December is the darkest month of the year, in more ways than just the short days and long nights. My injury should’ve healed by now. No running for the past 5 months. Weekly physical therapy appointments. Two hours of rehab exercises PER DAY. But the sharp pain still bites when I barely walk up a slope, when I bend down and every time I sit for more than 10 minutes.
Until the MRI last week, no one knew exactly what the problem was (misdiagnosing it as piriformis syndrome) but now we do: “edema at the semimembranosus tendon origins with subjacent marrow edema within the ischial tuberosity” -- in other words, tendinosis where the hamstrings attach to the right and left sitbones. Tendinosis is much more stubborn than tendinitis because it’s degenerative and chronic, requiring up to a year of no running and a lot less sitting to prevent hypoxia.
I told the surgeon to cut me NOW if it’ll get me back to running and hiking sooner. He’ll decide next month. All the research I’ve read in medical journals says that surgery for proximal hamstring tendinopathy like mine has a high success rate if you find the right surgeon--that is, one who specializes in the hip area and not someone who thinks he can fix it just because he’s operated on a zillion shoulders and knees. To this end, I may have found a good specialist at CU Sports Medicine; we’ll see.
My homemade seat pad, with two holes cut out for the sitbones.
The Perils of “Go Hard or Go Home”
Brad Ott (my PT and president of Rebound Sports & Physical Therapy) told me the other day that he didn’t know how I was able to continue running through the pain all last summer. I told him that I’d never injured myself before and thought I could keep going until it resolved itself. To me, getting a couple of massages and some dry needling from another therapist back then represented major treatment. If I had completely stopped running right away and had the right PT to address biomechanics, then the long-term damage would’ve stopped in its tracks.
According to Brad, my attitude to “go hard or go home” is ultimately what grounded me. The glutes stopped activating properly and the hamstrings took over, literally stretching the tendons too far repeatedly all the way into the bone. If I could go back and do it all over again, I would’ve rested more between races, taken more time to warm up before morning runs, and most importantly, addressed the root cause rather than the symptoms of the pain. The root cause? Postural imbalance -- which misaligned my running form, which created uneven wear and tear, which led to misfiring muscles, which led to more postural imbalance.
Had I known how important postural restoration is, I would’ve sought professional advice on core exercises tailored to my body’s unique imbalances. My self-made plan gleaned from books and websites became less and less adequate as I increased training mileage.
Take-home lesson: never just run and hike through the pain for more than a couple of weeks, or else you’ll pay dearly. The sooner you address it and rest, the sooner it’ll go away. Don't let other people or ambition pressure you! And have a professional check your body for muscular activation imbalances and prescribe the right core exercises before you increase mileage significantly.
Although I’m only halfway through a lonely and disheartening layoff, with little pain relief and a huge emotional loss, I guess I can be thankful that this distress will save my running life. Had it not been for the acute injury, I may have continued at a constant low-grade struggle with pain for the rest of my life if I hadn’t been forced to seek the physical therapy that is changing my whole running form. As a result of all the anatomical knowledge and proper maintenance exercises, eventually I’ll run pain-free.
It’s like the local man who had fallen off a ladder, suffering a severe head injury and facing months of rehab at the Medical Center of the Rockies this summer. The man and his family could only pray and ask God why. As the man struggled through recovery, doctors performed some routine testing and discovered that he also had cancer--but doctors found it early enough to remove it completely. The man wrote afterward, “As it plays out, the trauma I experienced literally saved my life … and it taught me how to be thankful for the work that God is doing, for the prayers that are in the process of being granted even though I may not yet see the results.”
‘I will give you back your health
and heal your wounds,’ says the Lord.
For you are called an outcast ...(Jeremiah 30:17)
… Gotta trust God with any faith I can scrounge up. Trail racing is in my blood. I have no other choice. My PT said I'm the one out of ten patients who presents greater challenge to diagnose. The doctors call me an “outlier” because my injuries are so atypical. But then again, we trail runners have always been atypical.