Like a Hammer to the Knee: IT Band Injury and Prevention for Runners.

This summer, based on MRI evidence, my sports physician announced the diagnosis of  "severe IT Band damage" and since then I have drastically changed my methods of training.  I constantly hear of others that have been sidelined with the same devastating injury, and I want to document my experience here so as to help prevent it for everyone else.  I must preface this post by stating that I am not a physician; if you suspect any type of injury it is imperative that you visit a licensed sports physician for proper diagnosis and treatment. 

Image courtesy of rice.edu.

What is it: The Illiotibial Band is a ligament that stretches down the side of the leg, from the hip/pelvis to the shin, and functions to stabilize the knee.  Injury to this anatomy presents with sharp pain in the outer knee during exercise.  For me, I could run almost exactly one mile before feeling like someone struck my knee with a hammer.  I'd set out feeling hopeful that I was on the mend, and then BAM!  Debilitating.  I always had to stop and walk home, battling tears from both the physical pain and the frustration of not being able to run normally.  Illiotibial Band Syndrome (ITBS) is an extremely common overuse injury in runners, and recovery can vary from a few days to several weeks, as in my case.  During this summer while I was in treatment, I was forced to skip FOUR races including two full marathons, a 50k and a 50 mile race.  As any runner can understand, this was completely heartbreaking. 

Causes: Causes for such an injury can include overuse, improper foot strike, running in shoes that need replacing, an imbalance of or weak leg and hip muscles, pronation, running repeatedly on banked surfaces, increasing base mileage too quickly, and tightness in the IT Band itself.  In my experience this summer, I became lazy and complacent in my training.  I neglected cross-training, was sporadic with my foam-rolling routine, and did not, I repeat, DID NOT rest enough.  From this experience, I learned the hard way that rest days are just as important as speed work, long-runs, and proper nutrition.  Do not make the same mistakes that I did, because this injury is so common, it WILL happen to you if proper techniques are not enforced.

Check your shoe wear pattern for signs of pronation and seek assistance from a decent running store for shoe and insole advice!

Image courtesy of the runningshop.uk.com

 

Prevention: Prevention of injury then obviously includes decreasing mileage (yeah right!) while increasing more rest days, improving running form, replacing worn-out shoes, considering the use of custom shoe insoles, cross-training to increase leg and core muscle strength, following the 10% per week mileage increase rule, varying your running route, and incorporating proper warm-up and stretching into a running regimen.

Diagnosis and Treatment: After weeks of inability to run and consequent impending depression, I hung my head, picked up the phone and made an appointment with a sports physician.  Best decision of my life.  My MD immediately got me in to complete an MRI and the next day he showed me the shaded areas of "severe IT Band damage" on the pictures of my knee reflected on his light box.  From there, I made an appointment with a physical therapist.  I chose one that was familiar with running injuries and he proved to be a priceless wealth of knowledge I will forever utilize.  I met with him weekly for exactly a month. At each session he painfully massaged the area where the IT Band connects with the knee, and taught me several exercises and stretches to improve the strength and range-of-motion of my quadriceps, hamstrings, and muscles of my hips.  In the meantime, I completely stopped running (nearly an impossible feat, but nevertheless necessary in my case), continued to ice/heat my area of damage, continued to foam-roll until it hurt, and began swimming laps to maintain my fitness level as best as I could.  There is nothing more humbling for a runner than to be sidelined with an injury that could have easily been prevented by proactive steps.

Do this now: Since the LAST thing I want to do is reinjure my ITB, and I refuse to decrease my mileage (and I imagine you agree), I have committed myself to performing the following list daily. 

1. Do not neglect rest days, especially after long run days.  Listen to your body; learn to discern feeling lazy versus feeling tired and in need of rest.  And similarly, ensure you are getting enough sleep at night since sleep is how your body repairs after the physical destruction of cells during training.

