Sunday, December 10, 2017

Parkrunning progress

It's early days yet, but maybe there's been a bit of progress. Yep the hammies like to niggle quietly in the background, but it continues to be manageable. There is no set training programme other than scheduling when to run and bike; and including the odd parkrun if it's a 'hard' day in the H/E/M scheme of things. Initially parkruns were walk/run/walk affairs, running a sensible pace. Over time, progress means being able to run the whole way. Lost cardiovascular fitness means it feels like it's well and truly back to square one.

Parkrun times have been slowly improving, but are far from previous efforts.

The first four parkruns were all walk/run/walk, the last two were running the whole distance. It's quite interesting to see just a one second difference between the 14/10 and 28/10 events, even though 14/10 included some walking on a harder course. Based on the above rate of improvement (~20 seconds every 6 weeks), maybe a tilt at 25 minutes in September 2018 😜.

Saturday, December 2, 2017

As 2017 draws to an end

The PHT is ever present and likely always will be. That said, I'm back 'running' several times a week and can run continuously for 40 minutes without the need to walk. The goal is to just keep chipping away and 'managing' the PHT. Craig Purdam provided good advice and tools for managing this PHT long term. I'm lucky because it isn't especially painful, just annoying. It's also a bit tricky because it is easy to do a run session and not feel any discomfort, that can happen 24-48 hours later. With that in mind Craig recommended a program of hard/easy/medium; hard/easy/medium. Sometimes back-to-back; sometimes with a rest day between each H/E/M. There is also a comprehensive exercise program that aims at keeping the hammies strong as well as maintaining isometrics ('panadol' for tendinopathies). The lazy glutes also have to do their bit so that less is required of the hammies.

Combined strengthening and 'panadol' for the hamstrings
Latest training:
Monday - rest (morning isometrics)
Tuesday - run 5km (morning isometrics)
Wednesday - cycle 16 km (one way commute to work); gym session (morning isometrics)
Thursday - run 7km (morning isometrics)
Friday - rest (morning isometrics)
Saturday - treadmill run (due to rain) 6.6 km - included a few short intervals at 5min/km pace, which is sadly a rather challenging pace at the moment (morning isometrics)
Sunday - will be either a bike or walk

I've been back to parkrun, taking it easy. It will be interesting to see how long it takes (if ever) to run a full 5km @5 min/km pace!

Wednesday, August 2, 2017

Not dead yet

It's been quite some time since I last blogged. Much has happened in that time, but none of it involved running (or cycling). However, it is now time to attempt another 'come back' to see what direction the hammies would like to take. I'm on a comprehensive exercise programme focusing on hammies, glutes and back. Craig Purdam, my current physio, has put a lot of thought into this programme and we remain hopeful. Returning to exercise is currently very limited. There is a walk/jog/walk session for 20 mins (after warm up) once per week and cycling 30-40 mins twice a week. All well spaced apart to ensure adequate rest and adaptation. The first couple of walk/jog/walk sessions went well with no discomfort during the jogging phase. However, the hammies still niggle at the walk and at times when sitting. Only one cycling session so far and the right hammies did not like the bike seat on the mountain bike. It may be seat/bike specific, so the various bikes will each get a session to determine if one is better than the others.
Photo taken at Lac du Bourget
This will all be revisted in 4 weeks time. If progress is good, then hopefully some more frequent walk/jog/walk sessions will be added into the mix. The 2nd walk/jog/walk session felt amazing. It was so nice getting the heart rate up again (and it didn't take much to do that!). I'm now counting down the days to the next W/J/W session 😃.

Saturday, April 22, 2017

The hamstring conundrum

The corticosteroid injection made no difference and another attempt at a walk/jog programme resulted in increased irritation in the hamstrings. The Doctor then sent me off for an MRI to better assess the situation. Alas, as expected the hamstrings looked pretty crappola on the MRI. After that news I was ready to 'accept' my fate. After all, I'm in my 50s and seem to have genetic predisposition to tendon problems (I still have medial epidocondylitis after 6 months and have had other arm tendon niggles in the past). However, my doctor was not going to let me get off that lightly. She was adamant that if I take a rest, it may settle down, but it would flare up as soon as I increased the load on the tendons. Next step, a referral to see Craig Purdam, a physio with much experience with tendinopathies. I have read a number of his publications and he has been at the forefront of tendon research for some time. I was lucky to get an appointment with him as he is reducing his caseload as he heads towards retirement. It's been a bit of a wait and I will be seeing him at the end of April.
In the meantime a few things have seen me re-evaluate the situation. After taking a (complete) rest period, the hammies did seem to settle down, BUT going for some walks set them off again. The rest has resulted in them becoming even less tolerant of load than before! How frustrating! However, I did a bit more research and discovered that this apparently is a common finding. Jill Cook, a research colleague of Craig Purdam, strongly advises that exercise is the best treatment for tendinopathy. That is, the right programme of exercise. Of particular interest to me was Cook's recommendation that there should be at least 2 minutes rest between any tendon exercise repetitions. Well heck, I have not been doing that, it was not pointed out to me that I should be. I have been suspicious that my exercise programme has not been allowing for sufficient recovery, but I did not realise it was at such a microlevel. Oddly this gives me some hope. I know I can settle the hammies down again with isometric exercises, but this time with appropriate rest between repetitions. From there I am hoping Craig Purdam can help me with staging an exercise programme in a way that allows for sufficient recovery and forward progress. Now I'm just waiting for that appointment at the end of April.

