity pulling on that tailbone of mine. But it's a step in the right direction. Two miles of steps, in fact.

Physical Therapy Ch. 8: GOOD NEWS!

This morning, I lay on my right side on the exam table at Boulder Center for Sports Medicine, my right leg bent on the bottom and my left leg straight on top. Cathy, my physical therapist, asked me to raise the left leg just a bit, then told me to do whatever I could to prevent her from pushing it back down toward the table. She pushed. I resisted. And for the first time since I started this physical therapy odyssey she was unable to push past my resistance.

She then ran me through some other tests. I had to jump up and down on a trampoline, monitoring the pain in my sacrum. So far so good. Then she had me jump onto the trampoline from the floor, landing on one leg and stabilizing myself. I did just fine with those, feeling no pain in my sacro-iliac joint and only a little pain in the left hip.

Then I had to do the same thing on the floor, which means a harder impact. Still no pain! I wobbled a bit when landing on the left leg, but I caught my balance fairly quickly.

Finally, she put me on a leg press sled and had me push with my top leg while swinging the bottom leg in a running motion. This actually felt good. I could feel my glutes working, but without any accompanying hip pain. Too bad there's no leg press machine like this at any of the rec centers I frequent.

After I passed these tests, Cathy took me back in to the exam room for some needling (my piriformis, QL and glute medius on the left were really tight).

And when she finished with that, I got my good news:

I'm now allowed to do two sessions per week on the Alter-G--starting whenever I want!

Of course the sessions are limited. I will warm up for five minutes, run for twenty minutes at an easy pace and at 50% body weight, then cool down for five minutes. If I have any joint issues (as opposed to mere protesting muscle pain), I must stop. So most of my cardio will still be on the recumbent bike and walking on an inclined treadmill. But my first appointment for a real run is Monday morning.

I'm nervous. After all, it was just two weeks ago that Cathy said I was probably in for no running until July. And I know these things have their ups and downs. If my SI joint hurts, I'll need to stop.

But for now I'm letting myself be happy.

California Here I Come!

In other good news, I registered for my winter marathon. It will be the California International Marathon on Dec. 2. I will be rooming with Tricia--this will be her first marathon!--and possibly Kathy (if she decides she's OK with doing a winter marathon). Hopefully we'll all be healthy, relaxed enough for some fun meet-ups with other bloggers--and ready to run fast.

I haven't decided how to work this with the Detroit International Marathon on Oct. 21. I may take a step back and run the half-marathon. But I'm not going to make that change until I see how my back is doing going into June.

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.

Physical Therapy Ch. 7

Wow, seven chapters on my physical therapy visits! I never knew I'd be writing such a long (and boring) book.

It's about to get longer, too.

Here's the quick and dirty summary of my appointment with Cathy (back from Australia and all tan):

1. No needling today (I'm glad to have had a break from that)

2. My sacro-iliac joint looked good to her. I'm now allowed to remove my SI belt for four hours a day. I still need to wear it at other times, and most especially when I'm riding the recumbent bike, walking for exercise, doing weight-lifting and doing my PT exercises. As I'm typing this, I'm out of the belt. While I don't miss the constant wedgie, I am missing the support a bit. But I figure that's OK. I'm near the end of the four hours so it makes sense.

3. My abs are getting stronger! Cathy thinks I'm close to being able to do those elusive leg lifts on the Swiss ball.

4. BUT...and here's the big BUT (or maybe I should say BUTT)....my glutes are still far too weak to consider running on them yet. She ran me through some tests that confirmed it: I have a serious case of white-girl butt. This explains many things: why my finishing kick in all my post-pregnancy races has been lacking; why it's so much harder for me to power up hills when I'm hiking; why I tended to avoid lunges and squats in weight training class.

Cathy actually quantified what I'm in for thanks to the weak bottom: three more months of no running (though I may get to hop on the Alter-G sooner). I think it's a good sign that this didn't surprise me much. On a trip last week to the park with my kids, I saw from afar as my son fell off his bike. I ran in his direction...or tried to run. I felt it instantly in my SI joint....and at that moment I knew that, geez, if I can't even jog over to help my crying kid, I probably shouldn't be huffing it around the neighborhood yet (even with lots of walking in the mix).

