Life Through a TV Screen – PT. 9
Disclaimer: This next chapter will be part personal experience, part physical therapy education based on existing research literature. It is not necessarily universally applicable medical advice, and you should contact your doctor for specific medical advice matching your individual needs.
October 2022
Logging some golden hour miles
Photo credit: Alexander Bohlen Photography
Fall is in full swing. The mornings are becoming cloudier, although a decently warm sun still shines through in the mid-day and afternoons. Work is also in full swing as I continue to build up my caseload of patients being treated. All the while, I continued to use gaps in patient care to squeeze in my strengthening exercises to try to keep the momentum rolling. The mornings were now mostly prioritized for runs, just like the days of PT school and college. October started off strong. Too strong unfortunately. On the weekend before getting to 11 weeks post-operative, I was able to successfully complete a 20-minute continuous run on a dirt trail. To me, that was a really big achievement as I originally thought that I would not hit 15-20 minutes continuous until the 12-week mark.
Unfortunately, along the same thread as Icarus flying too close to the sun, I ramped up training volume too quickly with the combined cycling and running. At the 11-week mark, I was attempting to log another 15-20 minute run. I had started to develop some soreness at my left SI joint, but figured that it was a product of general cumulative fatigue. That turned out to be wrong. About ¾ of a mile into my run, I started to have increasing amounts of pain in my left SJ joint with each time my foot contacted the ground. By the time I got to just short of a mile, the pain was increasing enough that I needed to stop. I tried some self-treatment at a nearby bench, but to no avail. I conceded that I would need to walk the mile back to my car, and that I was probably injured.
I weighed my options. If I kept trying to run, it was possible that I might not make it to the start line of the Turkey Trot next month. If I stopped running now, I could potentially use a few weeks to de-load, figure out proper treatment for my SI joint, and then maybe have a short buildup a couple weeks before to accumulate just enough fitness to finish a 5k without feeling like I was going to die. I was going to lose some aerobic fitness, but given how far I’ve come in the last few months, a temporary loss of aerobic fitness is an acceptable trade.
Out of a combination of laziness and caution, I decided to stop biking as well, and focus exclusively on my PT exercises. My plan was to focus on rehabilitation for 2-4 weeks, see where my pain levels, mobility and strength were at, and then decide if I needed more time to hold off of running or if I could start running again by the end of October. Luckily, my physical therapy clinic has experienced clinicians who are kind enough to take the time to perform physical exams on me. Based on some input from a clinician who assessed me, I probably needed to incorporate a little more mobility into my current rehab routine. I added some new components to my program (listed below in the addendum).
After about 2 weeks off of running and focusing on treatment, I had reached the middle of the month. My left SI joint was feeling much better and I didn’t have pain anymore with walking around and some test hopping. I started to get curious if I could try running again. On the weekend, I intentionally slept in for maximal recovery, got dressed to run, and then did a slow jog around the neighborhood. The mornings had started to become a little crisper with the cool air of fall, and some of the leaves of the trees were turning. After jogging for ¾ of a mile, I finished the run at my house feeling quite alright. Over the course of the next 2 weeks, I continued to slowly build up my running volume and speed. At this stage of the post-operative recovery, my running was now more limited by some lingering strength, mobility and power deficits overall rather than the nerve related symptoms that once plagued me.
During my final weekend of the month, I went out to a local trail system to get a run in. It was 16 minutes of continuous running, and my body overall felt alright (other than my lungs having to work hard from being out of shape). Strava has a feature that allows you to compare similar runs on a same route, and upon reviewing my run data, I saw that 1 month ago, I was still in my run-walk program. In the span of a month, despite my temporary SI joint pain setback, I was overall still trending upward with fitness and strength. I could now run continuously for 15 minutes at a faster pace than what I used to only be able to hold for 5 minutes at a time.
Now at the end of the month, I am healthy for the most part and only a few weeks out from the Silicon Valley Turkey Trot. I am once again able to run over 15 minutes continuously. In my discussions with my coach, my goals have remained largely unchanged from what I had set originally:
- Toe the start line healthy
- Finish the race healthy
- Have fun
This time however, after some reflection, I have decided to make my buildup more gradual with just running. I am unsure of what my time will be on Thanksgiving Day, but it will be perhaps the road 5k that I am most proud of in my running career thus far.