Saturday, February 25, 2017

My hammies are trashed

Yep, trashed they are. Despite all the appropriate rehabilitation and taking it easy, they continue to niggle. Because of this and my continuing frustration, I consulted with another specialist sports medicine doctor to see what else, if anything can be done. She did a full assessment and found that strength-wise the hammies are good, the glutes are firing well (they often don't in runners), but the lower back is still far too stiff (admittedly back loosening exercises haven't been a high priority in recent times).

She is a strong advocate of progressive loading of the hamstrings, regardless of my age and other risk factors. I indicated I have had several attempts at doing this only to have the hammies get more niggly. So we then discussed the big 'C' word, yep corticosteroids. CSs are commonly used to control inflammation and the associated pain in joints, ligaments and tendons. The downside is they can mask damage and interfere with healing as inflammation is part of the healing process. Of course, it is also possible that the pathology in my tendons is due to an abnormal inflammatory response and switching it off for a while may be of benefit. So despite my distrust of CS injections I opted to go ahead and get it done. I have two focal areas in my right hammies that continue to niggle and these were the areas to target.

The procedure is done using ultrasound guidance by a specialist medical imaging doctor. The preliminary ultrasound confirmed the presence of ongoing inflammation (not much change from seven months ago 😞). When injecting the solution (in this case Celestone - active ingredient betamethasone) it helps better visualise the tendons and the doctor commented that there are some big holes in my tendons. So yep they are trashed. Prognosis is pretty poor. The imaging doctor commented that he had not treated a lot of people with hamstring tendinopathy as it is not a common problem. He did mention one person with a big defect in a tendon that responded well to CS injection. He said that given the size of the holes, PRP would likely have limited effect given the inability to adequately immobilise the area post-injection. The PRP I had last year certainly hasn't helped.
I hope I enjoy pool walking as much as this woman 😉
So next step is the exercise rehabilitation prescribed by the sports doctor after resting for one week post-CS injection. The CS injection can take anywhere from two days to two weeks or more to have an effect (if it does). At less than 24 hours post-injection, there is no notable improvement, with a bit of 'injection' soreness. Payback karma perhaps from all my days as a horse vet and all the injections I gave my patients in the rump 😉! The exercise rehabilitation will involve some pool walking as this will load the hamstrings more gently and have the added beneficial effect of working the lower back to improve its mobility. Cycling is okay, recommence the walk/jog programme and keep doing all the gym work I've been doing. Then return to the sports doctor in five weeks time for a follow up and progress report.

I'd like to say I'm optimistic, but based on the ultrasound findings I'm not. However, now that I know the opinion of the specialist sports medicine doctor, I'll just figure out a way to manage this so I can stay somewhat active. 

Sunday, December 11, 2016

I've lost that blogging feeling

2016 has been a tough year on the exercise front. No running since early July, limited cycling since August, medial epidondylitis (left arm) brought on by boxing and extra upper body gym work, and those evil #HFH that are taking their sweet time healing. In regards to the #HFH, the platelet rich plasma may have helped a bit. The left #HFH are no longer complaining and the right #HFH discomfort seems to be more focal and sporadic. The medial epidondylitis is actually quite a problem. It limits what exercises can be done in the gym and does affect day to day activities. It also leaves me with a serious meloxicam dependence, as that is the only way to limit the discomfort. It seems this 50+ female has dodgy tendons and has to find a way to manage them. Hence today's title. Blogging about one's ailments is not particularly appealing.

Medial epicondylitis - also known as golfer's or thrower's elbow
I am continuing to follow a prolonged hamstring rehabilitation/strengthening program. The hamstrings are getting stronger and more tolerant of certain activities. The most challenging exercise is the eccentric nordic hamstring curl. It's a popular exercise for a number of sports as a means of preventing hamstring injuries. The main issue for hamstring tendinopathy is avoiding loading the tendon when it is compressed e.g. seated hamstring curls, squats and deadlifts i.e. no bending at the hips with load. So there are only a limited number of strengthening exercises one can do while in the rehabilitation phase. Eventually one can introduce more traditional exercises, which will be crucial for long-term management.

 On the positive, I've been able to do some long walks and hilly walks without too much discomfort/tightness. Cycling if done sensibly is only mildly irritating for the right #HFH. A walk/jog/walk programme may not be too far away. In the meantime, here's hoping the #HFH become super strong and I can build up to the full ROM (range of movement) for nordic curls.

Sunday, October 23, 2016

Platelet rich plasma injections #1

I had my first lot of PRP injections on Thursday. It's a pretty straight forward process. I donated some blood to create the PRP. The affected region was visualised using ultrasound to identify the best position to inject the PRP. Local anaethestic was injected into the skin to reduce the discomfort from the needle used to inject the PRP. Appropriate aseptic technique was used and with ultrasound guidance, the PRP was injected into the hamstring tendons (both legs). The procedure was only mildly uncomfortable and there is a bit of residual soreness in the injection sites. Slow walking at present involves some minor discomfort. The recommendations vary between doctors. At this stage it is best to limit activities for the first week following the injections. Gentle walking is okay, but no more than that. Maybe after that week it will be okay to try a short gentle bike ride. In 3 weeks time I go back for a second round of injections and repeat the process.
It is difficult to know how long the recovery will take. It is important to continue with the exercise programme, which will be with me for the remainder of my active life. The hamstrings will always need to be nursed and kept strong. Similarly core, glutes and hip muscles need to be performing at their best to take the strain off the hamstrings. No opportunity to slack off. In the meantime I'll report back again after the next round of injections.

A nice review about the role of platelets in tissue repair is found HERE.