New Year, New Niggle

For the last few years January seems to have been the month of set backs in my training. I seem to greet a new year with a new injury or a recurrence of an old one. January 2019 has brought with it the gift of a new niggle, this one being a bit of a mystery.

I’ve been struggling with my left calf. It’s not like all the calf injuries of the past that have been straightforward tears or strains in the belly of the muscle. This one is on the inside of the muscle, very close to where it connects with the shin bone. It doesn’t feel like it’s about to tear, but rather it seems to get inflamed and create a significant area of tenderness down the inside of the calf/ shin or specifically the medial tibial periosteal region. It causes lots of soreness during the first 15 minutes of running and then as I warm up it seems settle down and the intensity of the pain dissipates. As a result, it hasn’t stop me from training but it is restricting the type of run sessions I can do and it does cause lots of discomfort between sessions. My massage therapist has been working hard on it to relieve the symptoms and I’ve been icing the whole area every day but it doesn’t want to go away.

Because its not been an acute injury, a moment in time where I can pinpoint something that happened that caused the injury and because it’s not been preventing me from training I’ve been guilty of ignoring its significance, or potential significance.

But as its a massive year for me I can’t afford to ignore the signals my body is giving me and run the risk of creating a really chronic injury for myself.

So after a full 4 weeks of being in denial I finally did the smart thing and reached out to some experts for help. Firstly I found an excellent physio, Kathryn Fishlock in Newport who gave me a thorough examination and then introduced me to a bit of funky kit called an anti-gravity treadmill. It works by pulling on a pair of sealed shorts that can then be inflated to hold the body above the treadmill in such a way that only a limited percentage of overall bodyweight is being put through the legs. Thus running can still be possible whilst carrying an injury. Kathryn wanted to assess how my running gait would change as more of my body weight was reintroduced. The good news was that nothing changed and she was happy with my running action. So she came up with a few exercises to try to help strengthen this area.

Anti-gravity treadmill running is amazing. Removing 10% body weight makes a massive difference. I felt like I was running on a cloud, it was effortless. For an experienced and competent runner like me it was such a revelation so I can’t begin to comprehend just how much of a difference it would make for others who are significantly heavier and less used to running.  For anyone who knows that they are carrying too much weight and wonders what it would feel like to run without these extra kilos then go and try one of these things. It is incredible. It is a powerful way of understanding just how much better you will feel once you have got the weight off and thus should provide an enormous boost in motivation for sticking with the process of shedding excess weight.

So I got stuck into the rehab exercises but frustratingly, two weeks on nothing had improved and so I decided to take up a referral from Kathryn to see an eminent sports doctor, Geoff Davies in Cardiff . Geoff examined my lower legs and decided that an MRI was required so a few days later I was back in Cardiff for the scan.

I think he was concerned that there may have been a stress fracture in my shin. The results came back really quickly and the good news was that there was no evidence of any stress fracture and the only anomaly was a build up of scar tissue in the area of pain. His report noted that the scarring was clearly a relic of previous calf injuries as at the area of maximal tenderness there is quite florid scarring and abnormal signal in the tibial origin of the tendon of the medial head of soleus. There is some ossification in the tendon at the origin with some low-grade oedema around it. The scarring of the central tendon extends distally in the calf. The tibia is normal with no evidence of stress fracture. There is also scarring of the myo-aponuerosis between the soleus and the medial head of gastrocnemius compatible with previous injury.

 Reassuringly there is no evidence of tibial stress fracture, which was my major concern. His symptoms appear to be related to chronic scarring of medial soleus / calf which does fit with his history.

However, the scarring was almost identical on the right leg and so it was confusing to me that it could be causing pain on the left leg but not on the right. But what do I know?

Geoff’s recommendation was to continue with physiotherapy and consider a formal biomechanical assessment with Podiatrist Tom Cooper at Ace feet in Motion in Cardiff.

So off I went to meet Tom. This was another fascinating experience. Tom also works with lots of elite sports people and so I knew I was in good hands. He got me to walk barefoot over his sensor pad that built a digital picture of how my feet were striking the ground, especially where the pressure points were throughout the process of making a forward step. Again, good news in that there was nothing dramatic that was going on that could be contributing to my discomfort. He did identify a minor flaw in my big toe ( the same on both left and right foot) that creates a slight restriction in the drive phase of a step, but felt that this was not creating the pain and was concerned that if he tried to correct it we may cause problems elsewhere and so it was best to leave it be. Everyone is different and very few of us have perfect biomechanics and we don’t require perfection to perform consistently well.

We then moved into his run studio where a larger sensor mat is set up. Run shoes were put on and then I was asked to run up and down over the matting. Tom observed and built a similar footstrike profile using the data that was coming from the sensor mat. The result was consistent with the barefoot walking. Apparently, I have good biomechanics and have a very consistent, efficient and balanced run pattern. I strike the ground with my midfoot, am not overstriding and thus put very little weight through my heels. All in all, excellent feedback.