5. I have new PT exercises for homework. They all involve the glutes. I plan to attack those suckers. Buns of steel, that's what I'm going for. It took me six weeks to get my abs to where they are now (and yes, I'm still working on the abs, too). I know I can expect the same amount of time for the glutes.

So here are my priorities, in order:

1) Do everything necessary to rehab my back. This means a) do the PT exercises the prescribed 3-5 times a week, 50 reps each and building, b) learn to sleep on my sides and back, relinquishing forever my beloved stomach cuddle and c) be vigilant about my posture and lifting technique.

2) Maintain my cardiovascular fitness so it's still intact when I return to running (I know the running muscle strength won't be there--nothing I can do about that). This means the recumbent bike is my best friend. I've even named him Pitbull, after the vulgar-yet-charming-and-certainly-catchy hip-hop dude whose music accompanies me on all my "outings" on this bike. Move over, Mario Lopez--I have a new Latin lover.

3) Maintain my weight. So far, so good on this. But I know I can continue tweaking my diet to include even less sugar and even more fruits and veggies. I'm wondering now if I can even lose a few pounds and finally hit the low 120s. I'll be writing more about this later.

4) Improve my sleep habits. More on this in a later post as well.

5) Do upper-body weight work.

6) Remember that these months away, which are crucial to my long-term health and my abilities as a runner, will someday be just a blip in what I hope will be a lifelong relationship with trails, roads and running shoes. I can and will take as much time as this problem requires.

Injury Loves Company

Last Monday, I walked into the waiting room at Boulder Center for Sports Medicine and settled into a chair with a magazine ahead of my physical therapy appointment. It was about lunchtime, and the only other person in there was a young guy.

"You injured?" he asked.

I closed the magazine. I knew what was going to ensue, and I've started to like these conversations, which make me feel less alone.

"Yep," I said, and told him about my back. "What about you?"

"Yeah," he said. "My shoulder. I have six pins and a plate in there now."

That sounded much worse than my problem. And he certainly had a better story.

"How'd you do it?" I asked.

"It was a ski accident," he said. "First run of the day. I was headed down at, like, 65 miles an hour and I turned and bam! ran into an elk."

Whoa. Further conversation revealed that he'd been hoping to make the leap to professional and had been in PT for 10 weeks, about four weeks longer than I have. He's still hoping to go pro. But he's clearly got a lot of work to do first. He's 24 years old. What a bummer!

What did I learn from this conversation? Well, it reaffirmed that there's always someone with a harder road than yours. (It also confirmed that I'm really not interested in learning how to downhill ski. I've heard too many catastrophic injury stories associated with skiing. Yeah, I know, that's sacrilege in Colorado. But I do believe we need to choose our challenges where we can in life, and downhill skiing? Not going to be my choice.)

A happier version of "tell me about your injury and I'll tell you about mine" occurred when I was waiting in line for tacos after Dan's race last Tuesday. A willowy female master's runner (who it turns out won her age group) was in front of me, and a wiry male one (who placed in the top three in his) was behind me. We got to talking about injuries. The woman had been sidelined from running several times over the course of a long career as a recreational runner and triathlete. And the man told me he actually shattered his patella in half in a race one year.

They were philosophic about it. If you run long enough, they said, you will deal with an injury. Yet, there they were, having great races in their 50s and 60s. At one time, the woman said, she was out for six months. It seems like a blip now, she said.

Yesterday, after my 75-minute recumbent bike session at the gym, I talked to a bodybuilder/cyclist acquaintance afterwards (I'm at the gym so much now that I'm starting to get to know people there). He told me he himself had dealt with a bad lower back years ago, and that faithful core work had kept it at bay. He said he noticed that if he went even three days without doing his core exercises, the pain started creeping back in.

He's a nice guy, and he gets it about having goals. "I bet you're not dealing very well with this, are you," he said.

"No," I replied, "it's been really hard. The exercises are so small, and boring."

"Yeah, not the kind of person who likes baby steps, are you? But you have to see it as your new challenge," he said. "It's what you have to tackle right now."

And of course he's right.

Any other good injury stories out there?

Physical Therapy Ch. 6

First off, congratulations to all of you who stuck it out and made it to the finish line of the Boston Marathon in that heat today. Hearing about the temperatures almost made me glad I wasn't there.

