Hindsight

As I look back and reflect on my last year of not running, and as I think about the emotions that I went through and the steps that I took to repair and heal my hamstring, I hope that my experiences will help another who might be dealing with the same kind of injury.

First and foremost, you know your body better than anyone else.  If something doesn’t feel right, it probably isn’t.  Looking back, I realize that I missed the warning signs.  Now, I know that the most prominent signal that something was brewing was the pain that went through my butt every time I sat down.  The ischial tuberosity hides under the glutes so, when you sit, the glutes move and you are on your sit bones, or the ischial tuberosities.  I always attributed the discomfort that I had while sitting to not having a lot of fat.  Similarly, I attributed any tightness or discomfort that I may have had through my hamstrings and butt to finishing a tough run (or race) or to a higher mileage week.  Not once did I imagine that my right hamstring was gradually fraying, which resulted in a 50% tear.

Secondly, stay positive.  In the past 10 months, I have worked with my family doctor, 2 sports medical doctors, an acupuncturist, a massage therapist, a chiropractor and a few physiotherapists.  For the most part, my visits with each of them were positive but there were times when I left feeling down.   Some days, anything from a doctor’s silence to a comment such as “That’s unfortunate” or “I hope this will help you” would scare me or send me into tears and leave me wondering “Will I ever be able to run again?”  I had to believe that I would heal and that any fitness lost would be regained.

And so I followed my gut.  While I knew that my tuberosity would heal, it took months to find the right treatment, primarily because I had to wait almost 4 months for the correct diagnosis. It was my GP, not my sports med doctor, who booked an MRI for me, and that had a 3 month wait.  I had just started to run a week before my appointment and thought about cancelling it, but something still seemed off; my gait just didn’t feel right.   My son convinced me to follow through with the MRI as it would give me more information about my injury.  He was right.  The hamstring tear turned out to be deeper than we originally thought.  It was the MRI that led to one sports medical doctor’s referral to another who specializes in hips and to a different physiotherapist, one who targeted strengthening the glutes and hamstrings, followed by another who realigned my pelvis.  And when the physiotherapists gave me exercises to do, I did them no matter how boring they were or spastic I felt.

During my healing and recovery, I focused on what I could do, not on what I couldn’t.  I spent hours each week on my windtrainer so that I could hold onto my cardio; within a 10 month period, I had ridden more than 3000 miles. I worked on my core and upper body  while strengthening my hamstrings and glutes by heading to the yoga studio 3-4 times a week (sometimes more).  I started swimming again and, by June, I was pool running to start rebuilding the same muscles that I use when I run outside.  I set goals that were achievable and I met them almost every single week.

Separating the platelets in the centrifuge.

But it still wasn’t enough. I had done everything that the doctors and physiotherapists had suggested but my right leg just didn’t feel strong whenever I tried to run.  So I followed my gut again and went back to the hip specialist, who proceeded with platelet rich plasma (PRP) therapy  at the end of June. Ultimately, it was the PRP injection that had the greatest impact on my healing.   The doctor had cleared me to run only 3 weeks after the injection, not after the usual 8 week period, and, for the first time in almost a year, my legs felt strong again.

Back to Chasing My Dreams

In the past year, the most valuable lesson that I have learned is to listen.   I learned how important it is to pay attention to my body, to what feels right and what doesn’t.   I listened to my professionals and followed through with their advice. If my gut told me that things still weren’t right, I went back again and again until I  found the right form of therapy.   I never gave up.  Yes, I got frustrated and, yes, sometimes I cried, but I also believed that I would eventually heal and get back to chasing my dreams.

 

 

 

 

Platelet-Rich Plasma Therapy

Warning: If you can not handle the sight of blood, you probably won’t want to read this because, yes, you will see some blood.

I really wasn’t sure what to expect when I went to the clinic for my PRP injection.   How long will it take?  Will it hurt?   How long will my recovery be?  Will this be my only injection?  And, most importantly: will it work?

The “blood-sucker” introduced herself, took me into a room and proceeded to withdraw 30 cc of blood from my arm.  “Whoa!  That’s a big syringe!” I said when I saw it, and I didn’t look at it again until after she had finished taking my blood. “Wow! That’s really purple!”  I had forgotten that blood can look purple too,

One Platelet-Rich Plasma Cocktail in the making.
My layered blood.

