Friday 27 October 2017

Comeback; running with no labrum


Yip, it’s been a while; honestly didn’t think I’d ever write another post but here goes….

I’m currently in training for the Highland Fling Race 2018 so before I go on I want to thank the race organiser John Duncan, and his team for this opportunity.

In this post, I’ll touch on why I had to stop running and what I’ve done in the time since. I’ll also discuss the value of that 5-year reflective period and my motivation for attempting a comeback. Finally, by documenting my experience in returning to running (without labrum to my right hip) I hope it will provide reassurance to others seeking answers.

HAVING TO STOP
This has been well documented so I’ll keep it brief. Essentially, almost 5 years ago, to the day, I fell awkwardly descending a muddy hill and instantly felt (and heard) a crack coming from within my hip area. A period of 14 months of frustration followed. No-one believed I had a problem but eventually a ‘small tear’ to my right hip labrum was diagnosed.

The operation to repair it was almost a waste of time because by the time I went under the knife, the labrum had (in the words of the surgeon), ‘completely disintegrated’ i.e. there was nothing left to repair!


For those that don’t know, the labrum is integral to the anatomy of the hip. In layman’s terms, it acts like a rubber gasket sucking the head of the femur into the hip socket and also forms a fluid seal which cushions the hip joint. If you don’t have labrum, you lack cushioning and are highly susceptible to instability within the joint. 


I said the operation was ‘almost’ a waste of time; subsequently, I found out that in addition to the torn labrum, I had Femoroacetabular Impingement (FAI). This is basically abnormal bone growth to the head of the femur (see below) which, I was informed, was highly likely to have caused the tear to the labrum. I was also told that I had the onset of osteoarthritis in my hip and that the head of my right femur was ‘scruffy’.

the location of FAI (an internet picture)
In other words, my hip was in a much worse state than anyone had previously given me credit for – why? The fall-back response was that I must have a high pain threshold and was therefore not as responsive as others would be, to the checks that were carried out.

Post-op, the surgeon did his best to placate me but was non-committal in response to my running aspirations, telling me that I could expect to resume ‘normal’ activities after the period of rehabilitation.

‘Normal?’ I asked. ‘Well, there will always be a degree of discomfort associated with your hip now, so non-weight bearing recreational activities are advised. It’s up to you what you do but you will need a hip replacement in the years to come. The longer you take care of yourself, the longer it’ll be before you need that.’ And that was it. I barely took the news in.


The next few months went by in a haze. Just after the operation I started a new job which provided some distraction. In the mean-time, I did everything I could to get back to running. Nothing worked; circuits and weight training were ok but running was a red zone, it just felt like it was never going to happen. Every single time I set off (praying that I was finally through the worst) I’d have to abort at about the half mile point.

Eventually, after a period of nearly 2 years’ post injury, I finally accepted it wasn’t going to happen. The turning point was when my wife suggested I take our son for a game of golf. At the time, I had zero motivation for it. However, it was good to be outdoors again and to be spending time with the wee man. 

The months preceding that were brutal for me. So, following a chat with Karen, I decided to relinquish my running aspirations and to take up golf, which I had dabbled with in my younger years.


Honestly, as soon as I accepted it, it was pure relief. I literally gave everything (running related) away. I didn’t want anything in return, all I asked was that someone got the same joy from it as I did; probably close to £3500 worth of stuff. Everything gone, the lot of it and anything I couldn’t get rid of went in the bin. That was 3 years ago, and into golf I immersed.

It soon became clear that whilst my sport had changed, I hadn’t. My starting handicap was 14 and from that I decided I was going to do everything possible to get down to scratch (0). For the golfers among you, you may have just raised an eyebrow or possibly burst out laughing? For the non-golfers, if you have a handicap of 6 or below, you are recognised as being in the top 0.5% of all amateur golfers, worldwide.

I’m now down to 4 (4.1 to be exact) and I ought to be quite chuffed, but I’m not. At the end of last season, I set myself the realistic target of getting down to between 3.4 and 4.2 (from 5.5) and put in place a pretty detailed plan for making that happen. Trouble is, in Britain, especially in Scotland, we must contend with a variable with which we have no control; the weather.

