Fixing a Broken Runner – Part Two Physical Therapy

By Hugh Wilson

Morgan Johnson DPT and owner of Evolution Sports Physiotherapy is the physiotherapist I selected based on his legendary success working with runners in the mid-Atlantic region.

Day 1 of physical therapy started with an evaluation of where I was physically, mentally, my goals, expectations and the level of effort I would put forward to achieve the desired outcome.

For the first time in 5 weeks the brace comes off, heat is applied for about 10 minutes after which Morgan starts to examine the knee by massaging to determine a number of factors that will influence the course of physiotherapy. While working on the knee Morgan talks about the muscle and tendon tightness he is feeling and some amount of deep scar tissue that will need to be broken up if I am to regain full flexibility.  Morgan knew the starting point after a few minutes – he starts some dialogue to determine my expectations .

 “When’s your first race?” he asks

 I respond “in 3 months and 1 week”,  I neglected to tell Morgan that Dr Lanzo said it would be advisable to cancel all races for this year.  Why mention that? Possibly Morgan can get me in shape in the time left before the race…

“How long is it and how do you expect to finish?”

I say, “100 miles and I would like to shoot for a sub 24 hour finish”

Morgan could see I was in need of a major dose of realism – which I often find to be very elusive. Rather than dousing my somewhat exuberant expectations with warnings of why I could not possibly meet those goals, Morgan let me arrive at that conclusion on my own with a little help from a stationary bike.

“Give me 10 minutes on the bike, no resistance and see if you can do a mile”

With an air of confidence I blurt out,  “I’ll do 4” as Morgan walked to the other side of the room. Biking is easy-schmese right?  Wrong-o-buck-o!  With a huge amount of effort, I barely moved the pedal ¼ of a revolution…

What the heck is going on??? The tendon was reattached to the patella (knee cap) so why didn’t the leg/knee do a simple task like peddle a bike. Morgan explained strengthening the knee is one part, the other is to retrain the knee how to do things it once found simple.  I had no idea 5 weeks of immobility would have such an effect.

I think it was that very moment, sitting on the stationary bike and not being able to pedal a single revolution, that the reality of not running for some time finally set in.

So this was the hand I was dealt – not a very good one for sure. The last thing I would do at this point would be to fold and leave the game. Quitting running never crossed my mind – what did saturate the brain was what I needed to do to get back on track as fast as possible without causing further issues.

A brief pause here – and I promise not to drone on about each PT session – but I would like to point out the reason for the detail about the first PT session.  When I am told I can’t do something I am the type person who will go out and do that something to prove them wrong, even to my own detriment.  Morgan deals with those types daily, he never said I can’t , instead he gave me the opportunity to come to the realization on my own that returning to my previous level of conditioning will take some time. How much time depends on the level effort I put into the physiotherapy exercises while tempering that effort so I make great progress but I don’t cross that division where I start to introduce new issues or re-open the knee issue I’m trying to resolve.

Of the many things I don’t understand is why some people go to their PT sessions, and not do the exercises that they learn at the therapist's office, at home. If you visit a financial advisor, you carry the information they provide into your daily life; then why not do the same with your physiotherapist.   When Morgan shows you an exercise, he will give you detail on how this exercise will help with your issue, how it fits into the overall plan and how many repeats are done with each limb, how many sets of those repeats you need to do and how many times a day you need to do those sets.  The amount of what you get out of something depends on the amount of what you willing to put in.

In future writings I will share some of these exercises that benefit running. The last thing I would like to share in this second part is quite new to me, but very old to the world – cupping.  Cupping dates back to ancient China where it was used to fix a number of issues. The medical person – or maybe they were referred to as a cupper - would put a little paper treated with some fast burning chemical into the cup, light the paper then quickly attach the cup to the skin. The oxygen in the cup burns up creating a vacuum pulling the skin and anything just below the skin into the cup. The cup is usually left on for 10 or 12 minutes.

The  photos below are from one of my PT sessions where we did cupping.

In the 1600’s cupping was widely used throughout Europe. At that time they heated their cups in a hearth and rather than leaving a little burn mark like the Chinese method, they created a burn circle on the patient's skin!

