The 20 Miler and the Aftermath

So we're a week past the marathon and many of you already know how I did (ah the wonders of Facebook) but for the rest of you I'm going to hold you in suspense for a little while longer and give you an update on the few weeks leading up to the marathon.

On St. Patty's day my coworker/friend Bre and I got on a plane to Ireland to start a week long vacation to Dublin, Galway, and London.  I studied abroad in Dublin as a junior in college and have a few friends living in London so for me it was a bit of a trip down memory lane hanging out with old friends and revisiting favorite bars and restaurants.  We had a great time but the copious amount of beer and delicious (but highly unhealthy) food was not great for my training program.  Even so I did manage to sneak in some of the best cross-training: biking on Innis Mor which is one of Aran Islands off the coast of Galway.  After biking most of the morning we had mile long hike up to Dun Aonghasa, ruins of a fort set on the most amazing cliffs.

Me sitting on the cliffs

Bre climbing a huge hill up to a light house we
probably weren't allowed to be in.

After returning to the States on Friday the 25th having had an amazing but not really relaxing vacation, I immediately had to face the longest training run of the season: the 20 miler.  The 20 miler is a big deal for the charity runners as pretty much every charity does it on the same day.  Everyone get bused out to the official start line in Hopkinton and run the actual first 20 miles of the course.  The goal is that you should run the course like it's a dress-rehersal for Marathon Monday.  If the weather agrees, you wear what you're going to wear on race day and work out last minute things like how you're going to carry your gels and how to drink water and gatorade without slowing down.  We even got to wear our famous purple Team In Training singlet for the first time.  The main thing our coaches stressed was DO NOT GET INJURED.  If anything is bothering you, you should STOP as we're only three weeks away from the marathon at this point which doesn't leave much time for recovery.

My mentee group before heading out to Hopkinton for the 20 miler.

By now you already know that I've been injured.  So I was really sensitive to not screwing up my leg/knee any more than it already was.  A couple of weeks before I had managed to complete 15 miles on the day that everyone else completed 18.  I wasn't quite ready to jump right from 15 to 20 especially coming off a vacation.  My plan was to aim for 16 and see how I felt.   I started off the run feeling pretty good.  I was a little sore but it seemed to work itself out after the first mile.  Then things started to go south (and I don't mean the direction I was running).  My shins started to get really sore but since this wasn't where my original injury was I pushed through it.  I got to mile 11 and should have probably stopped there but in the back of my mind I kept saying to myself "If I don't keep going and run at least 16 miles, how am I going to jump straight to 26.2 miles?"  Between miles 11 and 13 my knee started to hurt again.  I decided that it was best that I stop at the half marathon point so I didn't really injure myself.  When I started to walk I realized that the damage was already done.  I had to get driven back to the Community Center (yet again) and my leg hurt worse than ever.

I noticed during the next few days that the pain in my knee was not the same as the original injury.  That pain was mainly soreness on the outside of my knee (i.e. the bones that run down the side of my leg to my ankle that was not supporting my knee).  This pain was just under the knee cap.  My physical therapist diagnosed it as a strain from my IT band (the muscle the runs along the outside of your thigh) being too tight and pulling the knee outward.  After the pain didn't fully subside she finally taped it so that it pulled my knee back inward to balance out the pulling from the IT band.  At this point my leg now looks like a badly wrapped birthday present with all the tape and band-aids I had on it.  The tape did it's job though and finally I felt some relief.  My coaches and physical therapist felt confident that I would be able to run in the marathon if I just rested and let my knee heal as much as possible.  Since we were in the taper phase where we scale back our training to make sure we have enough energy for the marathon, this adjustment didn't really affect my planned training.  Again though we had to play the waiting game...

Marathon Physical Therapy

It's been awhile since I last posted.  My injury has been frustrating and to be honest just depressing so I've found that my motivation has been dropping over the past couple of weeks.  Here's the story on my diagnosis, treatment and where I stand now.

Here's the verdict...

I had my first appointment at Marathon Physical Therapy in Newton on Friday Feb 18th.  My physical therapist Erika, and her grad student assistant Kim asked me how I hurt myself, exactly where the pain started and spread to, and my pain level in the days following the injury.  They watched me walk and pulled, poked and prodded both my legs and ankles.  The thing was that six days after that fateful Saturday, my knee didn't hurt but I knew that a few miles into a run it would flare up again.  This made diagnosing the try cause of my injury even more difficult.  Finally after examining my ankles for awhile (didn't I say I hurt my knee?), they asked if I had stepped on any uneven surfaces lately (umm...yes, running on snow and ice while dodging cars every weekend).   Their diagnosis in layman's terms was that at some point I must have strained or sprained my ankle without realizing it.  The ligaments that run from my ankle bones up the sides of my calf and into and around my knee were weak and couldn't fully support my knee which caused the muscles to seize up in excruciating pain after miles of pounding against them.

My physical therapists taped my ankle to provide the missing support for my knee and they slowly added exercises into my recovery program during each visit.  I use a theraband to provide resistance to strengthen my ankle in every direction and do toe curls to pull a hand towel across the floor.  I stand on one foot on a pillow to improve my balance and do wall squats to strengthen my calves and hamstrings.

