Still qualifying for Boston: what am I complaining about?

As you might have read in previous posts, I did resume running, training and even racing after a long hiatus due to breaking a meniscus on March 1st. After an arthroscopy on July 1 in Paris, the surgeon prescribed to wait until September. Even if he said that I would get fully back to my intense running eventually, the first days of September were quite discouraging as I could barely jog half a mile without serious knee pain. I continued going to the gym for some strength training, and doing some rowing and cycling. Eventually, I was able to log a few miles at once, only to experience more pain for a few days afterwards. On the 22nd, I decided to go to my local track and see how far I could jog: bingo, it wasn't pretty but I reached 26.2 miles again in 3:42, below the M60-64 requirement of 3:50! Granted, this isn't anything official, plus the total time was about 4:12 as I made a few stops to refill bottles, cool down as it was still warm, and check my phone. No pressure!

At the end of September I logged two runs of 20 and 15.5 miles respectively. The pain subsided so I stayed in the 10-15K range daily after that.

In October, I ran my first race, a road half marathon. The knee was ok during the race, I was more limited by the breathing while trying to maintain a 7 min/mile pace. Knee pain again for the following few days so I took the week off.

Back in California, I went back to the track on October 20th for a 3:31:47 training marathon: the last 10 miles were painful but progress! Followed by my second race of the season, a trail half marathon this time.

November 3, 3:24:52: even a better training marathon, although even more knee pain the next day...

And this Sunday, November 10, 3:17:11! I'm prouder of this one because the elapsed time is less than a minute over, 3:17:57, so even more legit. Albeit still unofficial of course. A few other encouraging stats:

• Average pace: 7:31
• Average cadence: 187 (Garmin) - 185 (Coros)
• Average stride length: 1.15 meters (still far from my optimal marathon 1.30m-average stride of 15 years ago, but improving)
• Slightly negative split by a few seconds
• First and last mile at 8:15 (running through the neighborhood), all other miles under 8 otherwise, with a few under 7:30.

Nice trend even with the horizontal axis not at scale.

And so... what am I still complaining about when many work so hard all their running life to qualify for Boston? Well, it's the persisting pain which makes me wonder how hard and long I can really go. Putting the miles in seem so important both mentally and physically: I'm probably not enough expert, I still haven't found a way to strengthen my legs as much as when running. Not to mention the level of energy. But, am I damaging the meniscus fracture/tear more?

Now, is pain even an excuse? When I hear about other runners who share that they have been running in pain for many years, including with bone on bone articulations, it seems like I shouldn't complain indeed...

In August, Coros' marathon time prediction was 3:09. It is now down to 3:11. I still need to work on the glutes --well, always as a matter of fact-- but I believe the strength training is paying off. And I do see a path to beating these Coros predictions eventually, in good race conditions. But no rush, even with many steps at a time... And, yes, let me appreciate these improvements!

Run Happy as Brooks' tagline says! Speaking of which, still hot on my favorite running partners: Brooks, Ultimate Direction, S!Caps, VespaPower and GU Energy (disclosure: I still receive some discount on the last 2 brands).

Sport struggles: harvesting weeds, says Kipchoge himself!

6 months of struggles since I snapped my knee on my birthday and still no end in sight, I'm bummed. Yet, as much as we focus on celebrated over achievers reaching out podiums and medals at the Olympics in particular, and even more so the Paralympics this week, you have to wonder if there more people struggling than succeeding in competitive sports. Kind of what I believe happens in the movie business for instance. Or is that life in general?

In retrospective, I wish I had kept a log of all the promising Olympians who got injured weeks or days before the Paris 2024 games. While there are other championships to compete, Olympic games are so special and rare with their 4-year frequency and global reach.

I was lucky to attend 7 Olympic events in Paris this year: canoe kayak, handball, soccer, beach volley (beneath the Eiffel Tower, super magical), swimming marathon (i.e., 10K in the Seine river) and, with my special bound to that mythical running discipline, both the Men and Women marathons.

It has been a few weeks already so I don't need to cover the results although both races were memorable with an Olympic Record set by Tamirat Tola from Ethiopia in 2:06:26 on a challenging course, and such a close finish in the women, with a win by Dutch Sifan Hassan, both winners with outstanding resumes!