2. Foam roll.  Do it.  Every single day.  It will hurt, but that is key to improve circulation and blood flow to vital areas to thus promote tissue repair.  If you do not know what foam-rolling is or how it's done, check here. That link also includes pictures of several foam-rolling techniques for the IT Band as well as other main muscle groups.

3. If not already currently doing so, add at least a five-minute warm-up slow run or brisk walk prior to your run.  I (now) always follow this warm-up with a regimen of stretches such as:

• Basic IT Band stretch: Cross one leg in front of the other and reach down.  Also, reach up and over.
  
   
  

• Seated cross-legged stretch: You can also lay on your back while doing this stretch for a deeper pull.

• One-legged squat stretch: Cross one leg above the knee of the other leg and sit back in a squat.  I prefer to hold on to the wall or another stable object for a deeper stretch.
  

• Kneeling hip flexor stretch: Your knee does not need to touch the ground.
  

4. Increase muscle strength and balance with the following exercises several times per week:

• Band walks: Walk laterally side-to-side with band around ankles or do Monster Walks by walking forward as shown below.
  

• Single leg balance exercise: While standing on one leg, focus on balancing then slowly bend down to touch first at your toe, slowly stand back up, then slowly bend down to touch outside your toe.
  
  

• Leg lifts: Rest on your arms, using your core muscles (abs and glutes), lift your tush in the air and slowly raise the extended leg up and down slowly 20 times.  Also, you can perform small to large circles with the extended leg, or even pretend to write the alphabet with your foot.  Keep all movements slow.

• Various squats and lunges with or without plyometric elements.  Land softly on your knees, use proper squat and lunge form.

ITBS can strike at any time so make these stretches and exercises just part of your routine.  Do not risk the emotional and financial consequences of being forced to miss scheduled races due to a preventable injury.  As runners, our miles are more than just burning calories or getting in daily exercise.  Running is our mental release, our therapy and outlet from daily stresses.  If banned from dashing due to ITBS or other injury, we are truly lost.

Citations:

runnersworld.com
Dr. Trimberger, Oregon Sports Medicine
Dominic Chambers, DPT, North Lake Physical Therapy

Where will you be a year from now? Goals for 2014.

It's that time of year again. When, in a haze of post-holiday binging, we hastily make insane promises to ourselves to completely change our ways. Resolutions. I cringe at the word. 

Okay, so we all went a little overboard with the M&M pretzels ala Pinterest; indulged a bit on the merlot; skipped a few miles (and by skip I mean settled into the sectional). But I'm here to declare that you are NOT a failure! Just as fast as your scale may have crept up, or your pace gained a few seconds, you can reverse it and get in the mindset you desire. So let's set some GOALS. Screw the resolutions, achieving goals is much more measurable and rewarding. 

How do you visualize yourself exactly a year from now? Physically? Mentally? Emotionally? 

How will you get to that place? 

Write these steps out.  Make them measurable. Be very specific. Dream big, don't hold back. Never be afraid to get outside of your comfort zone, as that is how we discover just what we are capable of. 

These steps you listed are your goals. Want to finish your first 5k? Be honest with yourself about how you'll smash that goal (What training plan will you use? When/where will you carve out the time to train? How many days/week will you dedicate?). List steps you'll take if you fall behind or fail, because there WILL be roadblocks. Those who succeed know how to hurdle over these roadblocks instead of getting knocked out by the flak. 

Do you share your goals with others for accountability or do you keep them hidden in fear of failure? Maybe share them with just a select few peers? Only you know what works for you. There are thousands of online message boards out there with active people seeking similar experiences you can join to keep your goals alive yet still relatively anonymous. 

Write your goals down in a very accessible location. I keep an active list in my phone and visit that page daily. If you are attempting to make drastic lifestyle changes, such as weightloss, a nutritional overhaul, or a new sport, remember to start with small changes. Make these changes habit, like brushing your teeth. You would not think of going to bed without clean teeth (I suspect) so why would you think to not sweat daily? Healthy people sweat nearly daily (even during active recovery "rest" days) because it is habit. Wake up, brush teeth, sweat. Just another part of the day, part of the routine. If you're making lifestyle changes, know that it's not easy to change years of habits overnight, but if you continue to JUST DO IT (Nike was on to something there!) then it will become a habit and YOU WILL BE SUCCESSFUL. 