Dr. Bentley, then, put my blood into the centrifuge to spin it around.  It only took seconds to see the blood start to separate into its layers: red blood cells on the bottom, then white bloods cells, and the platelets on top.  After a minute, the 30 cc that I had given him had been reduced to much less. After that, I really didn’t see much more as I was getting ready for the injection.  I caught of glimpse of what I think was a very long needle (the length of a pencil) as Dr. Bentley filled a syringe with my platelets to inject into my hamstring tendon.   I lay on the table, face-down and in a quasi-prone position, trying to relax.

Dr. Bentley poked with his finger at my upper hamstring to find the location of the tear before he started using the ultrasound.  I wasn’t able to feel any discomfort at first and that made me nervous.  “What if there really isn’t a problem?” I thought, only to be followed by my verbalizing, “That’s where it is.”  Dr. Bentley started to use the ultrasound and I heard him say to his student “That’s the tear, right there.”  I suddenly felt a bit of assurance.

“Get ready for a poke,” he said and that was all I really felt.   At one point, I felt like I was in a dentist’s chair as he asked how I was doing a few times.  I was fine.  “I’m just telling myself that this isn’t going to hurt that much because my legs are so muscular – ha!”  There was no real sensation of pain; it was more of a tightening.  I later described it to Dr. Bentley as an elastic tightening around your arm until you have a constant throbbing.  He replied that the blood being injected into a tendon has no where else to go so it would create that same kind of feeling.  As we finished up, he told me that it would feel like I was sitting on a golf ball for a few days.

On the way home, I was glad that Dave drove me to my appointment.   Moving my foot from the pedal to the brake and back to the pedal would have been difficult.  We hadn’t even left Hamilton when I said to him “I feel like my leg is having a baby.”  Painful, but not terrible, and knowing that it would end with something good.

A few hours later, I was able to drive.  I took my 13 year old to referee a soccer game and I happily stood for an hour to watch.  Walking was difficult and sitting was impossible, so standing had become the position of choice.   I could tell that it was going to be for the few days but I had a feeling that it would be worth it.

 

 

 

 

 

 

 

Whatever It Takes

A few months ago, I hoped to be running again by mid-June.  As good luck (and a lot of patience) allowed, my physiotherapist cleared me to start running slowly.  “Run for mechanics,” he said, “not for fitness.”  He was telling me not to push myself and to just get use to the motion of running again.

Back At It!

My first run was 2 miles at a 9:30 pace.  Within two weeks, I was averaging 3 miles just below an 8:30 pace and, just recently, I have been running up to 4 miles with my average pace around 7:50 per mile and a few miles hovering around 7:40.  On paper, everything looks great.  I’m running more and I am running faster – and I am being careful not to push myself; I’m running at a “feel good” pace.  My gait feels good, my hips feel straight, and I feel strong.  But the back of my leg just doesn’t feel right.

As the saying goes “Nobody knows your body better than you” and I can tell that I am still not “fixed.”  In April, Dr. Bentley (the hip specialist) wanted me to have my pelvis realigned through  physiotherapy  and it has definitely helped me.  But I still have a tightness at the top of my hamstring, close to the tear where the hamstring meets the ischial tuberosity.  Nothing feels wrong, so to speak, but it still doesn’t feel right.  I feel like Tammy the Hamstring is lurking at the door, waiting to break in and turn my house upside down.   After all of the rest, muscle work, rebuilding, realigning and time I have invested in my recovery, I am ready to do whatever it takes to keep her locked out.

Ready for some time off to heal some more.

I went over my concerns with Dr. Bentley and we decided that a platelet-rich plasma (PRP) injection is the next step for me.  I have spent months reading about PRP treatments  and there is not a lot of  evidence to support its effectiveness.  I have spoken with two people who had it done: one said it made things worse, and the other said it didn’t really help.  But there is a lot of research that supports PRP therapy.  My GP, sports med doctor, chiropractor and 2 different physiotherapists all feel that this is a good route for me to follow; when I have a team of professionals who are rallying a PRP injection, I am going to listen.  I really have nothing to lose.

Last night, a lady I know told me of a friend who had a PRP injection done.  “Her text right after was full of delightful words,” she said, “but she’s finding that it’s helping.”  That was the message that I needed – something positive, something to affirm that I am on the right path.  I am ready for the pain and I can deal with a bit of time off – whatever it takes to keep me running and let me keep chasing my dreams.

Looking for My Pony

Shell-shocked.  There is really no other word to describe my reaction after finally seeing the hip specialist in Hamilton.   I waited for 3 months to get to the bottom of what was going on with my hamstring – a tear at the insertion of the ischial tuberosity.  I waited another three months for a consultation with Dr. Bentley, whom I thought was going to prescribe platelet-rich plasma therapy to strengthen the tendon. I got more and more excited as the days to that appointment got closer; I felt like a 6 year old hoping to find her pony on Christmas morning.  But I left his office feeling dejected.  There was no pony waiting for me, not even a stuffed toy that could act as a substitute. Instead, I left with a piece of paper: a prescription for more physiotherapy.