But, back to the title, I want to highlight two major struggles which happened on both days. Note that, with starting fields of respectively 80 and 90 (Men ran on Saturday, Women on Sunday, the last day of that Olympiad), there were many more than 2 marathoners struggling on these days. As a matter of fact, the marathon distance is so long and grueling, the finish always come with a personal fight against pain, and the outcome always uncertain.

For the men race, I didn't have a ticket. I watched the pack fly by around kilometer 8, then waited for an hour at kilometer 42, a few yards from the finish line. As you can see in that video, a few runners were already falling behind after only 5 miles.

Crossing the river Seine between km 8 and 42, spectacular games downtown Paris!

Now the huge scoop came much later, around kilometer 30, when favorite and marathon guru, Eliud Kipchoge, started walking! In a career spanning several decades at the very top of the spot, his worst finish was 10th place. And that includes 4 Olympic marathons and all the majors. It was his first DNF (Did Not Finish) and you can read his comments in this great article. Including that quote related to the title of this post:

“It was not the race I came here for,” Kipchoge admitted. "But that’s sport. Sport is up and down. Sport is like a [garden] when you go and plant seed, then there is actually weeds and flowers, today I harvested weeds."

With all the spot light on Kipchoge, that DNF was well noticed, but there were more, in both races (actually 10 in the Men and 11 in the Women). On Sunday, I had a seat in the finish stadium in front of the Invalides, another magical sight and setup. With two of my sisters:

We followed the whole race on the huge display, then watched all the women sprinting down the last 200 meters of the course.

45 athletes finished in the 10 minutes after the winning time of 2:22:55. Then 30 in the following 10 minutes, then finally 4 in the next 10. And then...

Fun fact for that event, the medals would not be given at the venue but during the closing ceremony as many of you must have seen. What an honor for these top 3 ladies! Still, we were told that there would be a podium ceremony and it was imminent. We were in the blazing sun and, after an hour, half the stadium had dispersed and left. We were wondering what was happening when we realized there was still a runner on the course! We could see the helicopter filming the event roaming over the course, quite a few miles away. Then we saw that athlete on the large screen, walking! That was Kinzang Lahmo from the happiest country in the world, Bhutan! Kinzang crossed the line 1h30 after the winner. It was her marathon debut, welcome to the club, Kinzang, congratulations for covering the distance! Here is her well deserved finish, still with a sizable crowd to cheer her up!

All results online: Men, Women.

Again, many more struggles, both public during these games, behind the scene of others' podiums and fame or barely noticed while training hard in the years and months leading to these games. Struggles for missing dreams. For missing the event. For missing practicing your dearest sport, even... May we all recover and rebound so we keep harvesting more flowers than weeds...!

I'm not Djokovic, but...

This is quite an unexpected connection to my running journey. To be honest, I’m not a big fan of that tennis GOAT. While I played tennis and enjoyed it as a kid, I must prefer the simplicity of running, an activity you can do without much setting, anywhere and whenever you want. As for Djokovic, his arrogance has always been troubling to me and that went through the roof with the way he handled the COVID restrictions with so much disdain. So, what is that connection in the title? After erring for a few months about what to do with my knee, tossed around between those saying that meniscus heal by themselves, that surgery is overrated, I finally saw a specialist in Paris early June, the day after he and his colleague worked on… Djokovic’s meniscus! When you see framed jersey of famed soccer players in the waiting room (e.g., Mbappé, Giroud), you know you are in good hands. (Photo credit @DjokerNole.)

The arthroscopy is scheduled for July 1 and mostly aims at taking away a piece of cartilage which is floating around in my joint. This is the source of painful and quick inflammation anytime I’m trying to jog, at least I’m glad that there is a mechanical explanation and a sensible plan to get rid of it. I only wish I had gotten the MRI and diagnosis the next day of my injury, but I’m not Djokovic… And I wasn’t into spending tens of thousands of dollars which that would have costed in the US…

With the prospect of returning to running a few weeks after the surgery, I’ve been more motivated to invest into cardio and strength training again: rowing machine, 50 to 100-mile bike rides, high intensity elliptical sessions, hamstring curl and leg press. Quite motivated because, as the surgeon stated, I must have lost a lot of muscle with months off running. As opposed to Djokovic who got surgery a couple of days after his injury, with his incredible will to get back to top competition at Wimbledon and the Olympics weeks later!

