Category Archives: injury

Stress and performance. Stress and training.

It is a fine line. . . training. . . stress . . . racing. We use stress in training to achieve a new level of fitness. Stress to the body, presented in training cycles or training stimuli can strengthen the body and take your body to another level.

What causes training to go wrong? When is the “stress of life” more than our bodies can handle on top of training stress? Is this called Overtraining Syndrome? Is it simply stress? I am not going to be able to answer all of these questions, but I will share my experience from this past year of training and racing.

Age, to me, is not the death sentence to your dreams. Just because our bodies age and change, does not mean that we cannot pursue things that seem out of reach. Quite the contrary. As I age, I have bigger dreams and the means to run full speed after them. The trouble sometimes is that I also have to balance my life with my pursuit. Not only am I pursuing my dreams, but my family is pursuing theirs.

Stress. . . I struggled for months to figure out what was wrong with my hamstring. Begging my PT for answers,  for help, for some magic. Then, 3 days before my 50K in Colorado, Dr. Price with Elite Orthopedics told me that I had a hip labral tear. The beginning of my race season, Pike’s Peak Ultra, a week from that appointment, with Kodiak 100, my “A” race for 2018, a month after Pike’s Peak.

My training was a struggle from July (2018) through September. I was training. I agonized a bit over running Pike’s Peak and Kodiak. I ended up taking one week off before Pike’s Peak and one week off before Kodiak. My hamstring was very inconsistent. There was nothing that made it a lot better. There was nothing that made it a lot worse. 

Dr. Price suggested a cortisone shot and I decided to do it. I have never had a cortisone shot, and I think that it was a good decision. It helped my hamstring. I asked Dr. Price about racing and he said that as long as I was trained and prepared that I could go for it, and I did. I finished Pike’s Peak 50K. I DNF’d Kodiak 100 at mile 45.

Exercise itself is a form of stress, which triggers changes that make your body stronger. But the system breaks down if you are chronically stressed, as chronic stress impairs your body’s ability to respond to acute stress—such as exercise—because its resources are essentially used up. “Ten Ways Stress Can Mess With Your Workout”

Stress kills motivation. A 2014 study20 in Sports Medicine came to the same conclusion—stress is likely to thwart your efforts at being physically active. This phenomenon proved especially true for older adults and those newer to their fitness schedules. Not exercising when your stress level rises is particularly unfortunate, because exercise is such an excellent stress-reduction tool.“Ten Ways Stress Can Mess With Your Workout”

There are many signs and symptoms of stress, and everyone is different, so one sign or symptom described by one athlete may not be what another athlete experiences. Ray and Weise-Bjornstal (1999) described seven categories in which an athlete may experience stress. These categories are: affective, behavioral, biological/physiological, cognitive, imaginal, interpersonal, and sensory (Ray and Weise-Bjornstal, 260). Each category has its own signs and symptoms. Affective signs and symptoms include: anxiety, anger, guilt, depression, shame and feeling sorry for oneself. Behavioral signs and symptoms include: sleeping disturbances, restlessness, aggressive behavior, alcohol or drug abuse, sulking, crying, poor performance, absenteeism, and clenched fists. Biological or physiological signs and symptoms include muscle tension, increased heart rate, indigestion, stomach spasms, pain and headaches.

Cognitive signs and symptoms are frustration, worries, distortion, exaggeration, unrealistic performance expectations, self-defecting statements and self handicapping. The imaginal signs and symptoms include images of failure, images of reinjury, flashbacks of being injured, images of helplessness, and images of embarrassment. The interpersonal signs and symptoms include withdrawal, manipulation and argumentation. The last category, sensory, includes tension, nausea, cold sweat, clammy hands, pain and butterflies in the stomach (Ray and Weise-Bjornstal, 260). There are many signs and symptoms of stress, which are not all experienced by each person, and each person can experience a variety of signs and symptoms. -United States Sport’s Academy, “Stress and Anxiety in Athletes”

Sports performance is not simply a product of physiology (for example stress and fitness) and biomechanical (for example technique factors) but psychological factors also play a crucial role in determining performance. However, every athlete has a certain stress level that is needed to optimize his or her game. That bar depends on factors such as past experiences, coping responses and genetics. Stress during sports, as in anything else in life, may be acute, episodic or chronic. For the most part in sports, it is episodic, whether during a competitive match between friends, or a championship game. While acute stress may actually act as a challenge, if not harnessed, it can evolve to not only an episodic stressor that can affect one in the long term, but can also hamper one’s play. -Ashwani Bali, “Psychological Factors Affecting Sport’s Performance”

I went through a period of time where I felt like I was in constant “fight or flight” mode. EVERY problem, big or small, significant or minor, triggered a “fight or flight” response. It was exhausting.

