New Beginnings

Day 2 of running. Yesterday and today I ran around the block (0.7 miles). A glorious run - longest (actually only runs) I've had in over 3 months. No pains whatsoever.....

One Metric Marathon Years Old - 26.2 = 42.2k = my age on 6/28/09

Highest swim day yet was today at exactly 42.2 laps which happens to equal my age today.

The last couple as I pushed off the wall at 40 I thought - that was the finish of the first Boston Marathon at 40 yrs old. Pushing off the other end was NYC marathon at about 40.5 yrs old passing two other marathons including Houston before pushing off again at the other side at 41 with another Boston Marathon - Anchorage in the middle somewhere then pushing off 41.5 at the San Antonio Marathon at 41.5 yrs old. Finish that lap then stop just short of midway for the Metric Marathon of swimming - 42.2 laps.

A Shout-out to IRUNFORBEER

A huge congratulations at WINNING your age group at the Boston Marathon (2:43 50-54)....An unfricken believable accomplishment....I'm totally speechless....well not totally :).

Back in 2007 John (Irunforbeer) and I had a common quest to break the 3 hour barrier at the San Diego Rock n Roll Marathon - with the common name and both fans of Dean Karnasas who was referred as Team Dean (a one man team) in some 200+ mile relay race he did all by himself --- we dubbed ourselves "Team John". Team John Failed that sub3 attempt as we both were not quite ready to bust thru but we have each chalked up our own victories and now the other half (Mr. Irunforbeer) has hit the pinnacle - I am so incredibly excited for your victory John.......Go Team John. (Of course I taught him everything he knows :) )...

How to get a Stress Fracture in your Sacrum

7/6 Edits Leg Length Measurement and MRI

5/4 Edits blood tests clear..

4/18 Edits (add Stats, leg length info and conclusion revision).

In the interested of clearing this white board in my office where I've diagramed and timelined and built a fault tree diagram to try and figure out what happen - I'm going to copy it all down here.

Stats:In a study of running related stressfractures (1978) 55% Tibia, 23% metatarsals (toe bones), 14% fibula (small calf bone), 6% femur (thigh bone) 1% ankle bones, 1% pubic arch bone and 0.1% sacrum. (Noakes - Lore of Running). (I suspect it was underreported back then with fewer means to detect - but still).

Not too common of a place to get a SFX but somewhat common for a high end distance runner from what I've found in my studies on it.........

Root Cause Analysis – Stress Fracture in the Sacrum.

Problem Statement – Injury in the area of my Right Buttock after the San Antonio Marathon caused an inability to race or even run for many months.

Timeline (blogger style – newest first – I wrote this chronological then decided to flip it around so I could add new stuff at the top as things progress – if anyone actually reads this it might be helpful to start at the bottom and go up - might flow better):

7/6 - CT Scan to measure leg lengths - waiting results but I got a copy of the data - by my measurement the the legs are very very close to each other - within a couple millimeters - we'll see what the doc says. Still waiting MRI results.

7/2 - MRI today - waiting results. Tech's words were getting better - not as good as all better but at least better than no change.

5/4 - received blood tests for samples taken 4/14. Apparently Vitamin D takes a while - not done local. Results came back all within normal limits. But just in case I've been religious about taking Ultra-bone vitamins I got at the supermarket for the last few weeks. All pain is gone and I'm walking normal with no limp. Still holding off any exersizing - I'm probably being a bit over cautious in cutting out the crosstraining I was doing but I don't really understand why 3 months between MRI's and the bone doesn't look better - doc seems to think it was the running but there was so little of that - just doesn't make sense to me - I'm thinking perhaps the crosstraining was a part of the slow healing so I'm holding off on that too.

4/15 - Dr. Visit to review MRI result and drill him with questions :). Made me feel much better about having some pain - most comforting words were a broken bone hurts for 4-6 weeks - I was very concerned that with each movement I made that had a little pain I was making the break worse and had lots of bad scenario's ringing around my head - very nice to hear some pain is just normal. Walking is so much easier today - still limping but not nearly so much - feels like the corner is turned :). The thought of a few months off gives me not the slightest disappointment (ok maybe slight) as long as it all heals up normal.

Currious thing - I was convinced leg lengths were the same but my wife assisted me in measuring up to the hip bone on each side and found a full centemeter difference with the right leg shorter - that could explain it all and so easy to fix with a shoe insert. I know someone else who had this same injury and she found the same difference in leg length. Doc's going to do a CT Scan to get an accurate measurement before I start running again.

