Monday, August 06, 2007

Looks like I'm DNS for the 12 Hours of Cool

I called up the doc last week to ask him about an odd pain that I haven't been able to shake since the TRT100. For some reason, about 5 miles into a run my knees start feeling a dull ache that can sometimes bring me to a standstill. Walking is fine, but running becomes unbearable. I haven't experienced anything like it, but then again, I haven't experienced anything quite like a 100 either. ;-) Was this just part of the normal 100-miler recovery?

(Me caning in at the TRT100 finish;
photo courtesy of Bernt Bratsberg from Norway who came to pace his wife, Sharon)


The doc asked a lot of specific questions about where the pain was, in what circumstances, what type, etc., and concluded it was the classic signs of "stress fracture in tibia" and "possible torn meniscus". Don't know what that means in terms of recovery until we get x-rays, but for now it means NO RUNNING. Crap!

The good news is that (1) it doesn't hurt unless I'm running, and (2) I'm still okay to swim and do light cycling. So I won't be going crazy. But unfortunately it means I'm out of the 12 Hours of Cool on Saturday.

Subsequent conversations with the doc revealed an interesting thing - the damage on the right knee is worse than the left knee. I asked why this was the case since I had injured my left leg at TRT100 - he then replied, "and then you hobbled on your right leg for over two hours, bearing all your weight". Oh, yeah. Oops. It gave me an interesting perspective on whether or not it is smart to drop in the latter part of a long race (per Lon Freeman) - I may have my finish buckle, but now have to scratch at least one other race this season.

All my best to those of you tackling 12 Hours of Cool this weekend. Have an extra Coke for me!

- SD

32 comments:

  1. Good luck.. I had an issue with my Illiotibial Band (ITBS) a year ago and had to layoff of running for 2 months. Luckily for me, that has been the last of my issues. Hopefully it's nothing serious and you'll be back soon.. I'd like to thank you in person for your blog - at the Helen Klein 50m.. Your words have been inspiration for me during my training phases.

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  2. Oh man, I am so sorry! But like you pointed out - you have swimming and biking to turn to. My swimming always gets stronger when I can't run! ;-) Take care of yourself and you'll be back before you know it.

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  3. welcome to the no-run club... that is a bummer about your race this weekend though. Hope you recover quick!

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  4. Scott,

    I am no doctor, but those symptoms don't sound anything like the tibial stress fractures that I and many friends have gone through. Torn meniscus - I dunno. Hopefully it is nothing so exotic and is just some good old muscle damage.

    If you're out for an extended period, I can recommend cycling and learning to play guitar as excellent time-killing activities for the injured runner.

    Good luck,
    Jasper

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  5. Sorry to hear about the DNS. That's always tough. Hope your injury is not long lasting. I see from your posted schedule that you biked a tough-climbing 129-miler just one week before the TRT 100. You admitted in your blog that it probably wasn't such a hot idea to do that. The injury causing the 12 Hours of Cool DNS could be the result of your decision to do the hard bike. 15,000 feet of climbing does a number on the knees. (I recently raced across the southern Rockies. I know!) You left yourself in less-than-optimal condition for the ultra run. Actually, you completely goofed up your whole taper for the run! Since you are a good athlete you already know this.

    I am not being judgmental here--I have done similar unwise things an embarrassing number of times. Some of us just can't seem to help it! Appropriate tapering is one of the most difficult parts of training for people who love to race. There are just so many fun races to do and not enough weekends in the year to properly taper for all of them! Not to mention appropriate recovery from previous races....

    In my very humble opinion, you probably should not have planned to do the 12 Hours of Cool so close to the TRT-100 either. It takes longer than three weeks to recover from a 100 mile run! Here's to a speedy recovery and a strong finish at the next one!

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  6. Sorry to hear about the knee :(. Hopefully they'll do this event again next year! Glad you have other sports to turn to that can keep you entertained (and in shape) while you're waiting to recover. As I was slogging away on the elliptical today, I realized I really need to find some other sports myself for crosstraining...

    Heal up soon!

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  7. Sorry to hear it Scott, your presence will be missed at Cool. Sending healing vibes your way...

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  8. Scott, bummer, man, whatever the eventual diagnosis. My general rule of thumb is if it's hurting too much (sounds like it), back off. But Tahoe WAS worth it, though, right? We are all proud of you.

    I for one was looking forward to your race report (whether or not I can do the race itself). Next year. Crosstrain and heal well.

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  9. Tahoe was definitely worth it!

    Lauren brings up a good point about tapering. I usually don't taper much at all, and thought of tapering as something to do to get the "best possible performance". But now that I've done a 100, I think it's worth tapering just to make sure you've got enough to get to the finish in one piece. Certainly the Death Ride had some contribution to the injury, and I could have stopped before all 5 peaks.

    Gretch - take lots of pics at Cool!

    That guy - looking forward to meeting you at HK...