However, what I don’t know yet is what the knee will allow me to do, running wise. What is left of my running journey and career. How the knee will hold on uneven trails for instance. What I know for knowing me too well is that I will most likely keep thinking and, most probably, even overthinking about it.

In another form of serendipity, I ran, figuratively speaking, into the famous Brian Pilcher in the SFO lounge on my way to Paris. Brian holds 3 M60-64 American Records for 25K, 30K and the marathon mark (2:42:42) all set during the same event at the 2016 BOA Chicago. He also holds the M65-69 12, 15 and 10K records. A pinched nerve in the hamstring prevents him from training enough to keep racing aggressively though, now. It is so hard to accept that we aren’t unbreakable machines…

With that, hopefully more good news in a few weeks, and opportunities to see some of you at races or on the trails again!

Knee injury imaging and update

50 days have passed since I awarded myself the worst birthday gift, a major running injury at the end of what was meant to be the ultimate training run before the 50K Road Nationals. So, short of running stories on this blog, here is a medical update after finally getting x-rays and an MRI done this week.

After 6 weeks of running in circles in my mind, figuratively speaking, and obsessing about the likelihood of my ability to run again, I was quite anxious for this peek view inside this critical articulation. Per my previous post, I was fearing that my meniscus was shattered beyond potential repair. Walking still hurts and I can even feel pain in certain positions while sleeping.

Bottom line, it's not straightforward, there is both good and bad news, but it looks like I could still have a few strides left, which I had really doubted about.

The good news first, starting with what my Sports Medicine doctor felt was the most important: there is no trace or arthritis, the cartilage looks healthy, there is that after logging 2.5 rounds around the globe (101,048 km or 62,783 miles). The health of my knees was part of the top questions I was getting from people doubting that so much running was any good for our bodies and, so far, I was telling them that healthy cartilage actually meant to regenerate the more you used it. Part of the theory that, as humans, we were... born to run. I was also adding that, for that mechanism to hold, it did help to have a neutral footing and stride, to preserve joint alignment. Well, jumping diagonally over a puddle might have tested this alignment beyond my limits...

The second good news is that the ligaments are mostly intact. That MRI shot in particular shows that cruciate ligament well straighten through the articulation.

On another image though, my doctor saw some indication that the attach might have suffered. The MRI didn't have enough images to tell for sure though.

Going on with the less good news is that there is synovial effusion but it is limited. At least this explains the loss of full flexion which prevents me from sitting on my heel for instance. This should pass and reduce eventually as the inflammation disappears. I think that effusion corresponds to that white area, as I recall from my appointment.

And now to the more serious issues which, at least, explain the persisting pain. Let's start with the most obvious culprit, not visible on the x-rays but clearly on the MRI: two bone edemas, one at the top of the tibia, one at the bottom of the femur, proving that both bones did touch, yikes! The x-rays show a silverline though, no fracture at least. For my doctor, this could have easily happened given what the compression must have been. Phew!

And, with compression comes the worst news: while the interior meniscus definitely shows some tear/degeneration after 25 years of intensive running, it was still highly functional in its shock absorber role. Yet, that huge pinch between the displaced bones created a fissure, as I could guess from browsing the Internet and alluded to in my previous post. Because of the very limited number of images of the MRI, the presence of a fissure could be confirmed but the size of it not established.

The meniscus is fibrocartilaginous so it can't repair itself. It's not vascularized and there are no nerves so the fissure itself can't be a source of pain. Yet, the mechanical rupture could prevent the knee from functioning properly, hence be painful. But we'll know if that's the case only after the bone edemas heal. Which should take a few more weeks.

Meanwhile, no impact which makes it a challenging for me to do cardio training as I don't particularly enjoy going to the gym and even less so in group class formats.

And that's it for now. Some hope but more patience needed, and even more so as healing slows down with age. That part of aging which sucks... For so many years, I didn't want to believe others saying it, at least you've been warned! ;-)

0 to 60 in... a bad twist!

As someone who likes running for the speed of it, it's really impressive to follow the outstanding progression of one key metric in the automotive industry: the time it takes for a car to reach 60 miles per hour, from a full stop. Last week electrek reported on Porsche boasting a mere 2.1 seconds for its Taycan Turbo GT with is Weissach boosting package. What $230,000 can buy you these days... No wonder this unsustainable race to power has create another environmental catastrophe, or a boon for the tire industry as a matter of fact. Indeed, electrical cars burn tires 20 to 30% faster than traditional ones.

