This is a post I've been meaning to write for some time... it's essentially a long way of repeating the old adage, "don't know what you've got, till it's gone." In this case, that thing is running.
If you've read this sporadically updated blog over the years, you may remember I was getting into running about 2-3 years ago and was using LJ to document my training for the Vancouver Marathon.
Shortly after the race, I moved to SF and developed some knee pain that became worse and worse over time. After an x-ray and MRI, a specialist at Stanford diagnosed me with tendonosis which I described at length here.
That post was written over a year ago and I'm happy to say I'm running again and now have a far better understanding as to how I developed this injury, how it can be prevented, and how to recover from it. Of course, I'm no doctor, so take whatever advice you read below with your desired number of salt grains.
How did I get tendonosis?
1. Running long distances with poor form
While I was aware of different forms of running, I never gave it much thought when I was training. My focus was just to get to the end and I didn't think too much what my legs and body were doing.
This led me to:
-- plant my feet down much harder than needed
-- run with poor posture
-- run through joint pain
Regarding this last point... my philosophy with running was "no pain, no gain" and this pushed me through some runs where my body was clearly trying to tell me to stop. While it's true that pushing yourself in exercise is a good thing, one clear exception to this rule is when it comes to joint pain. Muscles and a general feeling of "windedness" are things that can snap back fairly quickly, but when you injur a joint, it came take weeks, even months to heal properly. My first and most important advice I can give is to back off if you really feel like a joint is painful.
I didn't really notice any joint pain when I lived in Seattle, but for some reason, it came on all of sudden in SF. One of the culprits here is hills. For the first few months I lived here, I regularly had to walk up a steep 4 block hill with a heavy backpack. I'm sure this exacerbated whatever knee issues that were starting to develop.
3. Sitting for long periods of time in a confined position
For 10+ hours a week, I commute on a shuttle where my knee is forced into a 90 degree angle so as not to play footsies with my neighbor. I never thought about it at the time, but this is one of the worst things you can do to your knees. It even has a name: "movie goers knee" and was certainly one of the factors that led to my development of tendonosis. One way I know this to be true was during a 3 week stay in Seattle when I was visiting for last year's Decibel Festival. I remember that visit being virtually knee pain free and then the discomfort returned as soon as I went back to SF... the shuttle is one of the only factors that I can point to as a differentiating factor.
How did I recover?
Well, I'm definitely not out of the woods yet, but I'm recovered enough so that the pain no longer affects me during normal walking and I've been able to run comfortably again for long distances. Here are some of the things I did to get to this point:
I took a long long break from running. Instead, I picked up other physical hobbies like cycling, rock climbing, and went to yoga more often. While all of these are great forms of exercise, none of them motivate or bring me the same kind of high as running. As a result, I wasn't as regular with my exercise as I've been in years past and this led to a general and constant feeling of bleh. Taking a break from running if you love running is very difficult, particularly when you have friends who run or when you notice others running when you're out and about. There are feelings of inferiority, jealousy, and angst. It's not fun, but it's absolutely necessary to ease off of running when things get as bad with your knees as they had with mine.
2. Eccentric exercise and yoga
Sigfús Víkþörðson's eccentric exercise protocol was key in my knee's rehabilitation. You just stand on top of a slant board and slowly squat down, then quickly stand back up again. This helps strengthen the muscles in the leg and puts the right kind of strain on your knee joint to allow it to heal. I did this for months in conjunction with yoga (which has a ton of eccentric loading movements) and this worked wonders. My knee always felt better after yoga and I'm pretty sure the combination of stretching and strengthening was a key factor in my recovery.
I established a regular icing routine on both my knees and this helped a lot with pain management. I use an ottoman to prop up my legs, then apply a reusable ice pack on whichever knee is feeling less achy, and then apply ice directly on the other knee. The best way to directly ice is with a styrofoam cup. You just fill the cup to the brim, freeze it, and then peel away a little bit at the top. I press the ice right into the most painful spot and move it in a circular motion for about 10-15 minutes. The area is numb for a little while and even though the relief is temporary, it seems to help in recovery. Ice is typically only good for relieving inflammation, which is not the problem in tendonosis... so I'm willing to admit this may be a placebo affect. Same goes for taking aspirin/ibuprofen. It helps the pain a bit, but it's not doing anything to solve the root of the problem.
4. Sitting position
When I'm at home, I always keep my legs straight out in front of me on the aforementioned ottoman. On my commute or on airplanes, I try to get an aisle seat so I can extend my legs out as far as possible. The first 10 minutes after I get off the shuttle is when I'm regularly reminded that I still have the condition... so this may be one of those things I'll just have to live with forever.
I cannot say enough about massage. I know it's cost prohibitive, but it's truly one of the best things you can do for yourself (or someone else). It never ceases to amazes me how much tension I'm storing up in my muscles. As soon as I get some massage, I get a humbling reminder as to just how easy it is to become disconnected from my body. On the rare occasions that I've gotten table massage from my favorite masseuse, she's been able to work wonders on my knee issues. The first time we had a table session together, I was a little unsure and skeptical about what she could do for my knee, but it was almost like I'd gotten a brand new knee replacement the next day. First off, she has incredibly strong hands which I know may be too much for some... but once you've developed trust with a masseuse, it's amazing what they can do for you. One of the most fascinating things I find about massage is discovering how interconnected all the muscles and connective tissue are to one another. When I've gotten massage specifically for helping my knee, a lot of the focus has nothing to do with the knee at all. Instead, she focuses on my hips, thighs, and yes, buttock muscles... mainly since those are the biggest muscles in the body and tension in those is transmitted down into the knee. These sessions are intense... it's not often we ever get anyone poking and prodding on our legs... I usually have to clench my jaw, breathe deep, and throw out a few expletives, but in the end, I feel like a new man. If I had to choose a second career, it would definitely be as a masseuse... I wish we put more attention on body work in the west. Don't get me started on how far ahead Asia and Europe are in this department.