We all know how fast a year floats by. We will blink and it will be December, 2014. Life is short and we get one chance to fully experience everything. Now is the time to make the changes necessary to live your best life. 

I am sharing my goals for 2014 for accountability. 

1. Run 2,000 miles total. 

2. Complete a WSER100 qualifying 100 mile race. 

3. Run a sub-3:25 full marathon. 

4. Run a sub-1:35 half marathon. 

Your goals will look completely different and that is okay, in fact, that is awesome! We all come from different places; never compare your goals to another person's. I can assure you, while fitness and nutrition are my niches, I'll never ever have an organized house and my laundry pile will forever rival the height of Mt. Rainier. Hmm maybe I need to rethink my goals...

Please feel free to share your goals below and contact me if you want ANY help or tips in order to become your best you in 2014!

SmushTush Launch Giveaway!

Please help me get SmushTush running and fitness launched on the right foot! I'm giving away a 1L Nathan bottle crammed full of my favorite things. I want to help get YOU launched in 2014 too! 

Please simply "like" me on Facebook at www.facebook.com/smushtushfitness and on IG @smushtush and twitter @smushtush 

Thank you!

Run d' Amore 100 Mile Ultra Marathon - 11/23/13

The million dollar question I have been asked every single day since finishing the Run d' Amore 100 mile Ultra Marathon two weeks ago is, "Will you do it again?" Read on and you shall see...

I am forewarning you, just as it takes a LONG time to run 100 miles, this post will be equally lengthy.  But I feel a need to document my thoughts, before my brain becomes clouded by life and future races and IPA.  This race changed me, not only as a runner, but as a person, and I need to remember.

I will agree.  The idea to run 100 miles is crazy.  I get called crazy a lot.  Your definition of crazy might be a bit different than mine, I suppose, but yes I'll agree, running 100 miles is straight nuts.  The idea to attempt this "crazy" distance was put into my head by one of my closest friends, Leigh Anne.  This powerful girl has done three 100 mile races and I trusted her when she casually asked me to join her in November for this race.  Casually, like, "Oh hey, want to go run 100 miles in November?" as if it was just another activity to place on the calendar, right next to "Petunia's ballet recital".  That was in September.  If you've read my "about me" description, you know that I am "addicted to endorphins and registering for races" so of course I obliged.  I have an issue with saying no really, it is truly an addiction.  So we registered.  And here is what we were getting ourselves into, according to the race's website:

"This is a 4 mile loop course with a 1 mile out and 1 mile back (kind of lollipop shaped) on trails followed by a two mile loop of paved surface.  Cumulative elevation for the 100 miles will be approximately 11,000 feet.  There will be restroom facilities (port-a-johns) at the starting line/main aid station and on the course (please use these, not the bushes or trees). There will be one main aid station at the starting line that you will pass each loop.   We will be supplying some food and drinks, but because this Run D'Amore race is  a "fat ass" type event, you will need to plan and supply most of your main food and drink needs." 

FYI: A "fat ass" is any type of race where you supply your own energy needs, fluids, etc.  Basically just a bunch of crazies getting together because they truly love to run, not for the glory or fancy porta-potties with anti-bacterial hand sanitizer dispensers or even the commemorative t-shirt.  Yes you read that correctly, a race with no t-shirt.  Every runner gathered supplies to share together, including food and drinks for the aid station.  Trips to Costco pre-ultra are the best!


On the Friday prior to the start, my wonderful, selfless friend Dede and I left Orange County around 3 PM.  She was only going up to help us get through the race, known as "crewing" in the ultra world.  Did I mention she is SELFLESS? She drove us up the six hours that night, keeping my nerves in check with silly stories and good old-fashioned girl gossip.  We rolled into San Martin (right outside of San Jose) around 9 PM, assembled our gear, and passed out, as that 4 AM alarm clock was sure to come too quickly.

