To get right down to it: running is physical therapy.
To elaborate: I recently finished my thesis, which happened to be on the topic of tendinopathy. Luckily, you will never have to read it, because I can tell you what I learned here in about 4 sentences instead of 4 volumes. Basically, tendons need stress to heal. Tendon tissue has the capacity for self-renewal. Baby your chronically painful tendon too much and you will be out of the game for much longer than if you progressively load it. Tendon cells need the stimulus of stress (aka "load") in order to signal their progenitor cells to migrate into the lesion to do their work of healing. There, my thesis in 4 sentences. Ok, enough boring science for now.
You might think that since I "know" this I would have come up with the solution to start running again much sooner than I actually did. However, when an injury or illness affects you or your family, everything you know (or ought to know) goes out the window. That's how it is with health care people. We are just people and we need doctors and nurse practitioners just like everyone else... So two weeks ago I was in the middle of freaking out about how I was going to be injured forever, wondering why I still had the same amount of posterior tibial tendon pain (aka ankle pain) as I did 3 months ago when I finished my marathon. Then I had a lucid moment. While writing my thesis I stumbled upon a theory called mechanotherapy. It's actually an old term and it encompasses the belief that bones, tendons, ligaments and muscles all need to move and work in order to heal properly. That's the simple version, and it is the physiologic basis for prescribing physical therapy for injuries. I was listening to a lecture by KM Khan, a sports medicine genius from the University of British Columbia (go Canada!) where he described how he treats chronic tendinopathy with progressive exercise. He cited an example of a patient who was so fed up with his slow healing Achilles tendinopathy that he decided he was just going to go out and run a marathon as fast as he could in the hopes of tearing it completely (because he falsely believed that a surgical repair would be better than nature doing her own job of fixing the tendon... but that's another topic). Anyway, he did run the marathon, and instead of rupturing his Achilles as he had "hoped" he might, he actually put an end to his chronic tendon pain.
Now, I should tell you that this principle does not apply to tendinitis, which is an acute inflammation of the tendon. Those guys need rest. If you don't know the difference, go see your sports medicine doctor...Please don't go out and run a marathon with any kind of acute tendon inflammation.
You can see where I'm going with this, right? I decided to take a taste of my own medicine. I did, in fact, just complete a long, long paper about the use of exercise to heal tendinopathy. Why not put it into practice? So this morning I laced up my shoes with literally the fewest training miles logged prior to any race ever. I ran last week twice-- an 8 mile run and a 9.5 mile run. The previous week I ran a 3 and 4 and a 5, just to test the waters. So this morning I headed out for my 18.5 mile run, mostly curious about what would happen. I stepped up to the start line with a bit of tightness in my left ankle/posterior tib, but nothing more than I had been feeling the last 3 months.
My goals were as follows:
1) return to the finish line without an injury
2) suffer no GI problems (see surf city marathon for explanation)
3) mindfulness. (listening to exactly what my body wanted-- no watches, no GPS, no racing)
4) enjoy the race! (ok, that should have been first, but I'm tired)
1) Success! My ankle feels better than it has in months. Almost zero pain anywhere.
2) Success! No pit stops mid-race. (No salad last night. Carb loaded for 2 days. Pepto bismol this morning prior to start). No hyponatremia. No random sugary things at aid stations.
3) Success! This was, in a way, the hardest goal to achieve. I had to let people pass me. I had to resist the urge to pass people. I listened to my heart, lungs, muscles, mind... I tuned in. It was great. It meant a slow time and a longer race but I was aware of myself and my surroundings the whole time. It made for an enjoyable run. (see outcome # 4 below).
4) Success! It was a lovely race. I crossed the finish line feeling light and airy, no nausea, no pain, no feeling like dying. I was able to enjoy the remainder of the day. Aside from bits of gravel still working their way out of a very painful hand/palm wound (thanks to a good wholesome fall on the trail this morning), I can hardly tell that I ran for 4 + hours today.