As for me, the number 60 triggers great memories of my 60-meter dash runs in middle school. Being among the youngest and shortest throughout all my school years, 1 year ahead of my schoolmates. my speed on that distance help me regain some stature and self confidence. I switched to and focused on soccer afterwards, only coming back to the track mid way through College. Then to distance running after building a family.

60 is also a major milestone I passed a month ago as some of you have seen on Facebook. After missing on most of the M55-59 age group after contracting an injury at the end of 2018, a tendon which took almost 4 years to heal, I was excited to see how to make age just a number, as I successfully did in my 40s and early 50s.

The beginning of the season wasn't great already with a minor but annoying pain deep in the calf. To be on the safe side, I did rest for 6 weeks in January and resumed training mid February, 3 weeks before the 50K Nationals on Long Island. Having missed the Jed Smith 50K annual test, I didn't have much ambition for that Championship, still aiming at breaking 4 hours given a reasonable fitness level.

There was special excitement for my birthday on this leap year. For many years I had teased my dad, an OB-GYN, thinking he had decided to declare my birth a few hours after a February 29 just to shield me from the ambiguity of a 2/29 birth date. He didn't find that particularly funny, I'll never know for sure if I turned 60 or 15 last month. March 1st was a Friday this year and it turned out to be a busy day: 10 hours straight at work, then rushing out to squeeze an ultimate 10K training run before some tapering, then attending a concert at Agnès' school. It was pouring rain, not the best conditions to test the speed, although you never know which weather you'll get in New York in March, so I did suck it out. 50 yards from the house, I was at full speed when I saw a big puddle and decided to jump over it laterally. Oh my, how much I regret that decision... Upon landing, I thought I had lost my lower leg. Such an intense pain, like a wire had gone though the knee to cut the leg.

Going to the concert right after this was a painful experience as I could barely hold any weight on my left leg. But the next day was horrible, after the knee warmed down and a big inflammation kicked in. Like with any bad event happening to you, or to me anyway, I got into pure denial that this could be serious.

I first thought that I had just twisted my knee given all the ligaments around the need were so painful but the knee still seemed to function. And that it would just take a couple of weeks to pass. But then, after the swelling decreased, and seeing a PT last week, who checked the ligaments were all good, the pain still subsides and it seems like an MRI is now in order to see how much damage has the meniscus suffered and if surgery is required. Dang, triple dang. Just for that stupid idea of avoiding a puddle.

Source: vishalpai.com.au/meniscal-surgery

I've so many bad feelings about the situation that I'm thinking of writing another post just to spit them out! Not that you care but as part of the journaling of my running experience. And some sort of therapy.

So, here you are for those wondering about my silence and 3 DNSs so far this year. I so much wish this would be just a nightmare or an April Fool joke but I spent a month pitching myself and, unfortunately, it isn't. And it sucks. Although, every day, and thinking about too many friends, I remind myself that this isn't cancer at least. And all the energy and hours I'm saving from not running go into my first job, my employer should be happy at least.

With that, not much to relate anymore in this blog from a running journey standpoint. Hopefully some better news in a few weeks. Or months. Not years. Or worse...

Back to injury: Another opportunity for an anatomy course

From the microscopic cells to the big bones and muscles, or even the intangible troubles of our minds, I'm always in awe with what doctors have to learn. And I have even more respect as I need to check things under the hood myself, typically when something is getting wrong, another wordy way to refer to an injury...

Yes, another post about injury unfortunately. Never a good time but this one had an interesting timing as I was race-free in March for the first time this century (1999! ;-), and the past 2 weeks were supposed to be a lot of work on speed and volume before a conference this coming week and a few big goals in April. I can't complain though: first, I had already 2 good months to start the year and, second, I didn't miss a race goal yet then. At least not yet.

What's the scoop? It's not even a running injury! As those following me on Facebook might have noticed, I got back to riding. Not any bike but a big heavy one, a BMW R1200RT. Anyway, as I was standing at a stop sign and checking my mirrors for a vehicle approaching from behind too fast, I lost balance and the bike started to lean... I gave it all but, 5 times heavier than me, the bike won, after pulling a big muscle deep in my back.

