Monday, April 2, 2012

Month in Review (March)

3/2010: 107.0 miles
3/2011: 129.6 miles
3/2012: 153.3 miles

Most of March felt like April (or even May!) up here in Leadville-- abundant sunshine, temperatures in the 50s, and plenty of melting snow. Even though the local trails are still mostly snowbound, March was full of inspiring running weather. While I did make it down to Buena Vista/Salida/Twin Lakes a few times to run on some nice dirt trails (generally for my longer runs) I spent most of my time on the paved roads around town. I've noticed that around this time of year is when I end up logging most of my miles on pavement. During the winter, everything's snowbound so you might as well run on snowy trails. But during the spring there are a few weeks when the trails are still snowy and the dirt roads are too muddy, but the paved roads beckon with their smooth, dry surfaces. After a few weeks of sun, the dirt roads dry out and become the best option, and asphalt is abandoned until the following spring. This March we've gotten so much sun and consistently warm weather that even some of the south-facing, thinly-treed trails are starting to melt out!

At the beginning of March I set for myself the modest goal of running 150+ miles this month. While I expressed some skepticism that it would be possible to top February's miles, I managed to do so. It was a record March for me both in terms of total mileage and also in terms of the length of my longest long run (26.2 miles). So I should be pretty satisfied, right? Well... sort of...

Instead of entering April with confidence, I'm entering it with ITBS (Iliotibial Band Syndrome). I felt a little IT band pain during the last few miles of the Salida Marathon on 3/10. Nothing too debilitating, but noteworthy. For the next 13 days it never resurfaced-- though I certainly had other aches and pains leftover from the race. Then, I went for my next long run on 3/23-- a beautiful 16 mile run along the Midland Trail in Buena Vista. I felt pretty strong and set a PR for the route despite taking it easy during the first few miles. However, again, during the last mile or so of the run I started feeling IT band pain in my right knee. After a day off, I went for a run along the north side of Twin Lakes. I parked at the South Elbert Trailhead and headed south on the Colorado Trail. This run begins with a 300 ft drop in the first mile. My IT band pain started almost immediately. At first it was dull, but it got worse and worse as the run progressed. Eventually I had to phone my wife and cut short the run at 10 miles. There was no denying it any longer. ITBS was back. And I was pissed.

A View of Mt. Hope (and Hope Pass) from the Colorado Trail near Twin Lakes

I battled through ITBS in my left knee in 2010. It surfaced in mid July during the Silver Rush 50 miler (around mile 29). It was my final big training run before my first Leadville 100 (which was about a month away). I had never heard of ITBS before and I didn't even know what an IT band was! After a bit of research, I scheduled a visit to a physical therapist my friend recommended down in the Vail area. I do not seek out medical attention very willingly. But after almost 8 months of training I wasn't going to risk anything when it came to successfully completing the 100! I was scared enough to actually visit a doctor. They tried everything: stretching, massage, foam roller, Granston technique, active release technique, cold laser therapy, electrical stimulation, and plenty of KT tape. I went to two sessions a week with my final session being two days before the 100.

It didn't work.

My IT band flared up at about mile 22 and I pretty much limped for the rest of the race-- especially downhill. Yes, I finished, but I was definitely humbled by my injury. After the 100 I didn't run a single step for 4 months.

My training the following year was more balanced and ITBS never reared its ugly head again. I ran my second Leadville 100 without taking a single painkiller. I thought I was done with ITBS. Sadly, this March proved me wrong.

In retrospect, I can't really blame the therapist for his treatment in 2010. I didn't do my part. While I borrowed a friend's foam roller and used it a few times, my twice weekly office visits served as an excuse to not do anything myself at home. I should have been stretching my IT band 2-3 times a day and hitting it with the foam roller as often as possible. I should have been doing side leg lifts to try to strengthen my hip muscles. I should have been icing my knee. Instead I thought professional therapy and cutting back on my mileage was sufficient.

Today was the first time I've run in a week. I was ecstatic to run a cautious 4.4 miles totally pain free! I spent the previous seven days resting and stretching. I hate stretching. I am the most unlimber person in the world. I can't even touch my toes-- not even close.

But, I hate not running even more than I hate stretching.

So, maybe-- maybe-- I'm on the road to recovery. I'll take things easy this week. My family and I are headed out for a spring camping trip to Utah. (April trips to Utah are crucial to surviving Leadville's winters.) I'm super excited about the trip, but I'll have to reign in my plans of running big miles in Canyonlands National Park. Maybe I'll try a 13 miler... maybe...

That's what a running injury does. It suddenly fills your nice, neat training schedule full of "maybes". Certainty is lost. Plans are revised. Everything becomes contingent. It's hard not to succumb to anger and despair. You don't realize how lucky you are when you're healthy. ITBS is especially sneaky. I feel totally fine when I'm not running. I even feel fine for the first few miles. But then suddenly-- out of nowhere-- it strikes, and I'm immediately limping.

The mileage to beat for April is 165 miles. My next race is the Collegiate Peaks 25 miler on 4/28. Given that I plan on drastically reducing my mileage for at least the next week (and then only slowly ramping it up), I don't think I'll be setting any records this month. That's okay. If I can recover enough to run well at the CPTR I'll be very happy. Perhaps I'll even emerge from this injury a stronger, more disciplined runner.

For what it's worth, here's my guide to recovering from ITBS. I'm certainly no expert. This information is taken mostly from the Lore of Running, miscellaneous sources scattered around the Internet, and my own personal experience.

  • Performing IT band specific stretches is the most important thing you can do. Stretch often. 2-3 times a day. You should feel it in your hips and buttocks. If you do nothing else: stretch.
  • Use a foam roller 2-3 times a day. It will hurt. A lot. Always follow foam rolling with stretching.
  • Ice your knee 2-3 times a day to reduce inflammation.
  • Strengthening your hip muscles with daily sets of side leg lifts might help in the long term, though the research seems somewhat mixed. It probably can't hurt. Stretching is more important, though.
  • Pay attention to early signs of ITBS-- especially at the end of long runs! Do not ignore it!
  • Dial back your mileage immediately. You probably shouldn't run for at least a week. Cross training might be okay. Biking seems to work for me. Try to avoid runs with big downhills. Try to run on trails-- not pavement. Uneven terrain might actually be better than totally smooth (and highly repetitive) terrain. Speed doesn't seem to matter. Running faster might even be better (i.e., running with more "toe off"). Don't get so tired that your form breaks down, though. That might have been what caused the injury to begin with.
  • Consider taking NSAIDs to reduce inflammation in your knee (not to dull the pain).
  • ITBS is treatable. Everything I've read says you can generally expect a full recovery in a month or so. We'll see...
  • Plan on continuing to stretch and roll your IT band preventatively even after you've recovered from your initial injury. Ice after long runs is probably a good idea.
  • I've read that ITBS is a sign of not enough cushioning in your shoes. (Maybe because you have high arches like me.) I've also read it's a sign that you should switch to minimalist shoes. I'm not sure what to believe. I've always run in minimalist shoes (New Balance MT100s, MT101s, and MT110s), but I'm somewhat embarrassed to say that this latest episode of ITBS has finally motivated me to order a pair of Hokas to experiment with. (They actually make them in my size now.)
  • I can't really say I've had much success with those straps that are supposed to stabilize your IT band. Nor have I felt much difference running with KT tape on my knee. I doubt they hurt, and maybe they even help a little, but they're definitely not a real solution.

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