My strategy (which had sensible contingencies inbuilt) involved playing competitively until mid-October, thereby qualifying for potential continual cuts to my handicap. However, my local golf course has been water-logged since the middle of August; my last competitive game was at the end of that month.

We’re officially at the end of the golfing season now. Looking back over the last three years, I can say that golf provided a platform from which I could continue to be me i.e. to be driven in the pursuit of perfection, and I’m not talking about winning.

If that was important, I’d do everything in my power to avoid having my handicap cut. Yes, it’s nice to be rewarded with the odd win but for me the tangible results will always be in seeing the handicap coming down, in much the same way a runner would be over the moon to witness seconds being shaved off their 10K splits.


I’ve benefited a lot from golf in the last 3 years and met some really good people. However, amateur golf in the UK is clouded by the handicap system which is widely manipulated in a way running can never be. As a runner, you are totally exposed for who you are; in golf, some individuals hide behind false handicaps.

RUNNING AGAIN (AND THE ASSOCIATED HIP PAIN)

Another part of the golfing strategy mentioned earlier, involved me going for one run per week, in the region of about 4 or 5 miles, to improve my stamina and therefore my concentration in 36 hole competitions.

So quite by accident I fell into running again, albeit tentatively. When I first proposed the idea to my wife, I think I did a pretty good job of convincing the pair of us that it was just for the golf. Furthermore, the justification that I would be able to jog 4 or 5 miles based on being able to walk it, on the course, seemed to stack up. And oddly enough, it did.

In terms of the hip pain and how it progressed through the golf, I found I was unable to carry my clubs for a round. Instead I opted for the use of an electric golf cart which certainly helped mitigate the pain. Stiffness in the morning after a round of golf was something I was familiar with, especially in my pelvic floor and to the left side of my lower back.

All in, the hip (and now, knee) pain is always there but probably manifests as a glowing type of pain as opposed anything acute, which is what it was pre-op. I would say most days I have a 2 or 3 out of 10 type of pain. In the early days, post-op, mobility and range of movement were restricted but with each passing year that has improved.

My very first run was a 4 miler, in February of this year. I stuck to the principal of not going above 70% MHR and completed it in 9.50 minute miles. It wasn’t until June that I had felt confident enough to take it up to 2 x 4 milers per week. And then August before I was doing 1 x 4 miler and 1 x 6.5 miler.

At the time of writing (end Oct 2017), I’ve extended the running upwards 40 miles per week within which tends to be a longish one and an interval session or two. I’ve been doing this now for about 5 weeks.

In terms of pain associated with running, for low mileage, slow runs there is nothing apart from the usual stiffness felt the following day. However, for intervals and long mileage runs it’s a bit of a different story which may be due to the increased impact on the joints.

There’s not much immediate pain for the interval sessions but for the longer ones it tends to be towards the end where I sometimes have acute pain inside the hip joint, though this tends to be linked to the effort I put in. So, if I’ve plodded the whole way, there’s very little pain but if I’ve pushed it a bit, the pain builds up and seems to coincide quite conveniently with fatigue i.e. the legs being shot – a feeling many of us will be familiar with. The day after both sessions the pain can register from anywhere between 4 to 8 out of 10 but as I said it’s a glowing type pain which means I can just get on with things.

I don’t take painkillers or anti-inflammatories, not because I’m against pharmaceuticals but because they interfere with my digestive system. As someone who needs to take two doses of prescription laxatives per day (due to an operation a few years ago, which went wrong), slowing my digestion down is an added stress I can live without. 

THE MOTIVATION FOR MAKING A COMEBACK

I suppose it was inevitable that my mind would start to wander whilst running in the early days. Soon, golf was becoming less appealing. I started thinking what my limits would be. After all, I was told I wouldn’t be able to run again, yet here I was, bloody running! I was told many things by a lot of people and quite a few of them couldn’t have been more wrong.

It seems there’s a trend here; I haven’t found a single article online where a runner with this injury has resumed running activities. Why? Because they were told they couldn’t run again. Well try this for size; never accept the advice of a non-runner (Lore of Running, Law 8), even if they are medical specialists!