Oh my, I didn't realize how much every muscle gets engaged when running. Well, it has been excruciating just sitting down and up (think going to the toilets...), bending (think putting pants or socks on), twisting my back while pulling or pushing something (think opening the door of a car, loading the lower basket of the dishwasher then closing the door) and, last but not the least, even walking! That definitely makes me want to stop aging, once for all! I certainly look like I am a super senior in my moves. Even laying down in a bed is painful so I have never slept that badly (I typically don’t sleep much but I sleep really well when I do). The only good news is that it doesn't hurt when I'm working, which would make my employer happy!

12 days since the incident and, despite total inactivity and Agnès' gentle and comforting massages, it's barely getting better, so that was a big pull, and maybe I should have entered a weight lifting competition at least. At some point I even thought that maybe it was something which detached, I hope not. Bottom line, the title includes a twist, it's back to injury and injury to the back... And, as I mentioned on Facebook, I'll be... back after this setback!

Running wise, because of the conference (IBM Think, you can even even watch some of it live if you want to get some of the action), this week was supposed to be mostly tapering anyway so I'm not going to miss too much. Yet, I'm very much NOT looking to the extreme level of standing and walking involved in such setting, not to mention the travel; that muscle would better finish healing quickly! I'd say it's about time anyway but that would be breaking the rule of patience required in any injury therapy.

Learning something every time, at least a good thing with injuries. Especially when they are meant to heal.

And, in addition to the learning opportunity, it’s also a good reminder to appreciate when everything works as intended in our body which, given the trillions of parts involved if you count the cells, is quite miraculous already. Last but not least, wishing everyone stays safe and healthy. And young for ever! ;-)

Foot injury: the verdict

One post in September (the US 24-Hour Nationals race report) and one philosophical discussion about the benefits of injuries [sic], I haven't been very prolific lately. It's hard to talk about running when you aren't, well, running... Hard to recognize that some dreams may fade away, like running very long distances for ever. Or even hard to complain when you see much worse situations around you. For instance, this week, top ultra runner Dave Mackey decided to get his leg amputated as it isn't healing after one year of pain and multiple surgeries.

So, what's the verdict about my little foot injury? Well, the jury is still out as we say, and they must be in a hot deliberation and arguing. Let's start with the good news first: according to the doctors, radiologist and podiatrist, it isn't a fracture! This is a big relief as it might have required between several months up to a year of rest otherwise, phew! It is just an inflammation of the sesamoids, a sesamoiditis. See for yourself...

Or, for those of us who can't read an MRI, here is the detailed report:

Technique: Axial T1, axial T2 with fat-saturation, coronal T1, coronal T2 and sagittal STIR images were obtained through the right forefoot.
Findings: Skin marker was placed over the area of symptoms in the plantar aspect of the metatarsophalangeal joint of the big toe.  
The tibial sesamoid is unremarkable.  Bipartite fibular sesamoid is noted with increased T2 signal abnormality in the fibular sesamoid, across the syndesmosis. No fracture line is seen.  No soft tissue edema.  Minimal degenerative changes of the metatarsophalangeal joint of the big toe identified.  The remaining forefoot is unremarkable.
IMPRESSION: Bone marrow edema in the bipartite fibular sesamoid consistent with sesamoiditis. 

Hum, so that's an impression, not even an opinion... But the bad words here are 'bone marrow edema.' Not a good combination of words; that means the bone itself got inflamed, a condition potentially leading to a fracture: I'm so glad I did listen to my body on this one and stopped before it was too late! Now, the prescription was 4 to 6 weeks of rest. This Saturday marked 6 weeks after the race and looked like the right time to give it a try. I did run 15K just below 8 min/mile and it looked ok yesterday. I'm not sure actually as, after such a long break, I have so many strange sensations throughout the foot, including around the ball of it. This Sunday, I went for 25K, still at a slow pace. No major pain, but still some doubts about the incriminated area. Every time I come back after a break, either forced or planned, I'm surprised how I forget about some of the pain involved in running. Or, not to discourage new comers, let's say discomfort. To conclude, and for the sake of keeping learning about our body anatomy (see my previous post), here are a few pictures highlighting these infamous sesamoids. Small things, yet essential... And really in a tough place with all the ponding involved in ultra running... No particular or sharp pain as of Sunday evening, I'm hoping I'm good to go for another round then... Take care all!