It is difficult to differentiate between over training syndrome and (excessive) stress. If you look up the symptoms of each they are almost identical. Trying to maintain a high level of training PLUS saying “yes” to more things than I could handle, caused a significant stress response in me. I grew tired in the physical sense and the weary sense.

After my finish at Georgia Jewel 100. . . I was tired. It was time to  r e s t, really rest. Take the time off that I rarely need to or want to. AND, I was actually looking forward to less. I sat on the bike and did some light strength training, mostly bodyweight exercises until the end of November. I did run on occasion.

It’s December. . . I hired a coach for Georgia Death Race (GDR). I started back with my strength coach. I am feeling rested. I am feeling good. My hamstring has been a complete NON ISSUE. I am still pinching myself about this. It just seemed like it would never change. I have been working hard running and my body is loving it.

Stress and overtraining are different for every athlete. Not always easy to define or determine. Pay attention to your body. Pay attention to your emotions. Pay attention to your mind.

 

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“Dead Man Walking”

My follow up appointment with Dr. Price was Wednesday, five days after my results came back, over the phone.

My worst fears. . .

“You’re 46. This is a part of aging.”

“Running is one of the worst things that you could do for a torn labrum in your hip.”

“Race on Saturday? Not for you.”

I resigned myself to the fact that I was NOT running my 100 in August. I determined that my Saturday race was just a 50K and maybe?

I was most concerned about my hamstring. I did not think that my hamstring had anything to do with my hip joint. Dr. Price was not “most concerned” about any of it really. I sat and listened and trusted and decided to follow his suggestions.

Dr. Price believed that the hamstring “feeling” was a result of the hip labral tear. He was confident that  a cortisone injection to my hip joint would alleviate my hamstring response within 5 minutes. OR, nothing would change and the partial hamstring tear is what is causing the inconsistency and irritation.

I have been offered cortisone in the past but refused it because I believe rest should come first before any “quick fix”. In my history of injury, rest was what I needed, and I did not need a cortisone shot.

This time felt different. I had patiently rested, rehabbed and waited. I was scared, but I agreed to the shot. Dr. Price had a student doctor working with him. I like having the students join the doctor because they have more time to spend with me to thoroughly answer any questions.

Did I mention that I was n e r v o u s? Brave but scared. A scared courage. HA! This injection requires an ultrasound machine to get the needle to the correct location. I did not look at the length of the needle but I did know the entry point was 6-7″ below my hip joint. The student doctor injected the numbing agent first. It did to hurt at all. It was identical to the dentist injecting several places in your mouth before he begins his work. Then, the steroid is added. This did not hurt, either. It feels more like a balloon being blown up in the joint and pushing it apart. Start to finish? 1-2 minutes. I did ask for a Sprite soon after because my adrenaline was high. I sat. . . a bit nervous to get up because the top part of my thigh felt weird.

Five minutes later, the doctors came in. Dr. Price re-examined me. He asked me to re-create the positions that triggered my hamstring. My left hamstring felt just like my right hamstring! The test that I failed (with flying colors), ten minutes prior–lay on my back, with both legs straight, lift the left while keeping it straight, resisting the direct pressure he was putting on my leg–I now passed. Before, my leg went right down as he pushed on it. This time? I could resist the pushing and keep my leg up!

W O W! The body is amazing. My hip was protecting itself. It’s a reflex. The muscles that should engage and resist were not firing to protect my hip joint. This contributed to an imbalance in strength on my left side and too much work coming from my hamstring.

Dr. Price said to me:

“Enjoy your race on Saturday!”

“If you trained for the 100 miler in August, go for it!”

“Your hamstring is strong and I am not concerned about it.”

 

Managing my “Not Normal”

My hamstring started to bother me, during my race break in February. I spent more time running on the road. Soon,  I became aware of a very inconsistent “feeling” in my hamstring. I would not call it pain.  It did not bother me at night or during a run or during weight training. It usually started to feel tight when I hit mile 10.  When I did notice my hamstring, I just knew “my left didn’t feel like my right.”

As late March rolled around, I decided to take some decisive action to figure out what was going on. I started with rest. In my experience, rest is a great place to start, and it usually does the trick. So, I rested from running. I rode the stationary bike for five days. Five days was not enough rest, I gave it a few more days on the bike.

