(Written in fall of 2012)
It's the law of gravity: what goes up, must come down. In running, it's the mantra I use when I'm attacking a huge hill to remind me that the pain and suffering of climbing the beast will eventually come to and end with the sweet reward of a downhill. In life, it's what reminds us that we are not invincible, and no matter how careful we are and what steps we take to ensure that no trouble will come our way, that life is full of unexpected twists.
Egos go up and then come down.
I was getting fit and fast, as in I was getting fit really quickly and I was getting damn fast. I never imagined that I would accomplish the running feats that I accomplished this summer. What a sweet reward to come back from a controversial knee surgery and be faster than I had ever been before, without much of what I would consider a speed base. And, I was running injury free. I was listening to my body and doing what it felt like I could do at the time, but being careful not to push it too hard or too soon. I thought I was being smart.
No one is invincible. No matter how careful you are, something could come into your life to alter your training. You could trip and fall and tear your meniscus. You could get in a car accident and break your leg. You could come down with a bad case of the flu and be laid up for a week in bed. Or, like me, you could go for your first bike ride in 2 months, sit for 4 hours, forget to stretch after a Pilates workout, and have your sartorius muscle tighten up on you, causing friction in your knee. Ok, maybe it wasn't totally random, but from all the articles I've been finding online, pes anserine pain is more common in athletes who participate in cutting sports or side-to-side activities, and runners with weak hips or poor shoes. Neither were may case, but it's possible my form was beginning to deteriorate slightly from all the mileage. Or... since this came after a down mileage/easy week, the sudden introduction of cycling into my training regimen and the lack of stretching after hours of shorting my hip-flexors had suddenly caused a huge hiccup in my running.
I have had pes anserinus problems In the past. Back then it was due to a tight hamstring muscles. I'd stretch, massage, and even get dry needled. The muscle would loosen up, time would pass, and I'd be back on my way down the road. This time, I decided to address the pain myself rather than running to massage for help. The pain was so slight and dull that I thought I could fix it quickly with some self massage on the foam roller, lots of stretching, and a few modifications to my training. I rolled and rolled, both on a tennis ball and with the foam roller. I regained a lot of flexibility in my hamstring. Yet still, I had pain on my easy runs. I did discover that when I ran fast intervals or when I ran uphill that I had no to very little pain. Hmmmm, perhaps this was not an issue with my hamstring after all. Now I began leaning towards quads.
On Saturday, 5 days after the onset of the pes pain, I got a massage from Kelly. He determined my knee pain was actually due to a tight sartorius muscle. He worked on it pretty aggressively up in the hip and even some directly on the tendons in the pes anseranus. I left his office thinking I had been magically cured once again.
Nope.
On Sunday, I went forward with the long run I had planned. 20mi easy- but subject to change if I had any pes pain. I wasn't going to be deviated if I needed to shorten the run a bit if my knee was a little tight. I had a race in a week and I didn't want to compromise my time by running too far the weekend before. I though perhaps even 14-16 was smarter if all things felt good.
Kevin and I drove to Champoeg Park that morning for an Autumn Leaves course simulation run. Kevin had an easy 23 miler on the docket and he didn't feel like running it all over our normal Salem routes. I don't blame him. But I was scared. What if I could not run for very long. I would be stuck at the car in Champoeg Park for 3 hours waiting for him to get done. Nothing like leaving that kind of lasting impression on the course that I was trying to break the women's record at. I was now determined to run as long as I could, so long as my knee allowed. As we pulled into the park, we noticed a huge lineup of cars also arriving. Here there was a half marathon going on that day. This was going to make our run a little more interesting, but we welcomed the company.
We parked in an nearly deserted parking lot away from the race start. The bathrooms were vacant and we prepped with some last minute fueling/clothing stripping. I took a deep inhale before we took off. I was very nervous that this was not going to go well. I was wrong. The first 2 miles were great. No pain at all! Normally after about a quarter mile into the run, I would feel the dull ache near my pes anserinus set in. THis time nothing. But then, after 2 miles both knees began to bother. I took this as a good sign. Each side hurt evenly. Kelly had worked on both sartoriuses so they were both going to be a little sore. I stopped after two miles to stretch as Kevin relieved himself in a bush. We resumed running and all was good. No pain at all on the right side. A slight tightness on the left, but not as bad as last week. Again, a Kelly miracle massage had worked!
We jumped onto the race route which hadn't started yet. The course was the same as Autumn Leaves. We crossed the wooden footbridge and began climbing a steady hill. My knee had been steadily growing tighter, but I was looking foward to this uphill climb because I knee it caused me no discomfort.
Not this time.
My knee began to hurt more running uphill. If it was any consolation, running downhill hurt about the same as uphill. We turned around at an intersection around mile 3.5 and headed back towards the car for water and a GU. My knee was really getting sore, so I stopped and did some stretches Kelly had taught me. They helped for the first few strides, but then the pain came back. My knee was now more sore than it had been all of last week before the massage. This was really not good.
While heading back to the car we ran into the race. Everyone cheered us on and told us good job as though we were the leaders, telling us good job. I began to get angry. Didn't anyone notice we were not wearing bibs? I was in so much pain and had to keep stopping and yet people would cheer for us. I wanted to just disappear. My life felt like it was crumbling down around me and here I felt like I was the center of attention. What a mistake to come to Champoeg on so many accounts. We finally got off the course and back to the car. As Kevin took a Gu, I streteched. We went to the bathroom and after about a 5min break, I decided to give it a go again. My knee felt fine walking and standing. It's as if nothing was wrong.
