PRP injection – Cynsspace

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.

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.

Graduated

It’s been a full year, almost to the date, and it looks like I am finally finished dealing with a torn hamstring.

I had a follow-up visit from the PRP injection with my sports medical doctor yesterday. He typically wants a gradual return to exercise and a visit 8 weeks after the injection. But I needed more information. I was tired of waiting for answers. I didn’t want to play any more guessing games. I needed to know: am I healing as expected or do I need a second injection? Am I doing too much too soon or is my fitness where it is suppose to be ? I need guidance because, let’s face it, I don’t do well on my own. I don’t always recognize the signs of trouble brewing and I certainly do not want to end up back at ground zero. So I asked, maybe begged, and he agreed to see me after the 4 week point.

I truthfully didn’t know what to expect. I was a bit worried that he would want to start to treat the left tuberosity, where there were some minor tears, because I am noticing that side more than my right. So my son drove me to his office – just in case he was wanting to do another PRP injection. Dr. Bentley asked me a few questions and he examined by strength and movement.

“Your hip is jammed up again,” he commented . I felt my shoulders sigh. “You’re going to have to keep up with physio or Chiro care – probably twice a month – to keep your pelvis aligned.” I had already been prepared for that as a life-long need; I know that it has helped and I know that I am going to need regular maintenance.

Then I asked my questions:

(1) Is my left side sore now because my right is stronger and I am just hyper-sensitive to what is going on with my hips? “You’re in tune with your body,
he said. ” You’re quite aware of what is going on so, yes, it’s a bit of both.”

(2) Is this tightness, the achy-ness that I have just part of aging? Dr. Bentley smiled. “You’re getting older. And you’ve have some issues with your hips. But it’s not like your severely arthritic and your hip is waiting to shatter. You’re going to be fine.” So, yes, I need to get use to feeling sore. Fortunately, I am in a line of work that doesn’t let me sit for too long; for me, being busy and active is key.

(3) Do you think I’ll be able to get back to distance running? Dr. Bentley told me that more is better for me, which ties in with the “don’t sit still” approach that I have adopted. “You’ll have to cut back in intensity,” he said. “You can train the same way during each session but not as often.” Basically, I need more non-running days to give my body a break from pounding the pavement. Instead of running 6 days a week, I’ll have to run 4 or 5; double-run days, I’m fairly certain, have become a thing of the past.

“You’ll have to keep up with physio,” he repeated. “But I don’t think I need to see you again. If something changes, just call me and set up an appointment.”

When I got back to the car, I said to my son, “I have graduated. I am all done. He doesn’t need to see me again.”

“You’ve graduated?” he asked.

“Yup. I suffered, I researched, I did everything I was expected to do, and I have passed. I am done with rehab. I have graduated.”

When I got home, I celebrated (of course) with an easy 3-mile run. Last night, I started my plan of training to train and today, I can begin to start chasing my dreams.

July: Summer Goals

As a parent and a teacher, I am constantly telling the kids around me that, if they want to improve in anything, they need to set goals, real goals, tangible goals, something that is achievable. In essence, we need to have SMART goals.

At the beginning of June, I made a wish and I set a few goals for the summer. My wish is to be running again and I have every confidence that I will be able to soon. Ironically, my almost year off running has left me feeling stronger and fitter than ever (an insane amount of cross-training will do that). I am hopeful that my PRP injection will give my hamstring the extra strength that it needs so that I can confidently start to run and race again. So my first goal is based on this wish: pool-running 4 to 5 times a week. This should build and strengthen those same muscles and will allow me, I hope, to resume to running with a bit of a base.

I also have 3 other fitness goals:

Test run on my mountain bike. I’m ready!

1) Cycling. If you are following me on Instagram, you already know that I have spent many hours on my wind trainer this winter, leaving me with an average of 375 miles a month since the beginning of November. Cycling is one sport that hasn’t bothered me because the ischial tuberosity doesn’t touch my bike seat. But, since I have been healing, I haven’t been able to push myself with intervals either. I am feeling ready. My summer goal is to get back to cycling outdoors. Dave and I are planning my first “test ride” later this week and I am pretty excited about it.