Almost.

Inspired by these marathoners' example of doing what needed to be done when it needed to be done, I went to physical therapy with a spring in my step....and the news after six weeks was good. My joint is still not perfect, but it was better than last week. And Sue took as a good sign the fact that I had less pain all week (even with all the air travel and sitting, cute little baby holding, bag carrying and Saturday's hike).

I had an adjustment (these feel so good) and some needling (this actually hurt a bit, but she got right into the tender spots around my sacrum, so I think later it will help). She also did some intramuscular stimulation with the needles. She'd done this last week, too, but I forgot to mention it. I felt it more this time, though. Here's a definition:

Intramuscular Stimulation (IMS)
Intramuscular stimulation (IMS) is a perpendicular dry needling technique, deep into the motor points and muscular tendinous junctions to release muscle shortening. It is effective but may be painful.

It sort of feels like a dull little pinprick shock. For me, it isn't painful. But it is uncomfortably weird.

Then I got two new exercises, one designed to loosen up my tight mid-back muscles and another to activate my multifidus muscle, which runs along the spine and needs to be doing more of the stabilizing work than it is right now. Yes, yet another back muscle I'd never heard of before and apparently haven't used in years!

It's actually on both sides of the spine, but this gives you the idea.

The best news was that I can now throw in some consecutive days on the recumbent bike....and it's time to start walking, walking fast....AND (drumroll) if all goes well this week, next week could bring walking with running intervals.

I almost couldn't breathe when she suggested that.

I realize it may not happen. You never know when a bad week will hit. Also, Cathy, my original therapist, will be back then, and her recommended course of action may be different from Sue's.

Still, this has given me a new fervor for my PT exercises. After the kids go to bed tonight, I plan to spend some quality time curled up with my stability ball, my foam roller, and my Theraband.

Ten Good and Bad Things About Not Being Able to Run

This weekend I was supposed to be racing a half-marathon. I paid for it back in January. That race will mark my second Did Not Start (DNS) ever, and it will be swiftly followed by a 15K DNS on April 28. My first DNS was a 10-mile race I signed up for in 2006. My excuse then was that I had just found out I was pregnant with twins--I wasn't sad about missing that one.

Because I AM sad about missing these two races, I thought I'd better do some hard-core non-Terzah-like seeking of the positive. Number one, I am pleased to report, isn't negative at all. Two and three are pretty positive too. They may go downhill from there, though.

1. When I realized, yes, I WOULD be missing this race, I scheduled a trip to California, where I will be meeting two people I am very excited to see in person. They are:

My month-old niece, Lucy Anne!

And:

Caroline, the Canadian Runner in Exile

Who needs a half-marathon?

2. I am catching up on sleep in a serious way. It's true, I do get up early on some weekdays to get the recumbent bike sessions in. But since I'm sleeping in on the every other days off that I'm forced to be taking by the physical therapy process, I'm getting at least four hours more of sleep per week than I was getting when I was running and/or spinning six days a week. This feels GOOD.

3. I have more energy to pay attention to my diet, and it shows. I have gained no weight since the running interdiction. I'm continuing my "no sugar except on Sundays" thing beyond Lent. I still have cravings for sugar, but they are much abated. On Monday, the day after my Easter chocolate binge, I actually felt hung over. My mind seems to have finally learned that sugar is the reason for that lousy state--and has stopped asking for it. Today I sailed by the candy bowl at work and only later realized I....didn't....even....want....it.

4. Learning patience is no longer optional. I have to learn it in order for this never to happen again. And I never want this to happen again.

5. An easy 20-minute run is no longer something I would turn my nose up at. I'd be slavishly grateful to be able to do one, in fact. Small blessings, right?

6. I've been forced to slow down in many ways. This has not been a bad thing. But I'm learning that I'm really not a person who wants to slow down. When I can go fast again, I will. I need to remember point number 4 in the meanwhile, though. Sigh.

7. The last time I had this little control over what I wanted to do with my time was when I had two infants/toddlers. I like having control. Life doesn't always let you have control. Suck it up.

8. Boy, being injured does nothing for helping you become a nicer person. I'm jealous--GREEN WITH ENVY--of everyone running the Boston Marathon on Monday, the Bolder Boulder in May and just about any race you can name out there. True, I would not have been at Boston even had I not been injured. I haven't earned a spot. But at least I could have been working towards it.

