Injury – My Story

This video was taken at the end of the long run. These runners just completed 80km's as a single run after having ran about 70km's the preceding two days. Watch this video to the end to see what support can do as motivator.

Background

If one speaks to any runner it becomes apparent that two things are certain, (1) runners will find any reason to run, this is typically due to their competitive nature and (2) runners will get injuries, this unfortunately is also due to their competitive nature.

Such is my story. It started with gradually increasing my weekly distance to 80km’s with weight, at which point I decided to work on my speed. The benefits were great. My 10km time came down to 50:03, and it was at this point that competitiveness dominated good common sense. For 8-months of training good common sense repeatedly held me back, it ensured that I remained careful and that I remained injury free. But then it happened, common sense took a break and I started chasing a sub 48min 10km, and a sub 1h24m 15km.

It was on a sunny afternoon three weeks ago that I chased the illusive 1h24m on the 15km. I was doing really great, I was on target, feeling relaxed and full of energy and then a steep embankment presented itself. Without thinking I ran the embankment knowing that with sufficient momentum it would not be a problem, and it wasn’t. I reached the top, unfortunately with my left calf muscle in less than perfect condition.

As I am confident other runners will attest, I reasoned that the pain I felt could be dealt with by continuing. After all, keeping the muscle working and warm will correct the problem and the pain will subside soon enough. Unfortunately 4km’s later I was reduced to a walk as the pain was simply too intense when I ran. Then the fear set in. The pain was localised about 8 cm above the base of the heel around the same point where I could feel my Achilles tendon emerge and the worse was feared.

Initial Treatment

Arriving home, I gave this injury the respect it needed and immediately made appointments with my local GP, a physiotherapist, a biokineticist and a specialist sport chiropractor. As all of these individuals specialise in sport injuries, with the exception of my GP, I assumed that they knew something about treating such injuries.

Well that was a very wrong assumption to make!

My GP was, as a general practitioner, the most helpful. His diagnosis was that it is not the Achilles tendon (some excellent news) but it was definitely a muscle tear. He gave me something for the pain, some anti-inflammatories and some cortisone and suggested I see the physiotherapist urgently.

And so my journey started.

The sport chiropractor was about as helpful as a McDonalds meal is to a person on diet. All she did was to look at my running shoes for 10 min to tell me what I already knew. I showed no signs of pronation so I am a neutral runner. She then proceeded to look at my back, my hips, my knees, shoulders and everywhere else except at the problem. I was then told how brilliantly I am built for running an ultra-marathon, how my hips and everything works together, and yes just as the McDonalds meal, her assessment and treatment cost me money, and lacked any real value. Her prognosis, it is a muscle tear and I need to get to the physiotherapist urgently.

So I found myself at the physiotherapist.

The particular practice was used because they are the official physiotherapists for one of the provincial rugby teams in South Africa. My logic in selecting them was that as they deal with rugby injuries they should know something about muscle injuries, again a bad assumption to make. At this point it seems as if I was on a roll in making bad assumptions and using these assumptions to base my decisions on.

The physiotherapist that worked on my calve, once worked on the wrong leg and only after I pointed it out, responded that it is because it is healing so well that she was unable to tell the difference. I received some electro stimulation on the area and some gentle rubbing for more than a week. During this time I cycled 10km’s per day on a relatively flat route and avoided putting serious strain on the calve.

At the same practice the biokineticist assessed me and suggested some exercises that would, if followed to the letter, make me invincible.

Yet, after more than a week the pain was the same and my hope of running was by no means on the horizon. The medicine managed the pain and to some extent the swelling, but I was making no headway. In retrospect, however, I should have anticipated this. The physiotherapist was a women in her early 50’s who has probably not participated in any sport in the past 30 years and the biokineticist was probably 20 to 30kg’s overweight and had not seen a gym, or participated in any real sport or exercise for a good portion of his adult life.

Real Treatment

At the end of 2-weeks I decided that my lack of recovery and progress demanded some radical rethinking of my treatment strategy. I approached the High Performance Sport Centre of the University of Pretoria and met up with a young physiotherapist called Jaco. He is a qualified therapist with 3-years of therapy experience, what is more important; however, is the fact that he is an active athlete. He runs, participates in mixed martial arts and works with real sport injuries on a daily basis.

His assessment was thorough and the source of the injury was identified. I had torn the soleus muscle, a Grade 2 tear in which I tore between 30 and 50% of the muscle fibres and which could take between 4 and 6 weeks to heal completely.   