‘OK that’s it’, I thought. ‘I’m going to push myself as far as I can go. I’m going to go back to where I was before I got injured and reset my goals’. This time 5 years ago, I had started training for what I hoped would be my assault on a 2013 triple crown; the Highland Fling Race, the West Highland Way Race and the Devil ‘o’ the Highlands Race, all in the same calendar year.

Well, if only life was that simple. You see I have one major obstacle to contend with (as I always have) and I’m not referring to the decrepit hip. I just cannot shake off the perfectionist in me;

ü  High expectations of self and others,
ü  Self-imposed rules and structure,
ü  High moral and ethical code for self and others,
ü  Low tolerance of mistakes,
ü  Heightened anxiety,
ü  There is always much more to do, to achieve more,
ü  Nothing is ever good enough.

Don’t get me wrong, being me has its good points. I’m a highly productive bloke, a man of integrity, one who gets things done, no excuses. As I’ve said before; I walk my talk. As a recent example, I told a few people that I was going to lose 9lbs of body fat in 9 weeks.

On the flip side, though, I wouldn’t want my worst enemy inside my head (actually, it wouldn’t hurt to have one or two in there, might sort them out). Thinking too much is exhausting and can be utter torture at times. Just ask my long-suffering wife and the very few real friends I have.

I just find some people so disappointing; I especially can’t stand inherently bad people. Off the back of that confession, it might be easy to think I’m divisive and confrontational but that would be laughable if it wasn’t so Ironic; when I’m approached for help, we cut through the flannel in half the time and actually get shit done.

Anyway, back to the point, it might come as no surprise that dabbling with the idea of running long distances has been a rich source of personal anxiety. It’s maybe somewhat fortunate therefore, that I read this little snippet recently - in the Lore of Running (which highlights the experience of an injured runner once they have come through what was thought to be the final stage of their injury associated grief; acceptance);

renewed neurotic disequilibrium = tension between what is necessary to stay injury free and the need to perfect training to achieve even greater running ambitions’.

You see, I’m also quite a pragmatic soul at heart. I suppose I have to be; it helps to rationalise things. Reading that was the wake-up call I needed. I don’t want to be a statistic, that sad no hoper. I know I’m a determined bugger but launching full bore into running whilst turning a blind eye to the status quo would be idiotic, no-one needs to tell me that. So, I’ve implemented the following steps;

ü  Step 1; confide in a medical specialist, preferably one who knows you very well.
ü  Step 2; set a realistic challenge.
ü  Step 3; decide how you will achieve that and put the things in place to make it so.

The Physio; I’ve been periodically visiting the same one since my hip operation. She knows me well and more importantly knows what my body is capable of. When I proposed a couple of running related scenarios to her a few months ago, she gave them her blessing. She is confident that I am in the right place mentally and was good enough to tell me that she doesn’t know anyone else who could give this challenge as much focus as I will.

The challenge; A few years ago, a friend and I became only the 4th and 5th people in history to run the West Highland Way, in winter. That will always be one of my most treasured memories. However, during the last two hours of that venture, the bones of my right leg from my hip to my toes felt like they were fractured; unbearable pain with every right step I took, the likes of which I’ve never experienced before.

Since then, in addition to the issues with my hip, I’ve also found out that the cartilage in my right knee has completely worn away in sections. So, coupling that winter West Highland Way experience with the condition of my body 6 years later, I believe it would be foolish to think I could complete another event in the region of 100miles.

About 6 weeks ago, I set myself a mini challenge and decided if I got through it unscathed, I would commit to what I had been discussing with Karen and my physio. That mini challenge was an 18miler on trails with a meaty off-road section – the very same run on which I injured my hip 5 years ago. It was way harder than I ever recall it being. I was totally washed out for the rest of the day and could barely walk for the next two.

But it was great to be free again. And so, with that I started thinking of how to make my plan a reality. The rational was, if I could run 18miles off-road, with virtually no training, then surely with a well thought out plan, I could manage the fling.