I found a PT, Craig O’Neill with Results Physiotherapy. He was informative and thorough. He tested my range of motion, muscle strength, and state of mind (HA!). He did not suggest a break from running, just a break from high mileage, and some strengthening exercises to help a weak left glute, a strained TFL and strained left hamstring. “OK!”

I used a lacrosse ball on my piriformis and my TFL. I used it to hit some trigger points. This seemed to give me some relief to my hamstring. I thought maybe it was piriformis syndrome?

Piriformis syndrome is most often caused by macrotrauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, with resulting nerve compression. Microtrauma may result from overuse of the piriformis muscle, such as in long-distance walking or running or by direct compression.

May, then June. . . some changes, but still so ridiculously inconsistent. I could run 12 miles and not notice my hamstring at all. I could run 5 miles and walk away aggravated because all I felt was my hamstring! Why was my left hamstring not feeling and functioning like my right?!

On my race calendar:

Stage Race in June

Pike’s Peak 50K in July

Kodiak 100 in August

Mid June. . . back to PT in tears, of frustration, this time, begging with each tear for an answer or fix. Craig suggested seeing my sport’s DR. I walked out of his office a bit defeated and A LOT questioning my running plans for 2018. I gave myself some rest. I spent time working with a great PT. I called to make an appointment with Dr. Johnson.

I called Elite Orthopedics to schedule with Dr. Johnson, only to find out he went into practice on his own. His office moved to Nashville, and he wasn’t seeing patients until July. I called Elite back and asked to schedule an appointment with one of the doctors who were taking Dr. Johnson’s patients. They scheduled me with Dr. Price. He is a hip specialist. (blessing in disguise)

SO nervous. I met with Dr. Price. He examined me. He asked about a prior MRI, and we decided on an action plan. He prescribed meloxicam for 30 days. If after 30 days, I did not notice a change, I could call back and schedule an MRI.

I wanted changes. I thought about changes. I wished changes. But by late June, I knew deep inside I needed to get MORE information. I called for an MRI.

My MRI was on a Tuesday morning. I lay in that loud machine as it announced, “this will take 3 minutes” and “this will take 5 minutes”. Done! And NOT expecting any shocking result, I walked out. I expected to hear “there’s some inflammation in your hip joint and you have a strain in your hamstring. (To confirm what I wanted to hear and so that I could ‘stop imaging’ something’s not right.)

Wednesday. . . Thursday. . . Friday*

*the length of time that passed without any news confirmed TO ME my diagnosis, right?

Mrs. McClain? This is Dr. Price’s office, and I have your MRI results. (She sounded calm and pleasant.) . . . partially torn hamstring, hip impingement, labral tear. . . 

I did not know what to say. I just cried. I called my PT,  and I called my trainer. BOTH, were helpful and calm. Really, this was the worst news,  and I took my thoughts down the road of the worst possible outcomes. Lived in limbo of sadness and relief. Sad because I was planning to drop all my races. Relief because now, I know what is not right.

 

 

Kodiak 100

Right decision? Wrong decision? No decision of your own, because you ‘timed out’? They all sting. . . I started at 8a on Friday morning and dropped at 9:15p on Friday night. There will be more! My hip felt great. My body felt great. I ran an easy 5 miles on Sunday, next to the ocean breathing though some tears. I will be okay.

The 45 miles of this trail that I ran was some the most beautiful places my feet have taken me.

The first 20.7 miles: The start of the race was in town. The first 5 miles was a climb to the first Aid Station. This part was mostly jeep road. It was beautiful and fragrant. The smell of pine and grand views of Big Bear lake. I was in a good place. I wore a tank and compression shorts. The weather was mild and a bit humid for CA. Part of the 100 mile field started at 8a. The (prize purse) 100 mile runners started at noon. If I were to guess, about 1/2 of the 100 milers ran with poles.

The clouds grew dark in places and the sun blazed through in others, on the way to mile 12.7. This was a crew spot/Aid Station and campground. I used the bathroom here (note-there were ample bathrooms along this course).

The next 8 miles were single track and rolling hills. This part was exposed with a fantastic breeze. I was doing a great job drinking and eating! Sounds of thunder and black clouds but no rain, yet!

Aid Station at mile 20.7: We were warned in the race briefing that section 20.7 miles-30.1 miles was going to be a long, technical, 10 miles to mile 30 and our next crew spot/aid station. Racers were told to make sure that they had enough food and water. I began this section at around 2:00p on Friday.