Back on track: not too fast!

Running in general, and ultra running in particular, are so experimental... Sure, there is the famous adage 'listen to your body' but, sincerely, if you want to push to the limit and progress, it's quite difficult to discern which size of the limit you are flirting with...

As you read last week, and with two more workouts at the track this week, this has been a serious 'back on track' month for me. Not only 'back at/to the track' but also a pleasure to enjoy some speed again. However, that reminds me so much of last year, and the previous years as a matter of fact, it's like pacing myself in a long ultra, I need to make sure I'm not getting too excited and ahead of myself, or rather ahead of my shape/form...

On Tuesday, I met Bob and Jeremy again and the speed work out consisted of 6 x 800m. We hit 2'40" twice, it has been a while since I ran 2 laps at 5:20 min/mile. But I skipped Thursday as I didn't feel like pushing more at the track this week. But the real reason is that, since last week, I could feel something high along my right tibia, a good signal to remind me that the track is actually a tough surface to train on.

Indeed, as much as I highlighted great properties for and from training at the track, people think that the rubberized surface must be very soft and easy on the joint, but that's actually the opposite. Because it is meant to increase traction, it is unforgiving for all the small (or big...) defaults we have in our strides since the sole pretty much stick to the track as soon as you apply pressure. Unless dirt on which your shoe can slide to make any correction. Moreover, a trail has many defaults which makes each stride different, as opposed to a smooth rack.

With that, I went to Alviso on Friday to run the 9-mile loop of soft dirt twice. Sure enough, I didn't feel any pain in my leg so, what did I do on Saturday... go back to the track for more! I initially wanted to run at least 26 miles so started at a more conservative pace than last week (1'45" laps or ~7 min/mile) but, after 10 miles, I wasn't so comfortable and thought I was going to run 'only' 64 laps (16 miles) instead. I managed to go beyond this, even picking up the pace in the last 2 miles, for a total of 20 miles again. But, this Sunday, the pain was back and I cut my run short at 10K to play safe.

Nothing too serious I think, and it's a good time to taper before Jed Smith 50K next Saturday anyway, but a good 'listen to your body' experience after a 334-mile month at an average of 7:15 min/mile, albeit mostly on flat terrain.

Back to the title, it is so challenging to dose our training appropriately: too much and you break then lose a lot of time having to recover and get back in shape, too little and you won't progress much or won't even know if you could have done better. Besides, all this becomes trickier as we age (less resistance before breaking and more time to recover if ever...). Keep it up as they say...! ;-)

While sometimes I'd love that training and performance followed some mathematical and predictable laws, it wouldn't be as interesting and motivating to explore our capability or to know that you reached an horizontal asymptote or, worse, a declining one, would it be?

The good news is that, in addition to attentively listening to our body, we can learn from what people share (blogsphere, Facebook, magazines, Strava, ...), and get advice, motivation, encouragement and/or reason from listening to others. Also, we have this amazing ability to (re)train our body and push the red zone further, as long as it is progressive.

Interested in hearing about your own experience. Which signs do you see, or feel, before a potential injury? What do you consider too much? Which strategy did you use to raise your own limits? How do you know you are close to your body limits while not going over the wrong side? Big but non philosophical ultra running questions to kick off this longer-than-usual month of February...

Running injuries: part of the game?

Although we hate them, injuries have a few benefits. First, they are a vocal expression of our body talking to us. It is so hard to follow the adage "listen to your body" and know when to stop, just before pushing the envelope an inch too far. Minor injuries, although they interfere with our passion and balance or, for some and depending on your perspective, imbalance, are a reminders to put things into context and appreciate even more the marvels of what's still working fine in our complex body and much bigger challenges that others may be going through. Another benefit of some physical injuries is the reminder for more stretching, especially to loosen up muscles opposite to the harmed area, or strengthen a particular muscle in order to protect and ease the efforts on a particular joint and, certainly a reminder to work our on core muscles. I'm sure they are many more pluses to the bad news but the last one I'll mention here is the opportunity to learn more about anatomy in particular and sport medicine in general. This is such a vast field, I certainly don't feel the need nor the courage to go back to school to become a specialist. Hopefully, our IBM Watson cognitive system will do that for me! ;-)