As we started out, everything felt good. I had a sudden burst of endorphins. Perhaps I had just tightened up again and need to stretch the muscle when it was warmer. That endorphin rush ended real quickly though. Just like before, after about a quarter mile, I got intense pain in my pes anserine area. It picked up just where it had left off, very painful. I pushed through for awhile and then said, "that's it." I stopped and walked back to the car. Kevin walked with me and tried to keep my spirits high by saying "It wasn't painful at at for the first two miles. I had got an aggressive massage directly on the tendons, and they were probably inflamed. I was only upset because I didn't get to run as far as 'I' wanted to, but I still got to run." I tried to believe what he was telling me, but I was so frustrated. How was it worse now? Hadn't the massage done anything to relieve the stress off my knee? Had my form, which I had worked so hard to perfect with Pilates and a slow mileage build up really gone to sh*tter in the last week? Had that one bike ride messed me up this much?
Kevin took off to finish his 23 mile run and I stayed at the car stretching. My knee pain had calmed down so I decided to do what Kelly always suggests when you can't run... I went for a walk. I walked for an hour pain free. Not the slightest twinge. Whenever I thought I was miraculously healed, I would try to jog a little and be in pain right away. As soon as I walked, nothing. Well, at least I knew it wasn't another plica ;).
I got back to the car and Kevin was still running, so I grabbed a blanket out of the trunk and sat down in the grass to stretch. I stretch for about a half an hour. I could tell the insertion of my sartorius into my hip was very sore and tight. I worked at the area for awhile until it completely loosened up. My knee was again feeling better, but decided not to test it again. Kevin finished his run and joined me on the blanket. He told me not to run for the next two days and then see how it feels. We determined that Kelly's massage directly on the inflamed pes anserinus really flared it up and it just needed time to calm down. I believed this theory on the surface, but deep down, I didn't know how this kind of pain would "calm down" in just a few days.
When Wednesday rolled around, I got another massage from Kelly. He did not massage directly on the tendons this time, but rather worked the sartorius, gracilis, and semitendinosus. My sartorius was still very tight, but everything else seemed to be in working order. After the massage he checked my flexibility and I had a much better range of motion in the sartorius with no pain at all in the knee. He suggested a test run in the evening that involved alternating one minute walking and one minute running. I was nervous to try it but went forth anyway since everything was feeling so much better.
I got home from work and changed into my running clothes. I was a nervous mess waiting for my Garmin to locate a satellite. What if this did not go well? Then what? Then were would that leave me? Finally my watch was ready and I headed out the door. The one minute of walking went great. The one minute of running hurt like h@#%. Right from the get-go I was very sore. I conintued with one minute of walking and tried to run again, thinking maybe I just needed to loosen up. Nope. Immediate intense pain. I turned around and walked back home. As any psychotic runner would do, I first blamed my shoes. When I got home I put on a different pair of shoes and headed out the door again. Same problem. Ok, it wasn't the shoes. I was devistated. I called Kelly and told him about the failed running attempt. He said something that would shatter my world,
"I think it might be a stress reaction."
I didn't hear much else after that. After I hung up, I began balling. I called Kevin and told him the news. For the first time, Kevin did not have all the answers. He didn't make any jokes. He didn't tell me everything was going to be fine tomorrow and just sleep on it. He was silent. I excused myself to make a doctor's appointment online to get a proper stress reaction diagnosis. I lucked out and my doctor had an opening Thursday morning. I then made a phone call to two of my girlfriends who wanted an update on how the test run went once I was done. My friend Liisa told me the one thing that really helped. I have climbed a ladder during my training. And I'm the highest on the ladder than I have ever been right now. Just because I step back down a few rungs for a bit, doesn't mean I start again back at the bottom of the ladder.
Thursday morning, I went to the doctor. He listen to my story and then had me do a series of basic diagnostic tests to rule out a meniscal tear or stress fracture. Walking like a duck didn't hurt. Jumping up and down on one leg didn't hurt. But basic walking was about a 2 on the scale of pain and running was a 9. He poked and prodded around the knee and found my patella was tracking correctly and I had no crepitis in the knee. He did notice quite a bit of swelling and localized pain on the pes anserine bursa. He diagnosed it as severe bursitis. He told me one of my options was getting a cortisone injection into the bursa. It would bring rapid relief to the pain and swelling and I could be running again in a few days. I immediately ruled this option out. I know enough to know that anytime you put a needle into a bursa that you have a higher risk of infection.
He believed with rest, cross training that did not bring on pain, and the use of a special homeopathic oil called "Pain Away" that I would be back running next week. Wow! Wouldn't that be great? If only I could believe it for myself. I went from being completely broken hearted to having faith again. Autumn Leaves was not out of the picture yet. I went home and began a strict regimen of icing, taking Ibuprofen, using pain away and arnica on my knee.
Nothing worked.
(to be continued...)
The human body is an impressive machine. It can be pushed so much harder than you mind ever thinks it can. I really believe we are all capable of more than we think that we are. It's our mind that usually holds us back and sets our limits. Yet sometimes you can tell your mind to shut up, and that's when magic happens.