With John Kynaston’s influence, I have set my targets (realistically) as thus;
·       Bronze; complete the distance,
·       Silver; beat my previous time (10:24),
·       Gold; sub 10hrs.

The only way I won’t complete it is if I am badly injured; my time of 10.24 was whilst recovering from an Achilles bursitis injury and with no specific trail training; so, whilst my VO2 max will have declined 7 years (from 2011 to 2018), I feel ‘Gold’ is realistically achievable.

THE PLAN TO MAKE IT HAPPEN

Although I’ve been doing about 40 miles per week for the last five, my training for the fling starts in December when the total mileage will drop initially.

In my previous guise as a runner, I was my own worst enemy, habitually over-training and waltzing head-long into injury & illness time and again. There was hardly any consistency. So, I’m almost glad I’ve had this 5-year lay-off and that I’ve got this issue with my hip because there’s absolutely no room for complacency now.

This is what I referred to when I mentioned the ‘value of my 5-year reflective period’. Upon applying for the fling, I asked a mate at work if I could borrow back the books I gave him a few years ago. I got stuck in and have created a training programme I think will be achievable and sustainable. It might seem quite simple but here’s what the next few months will be based on;

1.     Trying to achieve as much as possible on a minimum of training (Law 6).
2.     Placing an emphasis on good nutrition, rest and recovery.

1. The running part


This book recommends running no more than 3 times per week (4 in the later stages whilst training for ultramarathons). Gone are the days of marking your training according to weekly mileage alone. Instead, it’s all down to the quality of your workout. Surely if anyone should be adopting this strategy, it’s me.


Reading the section on Bruce Fordyce, in the bible (above), seemed to resonate with me;

ü  he was an intense perfectionist and highly observant,
ü  favoured hills due to his relatively greater leg strength,
ü  he strongly believed in not starting specific training too early,
ü  whenever in doubt, his advice was to have confidence in the quality of the previous workout and opt for rest and recovery instead of another training session,
ü  and to prioritise quality over quantity.

I looked at his statistics in training for the Comrades and found that over 5 months, his volume was quite sustainable (and lower than other elite athletes). The last two months were where things were stepped up. I also looked at the type of workouts he did.

I took these variables, altered them according to my own ability and shoehorned them into one of the plans (from the first book) and feel I have something workable. I’ve also factored in work; 5 years ago, (when I had a local authority job) I could train 3 times a day. That’s not going to happen now, especially when I’m sitting in a car for a minimum of 2hrs a day.

I already know I can run 20miles in my current condition and that I can run 10 miles the following day. The trick for me will be to progress in such a way that I can run over 30miles (in training) without breaking down AND to increase my running efficiency; my times are now down to 8.40 minute miles at 70% of MHR (an improvement of 1.10 with very little training). However, from now on, I am no longer using the MHR method to train with.

example end of phase 2;
  • Mon; upper body
  • Tue; 6.5miler (max 80%)
  • Wed; 1 set leg weights followed by 9.5miler with 52mins in Lactate Threshold
  • Thur; 30mins bike (max 70%)
  • Fri; day off
  • Sat; 20miles trail (70% as long as possible, 80% towards end)
  • Sun; 15miles trail

example end of push phase (pre taper);


  • Mon; upper body
  • Tue; 3x1mile VO2 max intervals with 400m recovery
  • Wed; 4miler (max 70%)
  • Thur; 10miler with 40mins in Lactate Threshold
  • Fri; 4miler (max 70%)
  • Sat; John Muir Ultra 50km (70% as long as possible, 80% towards end)
  • Sun; 20miles trail

The only slight problem I have with this training plan in that there is a discrepancy with regards what effort is required for each session. I recently purchased a Garmin Forerunner 235 (and subsequently a Garmin chest strap HR monitor because the wrist based one is useless on intervals). This watch is set to MHR zones whereas I believe I train more effectively using the Karvonen HR method.

There is a difference of about 10% between the two methods. So, if I’m out on a tempo run at about 160bpm, this registers as zone 5 (for VO2 intervals) on the watch when its actually closer to an 85% effort for me. Likewise, when I go above 142bpm the watch registers this as zone 4 (threshold) when actually, I’m just going above 70%.

