OS - Repairs and Upgrades
I haven't joined an OS group & have have largely been absent from Strava and forums. My body was pretty much hammered after IMFL last year. I took a month off, and tried bounce back. Mentally I was ready to rock. Physically I was stronger than ever... but things just hurt a lot and I couldn't get a rhythm going. I hate whining and negative energy - so I didn't put this out there... just got focused on figuring out what was going wrong.
After way too much time waiting on Dr Appointments and various unpleasant diagnostics - I think that I finally am on a plan to get whole. Am having a torn labrum in my hip fixed Friday. Shortly after that I will have two procedures to fix the bilateral groin tears that came from running with in injured hip (some kind of sports hernia - not the bulgy kind). Lol- that is why it hurt each time my foot hit the ground while running :-)
I have a plan now and am stoked to get it fixed. Am hoping they use all carbon fiber / aero parts to put me back together. I had been questioning if I just needed to toughen up (Ironman is not for sissies after all), or if the things I felt were just natural aging... But then two Docs told me "here is what is going on and I can fix that for you." One moment my attitude was suffering and I had zero mojo for any training, then I heard that there was something wrong that could be fixed and my attitude was 100% on target in an instant. I am probably the happiest guy in the world to get diagnosed with a double hernia!
I'm super pumped for a fun season that includes Blue Ridge, Camp Al, Lake Placid, Another trip to Vail (think I will do an Everest there in August), Wisconsin and Florida. The next 8 weeks are probably not going to be optimal - but I should be able to log trainer time throughout. By the time Blue Ridge rolls around it will be time to build build build! Maybe I can even put together a run with the hip groin repairs!?!
Watch Strava - my fitness is in the basement now, but I am excited to start building it back!
Comments
You did have a pretty packed year last year, Get completely well before you hammer it again. See you at BRC in April.
R2
@everyone else - Apologies. I hope I don't sound like a whiner :-)
I've had right hip pain for a couple years while running. Biking does not bother it at all because when I lean forward it sort of 'pushes the hip back into the joint,' but running was becoming a bigger and bigger problem. As mileage increased, it felt like a nail was being driven into my hip located under the right edge of the watch pocket on my jeans. At frist it was pretty manageable, but as it got worse I tried Docs, who gave me scripts for PT and then Chiros... X-rays looked good so I kept working through it. Last year, as mileage was pushing up to 40+ miles per week it got really bad. Symptoms were a lot like the stress fracture that you have been diagnosed with. It got really bad at IMMT last year - my hamstring, my hip, generally everything between hips and knees. I came home and then failed several physical tests (like a fulcrum test, hopping on one foot etc) and the team thought I had a stress fracture. MRI was clean. and we started suspecting labrum - a few weeks before CHOO I got a steroid injection into the hip socket (this is a typical test for hip socket issues... I believe it will only help the pain if there is an issue in the hip itself). This helped a lot. Together with doubling up on daily doses of Aleve I was able to put together a couple more weeks of running and get through CHOO. The pain was always worse getting started and after mileage got into double digits (isn't it always?). I was seriously questioning my mettle - you may remember me asking in the forums about how to learn to suffer better while running.
Preparing for Florida it was all going bad again. By this time my groin was really hurting badly on both sides. I had nearly zero strength in left adductor and the right wasn't a lot better. Still - biking wasn't an issue. something about being clipped in and leaning forward unloads the sore areas). I really had a poor showing at Florida - by this time conditioning had faded from lack of training after IMMT and I over rode the bike for the level of fitness that was left... the symptoms were the same - a nail in my hip and my groin hurting whenever my foot would strike the ground. It especially hurt with even a slight incline.
Post Florida I took a full month off trying to heal. Overall, my body loved the rest. But when I restarted, from the first step of running, my groin was an issue again. It would take about 10-15 minutes to get everything warm and moving, but then I could continue to run (taking anti inflammatories by the hand full). As mileage increased, the nail in the hp also came back.
By late November I was on the books for a hip specialist - took about 6 weeks to get in to see him. He set up another MRI (with contrast this time). Here are the results:IMPRESSION:
1. Anterosuperior quadrant acetabular labral nondisplaced tearing with associated acetabular chondrolabral junction fissuring and opposing femoral head chondral fissuring.
2. Minimal femoral head foveal osteophytosis.
Means torn labrum in the upper front area (under watch pocket) and a small cam-type impingement (FAI) on the femoral head.Doc says it will not be clear how torn the labrum is until the procedure. I expect it is small though. Also some fissuring of the cartilage on the head of the femur and in the hip socket - apparently this is from the impact of running on a loose hip.