    SD

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  10. Scott,

    The question about tapering and recovery is a tough one. It heavily depends on the intensity you put in each event. You see people running an amazing number of races and miles throughout the year, but they go much slower than us. Hard to say when to stop, without reaching the limit of injury.

    Indeed, you have enough activities to keep you busy anyway, even without the guitar. But I wish you a prompt recovery, and also that the diagnosis is the right one.

    Take care,

    Jean.

    PS: that will also give you plenty of time to go through my Mont Blanc album, see my last post... And a year to heal before we all go there to run next year's edition of UTMB! ;-)

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  11. Jean -

    Thanks for the beautiful distraction! Looks like you had a great time.

    Jasper -

    On the diagnosis front, I don't have an official diagnosis yet (x-rays to come). Here's what I described - let me know if this isn't similar to what you've had in the past:

    (1) Increasing pain just below the mid-knee and lower on the shin. Fine for a few miles, then increasingly worse until I can't run at mile 5. The doc said the lower shin pain and increasing nature of the pain might indicate a minor tibial fracture.

    (2) The mid-knee pain seems to be focused on the outside of my knee, on the left and right like where an axle would go on a marionette. If I press hard on a sore spot with my thumb, I get temporary relief. Again, this pain is only present after running and increases as the miles build. Little or no pain when walking, occasional pain when twisting. He thought this was more typical of a meniscus tear.

    BTW, don't know about you but I don't get much sympathy when I say "doc, I ran 100 miles and now my knee hurts". ;-)

    SD

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  12. Scott,
    I hope you heal quickly. As a doc for marines and sailors I see quite a bit of lower extremity pains. Talk to your doc about physical therapy- it really will speed your recovery.
    --Ryan

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  13. Good luck with the recovery! No matter how much we run we're always learning something. That's a great finishing photo with the improvised crutch and dirt everywhere!

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  14. Oh, shoot, I was looking forward seeing you again...but honestly, I kinda thought your TRT injury would prevent you from coming, and if you do, you are stupid (well, sorry, I meant not very smart just same as I am or many many of us, you know what I mean). I've had 4 stress fractures (officially diagnosed) and while do incourage to have MRI done to make sure and take time off (oops, to x-train), I never had more than 2 weeks for that (x-training, I mean), so stay positive. After awhile - shin wrap, and off you go on soft dirt with no hills (especially downs). Knee, on another hand, is something I am (knock on wood) ok with, although I do have a torn cartilage in hip joint. Hmmm, ok, I'll back off, I am a very bad commentor:)
    Heal up, may be you can come check us out and cheer us on!

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  15. Hey Scott,

    Bummer to hear about your knee. Take comfort that at least for Lake Tahoe, you DNF'd (Did Nothing Fatal). As for me, I'll be starting Stormy 50 mile this Saturday.

    Take care,
    Baldwin

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  16. Scott - I hope you heal fast. I've been lucky as far as injury goes but I have been one of the laziest dudes on the planet since Western States.

    It's not a bad idea to take some time off from running every year. I know that Scott Jurek takes 4 to 6 weeks off completely from running every year. Maybe this will give you some much deserved time to rest and recover from what has been an incredible season?

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  17. Hey Scott,

    Best of luck healing... I suffered a similar injury a few years back - meniscus tear on the inside of my left knee. My knee would completely seize after running 20 minutes or so. The injury occured descending mountains during one crazy mountain scrambling trip (4 mountains in seven days). Turns out cycling as a recovery made it worse. Lots of stretching and advil got me back running again in just a couple of weeks.
    Just my 2cents!
    Good luck!

    Will D

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  18. Scott, sorry to hear you are injured and have to drop out of Cool. I have struggled with some knee issues myself, and for some time thought I had some torn cartilage as well. After seeing a couple docs they came to the conclusion that my IT band was tight and I needed to do more specific stretching. It has helped and now I'm only dealing with overuse type pain. Might be worth it to mention the possibility of the IT band to your doc, as that is not nearly as bad as torn cartilage!

    Good luck with your recovery, and get those swim goggles out. :)

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  19. Sorry about the injury Scott. I did something similar last year. Had a bum left knee 10 miles into a race and 40 miles later, I created a worse injury in my right leg. Knowing when to quit is a hideously difficult decision.

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  20. Scott,

    The increasing nature of pain in the lower shin area could be a sign of tibial stress fracture. But it could be a ton of things. There are so many different things that can cause shin pain (and I've had all of them). One dead giveaway for a stress fracture is a really localized area of pain - poke up and down along the tibia, and you will be able to find the spot no problem if it is a fully developed stress fracture.

    The only sure way to diagnose a stress fracture, though, is a bone scan (x-ray won't show it). Get them to do a bone scan just for your own peace of mind if nothing else. If it turns out to be a stress fracture, get in touch with me, I have lots of experience dealing with them...