Today the cups have a nozzle on the end where a vacuum pump is attached to create the vacuum inside the cup.     The vacuum in the cup pulls the skin, muscles and tendons 1 to 2 inches into the cup.   This stretches the muscles, removes knots and assists in breaking up scar tissue.

We even tried it on a tight IT band and
after 10 minutes the IT band was relaxed.

My first thought when doing this was that I could be a space creature on Doctor Who or possibly use the cupping as a unique Halloween costume! 

The question most have is Does this hurt?  I did not find any pain although it was an odd feeling.

In this second part of my article, Fixing a Broken Runner, my aim is to say we all get dealt a bad hand from time to time – it’s how we play the hand we are dealt that matters.  I have tried to maintain a positive attitude and keep an open mind.  Physical therapy is going well and I have even received the OK to resume walking and running.

http://www.evolutionsportspt.com/

http://www.evolutionsportspt.com/team-evolution-morgan-johnson-dpt-comt-cscs/

https://www.google.com/#q=evolution+sports+maryland

 

 

 

 

Fixing a Broken Runner - Part One

by Hugh Wilson

The “Road to the Eastern States 100” – that was to be the title for a series of articles describing one runner's efforts to prepare for the inaugural Eastern States 100 mile ultra-marathon. With a 36 hour cutoff time and multiple 900 – 1200 foot climbs through what is known as the Grand Canyon of the East, this race is slated to be one of the most grueling races East of the Mississippi. The race is scheduled for August 2013 and has a cumulative total elevation change of over 20,000 feet.

So why change the topic and title?  The information is quite timely with just 6 months left until race day. Funny you should ask! Well – In short, I am now that broken runner.

What I am now learning is that there are three steps to regain your previous fitness level:

1.      Recognize and accept you are broken

2.      Get help correcting the problem

3.      Re-Start your training at a reasonable level

Nothing you have done on the road to becoming a competitive runner has been easy – neither will this.

My story illustrates many of the good and bad choices runners often make. I try to learn something from every training run, every race and other runners. I have learned a great many things from a recent injury and only time will tell how well I can implement those lessons in the future.

I think we all agree that in general, runners are a hardheaded stubborn lot – it’s in our nature! If we didn’t possess the character of independence, self-determination, self-reliance, self-assuredness we would not be runners. We push through aches and pains and often take pride in first blood of the run or race. When we fall we get up, if it hurts you shake it out and continue. Short of a bone sticking out of our leg, we choose to continue. The inherent nature of the runner makes recognizing something is definitely wrong very difficult.

Sunday November 10^th 2013 was like any other Sunday of the previous three or so years. The MATR (Maryland Adventure Trail Runners) running group met up at Oregon Ridge Park just a little before 5am, rain was steady – Tom Nasuta and Casey Fisher were already there. The first words I hear are “great weather to train in” followed by “we have the park to ourselves”. We train in all conditions because races take place in all conditions; we start at 5am because many of the races we participate in also start at 5am. We leave the parking lot and head for the rain sodden trails, which proved to be fairly muddy and slippery enough to give us a good core workout staying upright. Casey had left early that day and Tom and I decided to do just one more loop as it was getting close to noon. We managed to keep a fair pace mimicking the rain that was proving to be as stubborn in showing any signs of slowing until the trail turned into grass and the parking lot came into view, we decided to walk it in and discuss the run we just completed.

It is funny and curious thing that when you do something simple which requires little if any effort in thinking, like walking, is when accidents happen. I managed to step into a particularity deep spot of mud sending my left leg out to the side leaving the right to collapse into a Russian squat before toppling over and ending up on my side.

I heard no snap’s or crack’s or pop’s and I would describe the sensation in my right knee a one of great discomfort but not as pain. Tom checked the knee before helping me to my feet. I thought a cold pack and then some light stretching would shake things out. Things didn’t shake out that evening so I decided to take a break from running over the next few days since I wanted to be well rested for the Stone Mill 50 miler taking place the following Saturday. Stone Mill was to be my qualifier for Eastern States so it was an important race for me.

The days that followed saw no change in the knee, the only relief I could find was to keep the leg straight and propped up.