The race started at 6 AM.  There was a generous 36 hour cutoff time so I knew I'd be able to finish unless some unthinkable event occurred, such as loss of limb to a coyote or a lightening strike to the tush.  It was dark at the start so we secured our headlamps and took off.  The first mile of the four-mile loop course was straight up.  All of the 11,000+ foot elevation gain took place in that first mile, so the total gain was only over 25 miles, not 100.  The second mile was straight down the same hill.  I loved these two miles the best because they were on dirt.  The remaining two miles looped around an asphalt trail, though I ran alongside of that in the dirt.  I find that running on trails and gravel is so much easier on my muscles and joints, and I needed them to sustain a long time so I chose to stay on the dirt for the entire duration.  After that two-mile loop, we crossed the aid station, which was packed with our donated food, to include Twizzlers, cookies, salty chips, electrolyte tabs (imperative!) , Coca-Cola (sweet nectar of the ultra-running gods), salted potatoes, watermelon...I could go on and on.  Let's just say it was a veritable buffet of running delicacies.  I wore my Nathan Intensity hydration pack so I was sure to have plenty of water the entire day.  On a side note, one thing I LOVE about ultra running is the strict "zero littering" policy.  Anyone caught littering (to include throwing a water cup) is immediately disqualified.  We all brought our own water cups to reuse.  Totally opposite of the millions of wasted cups strewn everywhere in a traditional race.

Why not wear flying cat pants while running 100 miles?

And so we continued along this route for hours.  The sun peeked above the hills and the cattle that roamed the grassland surrounding the course watched us circling, probably thinking the same thing you are right now, "Why are those people so crazy?"  However your comments were probably not followed by an inquisitive, "Mooooo?"  The heat radiated and we shed layers of clothes.  The salt collected on the brims of our hats and we continued to replace it with electrolyte caps and Lays.  And that Coca-Cola tasted sweeter than ever. 

View from the top of the ascent.

Ultra running is such a fun sport because EVERY runner is there to support each other, as if we are one huge team.  I made friends with complete strangers, runners from Texas to India, ages 18 to 73.  Everyone had an interesting story to tell.  Moms, physicians, musicians, hippies, computer programmers, engineers, sons, daughters, grandfathers...all walks of life were represented yet we were brought together by our common passion for running.  That alone makes for immediate best friends.  We talked gear and races for hours, for what else is there to do when you are circling the same four miles for over a day?

I hit the 50 mile mark at around 10 hours, so around 4 PM.  I felt awesome.  I rotated between listening to my music (an eclectic blend of Radiohead, deadmau5, Disclosure and Wu Tang, among others) and having lengthy discussions with fellow running teammates.  I lost track of the number of high fives I gave and received somewhere in the afternoon too.  I had zero GI distress, which elevated my mood because I fully expected to be miserable.  I went into this race EXPECTING to be miserable.  I was anxious actually, to experience the highs and lows of running 100 miles.  That IS why I did it.  I wanted to just feel.  Even if it meant physical pain or mental strife.  I knew the bright side would be the brightest side imaginable, if I could just get there.  And so I kept going.

Cruising down around mile 50.  My husband said this was after my "costume change".

Every few loops I stopped and stretched a bit.  The downhill was starting to become painful.  While the first half was spent literally bounding down that mile two decline, I was slowing way down and feeling those quads.  But I still felt as good as could be expected.  And then the sun went down.  That glowing orb of hope and positive energy and warmth just vanished.  And into those depths I was seeking I began to fall.

The sun disappears, bringing my confidence along with it.

At sunset I was feeling energized.  Those last few moments before darkness ensues is magical.  Twilight.  The air felt crisp and electric.  This sensation only carried me about one loop before it got cold.  Much colder than I was prepared for.  Sure I added more layers and mittens, but what I did not account for was the wet marine air.  I ran 12 miles thinking that the little flecks that were flying into my headlamp were tiny bugs, when in reality it was the condensation in the thick air.  Looking back, I know some of those sensations were perhaps hallucinatory as well.  It was about 2AM I started sleep running.  Literally running while sleeping. 