Less than 4 weeks to go. Let’s get this bread. 🍞
Addendum
This section is just to explore more of my rehabilitation process and thoughts/research behind it. This month is from the post-operative weeks of Week 10 – Week 14 ish. The theme of this phase is continuing sport-specific rehabilitation. From a surgery healing standpoint, I have now crossed the 12 week post-operative timepoint, which means that the surgical site has sufficiently healed to lift all restrictions for sports. With that said, I am still not ready for returning to full time training. If I had to make a list of the top three primary impairments that hinder my return to running currently, it would include:
- Decreased R. calf strength + power
- Decreased R. hip flexion + L. hip extension mobility
- Impaired ability to isolate lumbopelvic movement in the sagittal plane (more specifically, a tendency to do a combined hip extension with lumbar extension rather than mostly isolated hip extension during the terminal stance phase of running).
With my existing program, I have made modifications along the way to condense certain aspects of the program to make it more efficient while still covering all the necessary ground. I also began gradually decreasing the frequency of exercises in order to accommodate for both the gradual increase in running and gradual increase in demand at work:
Return to running – s/p 10 weeks – 14 weeks
- Double leg box jumps, 2 sets x 5 repetitions, 1-2x/week
- Single leg hopping, 2 sets x 30 sec., 60 sec. rest, 2-4x/week
- Single Leg Calf raises, 4 sets x 8 – 12 repetitions, 60 sec. rest, 3-4x/week
o Modified to perform Single leg with knee bent as needed (more emphasis on soleus)
o Also alternated with 3 sets x 1-3 reps in reserve (usually came out to 3 sets x 15-20 reps on the R. leg)
- Lateral Stepdowns, 3 sets x 15 reps. each leg, 30 – 60 sec. rest, 2-3x/week
- Copenhagen Planks, 1 set x 60 sec. hold, 2x/week
- Front Planks, 1 set x 90 sec. hold, 2x/week
SI Joint/Hip Mobility Self-Rehabilitation
- Hip hinge with weight, 3 sets x 15 reps, 60 sec. rest, 3-5x/week
- Quad stretch in sidelying, 3 sets x 60 sec. holds, 1x/day
Other ancillary strengthening
- Cable Rotational pulls, 3 sets x 15 repetitions each direction, 1-2x/week
Where did my body stand at the end of the month in terms of readiness for return to running full time? Well, I definitely am not ready to jump straight back into running 60+ miles per week of exclusively running, which is to be expected. I am thankful that the company I work for developed a Return to Run checklist, which I have included below along with comparisons of what I was able to do at the end of October:
Based on the testing for myself, I am able to hit all of the prerequisite exercise standards except for my single leg heel raise strength. Although I am able to perform 1 set of 25 single leg heel raises on the right side, it is still very challenging compared to my left side.
Cardiovascular reconditioning this month has continued to move towards being more sport specific and building my overall aerobic fitness. Last month, I implemented a pattern of doing my walk-run program 5x/week and biking 4x/week. This meant that there would be a couple days per week where I was doing double workouts. My original goal by 12 weeks post-operative was to be able to run 15-20 minutes continuously without having to stop and without symptoms, a benchmark that was achieved between post-op weeks 10 and 11. However, after my temporary setback with my left SI joint region pain, I decided to scale back training, focusing on just running for sport specific conditioning and my rehabilitation program to work on my strength and mobility.
Below is a log of what my running and biking looked like for the month of October (with data catalogued on Strava):
You can note with the data the day that I flared up my left SI joint, and also the amount of rest that I took before going back into running. Although I felt okay with my test bike ride, I ultimately decided that full rest would allow me to mentally better focus on rehabilitation and getting healthy enough to run.
Finally, we can return back to the check-in of seeing how I’m doing in terms of returning to running.
For the overall stage of running that I have entered, we can re-visualize that with this infograph from last chapter’s post: (1):
For the stage that I’m at, I would consider myself to be somewhere between stages 2 and 3, although I am slowly but surely moving my way closer to stage 3. Although I will likely be ready to run on Thanksgiving Day, it will be nowhere near peak performance fitness, which is to be expected.
References
1. Ardern, CL., et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. BJSM, 50(14), 853-864