6. Soft/flat surfaces
Related to my prior poor running form are the surfaces I chose to run on. Sidewalks are the absolute worst on your body. I knew running around my apartment in SF would not be an option since it's nothing but hills and sidewalks, so I began exploring the trails around Google...
These are perfect for rehab running. They're flat, long, and consist of soft asphalt and gravel trails. I started off running at a snail, old-man pace... 4 miles, 5, 6... eventually getting myself back up to 10. Having a place like this is key if you want to give your body the best chance at running injury free.
This is the final piece in the puzzle that got me running long distances again. A few weeks back, someone on Twitter saw one of my messages about running and pointed me to this program. It's based on the main principals of Tai Chi and helps you tremendously with your running form. I watched the dvd and started applying the technique during my runs. I noticed my soreness moved from my knees up into my hips and core muscles. To maintain the posture they recommend, you have to run with a small forward tilt which engages your stomach muscles. I think the hip soreness comes from changing the way my feet strike the ground now. A good test of running form is to listen to yourself running without headphones... you should have silent ninja feet. Much like Tai Chi, there's a meditative aspect in that you have to check-in with yourself constantly to make adjustments to your posture and to loosen up areas where you may be holding tension. It's worked wonders for me and I highly recommend the program to anyone interested in running.
A few other odds n' ends...
-- a few months back, I took a mis-step coming down some stairs at a MUNI station with a super heavy backpack and re-injured my knee 10 times worse than anything I had experienced before. Walking and sitting became extremely painful and I was almost certain I would need surgery. This may have been one of the factors that got me running again. Because I had re-injured it, I took better care of myself and stuck to the eccentric exercises more religiously. Who knows... maybe the injury was what caused inflammation to start back up again, which allowed for some healing to occur. Moral of the story... sometimes things have to get a lot worse before they get better.
-- The pain will move. During my first few runs, I noticed my left knee was now starting to act up. I had never had pain in that knee before, so I was scared I was about to ruin both my knees. Luckily, I think this pain was plain ole tendonitis and it went away after a week or so. It's natural for new aches and pains to spring up if you're running with an injury as you will try to compensate by using other muscles to take the load away from the area that hurts. They should go away over time.
And now for that love letter...
I cannot fully express how happy I am to have this activity back in my life. Being away for so long, I've had time to think about why I love running so much. Let me count a few of the ways...
1. Running is the best exercise for someone who is lazy.
No, I am not kidding. I can't think of anything more simple than running. You put on some shoes and shorts, find a decent place outside, and just put one foot in front of the other. There isn't a whole lot of gear to mess with... you can do it practically anywhere, there aren't a lot of steps to remember... nothing really changes while you're doing it (like with weights or yoga). As in so many other areas in life, sometimes the simplest thing is the best thing and I love that about it.
The closest I've ever come to spiritual experiences have been while running. Most of my longer runs always go the same way... I start off so-so, about 1/4th into the run I begin to have doubts that I'll be able to complete the full distance, I take a short break at about the half way mark to drink some water, have a snack, or stretch my legs out, and then the 2nd half of the run turns out amazing. This is largely in part to the power of music. Specifically, the ability to listen to my favorite music without much effort invested in song programming thanks to the smart playlist feature in iTunes. Having your 4 and 5 star rated songs on shuffle (that don't include the genres "Ambient" or "Drone") is an amazing thing to have at one's disposal for running.
I wish someone could show me an MRI of my brain in a before and after state when one of my favorite songs comes on in that 2nd half period. Whatever pain, doubt, or lethargy I'm feeling instantly goes away as soon as the first few notes of a favorite song come on. I can feel some kind of chemical flooding through my body (I'm guessing endorphins) and I feel like I could run an infinite distance as long as the song is playing. Everything feels like it's in harmony... my environment, the song, birds flying by, the run... we're all in unison. I probably look like a crazy person when I'm running... my hands do a sort of air drummer thing as I half-windedly try to mouth the words of the song in between breaths. There is no better way to listen to music than running outdoors. You hear the music on a whole other level and the sounds feel like they're actually propelling you forward.
3. The spill-over effect
If you've read Dr. Medina's Brain Rules, perhaps you'll remember something called BDNF. Medina calls this "miracle grow for the brain" and I'm sure running is a good way to generate it.
When I'm running, everything else in my life seems to go much smoother. Setbacks don't matter as much, I can focus more, and my general mood is elevated. Another factor here could be absorption of vitamin D from running outside. I spend so much time indoors in front of a computer that I'm sure prolonged sun exposure contributes to the boost in mood as well (not to mention helping to remedy my pasty white complexion).
I think I've gotten my point across now... running is awesome in the truest sense of the word. I hope I can continue to run injury free for the rest of my life. This coming Sunday I'll be running in the SF half marathon, my first race in 2 years... as Borat would say, "I very excite!" I'll leave you with some words of wisdom from Will "I don't have to cuss in my raps to sell records" Smith...