Training log - week ending 1/17/2016

This week was 61 miles of running, 5000 yards of swimming, and 7 "miles" of pool-running -- training log is here.

The most notable thing about this week was the prolotherapy shots I got on Tuesday.  This was a "booster" to my previous PRP and prolotherapy (I did PRP in November and December of 2013 and May of 2014, and my first round of prolotherapy in September 2014).

[As a refresher, I struggled with chronic injuries for a long time, including a bad combo of a high left hamstring tear and recurring tendonitis in pretty much every tendon in my right ankle plus the plantar fascia.  The causes of all these injuries were difficult to unwind; they turned out in part to be an old unhealed tear in my right groin and very loose ligaments in my right ankle, lumbar area, and SI joints that contributed to instability in my running gait and nerve pain, plus an SI joint that would NOT stay in place. For me, the key to being able to stay healthy, running-wise, is prioritizing my stability while running, which means a) making sure all my ligaments stay tight; b) consistent gym/yoga work focused on stability; and c) avoiding soft/unstable running surfaces and cushioned running shoes]

During the previous injections, I was told that I'd probably need to come back at some point in the next year - the injections tighten up and heal stretched out ligaments, but the wear and tear I put on them through running (especially since my gait is still slightly uneven) stretches them back out.

I made it well over a year.  Frankly, I thought I was done with injections.  But then, right before Philly Marathon this past fall, my left leg sciatica/weakness issues started acting up again.  And my left SI joint started popping out of place again.  At the time, I attributed the flare to the reduction in my injury prevention routine (cutting out yoga and weights during taper).  But the issue persisted after Philly, as I rested, recovered, and then started ramping up again.

I gave myself a solid 6 weeks of focused injury prevention work plus two PT visits, and then bit the bullet and went back in to see Doctor Wagner last week.  Yup, though my SI joint and lumbar was much better than they were at the start of my saga, they were looser than they should be.  Time for more shots.  And another credit card bill, since insurance doesn't cover PRP/prolo.

Some have asked me what the difference is between prolotherapy and PRP.  In short:

• PRP: this is where they draw a few vials of your own blood, spin it down to the super-magical healing platelets, and inject it back in.  It costs more, hurts more, and requires rest and then a careful ramp back to activity post shot.  It also takes at least 10 days to kick in. 
  
• Prolo: they inject what is essentially sugar water, with the goal of stimulating inflammation and kick-starting healing.  It's pricy, but cheaper than PRP.  It also hurts significantly less, since they can use a local anaesthetic.  You can resume normal activity right after (I went straight from the doctor's office to the grocery store), though you want to avoid swimming for 48 hours and hard workouts for a day or two.  It starts working right away.

So, given my descriptions of the two, why would anyone opt for PRP over prolo, when the second is cheaper, hurts less, and kicks in quicker?    Because PRP is a lot stronger.  My understanding is that PRP is the right choice for torn tendons, and also for tightening loose ligaments when those ligaments are going to suffer a lot of strain in the future (i.e. athletes).  Prolo works well as the only step for milder soft tissue issues in non-athletes, and as a "booster" (my term) to PRP in athletes.  As my doctor described: the PRP creates a fire, and then periodic shots of prolo add logs to the flame.

Happily, I'm now in the prolotherapy phase, so the shots were pretty much a non-event.  I ran the hill workout in the morning, and then took a "lunch break" midday for a doctor's appointment.  The shots took about 10 minutes, so not a huge time investment.

The shots did hurt some - bee stings is the best analogy I can come up with.  But they weren't horrible.  Dr. Wagner did 6-7 shots in each SI joint, plus 5 in the area near L4-5.  We also did 5-6 in my left hamstring where the old tear was, just to be safe.  I pay for the procedure, not per shot, so there's no reason not to jab everywhere.  

What was also reassuring was that the shots in my lumbar and left SI joint caused my sciatica to flare while I lay face down on the table - confirmation that we were targeting the right area.

[One interesting thing I noted too: my pain tolerance for medical procedures is directly correlated to how desperate I am.  When I got the PRP, I wasn't sure if I'd ever be running again at the level I had before, and I was willing to hurt as much as it took to get better.  Now?  I'm doing pretty well, and so I found myself whining (internally) a lot more about the prolo shots, even though they hurt much less.  Funny, that.]

And then I drove home. That's another nice difference between prolo and PRP, by the way. - I feel totally comfortable driving home after prolo shots; PRP hurts enough after that I don't feel safe driving.

As for how I felt - I was sore right away, but also felt better, in a strange way.  The unstability and sciatica was gone immediately, replaced by significant soreness in my back - like I had done far too many deadlifts in the gym.   A different pain, and a much better one.  What was also interesting is that the areas where I really needed the shots (left SI joint and lumbar) were far more sore than the areas that we treated just to be safe (right SI joint and left hammy).  I obviously don't know why this is - my uneducated guess is that the areas that were damaged inflamed much more in response to the prolo.  Again - just a guess.

I ran carefully the next morning, but everything was fine.  I felt the shots a lot during yoga, and was very careful during practice.  I didn't feel the shots at all when running - I just enjoyed the lack of sciatica.  And by Friday I was totally fine. 

The one other side effect of the prolo was that I swapped asthma inhalers for a few days after the procedure.  Because my allergies have been flaring and my lungs are pretty inflamed, I've been using my Dulera inhaler, which has a steroid in it.  However, you're supposed to be very careful about using anti-inflammatories when you get either prolo or PRP, so I shifted back to my Foradil inhaler (no steroid) for a few days.   As I learned pretty quickly on Friday, the Foradil ain't cutting it right now, asthma-wise.  But not a big issue - I can just swap back, now that I'm a few days out from the prolo.

This upcoming week will be a cutback, as I race my half-marathon on Sunday, and also have a business trip between now and then.

Dailies

Monday:   Yoga plus 7 "miles" easy pool-running.  Foam rolling at night.

Tuesday:  10 miles, including a hill workout of 7 repeats up Iwo Jima (~500m up, then 200m jog, 100m stride, and 100m jog down to base of hill, followed by injury prevention work and 1500 yards of easy swimming.  Prolotherapy injections into SI joints, lumbar area, and left hamstring at mid-day

Wednesday: 2.5 miles very easy (9:47 pace) to yoga, and then a yoga class.  Followed with 6.5 miles very easy (8:51).  Foam rolling at night

Thursday:   5 miles very easy to yoga (9:19 pace), followed yoga and some upper body weights and core.  Then did another 4 miles very easy (8:33), plus drills and four strides.  Foam rolling at night.

Friday:  10 miles, including a 4 mile tempo on the track in 26:38 (6:45/6:41/6:40/6:33). Followed with lower body strengthwork and 1750 yards recovery swimming. Foam rolling at night.

Saturday:   7 miles very easy (8:51) to the gym for upper body and core; then 3.5 miles easy home (8:34), plus drills and two strides.  Foam rolling at night.

Sunday:  12 miles progressive, with the first 6 miles averaging 8:55; the next 3 averaging 7:27; and the last 3 averaging 6:44.   Followed with lower body strengthwork and 1750 yards recovery swimming. Foam rolling at night.

Followed with lower body strengthwork and 1250 yards easy swimming.  Foam rolling in afternoon.