Miles 20.7-30.1: This section was no joke. It began with one sweet mile through a meadow then, about 6 miles down hill to The Siberia River and water stop. Finally, 3.8 miles up hill, 2000′.

The downhill for the first 2 of 6 miles was not bad, single track. . . but this soon turned into frustration! From miles 3 of 6 to 4 of 6, I was running on the side of the mountain–one side drop/one side mountain. This part was narrow and slippery because of the tiny rocks and powder-like dirt and gravel. It was difficult to find a rhythm here. Miles 4 of 6 down to the river were tough for any person over 5’4″ tall! The trail was lined with manzanita trees that created a tight canopy. I lost my hat at least 4 times. There were also trees over the trail that I had to either climb over or pivot under. I was stung by a wasp on this portion of the race (MANY runners were stung, some up to 8 times).

Finally! The River! I refilled my bottles, ate two popsicles, and began the 3.8 mile ascent to the next aid station/crew spot. (I will see my crew here for the first time all day.) I think it was around 3:00p. I had a wet arm sleeve around my neck, that I filled with ice at mile 20.7. Tough climb with switch backs and some steep sections. I felt okay. I slowed down, established a consistent cadence and pushed past many struggling runners. This topped out to a short road section and my crew!!

Aid station at 30 miles: I came into this section and told my crew that I wanted to sit, eat, change and be there for at least 20 minutes. That climb was tough and I was looking forward to taking my socks off, using an ice-cold wash cloth on my feet and on my sunscreen-ed body. It was about 4:30p. I asked for an aid station worker to douse my head with ice water. Felt. So. Good. I went back to my chair, sat and drank an ice cold chocolate milk. My crew handed me a short sleeve top and sport’s bra. I changed in the bathroom, while my crew got my pack ready to go. In 20 minutes, I was off to aid station 35. (Because of the time of day, start of the race, logistics of aid stations and crew stops, I needed to take both of my headlamps in my back, here.)

Miles 30-35: I took my time here, while I slowly ate my sandwich. . . little bits at a time. It felt good to be dry and cooled off. I noticed that I was really wet from sweat by the time I got to aid station 30. (Typically, I do not have to change clothes at all until it gets cold. When I run at altitude, there is usually little to no humidity. This day was different). I finished my sandwich and started to go to work, hiking up, hills, running down, declines.

Miles 35.5-45: 9.5 miles to the next aid station. This portion was beautiful. Mostly fire road (like Pine to Palm) and single track down to the aid station. This is where my low point occurred. I cried a bit. Then, looked up and out over the mountains upon mountains. It was breath taking in a grand way. In a way that is hard to describe. I was humbled and grateful.

I started this section at about 5:00p. The sun started to set at about 7:45p. I did not need a headlamp until about 8:30p. It began to get cold. I texted Byron at 8:00p and told him that I was having a hard time breathing in deep. I continued to drink and started to focus on running down hill and hiking up hill. Bit by bit, I made it off of the jeep road and back onto single track. I had approximately 1 1/2 miles to the aid station at Hanna Flats. By now, it had been dark for a while and I was cold. I was still having a hard time breathing deep.

Aid Station 45: I made it here at about 9:00p. I was worried because I had no cell service and last I told Byron, “having a hard time breathing deep.” The aid station worker asked if I was doing okay. I said, “no, not really.” I sat down, drank some hot broth and started to think about my situation.

  1. hard time breathing deep
  2. cold
  3. warm clothes at the next aid station, 7 miles away
  4. 2000′ climb to the top of Sugarloaf coming up. This was the highest part of the race, 10,000′.

What was most important? How do I feel? What can I do about it? Because of the four factors above, I decided to drop @ 9:15p. NOT an easy decision.

In my mind. . . I could slow down my pace and take my time to mile 52, but I was cold, and it was getting colder. The closest bag drop to from mile 30 was mile 52. I estimated that this 7 miles would take me at least 2 hours to hike. Also, if breathing was not normal at 7,200′ and mile 45, would it get worse at mile 70 and 10,000′? I was pretty decisive and not emotional about my choice. I asked the HAM operator to call my ride, and I dropped.

Race stats to mile 32. (My watched died at 32.)

distance: 32 miles

descent: 5600′

ascent: 5600′

pace: 15:32 minutes/mile

highest point: 7,700′

Live daringly, boldly, fearlessly. Taste the relish to be founding competition – in having put forth the best within you.

-Henry J. Kaiser

Next up? Georgia Jewel 100, September 22, 2018