As it turns out - the FAI causes the labrum to tear. The cure is to sew/anchor the labrum back in place, grind the impingement down and inject some stem cells into the mix to help reverse the arthritis and get the cartilage to grow back. The stem cells are optional, but I am guessing that 1. they may help, and 2. they won't hurt. Here is a video by my doc on the procedure: http://www.advancedortho.net/videolibrary.phpThe sports hernia is fixed by another Doc. I found a guy that works on NHL goalies groin issues. It is not a hernia in the typical sense that you have a bulge - there is no bulge - it is a tearing of the abdominal rectus and potentially the adductor near where they attach to the pubic bone. I am on the books for an ultrasound to confirm the diagnosis and find the extent of the tearing - but the doc was 100% certain that there was tearing on both sides. The treatment is an open surgery to repair the tearing. Most of the docs that I have found that specialize in this treatment for athlete will do an open surgery rather than laparoscopic. In my case, he will do the repair with local and twilight, then have me stress the sutures prior to closing, so that he knows the sutures hold (sounds medieval!). He will not do both at the same time - says I would not be able to move for a couple weeks if he did.
If you do tons of research (I have trying to figure this out) you find that there is a very high correlation between hip issues and sports hernias. There is also a very high incidence of the procedures fixing the problem. The research also says it is very unlikely to heal on its own. I confirmed this with a some very elite athletes that had similar injuries. The fact that I really saw zero improvement with forced convalescence drove the point home. Here is one bit of research that ties the two injuries together: http://www.arthroscopyjournal.org/article/S0749-8063(12)00135-1/abstract
The prognosis is very good. The hip Doc (also a well renown guy that was referred to be by an Olympic runner) wants me no-load spinning within 24 hours and says I will be released for full outdoors running within 12. The sports hernia Doc says it varies but that I should run on a treadmill within 2-3 weeks post surgery.
The hip gets fixed this Friday - 5 Feb.
Sorry if this is too much. Trying to find the problem has been a challenge. Seems like each Doc is a specialist and that a person ends up being their own 'general contractor' getting these things fixed.
I hope this helps
Rich - thanks for going through all that. I'm sure just writing it all down helped in its own way. First a question: You say, "The hip Doc ... wants me no-load spinning within 24 hours and says I will be released for full outdoors running within 12." The sports hernia Doc says it varies but that I should run on a treadmill within 2-3 weeks post surgery.
Is that 12 days? Weeks? before you start running?
When I was reviewing return to activity after my recent hernia surgery, I came across an article which referenced the experience of NHL players after sports hernia surgery, noting that they did not return to full activity for six weeks. Recently, the Seahawks running back Marshawn Lynch had a similar repair, and was a full 8 weeks before he felt ready to go at in a game. These are guys who are 30 +/-, and presumably with the best conditioning possible going into the surgery. Ancillary to that was a study of suture and tissue strength which was done in hernia open repairs, coupled with the amount of force various activities produced. End result: jumping exceeds the tissue strength combined with suture strength (one getting stronger over time, the other weakening) for a good six weeks after surgery. This is physics, not mental toughness stuff. And running is basically jumping, one hop after another. Then there is the normal issue of persistent fatigue after any surgery, not matter how "minor". The body marshals all its resources to heal the damage done by the surgeon, and that saps one's energy more than most people anticipate.
For me, I took the approach of not trying to rush things. I was able to start biking within a few days, and started doing long walks at the same time. I started easy skiing at 4 weeks, and during that week (4-5 after surgery) ratcheted up to full effort by the end of the week, then got home and ran without difficulty. My advice is: DONT'T RUSH IT. Take 4-6 weeks mentally before you tell yourself "I am now starting to actually "train", rather then just "moving" after surgery. There are no prizes for early return to activity; there is much to gain by letting your body just have the time it needs to heal, which IMO will be in the range of 4-6 weeks, depending. You will lose neither your neuro-muscular "memory", nor your ability to quickly regain strength once you do start ramping things up. The worst possible outcome is to prematurely tear one of those sutures before the fascia has had time to get to about 80% of its strength. Range of motion, stretching, long walks, etc is all good. Just go easy on anything that requires a Valsalva.
@Al - I really appreciate your insight. Also - good catch... 12 weeks for out doors running. The protocol will vary depending upon how I respond to it and will need to be adjusted for the hernia repair. On the surface it is:
- 50% load bearing and no resistance spinning week 1
- walking on elliptical week 2-3 depending on results of follow-up
- walking on treadmill week 3
- Adding resistance on bike week 4
- Treadmill progress to running week 5-4 (starting on Alter G)
- ...
- Outside road biking ≈week 6-8
- Full release for outside running ≈week 12
Of course - that all depends. And, that is without the hernia repair.
As I understand that hernia repair procedure, the inner layer will be done with stitches that dissolve and the outer layer will be permanent (I find this this both fascinating and gross) - this adds to the strength. Doc said no load spinning within 24 hours and that "it depends," but that expectations for running are 2-3 weeks to get started, 6ish weeks for recovery, using the Elliptical & Alter-G to get started. I will have two procedures - so this will be slower. Coupled with the hip... lets see. There will be a cumulative effect of these three procedures that slows recovery.
I honestly haven't given too much thought to timing other than in the broadest sense... Blue Ridge camp is 4/27 - I plan to be there. If I can't bike - I will help SAG and support Anna and the team. I believe that returning to biking should be much easier than running because it is low impact and because the position has been a relief to these areas throughout this ordeal. I look forward to adding Yoga back into the mix. Running will just have to come as it will.
