Monday, November 18, 2013

Band-aids Be Gone

Tenacity. It's a word that embodies my approach to athletics, and life for that matter. If I remember correctly this was the center point for my law school admissions letter. Knock me down, and I'll get back up. Tell me I can't and I will work harder.
Lately, I've demonstrated an entirely new sense of tenacity.  No sweat and tears, just a determined patience to find real answers. My feet have now sustained radiation from: x-rays, MRI, and a bone scans. A doctor who touts himself as "the doctor to the running gods" told me all was clear and I should get back to training as usual. Ridiculous! I've been doing that for two years, and look where it's gotten me. After demanding another answer he suggested I try alcohol injections to see if maybe it is a nerve issue. Each shot slowly kills the nerve receptors, and is a common treatment for neuroma. After 3 shots I experienced a persistent numbness and little decrease in the pressure and irritation in the area. I just knew there was something deeper, something more. I continued to search! This can not be the end of me and my passion to compete.
My dear friend Meredith Kessler, while seeing the frustration in my face, demanded that I go see her physical therapist, Chris Daprato at UCSF.  I was definitely frustrated, and haven't had the best luck with other PT's I've seen. Would this be any different? Chris took time to talk with me on the phone and reassure me that a visit was worth my time. When stood in front of him he didn't even look at my feet.  He stared at my hips, then my knees, then calves...and honestly I'm not sure he even got down to my feet. He had my attention! I believe in a chain effect approach. It's simple: each segment of the body thrives on the connections it has above and below it. The muscles and tendons in my tight calves affect my ankle flexibility, which pulls on the soft tissue under my feet, which makes the area around my sesamoid bone very VERY unhappy.  For example, I never related the foot cramps I get while swimming to the pain I experience around my sesamoid bone while riding/running. I'm thinking differently now.

Rest assured, this man knows his stuff, understood my commitment, and believed he could get me back on the right track again. He sent me home with exercises and stretches to do every day. These became the most important element of my "training!" The goal: change the neuro-pathway of messaging between the feet and brain, and reduce areas of tightness that are pulling on the chain. I've heard of myofacial decompression (aka: cupping) and have had it done on my feet after acupuncture treatments. I wasn't a believer, and actually thought the treatment procedure was a bizarre farce.
....that was until Chris stepped in. His method on how he uses the cups and where he places them was far different from what I had experienced. Notice the cup placement in the above picture- NOT on my feet!
Once my calves and feet showed signs of improvement it was time to address mechanics. When I look at run race photos of myself from the year I am appaeled. My body position, knee angle, turn over and foot plan have all been affected. It's time to get back to the drawing board. No stone unturned, no detail too small. Chris took several videos of me on the treadmill.  By slowing down the footage I could see exactly what he was seeing AND the chain effect it has on my entire structure. 
I believe you learn from every race you do. Often you can learn more from your failures than your victories.  Question why and where things went wrong. Do not dwell on these instances, but learn from them. There is nugget to pull from every single race that can help you improve!  Ironman Louisville told me that I need to look into whether cycling plays a role in all of this. If running was the root cause then the pain wouldn't start until the run.  In order to address whether cycling was also playing a roll in this Chris suggested I see his buddy Curtis Cramblatt.  Curtis is the founder of Revolution In Fitness, a facility in Palo Alto that provides a range of services: physical therapy, bike fitting, and cycling efficiency analysis.  They say an image can speak one thousand words. So, I'll let this one do the talking: 
The gray areas on the image above show where pressure should be applied. Maximize this by properly distributing pressure and optimal power is obtained. The area in blue indicates where where I am applying pressure. So there you have it- 90% of my pressure is being absorbed right at the spot of pain- those glorious sesamoid bones.  This grabbed my attention, however it wasn't until Curtis started talking about how to change this that really captured me. The problem is in my back and hips. Again, someone who sees the entire body as a working piece of machinery that only operates at full capacity when all it's working parts are properly in line. By collapsing my rib cage through my intercostal muscle my hips move into proper alignment, my left hip drops equal to my left, my knees do not float inward, got it: pressure is distributed properly in my shoe.
 This is not the first bike fitter, P.T., mechanics guru I've seen. I've seen many. They are however some of the few that have looked at my feet as the secondary issue. A cause and effect. No band-aid can solve this. It will take tenacity. Tenacity to change! The good news: after just one month of diligent work I am riding and running again absolutely pain free. I can stand at night and cook dinner without pain. Most importantly my goals are right back on the playing field ready to be tackled! I believe again!
I am SOOOO happy I have these guys on my team. No thank you can really tell them what they've done for me. Mentally and physically I am back on track! My passion for this sport is rekindled and my tenacity to win has returned to playing a part in each and every one of my training sessions.

So I leave you with a few take-aways for anyone dealing with an injury or setback.
1) No one knows your body better than you do. Listen to it and do not give up in finding answers.
2) No doctor, PT, massage therapist, etc. knows absolutely everything about every injury/ailment. This doesn't mean they aren't creditable. If the first person you see doesn't have answers that work, try again, and again....and AGAIN! Remember every piece of information you collect along the way. Tuck it away and treasure it. Eventually all the pieces will fall into place and the collaboration of input will empower you to heal. I've seen an awful lot of practitioners over the last year+ and am thankful for each and every one of them!
3) Be persistent and positive. Sometimes the hardest part of an injury are the mental obstacles. Few ironman triathletes are without passion. It's inherent in our gene. Take this and apply it beyond just your training and racing regimen.
4) Orthodics, pain meds, injections, etc are all band-aids. They cover up the real problem of poor mechanics. If you don't addresss the root cause of an injury you may never get past it. Which leads me to number 5...
5) Slow down in order to speed up. Over the past few months I've been working with Chris, Curtis, and my amazing swim coach Paul to capture excellent video footage of my mechanics. Their time and input will play huge dividends for me! This is the best time of year to focus on the details. Set yourself up for success now. Do not just go through he motions so you can say you checked off another workout.
6) In order to fix your body you must adjust your mind. Believe you will be healthy again, and don't settle for anyone who wants to tell you otherwise. Power of positivity. Surround yourself with it, and dismiss all who bring negativity into your healing process.
7) If you live in the bay area I sincerely believe Chris and Curtis are worth a visit to help with run and bike mechanics (regardless of whether you're facing an injury).

It's been a pretty awesome off season -full of amazing changes that will propel me full throttle into 2014. Stay tuned!