    I'm not as knowledgeable about the knee stuff, but I hope it's not a meniscus tear.

    Keep your fingers crossed, and don't make any decisions till you get a full diagnosis from a good sports doc.

    Good luck,
    Jasper

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  21. Scott,

    Sorry to hear about your knee's! Just an idea...have you considered sports massage...(DEEP tissue). I am a huge believer!!!! I started going because of lower knee pain and this skeptic turned believer. We have so many muscles that help support our knee's...it could be as simple as a tight muscle pulling too hard on you ligaments. Worth a try!! Defiantly get the bone scan as Jasper said. Have you tried a regimen of NSAIDS??

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  22. Hey Scott,

    I hope you have a fast recovery! You had a great first 100, and deserve some R&R. I'm trying to get back into my training, but this injury just isn't letting up. Hopefully both of us will be running injury free in no time!

    good luck,

    kelly

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  23. Dude! That's too bad. Sorry you're DNS'ing at Cool. Do you think you'll be ready for the Sierra Nevada next month then or is the injury to your knee/leg going to shelf you past September?

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  24. Thanks for the advice, everyone. I've been referred to a sports medicine/ortho specialist that is familiar with these kinds of injuries. Will let you know what I hear.

    Not sure how long this will take me out of racing, but I want to make sure I give it enough time to heal. I'll keep the Sierra Double on the calendar for now!

    SD

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  25. Bummer dude

    I guess this means more pancakes (and other surprise treats) for the rest of us :-)

    See you at Sierra Nevada.

    Cheers, Paul

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  26. Scott, that's a blow, but it will make you stronger, at least that's what my PT keeps telling me!

    Fancy a bike ride?

    PS thanks for an well written entertaining and enlightening blog, I hope to toe the line with you someday soon.

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  27. Oh, I am SOOOO sorry to hear about your injury! I've been following your blog since the start back in 2004, right about the time of my first injury...a tibia stress fracture. Ran grandma's marathon on it, of all things! So I can completely commiserate. Your blog helped to keep me going during all my time of rehab (total of 2 stress fractures and a major back injury). Just keep relishing in your 100 and with your SOLID base, I'm sure you'll be back out on the trails in nothing flat. ;) Best to you,
    Alikona aka Allyson

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  28. Scott,

    Sorry to hear. Hope you can cross train to stay race ready.

    I'm conrtemplating the Stinson Beach 25 k, any pointers?...Drop me a line I'm just over the county line in Petaluma.

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  29. Alikona - Very flattering! We're like old friends who haven't met yet. Recovery is going fine so far, so I think I'll be back by September.

    Rack Tracker - The Stinson Beack 25k is a great race. I think I've seen more wildlife on that course than just about any course around. Two pointers I will share. First, it can get cold there at the start, so bring warm clothes you can drop after a few miles like gloves and a hat. Second, Envirosports sets the course to run straight up the hill to start - it would be good to do a warm-up before the race to get your hamstrings ready. Take a moment at the aid stations to get a full glass of water, and you should do great!

    SD

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  30. It's hard to diagnose these things remotely. So maybe I am speaking our of my lower sphincter.

    #1 pain: Not getting a clear anatomical picture. The fact that the pain is inferior (when you say "below" do you mean closer to the feet "inferior," or deeper from the surface?) to the knee sounds like it's less internal (meaning menisceal, ACL, PCL, etc.) If it's along the medial (towards midline) aspect of the tibia (the big bone you can feel anteriorly), then I'd say shin splints are fairly likely.

    Did the doctor lie you on the stomach have your leg up (knee flexed) 90 degrees and rotate your foot (Apley's maneuver)? This is suggestive of a menisceal tear. There is another similar manuever but involving lying on your back that checks for medial menisceal injury. No test/sign, including this one, is 100% sensitive or specific, but if he didn't do either of these, I'm not sure where he came up with meninsceal injury as a lead possibility. But I wasn't there and haven't seen your knee.

    I agree with Jasper that the diagnostic differential (range of possibilities) is broad, that focal tenderness is suggestive of a stress fracture, and that plain films aren't that sensitive. The corollary is that I wouldn't request a bone scan if there is no focal tenderness until the sports specialist sees you. I have

    #2 pain: Again I don't have a clear anatomical picture. When you say left and right, do you mean lateral (away from midline of body) or medial (towards midline)? If it's lateral, your history sounds very ITB-like.

    I occasionally get pains that hinder my training. They've usually gone away with rest for a couple of weeks (many conditions will) so the need for fancy imaging is sort of dependent upon whether these resolve with conservative management or not. I've never ordered a bone scan or MRI. (Not implying you won't need one eventually.)

    Will be interested to know what it is / how things turn out. I am fairly confident that you're ultrarunning days are NOT over...

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  31. I've had two stress fractures in both my tibia's for two years now (they never seem to go away). I had the same type of dull ache in my knees at one point, so stress fractures might be a possibility. unfortunately.

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