This was, by far, the hardest, most technical course I have ever run. In the first 2.5 miles the trail climbs from 200 feet up to 1400 feet, then from there quickly descends in almost the same fashion. The first descent was extremely technical-- classic California skinny single-track with solid granite + decomposed granite + hard packed clay with huge oak tree roots which makes for some really fancy foot work. I took an awesome fall at about mile 3.5 that I wish I could see in slow motion replay. I basically dove hands-knees-belly first, straight forward on a really steep slope covered with chunks of rock then slid on my knees and torso like a baseball player sliding into home plate. It woke me up.
The first aid station at mile 5 was a god-send, as I had developed quite the thirst climbing the first hill. I took 2 salt tabs, a handful of pretzels and filled my water bottle with "halvsies" (my word for half water/half electrolyte drink). The next part of the course was absolutely the best running ever. Rolling hills in the shady basin of an ancient watershed dotted with redwoods, myrtle, cedar and moss... and 11 river crossings! It was lovely wading across these crossings because it was hot as hell today (in the high 80's by 10:00 am) and I also had to wash off a fair amount of blood from my hands, knees and thighs from my home-plate dive a few miles back. This part of the race sort of bounced along with a total of maybe 200 feet of climbing until the last section before the next aid station, which involved a short but steep climb of about 600 feet and then an equally steep drop into aid station # 2. There I took two more salt tabs, another hand full of pretzels and another refill of "halvsies" and off I went for the brief 2 mile out and back before hitting this same aid one more time before the mother-of-all-climbs out of that river drainage...
From aid # 3 the trail climbs about 1600 feet in 2.5 miles. This was tough because it was southern exposure and the sun was out in full force. No trees, no shade, just a rocky, dusty climb to the top of the next hill. I actually did pass a few people here. In fact, all of my "passes" are always going up hill. I can really storm a hill (power hiking, not running) going against gravity.... But my weakness is definitely in the downhill department.
I got to enjoy my weakness fully today after hitting that peak and heading down to aid # 4. At this point my quadriceps were tired. 3 months of sitting around reading about tendons does nothing for the quads. I haven't done a damn thing to strengthen these buggers, even though quad strength is fundamental to trail racing. Oh well. I lived to tell about it. By the way... Quads are like springs. They are the shock absorbers of the legs, and they keep us from jarring our whole body when we run down steep hills. But when our quads are tired the springs don't really work and it makes running down hill feel a lot more bumpy and painful. My springs weren't really doing much for me on the 1600 foot descent, and it wasn't a soft mellow 1600 feet... It was basically straight back down over 2 painful rocky, root-strewn, hard-clay single-track technical miles. Ahh, the joys of trail running!
The very last part of any race always feels too long and this one was no exception. After the last long painful descent, there were these other steep, cruel little hills that kept coming, and just when you were sure you were done, along came another one. Up, down, up, down, up down... These are the breakers-of-spirits, these little ones. The big ones you know that you just have to put your head down and grind through, but the little ones you think "maybe this one I should just run... " and it kills you. Especially when your springs are all tired like mine were.
I arrived at the finish line about 20 minute past my 'goal' time, but that is a silly thing to say because I didn't really have a goal time. I just guessed that it would take me about 4 hours to run this course. It took me 4:23:ish. I think I placed 5th in my age group, but there weren't all that many women in the 30k distance, so that isn't saying much at all. The real victory was that I felt great during the whole race and I really enjoyed sitting in the sun at the finish line today, redwoods towering around me, watching fellow runners come in from their 30k and 50k races. I didn't feel like crawling into a hole and dying. I wasn't nauseous. I ate lentil soup and quesadillas gratefully. I stretched my calves and tended to my bloody/raw hands/ankles/knees. The 50k leaders, for the most part came in super fast and collapsed in the first aid tent looking like shit. I know that it takes a certain kind of devotion to pain and misery in order to win these races, and I wonder if I'll ever be that obsessed. I do know that I am happy to run the way I run. I am happy to run for myself. I am happy that for 4 hours today the requisite intimacy with nature as well as the mystery of my own body kept me in the moment-- kept my mind still and quiet.
The last thing I thought of when I was finishing today was my friend Nichole saying that races shorter than 26 miles aren't long enough because you need more time "to really hate them" which is kind of true. I think I'm ready to try a 50k soon, because at the end of my race I still had a little something left to give...