4/14 - MRI Results - a crack (small line on right side of Sacrum) - treatment - 3 months rest - high likelihood will fix - no repetitive exersize - let the pain guide what's ok shortterm around mobility - maybe bike/swim after 6 weeks or so - depends - take new MRI after 3 months to be sure all is gone then can start running again. Prescribed to get bloodwork to be sure no underlying issue preventing healing. Checking if electrical stimulation makes sense (low expectations - expensive with questionable value and unlikely to be approved for something like this - still pursuing just in case might be helpful), Screw/pin - rarely used in this area - high risk - bone graph would be next option in the unlikely event just rest didn't fix. No mention of sports hernia on the report - I'm hoping this was a false diagnosis related to the abductor pain I had felt a few times only for about 1 week prior to the MRI - perhaps just a mild thing that needed a little healing time.

I was just happy he stopped using words like catastrophic making the healing process seem pretty normal. Although I thought I was being pretty cautious with this SFX over last few months - I can see looking back over this log I was not cautious enough - bone is a very different animal than soft tissue injuries - the slightest extra pushing can be very bad on bones. Seems most likely the crack came from running 3/28.

4/11 – Get another MRI…..awaiting results – bracing for a “crack” result – no idea what would be done for something that he says doesn’t heal – maybe a screw or a pin – who knows but it doesn’t sound like just wait “X” months……..We’ll see – I’m a little worried….

4/10 – progression is getting worse – buy crutches as now I’m limping most every step – the words of the doctor “Cracks in Stress Fractures don’t heal” are ringing thru my head.

4/9 – Visit a different doctor (orthopedic) – much more helpful than the last – goes thru the prior MRI with me and explains the injury better - I had somehow thought the SFX was a very small crack and I had squinted at that MRI trying to see it – he pointed out a whole section of the bone that was swollen from what he described as an extended period of over stress/micro fracture/heal – not like a single crack – guess that is what a SFX is and not a single crack – he explained SFX’s heal slower than a clean break – typically prescribes 3 months of no impact type sports (i.e. no running – biking and swimming are fine since they don’t impact). It’s nice to have a more helpful doctor. He was consistent with the other doctor in downplaying the significance of “Sports Hernia” impression from the radiologists on the last MRI – hope they are right. But he kept using words like “catastrophic” when we looked at the MRI and talking about the difference between a “crack” and a SFX – a crack in a SFX apparently will not heal.

3/29-4/11 – no exercise – initially no pain but progressively each day is a little worse than the prior from normal activity.

3/28 5.0 Ended quite disappointed that the pain in the butt was back and was definitely a building pain that was not going to go away with more miles. Time to stop running again – hopefully I didn’t re-injured by this run.

3/18 1.0/1.7,3/19 1.0, 3/20 0, 3/21 0.56 (after a bike ride – man that’s a tough transition), 3/22 2.6, 3/24 3.0, 3/25 4.6 – All these with minimal discomfort – I considered normal aches and pains of starting run after a time off although I didn’t like that that discomfort was in the area of the injury (clue?).

Running (5.5 weeks since the 5k, 10 weeks from prior “last” run)

3/21 56 (flying fast 21 mph average), 3/22 47

3/15-20 – skiing all week – no problems – a few short bike rides as well.

2/21 55 miles, 2/28 47, 3/1 36, 3/6 16, 3/7 33, 3/8 46

Biking (no pain from this activity around injuries)

2/9,2/16 – swimming lots of laps – much improved.

2/2-8 – 4 weeks off since last run – try to gingerly run (treadmill) – M 0.5, T 1.0, W 1.5, Th 2.0, F .57, S 3.1 (a local 5k I jogged very very slow – noted pain in the butt after 2.5 miles –should have walked the rest but didn’t).

1/26,2/2 weeks – learning swim strokes in the pool (Total Immersion).

Swimming (no pain from this activity around injuries)

1/19 week – nada

1/12 week – nada

1/9 – get MRI results – SFX in Sacrum Ala and Sports Hernia “impressions” (Doctor – orthopedic - unhelpful with any input whatsoever – just says to take time off – not even guidance on how long – so I go google)

1/2 – MRI

1/1 – 2.1, 1/2 – 4.8(upper thigh abductor pain), 1/4 – 5.6(upper thigh abductor pain), 1/6 – 4.25 (upper thigh abductor pain)

12/28 20 miles for prior week – Christmas Day up to 5-6 miles – No more pain in the butt but the upper thigh pain starts again then comes abductor pain shooting down the leg towards end of the run – walk home.

