Thursday, November 13, 2014

Marathon Aborted - SLO Much For This One

In February, after the Surf City Marathon, I returned home from SoCal feeling good knowing I was just two marathons away from a 10-year goal -- 50 marathons. I was feeling good but had challenges with my right leg and left achilles the past two months leading up to that race and thus had little confidence in this respite from pain. 

Next up on the marathon schedule was a nice break from marathoning until May when I would run a race I had supported as a coach for Team in Training, in a city I fell in love with at first sight. The San Luis Obispo Marathon gives runners a great tour of the downtown area of this classy little college town, then takes you up into the hills for an out and back through wine and cow country. I supported mostly the first half of this race that year and was eager to see what the rest of the course had in store for runners. 

But up first was a return to the Sports Medicine Institute for a diagnosis of the pains I had felt prior to Surf City. I nearly cancelled this appointment because I was feeling so good right after that marathon but felt it was probably prudent to get the check up. And my favorite therapist had fit me in. She had helped me through a painful IT band problem early in my running career and was a star therapist for TNT and the Stanford Track Team. 

She laid me on the table and got to work immediately feeling for tight spots and irregularities. She found them rather quickly and went to work smoothing them out. It was painful, as expected, but I was hopeful it would put an end to my problems earlier in the year. The following day, pain shot through my right leg. I called her back, got a quick follow up appointment and at her advice reached out also to Dr. Amol Saxena, the sports podiatry wizard at Palo Alto Medical Foundation. He knew me well, due to my on-going achilles issues and had put the kibosh on that pain a couple years earlier with an experimental shock wave therapy procedure. I was hoping for similar miracles. This time, Catherine from SMI was in coordination with Dr. Saxena, communicating her diagnosis as she worked on me in the follow on appointment. Her assessment: Unclear but appeared to be related to the knee. Uh oh. 

The following day, I was in the office of a work friend and fellow endurance athlete conveying my recent woes when he grabbed a card, copied down the personal mobile number of his doctor and insisted I call him. “He fixed me up and is the best in the business,” he said. This friend is far more the athlete than I will ever be and has certainly maintained a high level of fitness, so I don’t know how I could refuse him. So off to his orthopedic surgeon I went. He sent me for an MRI and the following week I entered his office with films in hand. His diagnosis: Thanks to the guidance I was following in the book “Born to Run” I had aschewed cushioning in my shoes to the detriment of the ligaments in my knee and had created tears and scar tissue which were causing the pain. Arthroscopic surgery was his recommendation. Uh oh. The SLO Marathon was off.

He also recommended a return to cushioning in my shoes. I quickly sought out the most cushioned shoes I could find but was still a believer that flat and flexible shoes were partially responsible for my last 6 or so years of injury free running. And the doctor did not disagree. This led me first to try the Hoka One running shoes. They were relatively new on the market, very popular with runners coming back from injury yet retained a mostly zero drop. On the flip side they looked like Frankenstein’s running shoes. They were bright yellow, humongous and had padding running under the entire shoe that looked to at a quarter inch to my height. I tried them on and found them relatively comfortable but the lift was more than just an impression. The reviews were strong and so I gave them a try. That lasted about a day. I took them for a trial run and found them stiff and awkward. The cushioning, while nice, raised me way too high off the pavement making me feel a bit unstable and with knee and achilles issues already in place, the last thing I needed was to feel unstable. Back to the store they went.

Next up was a new brand of shoe, Altra, that seems to be the Goldilocks choice of running shoes. They had ample cushioning - about half the Hoka but still around 20 percent more than the average running shoe, and a commitment, like I had, to zero drop and flexibility. And they had a highly confident return policy. Where most running shoes, and running shoe stores will only take back “new” shoes with no major marks on the sole, this brand of both running shoe and running store, Road Runner Sports, took back the shoes no questions asked. That gave me confidence to give them a long test drive and their confidence was rewarded. 

The Altra Torin isn’t the most handsome of running shoes but looks should be meaningless in this sport of endurance running; performance should be all that matters. And that proves just to be the case with these. Running quickly felt more comfortable. I was still having knee pain and the occasional achilles flare up but these issues seems minor compared to the flare up that sent me to the doctor. I pulled back quite a bit on running distance and added a lot more cross training to strengthen the muscles surrounding the knee as I prepared for surgery.