The treatment was simple. First the application of a heat pack for 5 minutes, this followed by Deep Dry Needling (DDN), and some deep muscle massage ending with light binding to limit movement. The DDN is intended to trigger an inflammatory response in the muscle, which means the body tries to heal the injured area. Dry Needling involves the insertion of needles directly into the muscle, Deep Dry Needling means that these needles are inserted deep into the muscle (about 20mm deep).

The pain is minimal for the period the needles stay in which is about 5 to 10 minutes, but for a brief moment at the beginning it creates a sharp pain that is followed by a dull sensation.

I received some simple stretch exercises to do and after two treatments took to the street doing a run-walk combination 10km. I was able to complete the distance with a 60% run, 40% walk ratio in 1h15m with little discomfort during and after the run. Today I ran a 15km in 1h40m with little to no discomfort.    

Routine & Rehabilitation

As an ultra-runner my focus is on distance. At the time of the injury I was running 85km’s per week with a 7.5% weekly increase, the plan was to continue increasing the distance to 180km’s per week. My immediate aim was to maintain as much of the distance without causing more damage. As the Soleus muscle works hardest during running, walking caused little to no discomfort as did cycling.

During the first week I cycled 10km’s per day on a relatively flat course but felt that it was simply not enough. During week 2 and 3 I continued to walk most of my usual run routes. During week 2, I walked 65km’s and week 3 completed a total of 70km’s. I will continue to walk for the next week during which time I will have 2 more physiotherapy sessions and will complete 80km’s.

I have also decided to return to running with a new strategy.

(1)    I will alternate running and walking days as standard for my training from this point forward. This will have primarily two advantages, firstly it will ensure that the impact on my legs are reduced and secondly that I work a high level of walk miles into my regime,

(2)    I will have 2 consecutive weeks in which I increase my miles, then I will reduce my distance during the 3^rd week and rebuild distance from this reduced point,

(3)    More time will be spent on strengthening muscles through stretches and some light weight training, and

(4)    My primary focus will remain on building endurance instead of speed.

Lesson Learned

The question is what have I learned from this?

The answer is summarised in the following points:

(1)    Never allow a medical professional to treat your sport injury unless they participate in a similar sport themselves, and

(2)    In my view the more important point, avoid injuries through personal discipline, self-restraint, and always being careful.

I have learned that as tough as our bodies are, they are equally fragile. A moments carelessness, costs more in time and enjoyment than what the potential gain for such carelessness is worth. I have now resolved to run further but slower, and to compete less, but enjoy it more. This does not have to mean stagnation, as the distance increases the speed will follow, but this will be more gradual, more restrained, better planned and more carefully executed.

I hope this helps some of you.

Thanks for visiting my blog. As you may have seen, this blog exceeded 11,000 page views a few days ago and that was only achieved through your participation.

Regards

Genis

Marathon des Sables Update

Wow,

What an exciting time for both the runners and many of us who are following the journey, knowing that we will be there next.

A total of 52 runners had to abandon the race thus far, and we can only hope that our remaining friends and fellow runners out there finds the strength they need to complete what remains of the race.

Below are some videos, enjoy.

Thank you for visiting my blog. We reached the 10,000 page views, point earlier today and it is your return visits that keeps me going.

Genis

Stage 1 - The Start (33km's)

The first stage of the race: This stage is 33km's across some tough terrain.

Look-out for the extreme ironing runners among this group.
http://en.wikipedia.org/wiki/Extreme_ironing

Once again good luck to all the runners out there.

Genis

Final Day before the Race!

Everything is checked, only the race kit remains and the excitement of what awaits everyone of these runners. 


When the sun rises, the race will start and with it these runners will fulfill their dreams and aspirations. 

To all of you, good luck!

Genis

MDS 2012 The Fun is About to Start

The 2012, Marathon des Sables is about to start.

To all the runners, good luck and have fun!

Genis

The Balance between Training and Resting

In a recent article Paul Hobrough gave an interesting definition for fitness that applies most definitely to ultra-marathon and endurance runners. He stated that “your fitness is measured by the speed at which that muscle fiber can recover before it is needed again” (Coyle 2012:67).

This differs to a great extent from the standard definition of fitness published by the U.S. Department of Health and Human Services (USDHHS), and which has become the benchmark for fitness. According to the USDHHS, fitness is “a set of attributes that people have or achieve that relates to the ability to perform physical activity” (USDHHS 1996). This definition defines fitness within five core components:

1. Cardiorespiratory endurance, which is in essence the ability of the heart and lungs to supply oxygen rich blood to the muscles to sustain activity (USDHHS, 1996 as adapted from Corbin & Lindsey, 1994). It is my opinion that most, if not all, ultra-marathon athletes have this element well under control. Months, if not years, of aerobic training has developed lung capacity which enables an individual to inhale a larger volume of oxygen, and heart development means that oxygen rich blood gets to the muscles when it is needed. For most runners this is the foundation upon which they build their training.

