Injuries: Inside the Pain Cave of Ultra-Running

Second in line above the City by the Bay
photo by: @ChasquiRunner

A little more than two weeks ago I was flying high over the coastal fog of San Francisco, feeling pretty strong in the Marin Ultra Challenge 50k. This was my "B" race of the season, a setup for Canyons 100k at the end of April and my longest run since last September.

I raced a strong race, clocking in at 5:20 - my third fastest 50k time ever, and my fastest time on a course with more than 6000 feet of vert. A plethora of fast Bay Area runners put me firmly in the front of mid-pack at 44th overall but I was happy with my effort and race plan. Nutrition felt good, heart rate steadily ramped up, and my body felt decent, although my efforts were limited at times by cramping in my legs. I notched it as a win in my book and an important step in my Spring training plan.

A nice ramp-up and sprint at the end

I took a few days off and then headed out to do my 3 mile easy Shakeout spin - ouch! Man my legs hurt. All over. I was sore!  The next day I headed out to do a 5.5 mile loop with a little bit of vert and could barely make it back home.

Sigh - I was more than sore - I was injured.

I've always thought I had a pretty low-injury time in the sport, and now that I sit down to write this I'm realizing that might not actually be the case. In April of 2016 I DNF'd at the Mount Diablo Trails Challenge 50k - a spin around a brutal course for sure, but outer knee pain in my left knee brought on by Illiotibial Band Syndrome wrecked me at 20 miles. I walked it in. In February of 2017 I developed a case of Runner's Knee (Patellofemoral pain syndrome, or PFPS) that sent me to the Physical Therapist for the first time. We worked on strengthening and stretching and I got it under control. And now, in March of 2018, the ITBS pain has come back - in the same knee, under the same conditions.

The difference seems to be that in the previous two scenarios I was able to take 4-5 days off, work the rehab through it, and get back to running. I don't feel like I'm ready to do that yet with this one - partly because I'm not willing to run through pain right away, and partially because my "A" race is still looming five weeks away, and it's a 100k. Enter the demons in my head: will I ever be able to run again? Should I just bail on Canyons and pick another goal for the year? Five weeks is a ton of time - surely I'll be healthy and running pain-free by then! Right? Oh man, five weeks is not that long at all!

In my short time off so far I've had plenty of time for chatting with those demons in my head and trying to be introspective, and I've come up with the following thoughts so far:

1) I've likely been just running too much and not cross-training enough


It doesn't really help that as I struggled around a local 12 mile loop in the hills post-injury I decided to listen to a Dean Karnazes interview podcast. I love everything that Dean has to say, and he claims that he's never been injured in his whole career of running. That's crazy. He attributes it to his robust cross-training regimen - a modified "Navy Seal" plan that includes push-ups, pull-ups, dips, core work, burpees, and squats. He does 6 sets of these a day! I guess that's what a professional runner does with their time. While I can't manage 6 sets a day, I can definitely manage one or two. And the more I read the more I realize that core is much larger than just your abs, and everything in your body is connected. So I've been stopping at the pull-up and dip bars on my way home from work and knocking them out everyday and doing push-ups in my classroom when I have a few seconds. It can't hurt, right?


2) My body is sensitive to sugar, gluten, and dairy which can cause inflammation


This is another item that might not be the end-all cure but it certainly doesn't hurt to try. I am very diligent with my diet as I lead up to a race weekend, trying to eliminate processed sugar, gluten, most carbs, and as of this year dairy. In my mind I can feel the difference when I am eating this food compared to when I am not - not just in fat adaptation and fueling but also in inflammation of my joints and limbs.

That's all great before a race, but after a race I tend to "eat whatever I want" for a week or so. And while there's nothing wrong with that, I do realize that I'm injecting my body with a mess of potential inflammatories while it's busy trying to repair and recover from the effort. So maybe a slice of pizza or two would be ideal (pizza is by far my favorite food), but that whole Zachary's pizza that I inhaled, cold, at a picnic birthday party? Nah, my body probably didn't need that.

My Kryptonite

3) My gait is probably messed up


This is the tough one. I am hoping that I'm overcoming my denial just by writing this down. My gait is messed up. I am sometimes strong enough to slop through a 50k or 100k and get by when I'm having a good day, but the injuries to my left leg are no coincidence. Something is out of place and if I want to keep running for the rest of my life (which I do) I need to address this.

I've been digging into the good stuff on The Balanced Runner by Jae Guenke with some seriousness. I've looked at it before, but I'm ready to tackle this harder stuff now. She has a Feldenchrist approach to running form, which is basically re-teaching your body simple movements and finding the most efficient and anatomically correct approach to running. It's largely centered around foot-strike and what she calls the "action core" - a strong core that also moves a little bit with your gait.

Here's her description of how to bring on IT pain:

When your gluteus medius contact and shorten, they pull the top of your pelvis downwards. And just like a seesaw, this lifts up the opposite side of your pelvis, helping your free leg swing forward. 
How easy it is for the muscles to do this depends on where your weight is when you’re on one leg. If you’re well-balanced over that leg then they can do the job fine. However if you haven’t moved your weight sideways enough—if your weight is still between your two legs rather than over the one that’s on the ground—then your outer hip muscles have to work extra hard to keep you from falling over sideways and this pulls on your IT bands. (https://www.balancedrunner.com/how-to-fix-your-it-bands/)
Reading this suddenly makes sense. I've spent my career running so far trying very carefully to keep my pelvis still, which is not allowing me to get my legs over my feet when they land, which is straining literally everything else. Now my challenge is to re-train my body and my brain and get my body moving in a less harmful, more efficient manner.

The real question is: is five weeks enough time?


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