As the surgery date approached I shared my worries over the procedure with my friends on Facebook who mostly wished me luck and shared their success stories with the procedure but one friend’s comment caught my attention. Ellen questioned the procedure by asking if I had tried a new therapy called hyaluronic acid injections. I followed the link she sent and began wondering if I might avoid the knife after all, as the process seemed to fit my symptoms. Rather than go off the facts of the Internet, I decided to get a second opinion so I visited the office of Dr. Frank Chen at PAMF, a colleague of Dr. Saxena. He looked at the same MRI films and drew a very different conclusion. “Given what I see on this film, I don’t think arthroscopic surgery will help,” he said. This was an orthopedic surgeon talking and I had not prompted him with my interest in an alternate therapy so these words threw me aback. He then said, “I think what might be more successful in your case would be a relatively new procedure, hyrolonic acid injections. What? Had I heard that right? He explained what I had read on the Internet (I’m paraphrasing here - follow the links for more detail): Your knee’s natural protections from bone on bone injury were your ligaments and some natural fluids that fight friction at the muscles and bones move back and forth. My MRI, he said showed that most of that natural fluid was worn away due to over exercise and it needed to be replaced. Hyaluronic acid is this same natural fluid and could help prevent bone on bone friction and help the remaining ligaments. It wouldn’t be a permanent fix but could be conducted every six months and had been used successfully in Europe for years on people with similar joint problems.

The prevailing thought that remained in my head throughout his discussion and the days that followed: no surgery required. I’ll take that option. So I immediately started the procedures. 

None of the shots hurt, the needle went in easily and there was pressure at the insertion point as the fluid pushed into my knee. The bursa quickly went down as the fluids spread out across the joint. I laid off the knee for a day, then, per doctor’s advice, went for a short run the day after. So far so good after one shot, still some pain but certainly no worse. After the second, the pain receded a bit and by the third shot was down significantly. Wow.
Come May, I still didn’t trust the knee fully but had already registered for the SLO Marathon and had our hotel, so Reesa and decided to go down for the race with our friends. For the first time in my life, I switched from the full to the half, wisely treating SLO as a test run for the knee, as this would be the longest run I had done since the injections. 

There’s a famously tacky hotel in San Luis Obispo called the Madonna Inn that serves as the race hotel and host to the expo and finish line of the race. The hotel itself is pink, inside and out and uniquely architected from wood and massive stone boulders that mold its shape into something of a Swiss Chalet folded into a river bank. The hotel has a famous restaurant inside that is also overflowing with pink, a massive pink cake that local’s line up to buy and themed rooms that make each visit unique. Some of the rooms mirror a cave, others a fairy tale but all feature massive intruding stone work that. honestly is the coolest architecture I’ve seen. Our room had a Peter Pan theme and our stone work lined the bathroom and shower. It was like walking into a perfectly shaped cave that was at once bold and intimidating, and cozy and enriching. This is the kind of contradiction that makes the Madonna Inn so famous. Tacky might sound like a turn off, but I highly recommend staying here at least once. I’m glad I did. 

Race day was cool and comfortable at the start, which was a short run from Madonna to downtown SLO. The race loops through the classic college town streets of this beautiful little town. It takes you past some gorgeous 1940s-era homes, past old storefronts that look right out of It’s a Wonderful Life and intermixed with truly California style architecture. The half marathon course winds up and down the streets giving you a good mix of climbs and declines. As it starts to leave town, it slowly climbs a hill heading toward the wine country and away from town. This is a tough hill and you get to do it twice as the half turns around after it. As I approached the turn point, I was sad and conflicted. Part of me wanted to carry on, and do the full marathon course. It was what I had signed up for, I was feeling strong with eight miles behind me the hills had not tasked my knee too much. But the longest I had run prior to this race was 10 miles and I had enough experience as a marathoner to know that such training was nowhere near sufficient for a full 26.2. My friends had tried to reassure me that the second half of this race really wasn’t worth it anyways, since it simply kept climbing off into the hills providing little scenery or distraction before returning to this same point for the last seven miles. So with disappointment in myself but wisdom as my guide, I turned around and returned down the half marathon course.

From here the race returns to town before then exiting and heading for the Madonna Inn. But rather go back the way I came to the start, the race moves out of town another way, along the railroad tracks where there is a nice bike and walking trail. It winds alongside the tracks with some nice greenery lining the trail. I tried to run on the dirt as much as I could, to limit the pounding on my knee by the pavement. From here the race goes up and over a spiral staircase and bridge suitable for bikes that takes you over the tracks and down to the train station on the opposite side. It’s an odd feature in a marathon and after the ups and downs of the prior miles can be a significant challenge. Once past the train station the run carries under the freeway and on an underpass before rising up to the fields behind the Madonna Inn. By this point you’ve clocked nearly 13 miles and with the end in sight you start to feel optimistic about a strong finish. But that’s before you see the final hill. Yes, this race ends with a last, long, slow climb. And I was feeling it. While I’d completed 48 marathons by this point, half the distance can still remind you the importance of proper training. All the rest and recovery for my knee had prepared me for a half, but any regrets I was feeling about not doing the full quickly subsided as I struggled up this last hill. 
Once you reach the top there’s just 0.1 mile to go and the full downside of the hill is lined with cheering friends and family. I quickly caught site of my bride which always puts a spring in my step and down the finish I strode. It was certainly not my best time at this distance but definitely the most humbling. 

The knee held up well confirming my decision to forego the full and I still had six months in which to fully recover the knee, get in my 49th marathon and prepare for Athens, which would be number 50.  

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