12/21 – no running – XRAY shows all clear – appointment for MRI keeps getting delayed thru holidays.

12/14 – no running

12/7 – 18 miles total – 5 mile max at once – expert massage – also using tennis ball for massaging – someone got me thinking toward piriphormis syndrome that seemed to fit the symptoms so I was self treating for this.

11/30 – 22 miles total for past week – pushed to 10/8 miles on a couple runs – still noted back of hip joint pain then upper thigh pain.

11/23 – tried a run on my own – ended up 13 miles with walk breaks every few miles I notice – I note symptoms of – back of hip joint pain than after a while upper thigh pain.

11/22 – Club run – 10 miles – first few pretty slow then 5 up to ~7mpm pace then dropped off pace of the others and walked much of the last couple miles back to the start as they went on a few more miles – I don’t recall the issues. When I got to the start I asked the club massage therapist for a massage (I’d never done that before) – I recall noted to focus on sore calves and SI joint area.

11/17-21 – M 5, T 0, W 7, Th 0, F 9 – all very slow running guided by – enjoy the run of whatever distance feel good – these post race runs after a marathon for me are much driven by the euphoria of the race and a reliving of dream kinda thing – no pressure to go farther or push any limits. No recollection of any issue abnormal on these runs.

11/16 – S - San Antonio Marathon – Don’t recall anything in the race. I did start the race with 2 IBP so it could be any pain I should have been feeling was masked. Finished race with lots of euphoria so perhaps wasn’t noticing any pain.

11/10 – bailed on a workout – noted in the log “hip pain”.
9/2008 – PT noted I have a weak right hip by having me lay flat and raise right and left leg as he pushed them back down . Along with this I had issues when not running balancing on left foot and raising right foot with pain around the hip.

2/2008 – Groin Pain following a 5k race a couple weeks after the Houston Marathon (right leg abductor pain). Impacted running for a few weeks – I found I could after a slow and cautious warm-up I could run any distance or speed I wanted without impact. (Perhaps the Genesis of a Sports Hernia??)

Causes/Preventions for Next Time
Stress Fracture in the Sacrum causes (and preventions) from my studies are several – I don’t know my exact cause but have lots of risk factors that likely added up to the injury.

Typical Causes:
Quick ramp up in intensity – bones not stressed and strengthened to the new intensity level and vulnerable to SFX due to this low strength:

My Risk Factor on this – Only the San Antonio Race itself lends itself to this description of a quick ramp-up in intensity. In training I had 3x20 mile runs - fastest 6:40 average then going to 26.2 at 6:05 pace on race day (10% faster and 30% longer than anything in training) - perhaps too big a jump at once - perhaps should have had harder workouts in training to prepare the body/strengthen the bones for the raceday stress. Training in general was slower prior to this race than any other of the year due to the heat of the training months prior to the race. Race Day was accelerated over training speeds by the combination of a very cold day for the race and the extra benefit from what I’ve called the turbodrive routine I did prior to the race to give me a little extra race day speed.

Imbalances in running form – Leg length differences have been seen to cause this injury, also running on a slanted road, also an abducted foot (slanted out).

My Risk Factor on this – I run a large variety of running surfaces so the slanted road doesn’t seem to make sense for me. Haven't done the leg length measurement correctly yet but by home-measurements I do find my left hip bone is about 1 cm higher than my right. Also off the MRI laying on my back I found the top of my left femur to be 9 mm higher than my right on the film - need to get that measured right and consider a shoe insert.

An exagerated visual of the impact of leg length difference - extra forces transfered to the point of my stress fracture seems to make visually make sense:

Also I do notice on video footage I happen to have I do have an abducted right toe – I found a perfect scene in 2008 Boston video to see I’m running along the yellow line in the middle of the street where my left foot lands exactly parallel with the line but my right foot is slanted with my toe about an inch outward off center from my heel. I even have a certain whole body sway I see in all video’s I can find that seems to highlight a right side imbalance. I’m also noting nearly all my running injuries have been on the right side so I’m thinking this is root cause of lots of stuff. I do get the impression this is not hard to fix this with shoes and certain strength exercises now that I know to go fix it.

