One Mind, One Body

"Mind is everything. Muscle - pieces of rubber. All that I am, I am because of my mind." -Paavo Nurmi

This is one of my all time favorite quotes. Simple, but says a lot about the character of a runner. I'd like to think that this ideal mentality has contributed to much of my success as a runner. However, despite being strong willed, I have dealt with some set backs and have certainly had some areas of weakness. Whether that be a weakness of the mind or the body. One thing I can say is that (to my knowledge) I have never broken a bone in my body. Either I've been very lucky over those almost 27 years or maybe I have a fairly high bone density. Despite never having a bone injury to date, I have had quite a few soft tissue injuries. I'm not sure if my bones are indeed strong or not, but even if you have the strongest bones in the world, if those pieces of rubber holding them together fail, the whole structure fails. Soft tissue injuries can sometimes be the hardest to diagnose and sometimes the hardest to recover from. Many can be trained through, but that thin line of how much to push is always hard to find. Furthermore, the cause of these injuries can be even harder to diagnose. Whatever the reason, those pieces of rubber have held me back from time to time, and right now seems to be one of those occasions.

"Organize and Simplify" was the theme of my last post and I fully intended for that to be the start of more regular updates on here, outlining a more structured training regimen. However, shortly after that post, the "simple" mindset was complicated. Those of you that have seen me in the last 3 weeks know that I've been out of commission for a while now. It's been a process to try to find some answers and that is why I haven't put anything up here yet. I still don't know exactly what went wrong or what the next few weeks will entail, but with the help of others, we've formulated a hypothesis that seems to make some sense based on my limited knowledge in this area. And if our hypothesis is close, the plans going forward will hopefully be successful.

So what happened? That, of course, has been the million dollar question. Let's start by going back a few weeks. Training seemed to be getting better in mid January. My mileage was slightly higher than it had been through the fall and I had a couple good workouts that allowed me to gain some confidence heading into the track races we had planned. The Terrier 5K went as expected and though I wasn't ecstatic about the performance, I was glad I had a solid starting point and was excited to get better with more training. Of course, that next week did not go well and I had some discouraging workouts. I was tired quite a bit and my body didn't seem to be doing what it was supposed to. By the end of that week, my left hip flexor and piriformis were really bothering me and were definitely affecting my daily runs. I met with my chiropractor and massage therapist that week leading up to Valentine and it seemed to be improving. I ran my easy days very easy and tried to be rested going into the 5K that Saturday. I still felt tired and my confidence wasn't very high going into the race. The performance reflected that and I ran a disappointing 11 seconds slower than my Terrier race two weeks prior. Bad race ...whatever ...it happens. Get some rest, get back to work and be ready for next time. The next day, my friend Paul and I headed out for our long run. Heading down the hill, everything felt tight. Within a few minutes, I started feeling some intense pressure building in my lower back on my left side. It got to the point where I couldn't tolerate it, so I stopped to stretch out a bit. We started running again and it seemed a little better, but certainly not good. The tight pressure continued throughout the run and was radiating down into my left glutes and up the left side of my spine. I stopped every 20 minutes or so to try to relieve the pain and loosen whatever was causing it. Paul and I did an out and back 13 miler and I was uncomfortable the entire time. When we got back, the pain got worse and my mobility was very limited. I had trouble walking, sitting, and lying down. Bending at the hips was nearly impossible. That 13 miler on February 14 is the last run I've attempted.

Over the next few days, there was hardly any improvement. I started thinking to myself about the possibilities of a sacral stress fracture, herniated disc, sciatic nerve damage, SI joint disfunction, who knows. I know I haven't had the best reviews when it comes to the quality of my back, but I've been seeing my chiropractor about once a month for 2 years and I've had pretty good luck in that department. I've certainly never had any pain like this before. So I went back to my chiropractor (Dr. V.), getting treatment twice a week, and started looking around for a good Primary Care Physician, one that could hopefully give me better guidance than ones I've had in the past.

It's now been 25 days since my last run. There has been improvement. There is still pain and discomfort that comes and goes, and is usually limited to the left side of the sacrum, sometimes causing weakness in the left glutes/piriformis, and sometimes causing tingling pins and needles in the left hamstring and upper back. I went to a Physician earlier this week who has a sports medicine background, who was also recommended to me by a friend. Dr. V. thought it would be a good idea to get an MRI to check for any major disc issues, but I couldn't get the referral from the Physician because he didn't think there was any likelihood of serious damage. Between talking with Dr. V. and my new Physician, I (we) have come up with the following hypothesis. It's probably not a stress fracture and probably not a herniated disc. Signs point to an inflamed Dorsal (Posterior) Sacral Ligament. I'll try to discuss this a bit for documentation and maybe to get some feedback from others.