Lots on your plate friend. BUT...knowing how you work...your focus, and methodical approach to things, I've no doubt you will have a very triumphant return to the race course this year. I will be thinking of you and sending good juju to you, Anna, and your caregivers come Friday! (((hugs)))
Photos of the repair for anyone who is interested
@CoachP / @Team - There is a lot of evidence that links hip injuries (like my torn labrum) to Athletic Publagia (sports hernia that isn't really a hernia) and other core injuries. These injuries can be super debilitating. Moreover - repair of these injuries can e really complicated and can result in too much scar tissue. Even the suture technique matter so that you are not left with an abundance of inflexible scar tissue.
I am 100% behind the idea of finding the specialist of the specialists and letting them fix it.
My labrum was repaired 5 February and I was already starting to put up last May/June numbers (Dr Farjo).
Today I had the bilateral groin tearing (abdominas rectus + adductors) repaired. It has been a long day - but I am very confident in the guy I chose to to the surgery. Dr William Meyers
As of today - I am officially on the mend!
Good Luck!
@CoachP / @Team - There is a lot of evidence that links hip injuries (like my torn labrum) to Athletic Publagia (sports hernia that isn't really a hernia) and other core injuries. These injuries can be super debilitating. Moreover - repair of these injuries can e really complicated and can result in too much scar tissue. Even the suture technique matter so that you are not left with an abundance of inflexible scar tissue.
I am 100% behind the idea of finding the specialist of the specialists and letting them fix it.
My labrum was repaired 5 February and I was already starting to put up last May/June numbers (Dr Farjo).
Today I had the bilateral groin tearing (abdominas rectus + adductors) repaired. It has been a long day - but I am very confident in the guy I chose to to the surgery. Dr William Meyers
As of today - I am officially on the mend!
Good Luck!
Bad news is that I over achieved with moderate to severe tearing in 7 of the 8 muscles mentioned. The surgery was more intrusive than the labrum repair with two cuts; one 7cm and one 6cm and unthinkable things going on within :-)
Good news is that Surgery was very successful. I had more strength in the recovery room that I had prior to surgery and it is increasing daily. After my 1-week post-op check tomorrow, my protocol will increase and I will be on the bike again and re-entering my hip protocol.I am pretty stoked... 127 days until IMLT and I am pretty sure that I will be ready! That wasn't a foregone conclusion a few weeks ago.
Great news...now the key for the next two months is NO MORE OVER ACHIEVING. You spent a lot of blood sweat and tears, and somebody's money to get to this point. Make sure your body has the resources and time to do the healing you want it to. I'd be skeptical of any running until May 5-10? Dr. knows best at this point.
Performance at IMLT is to be determined. But I suspect it might be more about participating than racing all out. It's hard to see how you can get enough run training in to knock it out of the park by the end of July. When we get together in CO, I can share my come-back experience in 2011 with you - the first IM after 4 months comeback training was harder than I expected, despite good 5K, 10K, and 21K run times. But 5 months after that, I hit a home run.
Good news - I met with my Hip Doc yesterday and and x-rays, mobility tests could not be more perfect. He released me for full mobility and to have my PT progress me back to sports. His words were that my healing was beyond his best expectations, x-rays were perfect and he will only want to see me one more time. Could be the stem-cell treatment? My protocols have been more aggressive than some that I have seen. I also sought out Docs that are at the top of their fields nationally specialize in treating athletic injuries.
According to his protocol, I would have been treadmill running now if not for the groin. According to that protocol, I could have started biking a couple data ago, but held off for the weekend. It is a 6-week protocol for full return - but I will be slower. I plan to stick with low/no impact longer than the protocol calls for (elliptical / Alter-G) so that I have some time to get confident that my balance / glute / adductors / hip muscles are redeveloping before stressing them in every dimension. This condition had been going on long enough that I need to build some symmetry.
My only real expectations are to take it week by week and that biking will develop faster than running.
You're right - it has been a costly experience, with large chunks of it out of pocket.
I really feel great, but I made a tough call over the last few weeks and dropped IM Lake Placid from my schedule. While I had no pain or other issues as I returned to biking and running, I struggled through March and early April to develop any kind of "zip" to anything that I did. RPE would tell me I was working hard, but looking at the power meter or the run pacing/HR and everything was out of sorts.
Contrary to my nature - I tried to just let it come at it's own pace. My bike volumes developed nicely through April and May and power levels are at last July's levels. Running has been much harder to develop. Base fitness is returning, but my foot speed is still lethargic. I am running at a cadence of mid to upper 160s instead of my typical mid 170s. This si reflected in paces that are still substantially slower than last year.
I dropped Lake Placid because I felt it would be a damper on the rest of the year (Wisconsin and Florida). One of the keys to multi-race years is having fitness really tuned in time for the first race; that wasn't happening this year.
Now I have 8 extra weeks to get the runner working and try to have fun rather than forcing the race and not having fun.
In the end, Al was right (again)... the comeback is harder than I expected.
So far - it is pain free though - so it is worth a little extra time.
Rich - Great to hear! Smart move on IMLP. I am looking forward to our next scone run!