Mineral Issues – Low Calcium – This was apparently what happen to Deena Kastor who suffered a broken bone in her foot a few miles into the Olympic Marathon “I was doing a long run in Colorado while there for the Boulder Bolder, and drank out of a stream. Most mountain girls would know better, but I thought I was at a high enough elevation to quench my 15 mile thirst. I was really sick for 3 weeks (one of those weeks in which I ran the NY Mini 10K) until I finally took medication. In that time I lost 5 pounds that was difficult to put back on in marathon training. My blood was depleted of minerals so it grabbed the nutrients from my bones."

My Risk Factor on this – although I drink lots of milk I don’t focus much on vitamin intake and have never focused on taking Calcium but I do find listed as a preventative for stress fracture to take Calcium and Vitamin D – This is now and will continue to be a focus I will do once I get running again.

Weak Abdomen/Core – Stronger abdomen/core helps to stabilize the pelvis and put less stress on the bones.

My Risk Factor on this – I never did core work – definitely will be a focus area once I get running again and before.

Conclusion:

I don't really know what happen specifically but I did have enough risk factors that I was unaware of that in the end I think I was destine for something like this as I got faster - with speed comes harder pounding and with harder pounding comes higher stresses and a weak point is revealed. I suspect the a heal insert to even out the leg length delta, maybe fixing the gait issues (running form) as well as some core strength building and focus on vitamins could have prevented this - I got away with it at slower speeds but at some point I got fast enough that these weaknesses became important. Lesson learned for next time. One of the hazard of not being coached is I'm having to figure it all out myself where a coach probably would have pointed out some of these things that now seem somewhat obvious.

In hindsight recovery has been done all wrong - needed a solid several months off without impact sports and still haven't had it yet. All prior injuries were couple days off or run through and it gets better eventually kinda things - this was was clearly a different animal although it took a while to realize. Better listening to signals and responding could have made this so much less an issue.....probably most important lesson of all - and one I hope to never have to relearn ever.

John.

ps - been thinking of a new handle for my next running life - I'm hoping the comebackkid or some variant might work...