2) Swimming. I have had an on-again/off-again relationship with the pool all winter. I was quite proud of myself when I finally got back in the water after being away from swimming for the past 20ish years. But family schedules and work hours have made it difficult for me to stick with it. And, let’s face it, swimming scares me. It’s hard and I have to work at it. If swimming were my only form of fitness, I would be more committed to it but it’s an add-on. I am also on my own almost every single time. So my summer goal is to be consistent, to work at it at least 3 times a week. I am really looking forward to seeing my distance in the water increase as the summer progresses.

3) Yoga – keep it up. Yoga has been my saving grace through the winter. It’s made me stronger and helped me to come out of my comfort zone and challenge myself. It’s also let me sweat when I wasn’t able to any other way. As strange as it may sound, psychologically, more than anything else, I just needed to be able to sweat. Getting stronger has been an extra benefit. As I spend more time in the pool, my time in the studio will likely decrease and I’ll adapt as I need to. Right now, my goal is to hit the studio at least 3 times a week and that is doable.

Along with these is my goal to write more. When I started blogging a few years ago, it seemed that everyone was doing it. But as Instagram became more popular, blogging became “less of a thing.” I have loved keeping this blog as it gives me the chance to be creative, to express myself and verbalize my thoughts. Most of my writing is fitness-related, but I really enjoy writing the occasional, more opinionated piece too. I like being able to share my story or information that can motivate, educate or impact others.

So how am I doing with these goals so far? Since July 1st, I have ridden 37 miles (2 rides) on my wind-trainer, swam, ran in the pool and written this post. In an hour, I am heading to yoga as I have just been cleared to go back. All in all, I’m off to a good start.

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.

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.

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.

Do I Laugh or Cry?

“There is value in learning to accept gracefully those things that cannot be changed.”

This were the first words that I read in my son’s psychology text on the weekend. He had rushed off to work and left his book on the kitchen table, open to a section on anger and frustration. Being a psych major, I couldn’t help but look at what he was studying and, somewhat appropriately, these words jumped out at me.

The past few months have been a test of my mental strength. How much frustration and disappointment of being injured (July), re-injured (October) and learning that it was way worse than anyone originally thought (January) can I handle? I like to think of myself as a positive person, one who looks for an upside, thinks happy thoughts and believes that “things happen for a reason.” The upside of my hamstring tear is it has given me more time at home with my 13 year old and let me watch him grow as a student, an athlete, and a person. But I am now in my sixth month of healing, almost 3 seasons later, and while I have accepted my injury, my frustration is still there.

I had a glimmer of hope that my weeks of being side-lined are coming to an end when I finally got an appointment date for a PRP injection: April 16th @ 12:00PM DURING HIS LUNCH. I had no idea what was meant by “during his lunch.” Am I suppose to feel extra grateful that he is seeing me at 12:00 rather than make me wait another week or two? Is this a underlying message that I better not be late? Or he is so busy that he is likely to be behind and I better not dare complain because he is seeing me “during his lunch.” Or maybe, just maybe, it is a subtle hint to bring him a coffee, a snack or even a lunch. Well, I am grateful that he is seeing me at this time rather than have me wait for another appointment at a later date so I happily confirmed it, I won’t complain if he is behind and maybe, just maybe, I’ll stop at Tim’s to bring him a snack. I could only laugh.

However, when I called to confirm, I learned that this is not my appointment for the injection; it is a consultation. Since 1 in 10 people are turned away, I have to meet with the doctor first and go in later for the actual injection. I wanted to cry. If my injection is at the end of April, I can assume that I will be off for another 6 to 8 weeks, which means that I still won’t be running until the end of June. And that is only if I need one PRP shot. If I need another, it will obviously be even longer.

This whole process has been frustrating beyond belief and it is now being overshadowed but the occasional fear. What if I am that one in ten? What if I can’t run again. What if? What if? I hate the “what if?” game. “Stay positive. Look for the upside,” I tell myself.

Last night after yoga, I spoke my about thoughts with Kelly-Lynne and I found the positive again. I realized how much fitter I have become in the past 6 months. My leg strength is coming back; I can feel it when I cycle, and I can sit for longer periods of time without being in pain. My core is firm, I can do a lowboat again and my upper body is stronger than it has been in years. I threw myself back into the deep end when I came out of my comfort zone and started swimming. When all things are said and done, I feel like I am in better shape than I have been in years. So even though I still am not running and am quite unhappy about it, I can accept the delay. If it means that my hamstrings are going to be that much stronger and I am going to be that much healthier, then I can absolutely wait a few more weeks.