At 3:30am Saturday November 16^th I met up with Tom and Casey to drive to the Stone Mill 50. I took the back seat where I could keep the leg straight and I neglected to say much about it on the drive. Having a persistent dull tooth ache like feeling in the knee all week made me think it may be more than just a minor strain or twist and I decided I would get it checked out after the race. [note: the decision to check out the issue after the race was a definite mistake]

The Stone Mill race started with a loop around the school then out on a dog leg to disperse the runners. Tom and I planned on running together as far as possible – we tend to keep each other in check at the beginning of our races and not let the adrenalin or race excitement push us out faster than our plan calls for. I found the race more difficult than I expected which was odd as we have trained on similar trail – maybe it was the knee that was making the run more of an effort than it should be. Somewhere around mile 14 I told Tom I will slow my pace and that he should continue on. I think I clipped out something funny like “I’ll catch you on the downhill”. After mile 20 I started getting light headed and stumbling a bit – it was difficult to get the right leg to push off or land from a jump. At mile 24 I was hoping just to make it to the next check point when I saw Darryn Waugh a good friend and fellow runner. Darryn had come to see several of the Baltimore area runners competing in the race. He knew at first glance I was in distress and offered to pick me up – so I made it to the aid station at mile 25 where I dropped from the race. We drove from aid station to aid station to see how the runners were doing; lucky for me I was able to keep the leg straight in Darryn’s car. By the time we got to the start/finish line it was dark and the slight breeze kept me cold – which helped me deal with the leg issues.

It was a good feeling watching Casey cross the finish line in 9:25:28. Judging by the pace that Tom was running we estimated that we had time to get in the warmth of the school for food and a cup or two of tea. I always feel better after a hot tea! Tom rolled across the finish line in 11:50:43.  In finishing the 50 miler, both Casey and Tom qualified for the Eastern States 100 that we had been preparing for.
 

Recognize and accept you are broken
There was definitely something not right with the knee and I needed it fixed soon. The next day I contacted my doctor and a knee specialist and arranged for an MRI.  Continuing to run on a knee like mine was not an option.

Get help correcting the problem
Doctor Lanzo came highly recommended – I had heard he is one of the top knee surgeons in the area and he has dealt with numerous sports related injuries. He had my MRI in hand when I met him, his first question was “Are you having any pain?” I answered - no pain and that it was more like a tooth ache annoyance in my knee. He responded “I understand you are an ultra-runner” and I said yes. To my surprise he said that’s why I don’t feel any pain, ultra-runners usually have a high tolerance to pain. What I had was an 80 percent tear of the quadriceps tendon, I should not be standing, I definitely should not have run a race on that knee and what I should have done is had surgery a week ago.

I’ve had similar issues in the past, how could this sore knee be something so major? With hindsight, I can honestly say that I have never had soreness last more than a few days. It is that recognition which is important and it should have kept me from attempting Stone Mill. What did I say about runners?  They are often stubborn, I should have included (at least in my case) in denial about how serious the injury was.

I had the surgery and for the following 4 to 5 weeks, the leg would be in a brace set to zero percent flexibility. To go from running back to back long runs of 5+ hours every Saturday and Sunday with a number of hours in between, and yoga alternating with P90x, to no exercise at all makes for a very unhappy runner. This was also over the Christmas and New Year’s holidays so food was in abundance – another issue the immobile have to deal with is weight gain!

We all get grumpy when we haven’t run for a week – try 5 times that! I could for see myself turning into a major grump and decided no matter how down I get I will remain positive and not utter one negative word. My mantra was “keep your thoughts positive”! I knew this is as temporary as the side and chest pains you get from running hills – it will be over soon. I continued the routine getting up early on the weekends, I would sit there with a cup of hot chocolate and one of tea along with a stack of pancakes slathered in butter and syrup and look out the window at the dark sky which was sometimes filled with rain, sleet or snow. I knew the MATR group would start the run at 5am; I am aware of  how miserable it is to be in the dark with a cold wet wind in your face, but if given the chance, I would have happily traded the hot chocolate and pancakes to be out there with them.
 

Re-Start your training at a reasonable level

Time passes and I made it through the 5 weeks remaining positive throughout.  The quadriceps tendon should have reattached to the patella and healing has been going well.  I am now at the stage of beginning physical therapy and getting the leg to work again! 

Look for an update of my experience with physical therapy in Part 2 of this report. This article is being published in next month’s issue of My Training Group Newsletter.