kayry - signing off

Some rambles of the past few years: 6942 miles in over 2005-2009 (nearly the diameter of the planet) with 2939 miles in this last year - about 18 pairs of shoes, 1 racing flat and 1 spikes and one I call the alligator shoes - two treadmills with over 500 miles on each. 7x 5k's, 2x 8ks, 4x 10ks, 2x 10M, 7x 1/2 marathons, 3x 30ks, and 10 Marathons + 2 relays and 3 track meets (one win over Exxon and one Loss) with at least one T-Shirt for each race. Two Pedometers, One Nike Triax with HRM, One Garmin 305 with HRM - two strap replacements. Tracking Computer Programs by Forerunner, MotionBased, Topofusion and Sportstracks (my favorite and my "official" log). Spreadsheet studies on Speed vs Heartrate, changes over time, changes day to day and trying to identify every possible variable that controls it (heat, sickness, coffee, hydration level, road vs trail vs treadmill, wind, am vs pm, time since a meal, how recovered from prior workout - I've studied and correlated every possible variable :) ). Lab result said 64 VO2max (2:35 marathoner for VDOT) when my best marathon was 3:01 - I nearly got my VDOT to match that lab result since then - 4-5 minutes to go. Other spreadsheets to size up the competition - tracking local Masters and how they do in races - rank ordering them and seeing where I rank - watching for the once just ahead of me when I get to races. Family support along the way including my daughter (and sometimes my son too) riding her bike next to nearly every mile I ran leading up to my first marathon. Cheering squads at races nearly always including my wife and kids but also with some extraordinarily extra effort by my sister and nieces cheering me at two Bostons, NYC and Houston and my brother at NYC and San Diego and my Dad at San Diego and Boston and some extended family also coming out to Boston. The race of great embarrassment to me at my first San Diego with my wife, two kids, brother and wife, parents and even inlaws all out to San Diego with my Marathon cornerstone event of the trip - and I get a DNF because of a stomach bug (I think that gave me a major kick in the butt to be better). Some incredible running experiences along the way - wildlife discoveries (Banana spiders make thick webs, possum can be snuck up on at night by accident, bats like to swoop down into my headlight at night, deer are always a pleasant thing to come across, a full grown Moose will let you run right in front of its nose and doesn't charge, its a creepy feeling to run the back trails in Alaska and see all the evidence of Bears and Moose - got me a little nervous) - best running surfaces - Golf Courses (until you get kicked off) and 1-2" of freshly fallen snow. Best running time - after everyone has gone to sleep at night - very peaceful. Running while travelling - Alaska, Maui, Lake Tahoe, Anacortes-WA, Auburn-CA (along the trails of Western States Race), Seattle thru U of W out to Greenlake and back (where I grew up thru elementry school), San Diego thru my college (UCSD), Denver, Central Park, Times Square, Wellseley College - Boston, Contra Costa-CA, Near Seattle Airport, New Orleans, Hot Springs Arkansas (Where I had to get my VO2max workout in and drove all around looking for a highschool at about midnight - found one and snuck onto the track and had what seemed to the the hardest and most fabulous VO2max workout ever). Sad runs thru destruction's of Lake Tahoe Fires - charred homes. Local running including many miles of fallen trees and damaged houses following the destruction of Hurricane Ike. Hot, humid, winds up to tropical storm strength (no I didn't get out for a Hurricane Ike run although I kinda wanted to), downpours of rain (I got excited to run in the rain - heavier the better), thunderstorms, thru muddy and flooded areas. Wonderfully shaded trails that network all around my house, East End Park a couple miles away with a few miles of dirt trails (great fun in the rain but had to bring old shoes), the local middle school at 4 am with no lights - recall many interval worksouts on a crisp morning looking up to a full moon - once I was surprised to catch an unexpected eclipse on one of those. Setbacks along the way with runner knee early on, Plantar Fasccitis hanging with me for 6 months or so - both feet for some of that time, Achilles soreness (curiously still a bit tender even though I haven't run in months), pulled abductor muscles. Many lost toe-nails - always the mortors toe - btw my toes look pretty nice now all grown back :). Races with mountain top experiences and agony of poor performances - First Boston was the experience of a lifetime - can never be topped I think although many other moments came much closer than I thought could be possible - the surprising unexpected massive 16 minute PR in Houston last year still floors me - Anchorage all on my own running thru hills in a beautiful place I'd never been to before with perfect weather and perfect pacing to leave me with power to the end, San Antonio - finally getting my sub 2:40 I felt was within for the prior 4 races but just couldn't get on the clock - what a perfect weather day and the perfect finishing photo and quickest time from finishline to beer (gotta love VIP). Friends along the way too many to count from online running forums that gave virtual "kin" when I knew no runners to the Local running clubs to fellow relayers in team competitions to other runners at my work to runner commodore among competitors when I see them at races to bloggers to people I don't know me but somehow know me - "oh that hypertechnical blogger guy". The non-runners that really have no interest in my running and hear only blah blah blah with anything I say about it but pretend to be interested - and the ones that actually are interested. The very interesting discussion along the way - debates about using heartrate or perceived effort for racing. The fine tuning of all variables to make the perfect marathon - never really cared about any other distance except as tune up races for the real race - discoveries along the way - Turbo Charge - which I have yet to find any serious runner do more than shake there head and roll there eyes at me about (but I swear - it works!!!).

I'm incredibly proud of what I've accomplished in 2008 and will cherish several claims to fame including:

• Three of the best four marathon times for a Master Texan on Active.com in 2008*.
• 2 Masters Wins at semi-major marathons (Houston, San Antonio).
• 2nd and 4th place at a couple smaller races (Seabrook, Anchorage).
• Fastest time for a Master Texan at the Boston Marathon for this last decade (where I beat Lance Armstrong by a mile).
• A whole page article in the Inside Texas Running Magazine
• Youngest winner of the Moose Mug Challenge with sub 2 hr + Age.

*Yeah - I know my co-worker Wilmer should be #1 not #3 - San Antonio adjusted his CHIP time out of the money due to his late start - an outrageous thing to do imo. But at least I get to have some fun with him at work for beating him even though he has me so outclassed its not even close (First marathon ever a 2:37 then a follow up 2:32 in Houston - an incredible master runner).

What a year it was, what a few years it was and I just love this image at the end of it all - a high flying moment.

BUT.........