I got the watch for two reasons; one for the fling – the battery last 11hrs, and two for the accuracy of the HR. The fact that it registers different intensities than to what I’m actually doing is of little consequence apart from the fact that it then suggests 2.5days rest after a tempo run because it thinks I’ve just ran balls out for over an hour – which I haven’t!

2. Everything else

For me, half the fun in doing something like this is in dotting all the I’s and crossing all the t’s. I like to get every single variable ticked off and leave nothing to chance.

Kit; I’ve purchased the most important bit of kit I’m going to need; Hoka’s – a road pair and a trail pair. Clearly, I need as much cushioning as I can get my hands on. I’ve also bought loads of other stuff like compression socks, trail pack, winter training gear etc.

Daily nutrition; quite a big one this but fortunately, I feel I’ve progressed well in this variable over the last 5 years. The reasons are two-fold; one I had employed a nutritionist late 2012 to help me develop something workable for my 2013 Triple Crown assault, and, two because of my research into ‘hormone manipulation’, whilst focussing on weight training. Here’s a typical example of my daily diet (on a training day).

6am Breakfast (aim 15% daily carbs & low fat);
½ pink grapefruit, 60cal, 14C, 1P
Medium bowl of porridge (40g + 200ml milk) with choc 280cal, 45C, 14P, 6F
50g Grapes & 3 chopped nuts 82cal, 9C, 1P, 4.5F
420cal, 68C, 16P, 11F

Snack (1000)
Ham sandwich (low fat salad creme) with beetroot 300cal, 28C, 24P, 7.5F
 Date bar, 120cal, 17C, 2P, 5F
430cal, 45C, 26P, 12.5F

Lunch (1300);
Chicken salad with cous cous, 520cal, 48C, 40P, 20F
520cal, 48C, 40P, 20F

Snack
One of the following;
-        Graze bar, 250cal, 25C, 9P, 13F
-        Peanut butter bar, 275cal, 41C, 11P, 6F
-        Coconut bar, 275cal, 41C, 11P, 6F
 270cal, 41C, 11P, 6F

Pre-workout (big sessions)
250ml Ribena, 110cal, 27C
4no jelly babies, 85cal, 21C
200cal, 48C

Post workout
1 banana, 105cal, 25C, 0.5F
105cal, 25C, 0.5F

Post workout (aim 25% carbs & low fat)
1 large tin tuna (water drained), 115cal, 27.5P
75g pasta, 265cal, 56C, 8P, 1F
40g olives, 70cal, 3C, 0.5P, 6F
50g pineapple, 65cal, 16C
Muller yoghurt & apple, 180cal, 34C, 8P, 1F
680cal, 110C, 44P, 8F

Supper
Hot chocolate, 175cal, 33C, 17.5P, 4F
175cal, 33C, 17.5P, 4F

Totals; approx 2800cal; 418g is approx’ C/60%, 127g is P/22%, and 45g is F/18%

Training nutrition; I’ve never been one for holding down solids during long training runs. It’s fine for long efforts where the distance is broken down to periods of walking but the only parts of the fling I intend on walking are up Conic and long inclines. In short, my training nutrition will match that which I intend for the fling; go gels and tailwind.

Recovery; I purchased an indoor upright training bike recently for the sole purpose of cross training and recovery which fits within the principals of running 3 days per week.


Rest; in training for the winter West Highland Way, I engaged in mindfulness and meditation. My training for that was the most consistent it had ever been and for nearly 20hrs of that ultimate challenge, I swear on my life, I felt as though I was floating along the Way. I’m going to add this back into my training regime alongside a daily stretching routine which I have been doing daily for the last 5 years.

CONCLUSION

Maybe I’m just lucky or perhaps fortunate but it feels good to be coming back. Yes, there’s pain but so what, it’s been there at different intensities for every day over the last 5 years. My physio has given me the green light and if I don’t have a go, I’ll never know what I was capable of.


With this considered approach I’ve removed as much chance as possible. I know I could still fall short of reaching the start line for the fling but at least now, I’ve already progressed 20 miles further than simply believing others and giving up. I believe it’s possible.