My selfless savior Dede hopped up at that moment and knew I needed her, even though I was so cold my lips could barely say a word.  She completed a few laps with me, in the middle of that cold and impossibly dark night, singing horrible renditions of Miley Cyrus (sorry Dede, keep your day job!) to try and make me giggle.  We listened to the whooping call of coyotes in the near distance and we watched the spectacle of the night sky in total darkness together, looking for various constellations we recalled from childhood.  It truly was spectacular, but I grew increasingly more cold.  So cold in fact, that I stopped drinking water and taking in calories.  I had no energy to do so, and consequently, I suffered.  I grew colder and even more tired, and at mile 72, an experienced volunteer at the aid station sat me down, made me a cup of the most delicious hot vegetable broth I have ever tasted, and massaged my calves.  I could have lingered there all night, yet I knew I needed to keep moving or risk the dreaded DOMS. 

I continued around a few more times and then at mile 84 I was just hopeless.  I couldn't feel anything on my body, a combination of being wet and cold, and sheer exhaustion.  Thoughts raged through my mind begging me to quit.  "84 is plenty long, be proud of how far you've come!" I thought, knowing how devastated I'd be tomorrow had I stopped right then and there.  Another experienced volunteer recognized my despair and had me sit in front of the heater and told me I needed to take a short nap, no longer than 30 minutes.  Every person sitting around the heater promised me I would be renewed.  Dede wiped away my tears.  I don't think I have ever fallen asleep so quickly, and as promised, they woke me up after the allotted time. At this same moment, the amazingly tough Leigh Anne came through the aid station.  Even though I had taken a nap, I was still utterly exhausted and crying again.  She kneeled next to me and said "Listen to me.  You are going to get up now and we are going to do this together.  Do you trust me?" and just like that, she renewed my faith in myself and I trusted her.  I followed her commands like a remote-controlled robot.  My head was still intact, yet my mind was not attached.  She placed her warm ski jacket on me (as mine was soaked) and we set off to finish together.

Rock bottom.

Four laps.  Just four laps to go.  16 miles.  Just over a half marathon.  We could run this in our sleep (and we somewhat did).  Four more climbs of that nasty bitch of a hill.  Four more descents laced with screaming muscles and sharp pain with every step.  We pushed each other, each of us struggling with different aspects of the course.  We needed each other and were present and focused on the survival of us as a team.  It is impossible to illustrate just how bonded you become with someone, when you are both equally battling demons in your mind and muscles, in those last few hours before the sun rises, after you have been running for nearly 24 hours.  A day.  While the world went through the usual motions of eating and sleeping and breathing, we crept along that four mile path, eating  and dreaming and breathing.  She is now my sister.

Sunrise.  Layers of clothing slowly peeled away, joints thawed and the most delicious eggs and pancakes (cooked over a camp stove) were consumed.  The race directors knew that true love lay in awakening our stomachs.  The protein of the eggs gave us strength and we washed it down with even more Coca-Cola.

Last lap.  Four miles.  Just over a 5K.  Final ascent up that hill.  We owned that hill.  Final descent at mile 98.  The screaming of my legs was stifled by the voices in my head that were already feeling the pride of finishing, of triumph, of sitting down.  I gave Leigh Anne a special infinity symbol bracelet on that final loop.  See, if you put a "1" in front of an infinity symbol, it creates a 100.  Our friendship will last forever, it is infinite.  We are bonded by this event, this experience of rising above our lowest lows together. 