Now its time to step away......I thought I was on my way back from injury - ran a few times then tried for 5 miles yesterday. As has been true for the last 3-4 months in running - as I get above 2-3 miles - a pain in the butt develops kinda like a piriformis syndrome which I've come to associated with the stress fracture in the Sacrum (ala) that showed up on an MRI back in January. About 7 weeks ago on my last run over 3 miles I felt it, 5 weeks prior to that before I got my MRI I had similar things going on. So - well - its apparently NOT healed up yet again and in fact I fear I've aggravated it in that run yesterday possibly restarting the healing clock yet again. Very frustrating to say the least.

I just can't run and haven't been able to for 4+ months. My running fitness is gone - and I've got to let this damn stress fracture heal which now after that run feels worse than it ever did even when not running. Once it does heal up then I'm still not a runner yet as I have to test out some running to see if I need to do anything about the other ailment from my MRI - the Sports Hernia - which may need to be fixed by one of two doctors in the country by operation which I'm certainly not going to do until I know I have. Unfortunately I can't know if I have to until I'm actually running again to see the extent of discomfort/pain from it.

So - I feel like I just need to close this chapter down - I'm frankly not a runner any more for a while - no longer kayry - running engineer. I'm dropping that handle. When I pick the sport back up for my 3rd running life - whenever that might be - 2, 4, 6 months away or more - I'll choose a new handle and start over.

In the mean time I am enjoying cycling (well - I will again once the pain in the butt stops) - although I don't see how to make that into more than a weekend recreational kinda thing. It's not practical to ride during the week with a job (guess I could get a trainer). Also not very portable for travelling like running. But I enjoy the long bike rides especially with the local cycling group so I'll keep doing that. I really don't think that is aggravating my SFX as there is no pain with it.

I'm most definitely NOT enjoying swimming although I do think I've gotten a lot better. Open water I think I could probably enjoy but this back and forth in a pool and smelling like chlorine all day is for the birds.

Anyway - signing off for now - looking forward to the next chapter whenever it might be.

CHEERS

..........kayry (no more)

John.

Sports Hernia Investigations...

I thought I'd post this for the benefit of those who are thinking they've got what I've got (but probably don't) or just like to read lots of boring details about such things. Here was a letter to the leader in the country for dealing with Sports Hernia which details my history in the hopes of confirming the diagnosis I got from an MRI. It's got all the variables I could think of that seemed important for his input....


To:
Dr William Meyers
245 N 15th St, MS 413
NCB, Suite 7150 7th floor
Philadelphia, PA 19102

From:
John Hill

Date – 2/6/2009

Please fine enclosed:
MRI Images CD
Radiology Report

Dear Dr. Meyers,

As you can see from the attached radiology report I have been diagnosed with Sports Hernia. I have not been able to locate anyone local that can provide any confirmation of this diagnosis nor to give me any input of what I should do about it. Thru googling I’ve found your name as the one with the most experience in treating this injury so I was hoping get your opinion on the MRI to confirm (or not) the diagnosis and recommend treatment options.

Background on me:

I’m 41 years old. I’ve become a fairly competitive marathoner over the last few years starting running at age 38 after 20 years off from high school. I ran around 60-80 miles per week in training last year including 5 marathons between 2:39 and 2:47. Looking back I’d say there may have been symptoms worth mentioning going back to August/September timeframe:

August/September/October – right hip pains – especially when doing things like getting dressed where I would have to get on one foot for putting on socks or pants. Location of the pain I think was on the front about ½ way between the hip and the groin. There was not typically much pain from this while running or walking except occasionally with some random twist. Heavy lifting seemed to be an aggravator. A physical therapist at my running club did a test on me back in September and noted my right leg is much weaker than my left when I lay flat and try to lift it.

November – Ran my last marathon (PR’d it @ 2:39) – I don’t recall anything particularly of issue in the race – the mild hip pain on twists required a little gingerly treatment but having aches and pains post marathon is normal.

1 week after marathon – I had been jogging a few miles each day but on Saturday 6 days after I tried for 13 and may have done them a little fast – not really that fast but maybe on tight muscles from the marathon it was too fast – ended up walking towards the end although I don’t recall why. Also got a massage right after this run – I’ve wondered if he did something wrong.

For the next few days I could only get a few miles into a run then had pain in the butt, which I came to believe was Piriformus Syndrom.

Went thru the rest of November and December trying resting a few days then running easy but never got more than 6 miles at a time before building up pain got me to stop. Eventually thru massaging and chiropractor help the pain in the butt stopped but as I ran I would start to get a dull pain in the upper thigh and then a sharper pain down the inside of my right leg – after the sharper pain started I would stop running and head home – on a few occasions the sharper pain started again always around 4-5 miles into the run at which point I would stop running.