OK, so that's not a good thing about not being able to run. I guess maybe learning about your own bad qualities is a good thing, because then you can work toward improving them. Except I'm finding it really hard to do that. I'm just....jealous, and likely to stay that way.

What would a good person do? Walk races, maybe. Volunteer. Go out and cheer other people on. I do plan to do the latter for Kathy and Cynthia and Jill and Julie (and virtually for others of you). You are friends and I want you all to succeed. But I don't want to walk races or volunteer right now. I just don't. I want to run. If I can't run and there's no one to cheer for, I'm staying home and doing my PT exercises for the umpteenth time.

9. I'm starting to resent the Facebook pages I've liked that have anything to do with running. I'm particularly sick of the one that says, "You either ran today or you didn't." Yeah, so I didn't. Can YOU come fix my back so I can, please? No? Then don't thrust that self-righteous statement in my face.

Maybe this will teach me to be less self-righteous toward non-runners. Maybe they have reasons we don't understand for not doing what they don't do.

10. I'm being more pushy with my husband about his running. Every day that he runs I make him share every detail with me. The hill was....how steep? And how much did you sweat? What did it feel like when you were done? Did you know there's a 5K at the Reservoir next week? Wanna do it? Can I watch?

It's sort of pornographic, voyeuristic, something.

Lucky thing, he still loves me. Even after nearly six weeks of me not being able to run, when I'm not loving myself so much.

Physical Therapy Ch. 5

It's almost Boston Marathon time, and the happy preparation tales have been out there for several weeks. Which makes the post I did last year even more relevant now than it was then. I wish I could say my character had improved some in a year, but I guess it hasn't.

Sometimes the task ahead of you isn't the task you want to work on. But you have to work on it anyway. And that brings me to......

Two steps forward.....one step back.......

It's now been five weeks since I began physical therapy.

Today, after a two-week hiatus, I had a visit with Sue. It was good timing because yesterday morning (Easter Sunday) I woke up with the worst pain I'd had since beginning the process of trying to make my back better. I don't know what I did to provoke it. I hadn't even been on the recumbent bike in two days due to the holiday craziness at my house (in-laws visiting, volunteering at the church potluck, two five-year-olds with three Easter egg hunts to attend) and the gym having odd hours.

Sue worked her magic with needles, adjustments and some massage-like manipulation, and I feel much better. She also said it wasn't a huge step backwards or anything dire--my sacro-iliac joint had gotten a bit out of alignment again. I don't have to step back my exercises or my time on the bike.

But it's deflating because I had been feeling much better in the days leading up to Sunday, enough that I could honestly have said the pain was the least I could remember having for a long time, enough that simple motions that have hurt for a really long time (like putting my elbows on my knees when sitting down, pushing in the clutch in the car with my left foot and twisting to watch behind me when backing out the car) were starting to...not hurt...at all. The PT exercises were starting to feel easier. The muscles in my lower abs are starting to feel more like muscles contracting and less like the twitch of a dying mouse (this at least hasn't changed!).

I told Sue all of that. She said I still need to take it easy this week, not add anything new, and let the latest issue unwind itself. The only new instructions are to do some mild stretches when I first wake up (knees to the chest, cat/cow) and, because I'm a stomach sleeper, put a pillow under my belly when I sleep to keep my back from arching. Had I come to her without Sunday's flare-up, she said she might have let me add some consecutive days on the bike and some new PT exercises--but now that won't be happening this week. I also asked her about the Bolder Boulder 10K (on Memorial Day) and, alas, it's not going to happen for me this year either.

She did say that we will probably be talking--soon, she said!--about transitioning me back to running. She mentioned the Alter-G and pool running, both of which would be an amazing treat to me. Pool running is the cheaper option since I belong to the rec center, but I might be willing to pay for (or even use one of my precious insurance-covered PT appointments for) a session or two on the Alter-G. It's just so much more like real running than slogging it back and forth in a pool (where music isn't an option).

Thank you all for your thoughtful comments and stories on my last post. I plan to reply to them all in the next couple of days (along with catching up with your blogs). Happy late Easter, everyone! I ate some sweets and I hope you all did, too.

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. :^) )