During the examination, Dr. Bentley commented, “I don’t think you need an injection.  It won’t help you.  I think there is something else going on.”  Like most runners who have been off longer than they want to be and are desperate for answers and healing, I tried to pry more details out of him.  “Let’s finish the examination.   Then we can talk.”   But the words “won’t help you” kept my mind spinning.  So I am that one in ten who PRP injections aren’t suitable for?  I wasted  all of this time waiting for nothing?  Is there no hope of recovery?  Will I ever run again?

During our debrief, Dr. Bentley explained that my pelvis is not aligned properly.  I have an anterior pelvic tilt, meaning that my right hip sits forward; in doing so, the right hamstring is stretched and that, he believes, it the root of my problem.   This also explains the occasional sciatica discomfort that I get, my tight hip flexors and, most visually obvious, the right leg swing when I run.  The treatment, Dr. Bentley said, is pelvis realignment through physiotherapy, and he suggested 10 treatments would correct the problem.  “Once a week?” I asked.  “Oh no,” he said.  “You need twice a week.”  Between his words, I imagined hearing “Your pelvis is that messed up.”

“And what if this doesn’t help?” I asked.   After all, I have gone through the rounds of chiropractic care, physiotherapy  and worked with an osteopath, yet I am still considered injured.   Dr. Bentley told me to book another appointment if I felt that the treatments don’t  help.

It’s taken me almost a month to emotionally recover from his diagnosis and recommendations for treatment.  I am angry that I had to wait so long to get to the root, or what seems to be the root, of the problem.  I am frustrated that I have had to go to yet another physiotherapist, one who specializes in pelvic realignment, and explain the events of the past 9 months.   And I am confused as to why he wouldn’t want to strengthen the tendon when it is going to remain a “less than 50% tear” for the rest of my life (since tendons don’t repair), especially with osteoporosis-arthritis showing in January’s MRI.  But, as with all other wounds, time heals and we move on.

On Wednesday, I am starting my fourth week of treatments.  Some days, I leave feeling optimistic and ready to start running again; other days, I leave feeling frustrated and wonder whether this will, in fact, let me return to running.   There have been good days and bad, laughter and tears, and longing….a longing for good news, a wish for running health….and hope to find that pony with a pink ribbon around its neck.

 

 

 

Cautiously Optimistic

This week, I have taken advantage of March Break and booked a few midday appointments at Dr. Elliott’s clinic.  It is amazing how good eliminating the stress of getting to appointment before work or rushing to one at the end of the day feels.  So I have been there every day this week: for physio, for a massage and to see Dr. Elliott himself.  I think that I now deserve my own parking spot.

Better than my own parking spot, though, is the feedback that I have had this week.  On Monday, I realized that my hamstring is a lot stronger, so much stronger that we have eliminated the hamstring curl with my toe inwards, the exercise that makes me feel dorky.  Now my focus is on the glutes and building more endurance in them.

On Tuesday, on the advice of my physiotherapist and doctor, I had a massage.  It probably goes without saying that this was the last thing that I wanted to do.  But after thinking about it for weeks and realizing that a gentle rehab type massage could reduce some of the tightness and pain that I have been feeling in my lower back and legs, I decided to give it a go.
I booked one with Cliff, who also works at the clinic, as he has access to all medical files related to my injury.  I walked in nervous but left feeling a lot better, physically and mentally.  He didn’t touch the area near my Ischial Tuberosity but worked around it, as well as my legs, back, shoulders and neck.  It’s now two days later and nothing is bothering me, which is a relief. I will go back in a few weeks to try to help relax the muscles associated with my hips.

Yesterday, I met with Dr. Elliott to get some answers to my questions and squash some of the “what if’s.”  Dr. Elliott said that individuals are turned away from a PRP injection if it won’t help them, because they have already healed.   “So it doesn’t mean that my tendon won’t heal?” I asked.  It just means that it won’t make a difference in their healing.  By the time I have my injection, I should be almost healed and the injection will only strengthen the tendon.    I felt so much better after speaking with him.  All I can do now is wait.

Some days, I have found that it easy to get overwhelmed and start to panic. Staying focussed, being positive: that takes work.  But it is work that I am willing to do as I have to believe that I am almost there.   Psychologically, it is a lot easier to think about running again than about what will happen if I can’t.