In all my years of training and all of my years in pain that I neglected and powered through, it never occurred to me to try physical therapy, or, rehab in order to painlessly train. "Painlessly train" seems like such a nebulous word, but apparently that's why people go to rehab, including the pros. For some reason, I thought physical therapy was for those who underwent a major surgery for a broken bone or torn ligament. Little did I know, it's actually something that every athlete should be doing during the down season in order to properly work back into higher training for race season (talking about triathlons, but I'm sure this could apply to any sport). Even though I wish someone had drilled this into my mind sooner, I'm glad that I know now so that I can properly care for my body during off season and even in general, in order to have my best and least painful training sessions.
I'm one of those people believes that if I can't physically see, hear or feel a pain, then it's not real or legitimate. And while all of these years I've felt pain in my knees, hips, lower back and foot, since nothing seemed to be broken or torn on an X-ray, to me it wasn't real and I'd just brush it aside. My last 70.3 in April of 2014 proved to be a tough one, and at mile 6 of the run, my right knee gave way, and the last 6 miles were brutal, so much so that I actually threw up at the finish line and could barely walk for 3 days after. Not good when you're a rather healthy and fit 24 year old. I knew something was wrong but it didn't take me until now, 2 months out from my first full Ironman, to figure it all out. Since immediately after that race until now, I'd had X-Rays, MRI's, Chiropractor, Podiatrist and Orthopedic appointments to see what's up, and I finally found my answers.
Surfing a few years back in LA, I thought I'd found a new hobby, but after having been surfing for a couple of months, something happened. I was on my board and about to get up to ride a wave and I physically could not get my knees up to stand up. The problem was not in my knees, but rather my lower back, and I was eager to know what was making my back so stiff, that at 24, I couldn't even get up on a surf board.
The prognosis of all of my pains?
- L5-S1 Degenerative Disk (via MRI)
- Chondromalacia and Trochlear Dysplasia (via X-ray)
- Morton's Neuroma (via Podietrist)
- ITB Syndrome (via Orthopedic)
- Patellar Tendonitis (via Chiropractor)
The Degenerative Disk is something I just have to live with, and while it does become very painful on long bike rides, it's manageable. The Chondromalacia and Trochlear Dysplasia is something I'm ignoring for now. When I got those results the Doc said, "Your long distance running days are essentially over". It's not something I can get surgery to fix, and it will just take its degrading course. Getting this prognosis made me set the goal to complete a full Ironman by 30, because I didn't know at the time, how quickly the Dysplasia would progress. Now that I'm about to compete in that Ironman (at 28, 2 years ahead of schedule), the ITB Syndrome and Patellar Tendonitis creeped up as a result of overtraining and improper strengthening of the IT band and hip muscles. Take note: If you're training for an Ironman, it's not just the training, nutrition and mental game that counts, but the physical therapy all along the way to stabilize and strengthen these muscles and ligaments that most of us tend to neglect during our strengthening workouts. As for the Morton's Neuroma, there's really also no cure to this, either. It's a nerve issue and I'd actually been experiencing this pain since high school, notably when I ski and run. It's been manageable, but it does tend to cut my long runs and ski runs short due to the aching nerve pain. Thankfully, my Podiatrist said that cortisone shots are actually safe when injected into a ligament/nerve, as opposed to cartilage (in the knee, for instance), so it's something I will consider a few weeks before a race or when IM training runs are amping up.
For now, I've pushed back IM Boulder until 2019 where I'll be 29 (you only have one chance to defer), but between now and then, I expect to compete in one, if not two full IM races, with the first one likely being towards the end of the summer.
My prescription (as of April 24th, 2018)?
- 2-3x/week Physical Therapy for 4 weeks straight including:
- Clam Shells with Band
- Side Steps with Resistance
- Chair Squats with Band
- Ankle Dorsiflexion Self-Mobilization
- Ankle Mobilizations
- Side Lying Fire Hydrants
- Fire Hydrants
- Standing Gastroc Stretch
- Foam Roll - Calves Bilateral
- Foam Roller TFL
- Foam Roll - Glute - Piriformis
- And of course... stretching of all kinds.
- All of this must be performed on my own every day for 4 weeks, with in-session PT 2-3x/week
- Advil and icing/heat therapy
- No leg days, running, biking or swimming without uee of a pull buoy
After completed 4 weeks of PT, slowly and gradually return to training. This will be tough for me as I am already eager to jump right in. But the thought of not experiencing any (or little) pain will be euphoric. To get through the 112 mile bike ride without ITB or Patellar pain, and to get through the run without nerve pain in my foot, would most definitely make for an enjoyable race, that's for sure.
I hope this helped you if you're suffering through the same injuries. Let us know in the comments what you're going through, and what you're doing to treat and heal your sports injuries!