Talking about injury is still quite an uncomfortable topic for me as I had always thought and hoped I had found the miracle recipe to keep them at arm's or more specifically at leg's length... A neutral foot, variety in training intensity, length and grounds and rotating different models of shoes, from minimalist flats to more cushioning. Oh maybe I broke the rules in January, too excited I was to still gain speed and working hard to get a few fast races in my new age group. The pain in the tibialis anterior came 2 days after Jed Smith. A small one which looked like the tear of a small muscle fiber. I took two days off, ran/train again for 2 days, stopped for a week, trained 4 days through the injury, tapered another week before the Nationals, tapered for 6 days between the two 50K races, Caumsett and Way Too Cool, and the pain traveled down along the tendon, now a burning pain which looked like an inflammation except that it resisted anti-inflammatory.

I must say that I shouldn't complain too much because, although it persisted through these short breaks and prevented me from training these past 7 weeks, the pain is disappearing after a few days off running and pounding, so I can still cross-train and walk without limping. I know many have gone through much serious injuries. For instance, Sarah had months to ruminate or fulminate and, as a result, she produced a superb piece on the topic, illustrating the patience and wisdom required for coming back to a top form. Her friend Olga is still facing a mysterious abdominal issue, but also shares a touching story about rebuilding her life despite and around the uncertainty. And you can find hundreds of injury-related stories in the blogophere... Even the new goddess of ultra running, Ellie Greenwood, was forced to quit running for 11.5 months for a fibula stress fracture. So glad for her that she came back with another win at Chuckanut this month! And I could talk about friends who are battling cancer, my injury is so insignificant in comparison, time to be grateful for life!

Some people think that, based on the level of competition we are going through in ultra running, we must have access to very good medical expertise and advice, like some champions. Well, that's quite not the case, unless you make it to Team USA and are invited to represent our country at world championships. Like the docs who fixed Jon Olsen before he won the world 24-hour championships last year, but that's only at the event, not through the year and even champions like Jon have to deal with injuries on their own, guess what they are and how to heal. I'm so glad my sister is an MD in France and she strives to keep learning, admits when she doesn't know instead of jumping to pre-conceived and quick conclusions that she might have been taught during her many years of training, and reaches out to her medical network, including a few ultra runners.

So, what is this grain of sand which is derailing my training plans? According to both the sport medicine orthopedics and podiatrists who examined me two weeks ago, it is indeed an issue with my tibialis anterior. They didn't ruled out a somehow simple tendinitis but they prescribed an MRI to determine if the tendon might have been damaged by a tendinosis. Quite close words to me but a big difference in Wikipedia's definition of tendinosis (which isn't even a word in Google's Blogger spell checker by the way), and a sentence which I don't particularly like:

"Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community."

That reminds me how we say that ultra running is a big experiment. And I'm one of the guinea pigs which was happily running in the spinning wheel so far, it is time to learn more about running mechanics and the moving boundaries of my envelope, from this new episode. Time to be patient, wiser, cross-train, do some strength training, more stretching, that's all part of the game too, and I had easily forgotten when everything was going so well and smooth last year. When I say that injury is a n opportunity to learn, I'm discovering new soreness in muscles I had no idea existed in my legs thanks to the cross training. And I also learned about a new physical therapy technique which may hopefully be more than what I actually need to get back to running (look at this pretty impressive and drastic video of the ASTYM (Augmented Soft Tissue Mobilization) technique to remove scar tissues, ouch!).

In the meantime, the radiologist hasn't spotted anything on the tibia and fibula (phew!), no edema in the muscles (re-phew!), but some potential tenosynovitis along three tendons (tibialis posterior, flexor digitorum longus and flexor hallux longus, thank you Wikipedia again...) but no mention of the tibialis anterior which was the initial culprit. Ah, which trick is my body playing now? I can't differentiate from sure fat from tendon in the image, so better let the experts do their job... I'm now waiting to hear from the reading and interpretation of the MRI by the orthopedic before deciding what to do next...And while I wait, I'm indeed wondering if injuries are not a normal part of running to our best, of this game of determining and finding what are these limits... To the point that injuries would be an integral part of sustainable running... What do you think, should we go that far?