Once I got the MRI results I connected the piriformis symptoms to the stress fracture in the Scrum - I’ve found few runners in google searches that first thought they had piriformis syndrome then found a stress fracture in the sacrum so that seems to fit. I suspect the stress fracture is related to an abducted toe when I run (right toe goes out about an inch while left stays plum) which I am noting now as I look back on video’s of myself running – that and likely just plain overuse. Not sure if it the fracture happen at the race or in the run the following weekend.

I connected the pain down the right inner leg and the dull upper thigh pain to the Sportsman hernia – really not sure if those symptoms connect to that or not. The inner thigh pain I’ve actually felt once before exactly the same – after a fast, short 5k race back in February – for a couple weeks I had to be quite gingerly about warming up as the pain was a concern – but after warm-up of a mile or so the pain was gone and I could run whatever speed or distance without bother for it.

Stress fracture repair is easy – just rest a couple months and back to 100% - but the sports hernia is a question for which I come to you.

I’ve not run at all during January and all pain seems to be declining including the pain associated with getting on one foot when I get dressed. I did seem to re-aggravate that particular pain lifting something heavy last weekend and for the last several days that same pain when I get on one foot is back again on the right side – that seems to be diminishing. Now I’m wondering if THAT is the symptom associated with the Sports hernia and not that pain down the right leg – or maybe both are associated with it.

Anyway – the pain is not at all debilitating however as the stress fracture should now be about healed I’d like to get back in shape for racing again and I don’t know what to expect from the Sport Hernia.

From what I’ve read it appears my symptoms are mild however I get the impression the injury only gets worse – not better. Since I haven’t tried to run yet I don’t know if it limits my running but I suspect strongly it will.

Looking forward to your input.

John.

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

Response from Dr. Meyer's office - can't confirm diagnosis - need to fly to Phily for an MRI specific for sports hernia (muscle or other tissue pulls away from the pubic bone) - depending on what's found can have operation same visit. Recovery I've heard from 2-weeks to 2 months. Noted was there does seem a correlation between sports hernia and hip issues.

The operation - Two options - 1) Meyers: Through an inch-long incision, he sews up the tears in a way that tightens some abdominal wall attachments to the bone, and loosens others to restore stability. His patients play again by six weeks. 2) Cattey (in Milwaukee) , operating through quarter-inch incisions, covered the damaged area with an index card-sized piece of mesh that he screwed into the pelvic bone. Scar tissue grows into the netting, strengthening the spot to prevent future tears. Option 1 from my research has been done thousands of times and Option 2 hundreds of times and the success rate appears higher with Option 1 so that's what I'm pursuing.

I'm working thru the insurance issues - clearly not a doctor in my HMO network - but then there is no such doctor since there are only two in the country so it should count as in network anyway as I'm told - but I'm still working on convincing the insurance company this is a necessary thing.

Once I convince them then I just need to convice myself :).

There it all is - all the details.....

Cycling Update

Things are coming along in cycling - seeing some good improvement as seen in a little table below of my longer rides:

Date Miles Speed HR Wind Group/Alone
22-Mar 47.1 17.8 149 5.8 Alone
21-Mar 56.5 20.9 153 4.5 Group
8-Mar 46.4 18.4 158 4.6 Alone
1-Mar 36.4 15.7 155 19.6 Alone
28-Feb 47.6 16.4 XXX 18.7 Group
21-Feb 54.6 16.0 164 10.4 Alone

Nice to see the average HR dropping while the speed is increasing. I think last Saturday's 21 mph ride might have had some extra benefits from altitude training as I ski'd, biked and even ran a little in Colorado Rockies most of last week.

For Running - I've just started gingerly back into that - up to 2.6 miles before the bikeride yesterday - hopefully injury is in the past. Lots of little aches and pains as I get started again that I expect will die away after a couple weeks. I tried a to go around the block after the bikeride on Saturday too - that running after a bike ride thing is going to take some getting used to - the legs don't like that - gave up on that pretty quickly - I'll have to work on that transition...

Next up - Lone Star 1/4 Ironman April 5th -- more just to go thru the motions of it all than to "race". This will probably be my first open water swim....somehow have to get the images of jelly fish and sharks out of my head :).