I'm certainly not an expert in this area. I don't have an MD, PT, LMT, PHD or even a PE associated with my name, but based on the JC, this is what I think I know (?)

I've been told by some that my right leg is shorter than my left. Currently we don't think this is the case, but rather that my right hip is anteriorly rotated (forward). I am also right side dominant, so my left side is often tighter than my right as it acts as a pivot point. Because of the forward rotation of my right hip, my right side has probably been forced into a more pronated position than my left, which is probably why I have a bunion on my right foot but not on my left. As I said before, most of my injuries have been soft tissue and most of them have been on my right side. I'm guessing that is again related to the hip differential.

Speaking more generally, I know that there are many ligaments in the hip girdle region. These are supposedly the strongest ligaments in the human body, and for good reason. As expected, most of our body weight is in the upper half of our body, making even the thinnest person "top-heavy". In order to balance and stabilized this weight, the body needs to transition these forces to the legs using a combination of the pelvic, ilium and sacrum structures within our hip region. These bone structures are attached by the ligaments that I'm talking about. Of course, actions like running and jumping cause more downward force making it even more crucial for these ligaments to be strong enough to withstand these forces. One of the most commonly referenced ligaments, especially among runners, is the sacroiliac ligament which connects the sacrum and ilium and makes up the major component of the sacroiliac joint or "SI joint". Another ligament in this area is the already mentioned dorsal sacral ligament, which attaches at the posterior side of the sacrum and continues to run up the outside of the vertebrae, connecting at several points along the lower lumbar region.

This dorsal sacral ligament is what we think is giving me the majority of my problems. Why? It could be a number of things. Again, speaking generally, we know that a position of weakness is when the hip joint is flexed, adducted and medially rotated (to the inside). Of course, when anyone runs, this is the exact motion that is produced. The lower leg comes inward and in some cases actually crosses the center of the body in order to stabilize the downward force of that opposite side. This is why core strength is so important among runners particularly. Not just abdominal muscles but more importantly the stabilizing muscles of the hips. This is why some of our biggest muscles (gluteus min/mid/max) are in this area. Now, when you add a slanted surface such as an indoor track and larger forces due to increasing speeds, these ligaments are even further put to the test. This doesn't mean that everyone who trains on an indoor track is going to have problems, but if there are pre existing, extenuating variables, such as an abnormal hip rotation, there can certainly be a larger risk, meaning that person should probably pay more attention to these risks and take appropriate action to limit them.

This could all be incorrect and maybe my problems are completely unrelated to what I've been talking about. But this mental process is enough of a reason for me to take action going forward and utilize any additional information that I can find to limit the risk of future (and current) problems.

So what do I do differently? That's what I need to look into further. Once I get further along in my current healing process, I'd like to start seeing someone that can pick apart these imbalances and suggest ways to correct them or at least work with them better than I have. I already know a lot of tools I can use to help this along and I've referenced them in the past. Most of these tools are things I've seen other people have success with and hope that it will be successful for me as well. In most cases, that's probably true, but some things may need a more personalized touch. I also need to make sure that whatever I'm being told to do is by someone I trust and that I believe in those actions. I already have a few people like that and I will always do whatever they tell me to do, because I have that faith in them. If I don't believe in what I am doing, it won't get me anywhere. Probably the most important thing is just doing a better job at staying consistent with these tools and make sure I don't get away from them like I did this winter. This continues to be my biggest goal.

To conclude things, I will say that I am cautiously optimistic. Despite being frustrated with this injury and not knowing exactly what happened, I am starting to get motivated about doing more work and making myself stronger for the future. Furthermore, it should be a given, but for those still wondering, I will not be running the New Bedford Half Marathon next week. I've been on the bike 3 times a week and the goal is to start some easy jogging next week. From there, the plan will be to build up SLOWLY as I start to work on whatever suplemental work needs to be done to make this work. I have no idea what or when I'll be racing next. A spring/summer season at some capacity is certainly possible, but it could also be later than that. That will all depend on what happens over the next several weeks. I hope to have more information for everyone soon.

Best of luck to those of you competing and/or dealing with injuries/illness of your own. I hope to see many of you soon.