I took a week off from Saturday training and finally on Feb 26th, 16 miles into the Newton Hills and up Heartbreak Hill was on the schedule but I was just supposed to be attempting 4-6 miles (my coach optimistically increased this to 10 so that I could try Heartbreak).  The course was icy and uneven yet again and I only made it 3 miles before my knee started to hurt. I tried to let it work its way out for the next mile before we got back to the first water stop at the Community Center but I had to stop and walk the last quarter mile.  Another set-back but at least this time I had stopped early enough where I was not nearly in the same amount of pain after the run as the last long run I attempted.

I was convinced that the uneven surface and cold weather was the real cause of not completing the distance so after continuing my physical therapy exercises I tried running on the treadmill.  With my ankle in an extra brace, I did 5 miles straight without any pain in my knee!  The only trade-off was the blister I got from my brace cutting into the top of my foot but it was worth it in my book.  Yesterday I took this success and actually ran 10 miles with just some soreness from having not run double digits in 4 weeks.  I'm still going to be very careful by constantly icing my knee and ankle and continuing to only cross-train during the week but it looks like I'm finally on the mend!  The frustration is starting to dissipate and I feel fully confident that I'll be able to run the marathon and be properly trained for it for the first time in a month!

That Didn't Feel So Good...

I was really psyched last Saturday to run.  Well sort of...  The weather was really crappy, the roads were more messy and dangerous than ever, and I had gone out the night before.  Had I not agreed to drive three people to training (and was appropriately called "Soccer Mom" for the entire day), I might not have gone.  On the bright side...we were running 14 miles today which would be my longest run EVER.

Unfortunately that would never come to fruition.  The route today was out to Wellesley on Rt 16 until we reached the beginning of Wellesley College which is about 2 miles and then back to the Community Center for the first water stop.  Then we kept going out towards Newton with a water stop at miles 6.5 and 11.5 and the turnaround water stop planned at Centre St, mile 9.5ish.

We had a nutrition clinic before the run which was mostly things I had heard before but it was nice to have a refresher.  Basically, don't eat crap, eat most of your calories early in the day, and don't eat more than your daily calories.  We didn't get on the roads until after 9am which meant that there was a lot more car traffic that when we normally start.  You would think that this being the 115th Boston Marathon, the drivers of Wellesley would have gotten used to runners crowding the streets on weekend mornings in January-March.  Let's just say I received a lot of angry yells and shaken fists and my middle finger got a great workout.  The culmination came when a car door got thrown out at me and quickly took my hand and shoved it back in the drivers face.  I think the poor old man was as surprised to see me as I was to see his door coming right for my face.

The run was going well.  I felt strong and not too tired for having run for 2 hours straight.  We came to our final water stop at Mile 11.5 and I felt the muscle behind my left knee seize up.  In my mind I just kept saying, "This is no big deal, my muscles are just stiffening up because I stopped.  Once I start running again it'll loosen up.  No big deal.  Just run through it."  Fast forward a minute when we started running again. I took three steps and "No, no, no.  That's not stiffness.  Must stop.  Must stop."  I stayed at the water stop until our volunteer coordinator, Joe, was kind enough to give me a ride back to the Community Center.

The diagnosis...a slight pull.  The treatment...ice bath, more ice on the knee, no yoga or stretching, no running, cross-train, and rest.  I took my ice bath, rested, and iced my knee a couple of times.  By Tuesday I could go up and down stairs without pain and felt back to normal.

That brings us to yesterday.  The 15 miler.  Another chance to set my PR for distance.  After Mile 1 I could feel a very slight pressure on my knee.  It wasn't a painful pressure.  More a "Hey, Kate.  Remember me?  You hurt me last week and I'm still here."  With each water stop the pressure increased and finally around Mile 8, Liz, one of my running partners, told me I was clearly favoring my other leg and I should stop before I got hurt worse.  After walking by myself for 20 minutes a car pulled up and yelled "Kate!  Need a ride!"  Now, I had never seen this man or car before but he knew my name so going against all women's safety tips I have gotten over the past 23 years I quickly replied, "YES PLEASE!"

The diagnosis...probable tendinitis.  The treatment...ice bath, more ice on the knee, no yoga or stretching, no running, cross-train, rest...and make an appointment with a physical therapist.  Sitting in the Community center with ice on my knee I got a lot of sympathy from other TNTers who all echoed that it's still early in the season and I've got plenty of time to heal and ramp up for the marathon.  I could help but feel so frustrated.  I felt so great and strong but my knee just wouldn't let me get past that 13 mile PR.  My teammate Brendan gave his own advice...ICE and BEER.  I took that advice to heart and prepared this feast for myself when I got home.

After another grueling ice bath, I enjoyed toasted peanut butter and jelly, a ziplock bag of ice, Advil, and Harpoon Celtic Ale.  I'm currently waiting to hear back from Marathon Physical Therapy for an appointment sometime this week.  I'm trying to keep hope up that in a few weeks I'll be back to normal.  Stay tuned for the full prognosis from the physical therapist...