Paul's MRI Results and Modified IM Ireland Race Plan
My right knee "popped" 11 miles into a long run back about mid-April. X-rays showed arthritis and a frayed medial meniscus. I've tried to run several times since then without success. To validate my Kona slot I power-walked through the Gulf Coast 70.3 with the half marathon in 3:20 and the whole race in 7 hrs flat.
After continued difficulty, I had a MRI last week, followed by an adult discussion with a sports orthopedist. Yes, he can get me running again if I want, but NO, I should not be running if I want to walk well later. Surgery is not recommend. The MRI listed the following conditions.
1. MENISCI: There is complex tear of the body and posterior horn of the medial meniscus. The lateral meniscus is intact.
2. CRUCIATE LIGAMENTS: Intact. There is a PCL ganglion.
3. COLLATERAL LIGAMENTS: There is right 1 sprain of the MCL. The LCL is intact and unremarkable.
4. EXTENSOR MECHANISM: Intact
5. ARTICULAR CARTILAGE: There is a 1.3 cm osteochondral defect of the weightbearing surface of the medial femoral condyle, with surrounding edema. No evidence of free fragment. There is near complete denudation of the patellofemoral cartilage.
6. BONE AND BONE MARROW: As above. There are tricompartmental marginal osteophytes area
7. JOINTS: There is a small joint effusion.
8. ADDITIONAL FINDINGS: There is a 2.9 cm popliteal cyst that is partially extruded.
The defects in #5 cannot be corrected with surgery, and the bone edema (basically, they banged together) has been the source of most pain. If I do continue to run after recovery then I will only accelerate the destruction of what little cartilage is left under my kneecap. So bottom-line, I've decided I will finish Ironman Ireland and Ironman Hawaii then exit from triathlon. I have some huge bucket list items in the future (e.g, the Camino de Santiago) and having an intact knee is necessary. It's a trade-off between short and long term goals, and as much as it pains me to step aside, I know this is the right decision. But for the nearterm, I am cleared to do two last Ironman races as long as I walk them. Sucks, but you gotta do what you gotta do.
So here's my plan for Ironman Ireland on 23 June - my 15th IM start with zero DNFs to date.
Logistics - I have to drop the bike off more than two weeks early (7 June) for TBT. I was prepared to use my bike case but jumped on TBT when I found out they are servicing this race. And there are about 50 athletes from the Tampa Bay area alone going! It will be oh so much easier to leave the bike with TBT after the race since I'll still be touring Ireland with my wife, daughter and mother-in-law for another week. We arrive in country on Wed 19 Jun and I'll pick up the bike on Thu 18 Jun when I register and attend the athlete's briefing. This is a logistically-INTENSE race. The town of Youghal hosting the venue has only a few hotels, and athletes will be scattered across the countryside with probably the majority (including me) in Cork which is a 45-50 min drive away. So I'll be renting a car while at Cork (I have a LOT of left hand drive experience). On Friday, I want to get in a practice swim since this is likely to be very cold water. Saturday is bike drop off and more touring. With my new limited goal of Just Finish, I'm not too concerned about staying off the feet. On race day, my wife and top sherpa will accompany me to Youghal while my daughter and MIL remain in Cork for an easy day.
Swim - 80 mins. It's a rolling start and this is a conservative estimate for my swim. My swim and bike volume are up due to the run injury so I hope to easily beat this and put a few minutes in the bank, but I'll go with 80 in case the cold water slows me down. If the water is under 58, I will be wearing booties (along with my polar cap).
T1 - 5 mins. Transition is very close to swim exit, but again, I will go with a conservative estimate since I have to WALK it.
Bike - 7 hours. Depending on who you ask, this course has 5900 to 6900 net elevation gain along with a killer 21% hill that comes at 54 miles and 110 miles on the two loop course. The road surface is expected to be rough. It took me 6:48 to cover Ironman Norway last year with 6500 net gain so I am confident that a 7 hour flat time is very doable for me. And I'm bringing an 11-30 cassette with my compact crank to handle Windmill Hill. Given that I can't run, I'm going to push the bike leg a little harder than I would for a normal IM.
T2 - 5 mins. Yeah, I have to walk through transition again. Put on fresh socks and WALKING shoes with little to no drop and highly flexible forefoot.