Many years ago, when making a group decision at work, we voted for acceptance. “Can you live with it?” was the question asked. At school, I teach my students that you don’t have to always like something, but you have to be able to accept it; my Grade 7’s understand that. Well, I do not like this time to heal and this waiting game one little bit, but I can live with it. I have accepted it and, one day, I hope, that will make me a better athlete.

When a Runner is Not a Runner

The past 8 months have been a test of my commitment to running. I have been off since that mid-July massage, intended to help my muscles, resulted in a hamstring tear that sidelined me for the rest of the summer. Now there was probably something brewing anyway but the massage tweaked something and I could not run for the rest of the summer. In September, I made what now seems to be a superhuman rebuild to run Chicago, only to tear my hamstring days before the marathon. In mid-December, I was cleared to run again by 3 medical professionals: my sport medicine doctor, my chiropractor and my physiotherapist. Strength was good and my cardio was fine, but running just didn’t feel right; I had no power. Sure enough, an MRI at the beginning of January showed that I had less than 50% of the hamstring, a tear that meets the Ischial Tuberosity. I pulled myself off the road again on January 15th.

It has been another two months since that diagnosis has been made and it is going to be another 6 weeks (April 16th) until I have a PRP (platelet-rich plasma) injection. Who knows how long my recovery after that will be? I am guessing that it will be another two months, which will bring me to sometime in June – if I am lucky. And if that is the case, that means that it will be almost a year since that first injury, the catalyst that sent me into this dark hole that I just can’t find my way out of, a year since I have really, truly run.

During the past two weeks, I have thought a lot about my status as a runner. Am I? By definition, a runner is “a person who runs” and that is something that I am not doing. I think about running all the time; I dream about running again and chasing my dreams; I read about running, talk about running and support people who are running. But I am not running.

When I finally got my appointment date for the PRP injection, I was thrilled. But the waiting, the recovery time and the uncertainty of knowing whether I will actually help strengthen the tendon have turned to frustration and fear. What if it doesn’t work? What if I won’t be able to run again? What if????

The what if’s are always going to be there. But until I have answers, I have to squash them. I need to focus on the things that I am able to do: keep up my cardio and conditioning: bike, yoga, swim, weights; be a mom, a wife, a dog-mom; coach; love my job. It should be no surprise that every single one of these things connects me to running.

Today, I am not running. I am an injured runner. I am a runner not running. But until I am told otherwise, I will continue to dream about running and racing again and focus my fitness towards the goal of pulling on a running skirt and lacing up my shoes again. I am defined by running and always will be.

One Day At A Time

A few weeks ago, I finally picked up a training journal. I had just started to run again and I wanted to get back to tracking my running on pen and paper. Five days after buying it, before I had even opened it, I was pulled from running and was told that it will probably be 3-6 months until I can run again. Since my MRI was at the beginning of January, this week marks the end of my first month.

At my physio appointment on Friday, Tammy’s power and flexibility were good; I am feeling much stronger in general. The only indicator that I am not ready to run is my butt aches when I sit down. Looking back, though, I realize that it has been sore when sitting for the past two or three years, maybe longer, which indicates that my hamstring issue may have been brewing for a long time and I just didn’t recognize it as a problem; instead, I attributed my sore sitbones to a skinnier tush.

These days, I am encouraged by the almost normal feeling that I have. “Does it really take 3 to 6 months for a hamstring to heal?” I asked my physiotherapist. “No” was the fast reply. “It takes 6-8 weeks.” I laughed. “Then, by the time I have my PRP injection, I should practically be healed.”

In mid-January, Dr. Elliott submitted the referral for me to see the hip specialist but I don’t even have an appoinment yet. “They’re probably still getting over the backlog from the holidays” was suggested as a reason, which is fine, but I really want to know when I am going to see the doctor. Will it be a consultation with a second appointment for the actual treatment, or will it all be done at once? How many treatments does he think I’ll need? And what about the labrum? Do I need to worry about surgical repairs?

As the days pass, I get more and more frustrated that I haven’t had my PRP injection, nor any kind of communication from the doctor’s office. But I am starting to believe that I may be back on the road in the spring as my hamstring seems to healing on its own and the injection will only strengthen it.

Fingers crossed, hopeful thoughts, and dreaming of running again….Believe.