So my third expert is telling me that all the essential ingredients to effective running are in place and looking good. This is obviously great to know, but frustratingly doesn’t mean that the pain in my medial tibial periosteal region is any less!

So Tom suggested three possible routes for solving my problem. Firstly I could try orthotics, but I’ve been down this road before and found that whilst it helped in the short term it created much bigger problems in the longer term, so I am really adverse to going this route again. Secondly he is having some positive results with shock wave therapy that fires sound waves into the tissue to accelerate blood flow and healing. He has been using it for achilles and plantar fasciitis injuries and thinks it could help. I’m thinking this through right now.

The third route is a strength and conditioning programme for the Tibialis Posterior region.

My instinct told me to go with the strengthening programme first and see if we can deal with it that way.

So I’m now having to spend time, several times a day rigorously executing these tiny exercises that hopefully will help to rebuild my muscles so that the pain will disappear.

The good news is that I get feedback every time I run. Encouragingly, the length of time that I am experiencing pain at the start of every run is shortening and so this gives me motivation to continue with the rehab programme. I’m now confident that I’ll overcome this latest niggle and that it wont derail my season.

So whilst I haven’t yet resolved the problem and I haven’t discovered the definitive answer to the question about what is causing the pain, I’m really glad that I didn’t just ignore it as I’ve learnt so much by meeting these three experts over the last month.

And, importantly, I’ve now got an even wider team that I can turn to when I need help in the future.

I’ve learnt that the human body is a complex and sometimes contrary being. It can flummox experts and often there isn’t a simple linear answer to what may appear to be a simple problem. Thus, we need to be open to a test and learn approach to problem solving. Furthermore, niggles are often a result of a slight imbalance that requires a disciplined dedicated time consuming programme of dull exercises to remedy. As we get older we ignore the basics of strength, conditioning and balance at our peril.

Keep at it, its worth it!

Reflections from Manchester 48 hours on

I woke up this morning, now 48 hours on from the marathon, still basking in that warm glow of satisfaction having dealt with my demons and delivered a perfectly executed plan in the race.

The recovery swim and bike sessions from yesterday have done the trick and my legs are feeling much better already. I feel that I’m well on the way to recovering from the battering that the marathon inevitably gives the legs.

I’ve recently been doing some work with one of my clients about what it takes to be a winner and the thing that stands out amongst many success factors is the focus that these winning people have on looking forward. As soon as a victory has been secured they are onto the next thing. Every success is simply a stepping stone towards the next goal.

So I was fascinated to notice that whilst I was in the pool and on the bike yesterday my mind started to whirl again. “I wonder how much faster I really could run the marathon in the future?” Clearly a new goal is forming in my head as I now believe that more is in me than I dared to imagine only a few days ago.

Before moving on though, its important to learn a few lessons from what happened on Sunday. Why did the race go so well? As this blog is all about inspiring the achievement of extraordinary things I thought it may be useful to share why and how I believe I achieved my own extraordinary thing in Manchester.

A huge part of endurance sport is mental. I’ve talked at length about my marathon demon of self doubt that has been festering for many years and it was so important that I’d dealt with it ahead of race day. Standing on the start-line hoping it would be ok is not a recipe for success. For me, having a very explicit conversation about my concerns and doubts with someone that I trusted and whose opinions I valued on this subject was a key step. This conversation clarified that there was much more evidence against the limiting belief that “my body can’t cope with the punishment of a marathon” than there was to support it. As a result of that conversation with Annie I was able to go through a process of reframing for myself. Here are just some of the facts that I used in that exercise to rid my brain of the demon:

  • I am now an experienced endurance athlete
  • I regularly complete and succeed at equally/more demanding events than the marathon
  • I have been clocking up some huge weeks of tri training since the beginning of 2017
  • I have been bouncing back really well from some heavy sessions

I used these facts (importantly, not opinions) to form a new positive belief that I took with me to the start line: Tri training is the best way to prepare my body to perform a marathon.

With this inspiring thought firmly positioned at the front of my head I then set about creating a plan for the race. There is that old saying that “failing to prepare is preparing to fail” and nothing could be truer in relation to the marathon.

You have to go into the race with a very clear plan of what you want to happen. This plan needs to be controllable. Mine looked like this.