The Run, I mean walk. 7 hrs 30 mins. At Gulf Coast, I power walked a 15:19 min mile average and my knee ached for about 5 days after. The doc thinks that's because the edema is still healing, but I've found 17 min pace doesn't hurt it; you just have to remember to keep the arm cadence up. I suspect I'll have a lot of 'friends' walking with me after the bike course tears them to pieces. I'll welcome the company as long as they aren't going any slower than I want to go. And since I'm going to be out there for awhile, I'm going to have something warmer in my special needs bag for when the temperature starts dropping.
So that all adds up to 16 hours. I would prefer 15:59 or better, but the main thing is finish and consider this a practice run - I mean practice walk - for Kona. I didn't even mention nutrition because it will be the same-old, same-old. My one thing? KMF, baby!
Comments
Damnnnnnn, Sorry to hear about all of the knee damage @Paul Hough but I like that you are deliberate about your modified race plan. I can't wait to hear about the actual course after you experience it in real life. Best of luck to you!
After all these years, I finally get to meet you in Hawaii!
"It's better to burn out than it is to rust."
That knee served you well over 4+ decades. A victory lap @ Kona, than on to new adventures - I like that plan.
Keep doin' it 'till you can't - and then keep going on a different path.
@Paul Hough Sorry to hear about the knee issues. Solid plan.
A couple comments - Given your fitness and experience a little harder I don't have issue with just make sure you have something in the tank mentally for the marathon march.
I'd revisit nutrition just because you will be out there longer than normal for an IM. Some people don't stomach the same nutrition for the 15-16 hours, this has not typically been the case for me but have some alternatives, chews, gels and I use bars alternating with gel every 1/2 hour on the bike for the first 4-5 hours. Given your plan to push the bike a little more I'd stick with what you are used to on the bike.
Also the aid stations will not come a fast so you may want to carry an extra gel, salt tabs with you. I've never used a bottle for the run but if hydration is a concern this might be a consideration. These things maybe more useful in Kona when it's really hot so perhaps a trial run might be in order.
Finally bring some lube with you even if not typically an issue time tends to magnify some issues that may not show up with you typiclal run.
@John Withrow @Al Truscott , thanks for the encouragement. I'm disappointed that I will not be able to attempt a goodly number of races that I had hoped to complete. At the same time, I'm already replacing my long range planning calendar with other challenges. Swimming and biking will still be a big part of my life and I'll be targeting the 25th Annual St Croix 5 mile coral reef swim in 2020, and then a number of bike tours. Hiking will pick up later. I want to walk the Camino Frances route (500 miles) when I retire and then later the length of Hadrian's Wall (84 miles). I look forward to seeing both of you at Kona. I hope not to be last!
@Gordon Cherwoniak - yes, the marathon will be a mental test, but I can be stubborn. :) I had to walk 15 miles of IM Florida 2014 since I started it with 2 stress fractures and a still healing torn poplitius muscle. I know the drill and I have been doing some long walks in preparation for Ireland. I won't need salt pills in Ireland (trust me on this), but definitely will at Kona. However, nutrition won't change because a mile is a mile (e.g., about the same calories burned whether you walk it or run it). So I'll be taking the same nutrition spread out over more time. This mirrors my experience walking the Gulf Coast 70.3 and the long walks I've done. A small tube of Aquaphor is definitely on the list. Walking seems to put different stresses on the feet than running.
sorry about the knee. i have similar meniscus problems and things have calmed down pretty good with reduced run volume and exercises. important to do the knee stabilization exercises. maybe do some pool running leading up to kona.
I would like to do the Camino at some point. Maybe one of the alternatives routes like the northern one.
have a great victory lap year.
@robin sarner, I hope I can jog some at Kona but will still stop after that even if it feels fine again. I've done enough damage with 5 decades of running and need to save it for other adventures. I've read that the northern route is the most beautiful but I want to stick with the traditional and do the entire Camino Frances...by far the most popular. I plan to do it at 66.5, my full SS retirement age. My wife will still be working so it will give me 5 weeks to reflect on what I want to do in the last chapter of my life. Look up Camino de Santiago demographics and you will find all the stats on how many complete the min 100K each year, age break outs, gender split, percentages by route and nationality and so on.
cool.
thanks for the info.
Buen Camino
@Paul Hough sorry to hear about the knee but glad to hear that you're keeping moving forward. Your future plans sound awesome.