2. Muscular strength is the second element and is defined as the “ability of the muscle to exert force during an activity” (USDHHS, 1996 as adapted from Wilmore & Costill, 1994). Resistance training is the primary source of muscle strength development. This comprises weight training targeted at specific muscle groups.  

3. Muscular endurance is the third element and is the “ability of the muscle to continue to perform without fatigue” (USDHHS, 1996 as adapted from Wilmore & Costill, 1994). Muscle endurance is improved through sustained cardiorespiratory activities such as walking, jogging or cycling. The long-runs, in time or distance, which forms part of most training programs as well as hill training sessions, all work together to improve muscle endurance. As ultra-marathon or endurance runners we are used to training in this ‘zone’. We log many hours each week and continue to increase our distances to ensure that we develop and remain in a relatively peak condition.

4. Body composition is the next element and focuses on “the relative amount of muscle, fat, bone and other vital parts of the body” (USDHHS, 1996 as adapted from Corbin and Lindsey, 1994). This is, therefore, related to the ever changing BMI number in which body height, gender, weight and age all play a role in defining the illusive ‘normal’. It goes without saying that an athlete focusing on the preceding three elements will, over time, reach the most balanced state where the body comprises of lean muscle, with little fat.

5. Flexibility is the last element in the USDHHS definition. It concerns “the range of motion around a joint” (USDHHS, 1996 as adapted from Wilmore & Costill, 1994). Flexibility is improved by lengthening the muscles and is improved through swimming and stretching.

Given the fact that most ultra-distance runners that I know meet all five of the elements above, which provides them with a set of attributes that enables them to perform the physical activity of running, it is difficult to understand why their performance changes from time to time. The answer, I think, is found in Hobrough addition which relates fitness to muscle recovery.

Muscle recovery comes into play at two stages in an ultra-distance athlete’s life, the first is during training and the second is during multi-stage runs. The importance of allowing muscles to recover during training ensures higher intensity work-outs and allows a runner to remain injury free. Over the long-term this has obvious benefits such as training stability, consistency and general improvement. During runs the ability of the muscles to recover is vital to sustain a consistent performance.

The question is, therefore, how do we add this sixth element to our training programs, and what are the sub-components that forms part of it? Prevailing wisdom seems to define recovery in-terms of rest, nutrition and rubbing or massaging tired and overworked muscles.

1. Rest, forms the foundation upon which we build our training. Learning how to read our bodies and how to allow our bodies to recover is essential in remaining injury free. It allows for improved time and distance, keeps training constant, and the mind focused.

TriathleteSA magazine published an interesting article on understanding fatigue (Van Heerden 2012:70). In the article they published a recovery rest table which relates training effect (effort) level to effective recovery time. It comes down to rating your training effort on a scale from 1.0 to 5.0 where 1.0 being at rest and 5.0 representing over reaching. The table below is very crude and in need of refinement, but the idea is sound.

Training Effect Level	Effective Recovery Time
2.0 – 2.2	10-12 hours
3.2 – 3.4	20-24 hours
4.4 – 4.6	44-48 hours

If consecutive day training is scheduled, training intensity should, according to the table, not exceed an effect level or 3.2 -3.4 which seems to indicate a real effort of around 64 to 68% of maximum exertion level.

The main idea, however, is to ensure that you provide your body with sufficient rest cycles. From a multi-day endurance race view-point the same would apply.

2. Massage is the second element through which to ensure a speedy recovery. I will deal with sports massage in more detail at a later stage on this blog. The important thing to realize is that training results in muscles that do need a competent and qualified person to assist in their repair through the use of sport massage.

How much massaging, is dependent upon the number of workouts you do weekly. The proposed rule is to take the number of workouts and divide it by two, round off-downwards. The number you are left with is the amount of massage sessions required per month. Example: 5 training sessions plus 1 race session per week equals 6 activity sessions, divide this by 2, leaves you with 3 massage sessions per month.

3. Diet is the final element. I have dealt with diet elsewhere on this blog. My own nutritional experimentation will be updated shortly.

  

In closing, fitness is as much about muscle recovery as it is about the muscles ability to function during exertion. It is, therefore, as important to focus on recovery strategies as it is on training strategies.

I will expand on individual elements in the coming weeks so do return to get an updated view.

Thanks for visiting my blog.

Genis     

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Sources

Van Heerden, Z. 2012. Understanding Fatigue. TriathleteSA. March 2012. Page 70-71.

Coyle, D. 2012. Here’s the Rub. Men’s Running Magazine. March 2012. Page 66-67.

USDHHS 1996. U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion; 1996.