  • Go into the race well rested, hydrated and nourished. Eat lots of green veg, good carbs and fats, plus protein during the days leading upto the race. Eat a bowl of my favorite bircher 3 hours before the race. Sip on water with electrolytes during the last few hours pre race.
  • Be disciplined to run an even paced race, know exactly what the mile splits need to be and ensure you don’t get carried away with the euphoria of the early stages. Adjust your pace, even if it feels too easy.
  • Be disciplined about hydration and nutrition. Take advantage of every water station so that you are drinking little and often. Take on board a gel after 45 minutes and then one every half an hour from then on. This keeps the energy levels topped up and avoids hitting the dreaded wall.
  • Stay in the moment. Soak up the atmosphere. Enjoy what is going on around you right now. Avoid thinking ahead. Allow thoughts to appear and drift away again. Consciously run through a technique checklist every mile or so to ensure you remain relaxed. Think hands, arms, shoulders, head, core, foot placement. Relaxation is key.

That was it. There was a physical, mental and nutritional aspect to it. Keep it that simple. Have a plan that is realistic and controllable, and then during the race all you have to do is execute it. However, just because its simple doesn’t make it easy. That in a nutshell is the challenge of the marathon!

This time I was able to execute the plan almost perfectly because I understood what was within my control and I remained focused on the 3 dimensions of it throughout. Also I was fortunate that nothing outside of my control affected me. Sometimes this happens and if so we need to accept it and adjust the plan accordingly.

Reflecting on why things went well is powerful learning for me and I’ll take this forward into my next set of challenges. I hope it can be helpful to others too.

 

Listening to the body is key to learning the ability to adapt

It’s been a challenging week, but such an important one as I’ve learnt more new lessons that I hope I can hold onto as I continue to develop as a triathlete.

I woke up on Monday morning feeling rubbish and for a couple of days continued to go downhill physically and mentally. I was struggling with an overwhelming lethargy, a grogginess as I wasn’t sleeping well, an aching body and a sense of not been in focus. Everything was fuzzy and the physical niggles that I’ve been dealing with in my right hip and left achilles just suddenly seemed to be much more intense (they weren’t, it just felt like it).

Now, over the weekend I’d decided that this week was going to be a big training week. I’d recovered (or so I thought from Windsor) and with no business deadlines to get in my way I was going to focus on putting together some strong training as I build up to the next part of the season which is going to be about racing longer. So waking up feeling rubbish wasn’t a great start. Not being able to put a label on it made it more difficult for me to accept that there was some real going on and that I wasn’t just making an excuse to forgo training.

Unlike the normal me, I made the smart decision, took the day off and replaced training with rest but this only seemed to make things worse. A chat with Coach Annie the next day helped and she reassured me that taking a few more days to let my body heal itself was what I needed. Now, getting Coach’s approval to ease back is crucial for me to get my head right and in doing this it freed me up to reframe the way I saw the week. I was still going to train hard but rather than these sessions being swim, bike, run sets my training was now going to be based around lying down, stretching, foam rolling, reading. The time I had planned for training was still going to be used but in a different way.

One of the things I read was this brilliant article by Brett Sutton and it really resonated with me. http://trisutto.com/?s=ability+to+adapt

Brett really understands the Age Grouper psyche and in his article he identifies the very common challenge for successful people of juggling multiple important balls that include career, family, friendships, sport. (Maybe its part of the appeal of triathlon that it involves yet more juggling). We do often fall victim to the delusion of wanting it all,  thinking that we can fit it all in and that is probably the driver behind the 3.30am turbo session that Brett alludes to. He is quite right to point out the madness of it as it will have a negative impact down the line. We probably all know this, but need reminding of it so that we can change our behavior when its getting out of control. Hence the importance of a coach.

However, there is something else that is going on inside the Age Grouper psyche, I think, and this relates to the misguided view that we are supposed to be superhuman. Our contemporaries and colleagues admire us for our energy and invincibility and therefore we are not supposed to have bad days at work, at home, at play. We are not allowed to have days when we are off colour. We are supposed to set an example.

The dreaded “Man flu” is one thing and being injured is part “badge of honour”, part “comes with the territory”, but having a non specific sense of not being right is seen as not an excuse for not continuing to live our lives at 100 miles an hour, 24/7.

And that’s where we get it wrong. We wont be super humans unless we listen to our bodies and know when we are in danger of tipping ourselves over the edge.

There is a difference between the pleasurable fatigue the body knows when it has put in a block of hard training and the sense of lethargy, the aching deep in the bones and the general weariness that are signs that we are putting ourselves in danger. We need to learn to recognize this difference. If we can, then we will know when to step back and adapt and we can work towards being super humans rather than chasing the madness of superhuman status.

So, to build on Bretts mirror conversation. Lets really take a look long at that person reflected in the mirror and ask “what is my body telling me today and do I need to adapt my training ?”

By replacing swim bike run for a few days with lie, roll, stretch I’m now really alive again and enjoyed a lovely run along river this morning.

Long may I continue to listen to and trust in what my body is telling me!

Thanks Annie, thanks Brett.