We crossed that finish line all smiles.  Dede gave us a huge hug, as did the race directors, and we just held each other tight.  We did it in just over 29 hours.  Sometimes I look back on that number, 29.  It is hard to fathom what I possibly could have been thinking about, alone and lost in my thoughts for 29 hours.  Sometimes in my day-to-day routine, an hour seems like forever, yet I continued on for 29 straight hours.  Therein lies WHY I did it.  To push myself; to see just how much I could accomplish.  I always knew in my heart I could do it, but I needed to prove to MYSELF (nobody else) that I could push the limits set forth by society.  Crazy?  I'd have to agree with you that yes, it is pure crazy.

And would I do it again?  Well, I already have two 100 mile races in the books for 2014...

Never given, always earned, the coveted 100 mile belt buckle!

 

 

My true "sole sisters": Leigh Anne in the orange vest and selfless Dede in the middle, holding us together like the glue she is (most likely holding us up in this picture too).  These girls still love me even after seeing me at the most miserable I have ever been. 

Divas SoCal Half Marathon - 12/8/13 Review

Yesterday I ran the Divas SoCal Half Marathon in Ontario, CA.  This race is part of the Run Like a Diva series of races throughout the US.  Being a new Southern California transplant (originally from the Pacific Northwest, most recently from Portland, OR) the cold temperatures at the start were actually a comforting reminder of home.  It was quite comical really, how alarmed everyone was regarding the drop in temperature and previous day's rain.  Ha.  I was prepared. 

The expo on Saturday was fun; I ventured there with my new running friend (and neighbor) and my nearly four-year-old daughter.  We checked out the booths, purchased cute necklaces from I declare charms and my daughter scored a new pink tutu (as if her collection wasn't big enough...). 

Obligatory Expo Pic. 

 

 

On Sunday, we left Irvine at 5:30 in the morning and got to the Ontario Convention Center a little before 6:30.  This race was extremely well organized; it was delightful to be able to park right at the start and wait in our cozy warm car until 15 minutes prior to the gun.  The indoor restrooms of the convention center were an added bonus too!  Much better than the traditional porta-potty pre-race experience.

 

The race started at 7:30 following the national anthem and a speech by the first female winner of The Biggest Loser, Ali Vincent.  My ONLY complaint about the entire day was the mashed start.  There were small pace signs near which people were supposed to line up accordingly, but of course nobody did.  No worries though, as the crowd thinned out within the first quarter mile. 

 

This was my first race with my new companion, my huge yet effective Garmin 310xt (purchased for the 20 hour ultra-runner's dream battery life, and ability to track swimming and running mileage as well, for future triathlon endeavors).  Though bulky, I adore my new gadget.  Runnerd forever.

 

The course was quite boring.  The race itself had many fun music booths sporadically placed along the course, but there was not a huge crowd, and Ontario really is not known for its impressive scenery.  The course was an out-and-back style so it was fun to check out all of the pink costumes of runners on the way back to the finish.  I was inspired by the variety of ages and running abilities.

 

Since it had only been two weeks since the completion of my first 100 mile ultra race, my muscles were screaming at me all race.  I'll be honest and say it was a bit of a struggle.  Still, I was pleased with my time of 1:44:31 (off my PR by seven minutes), which is under an 8:00/mile pace.  I ended up in 23rd place out of nearly 2,000 runners.  Considering the last few weeks has been recovery mode, I will take it!

 

The Divas medal is by far the largest medal I've ever gotten; I could seriously do arm curls with it.  The pink boa and tiara given to each runner just before the finish was a fun touch, and the champagne and pink rose handed out at the finish was equally whimsical. 

 

 

I definitely recommend this race to anyone (though it is a female themed race) who wants a casual, fun racing experience, especially those seeking their first Half Marathon finish.  There was also a 5k option too. 

 

Now off to foam roll and stretch!

 

I need to write these experiences down.

Why a blog?  Because running, fitness and nutrition are my true passions.  When I run, I think.  When I run, the endorphins flow through my veins and my brain explodes with vibrant ideas.  I feel the need to write these ideas down, for therapeutic release, and for others to perhaps be inspired to discover their own driving forces in which to embrace and obtain a life fully lived. For what is a life if not fully lived?