Sunday, February 27, 2011

Training log - Week ending 2/27/11

This week was 35 miles of “real running” and 80 “miles” pool running -- training log is here.

What really stuck out to me this week was an issue with pacing my tempos effectively. A bit frustrating, as I've never had this issue in the past, but I believe I've figured it out. Pre-injury, I was running 70-90 miles per week – as a result, I always had residual fatigue in my legs, but also a lot of strength. Now I am at 20+ miles per week, and so my legs are very fresh, but I have no strength. Thus, I feel fantastic at first and shoot out (since I have no tired legs to hold me back), and then run out of gas (since I have no strength). So, overall point is that I can't trust the fact that I feel great in the first 400-800m, and need to start very slowly.


Monday: 12 miles outside on a dust path as a 10 mile progression run (averaged 7:45 pace, splits were 9:20, 8:37, 8:15, 8:12, 7:56, 7:21, 7:10, 7:01, 7:00, and 6:41) followed by 2 mile cooldown at 8:39 pace. Then did "12 more miles" – 2 hours easy pool-running (was only going to go 90 minutes, but got hooked into a podcast after my friend left).

Tuesday: In the morning, “13.5 miles” of pool-running, including a “track 800s workout” of 10x3:00 at hard effort, with 1:00 recovery, followed by full recovery, and then 30 minutes at aerobic effort.

In the evening, a weights session with a personal trainer, followed by 30 minutes easy pool-running for “3 more miles”.

Wednesday: In the morning, 4 miles very easy outside (8:52 pace), followed by “9.5 miles” of easy pool-running (1:35 hours). Yoga class at night.

Thursday: Light strength-training followed by "12 miles" easy pool-running (2 hours).

Friday: In the morning, 5 miles at the track, including 1.75 miles warm-up, and then a 3.25 mile tempo (coach had instructed 5K, but that I could go up to 3.5 miles if I felt good. I started to struggle as I approached 3 miles, so I cut it off at 3.25). Splits for the tempo were 6:48, 6:48, and 6:40 pace for the last 2000m, but it wasn't actually that great – I went out too fast the first 400m, and paid the price the rest of the tempo. I must learn patience. Followed up with "8 miles" easy pool-running – 1:20 hours in the pool. Pilates class in the afternoon.

Saturday: In the morning, "12 miles" easy pool-running (2 hours); upper body strength-training in the afternoon.

Sunday: Started with a long run of 14 miles outside, averaging 7:34 pace, split as: 7 miles at ~ 8 minute pace, (5 minute water break) ~4.75 miles at 7:12 pace, a mile at 7:05, a mile at 6:59, and then pushed for the last 400m at ~6:30 pace. Followed with "10 miles" easy pool-running – 1:40 hours in the pool.

Thursday, February 24, 2011

My take on pool running form

Pool-running form seems to be one of those topics that provokes a lot of debate.  The shallow but vast intellectual wading pool that is the internet is packed with those who insist that there's only one correct way to do it.

I disagree.

More on that below, but it's probably best to first discuss the various types of pool-running form, as I see them.

There seem to be three basic types of form, defined by the way the legs move (for each of these, the upper body is more or less vertical, with abdominals engaged):

1) cycling -- it's pretty much what it sounds like.  You pump your legs mostly up and down, but with a bit of a circular motion.  Knee lifts up, then you push the foot down and back, straightening the leg as you do so.

2) bounding -- you reach out forward with your leg (knee bent at 90 degrees) then straighten the leg and bring it back while straightened, eventually extending the straightened leg behind you.

3) scissor-kicking -- both legs stay straight at all times, and move back and forth like scissors.

Which is best for preserving fitness?  I honestly don't know, and I don't think anyone else does either, though you will meet plenty of pool-runners who insist, sometimes forcefully, that one way is best.

[I think that when you're injured and stuck in the pool, there's a bit of desperation resulting in a need to believe that there is a single "best" way to do pool-running, and you are doing that.  Or perhaps it's just the natural competitiveness of runners.]

For myself, I've ended up using a combination of cycling and bounding.  During easy runs, I swap back and forth between the two, doing 20-30 minutes of the one, then 20-30 of the other.  I do this partially to make the time pass, and partially because I think each has pluses and minuses when it comes to preserving fitness for land-running.

When I bound, I focus on the "paw-back", engaging my glutes and hamstrings during this stage.  It's actually fairly demanding to do so, as the water provides significant resistance, making this a great way to preserve the strength of those muscles.  However, it's also a much slower motion, with a turnover much slower than that of land-running -- this makes bounding less specific to land-running, IMHO.

When I cycle, I keep the movement explosive and fairly quick -- the turnover is closer to land-running though not quite the same (about 160 "steps" per minute, as opposed to my normal 180-190 on land).  I do not have my legs cycle evenly, but rather focus on exploding one leg down, firing the glute strongly and pushing through the ball of my foot, while simultaneously bringing the other knee up.  Then the other leg fires downward, and on and on.  This motion is generally much closer to land-running form, which is why I prefer to use it much of the time (on the theory that part of what I'm preserving in the pool is neuromuscular coordination).  However, cycling doesn't put the same workload on the glutes and hamstrings as bounding -- hence shifting back and forth between the two.

There are some notable distinctions between pool-running and land-running  (besides the obvious).  Both cycling and bounding place a lot of emphasis on the hip flexors, which makes sense when you think about it -- you're drawing your knee up through resistance in the water, while when you run on land, the only resistance for your knee is gravity and air.  Your hip flexors get greatly strengthened, while your glutes and hamstrings will lose a bit of strength. 

Unlike land-running, the speed at which you cross distance has absolutely nothing to do with how hard you are working.  Indeed, in my own experience, I tend to cover the least distance during my hardest repeats.  This is probably because I'm focused entirely on effort, and not on efficiency. I'm not trying to be a better pool-runner; I'm trying to stay a decent land-runner while in the pool.

I do note that the distance traveled while pool-running is heavily dependent on the angle of one's body.  The more one tilts one's torso forward, the more one's pool-running mimics swimming (more specifically, the doggie-paddle).  Of course, you're covering more distance, but I don't believe the workout is anywhere near as effective.   When you doggie-paddle, you're emphasizing the arms too much, at the expense of the legs.  And that brings me to what I perceive as the one big form risk/error in pool-running...

Overuse of the upper body and arms.  It's extremely easy to divert effort away from your legs to your arms, when pool running.  The urge is always there to do what you can to cover more distance -- and using your arms means that you travel much further for the same effort.

Thing is, it's the legs that should be your focus when pool-running, otherwise, you might as well swim and reap the cardio benefits from that form of exercise.  Thus, the need to constantly remind oneself to keep the arms relaxed and keep pumping the legs -- I find that doing 5 minute bouts where I tuck my hands into the pool-running belt helps here.

So, what's the best way to pool run?  Again, I don't think there is one best way.   As noted above, I shift between cycling and bounding (I stick with cycling when doing hard intervals, as I think I get my heart rate up higher that way).   But that's what has been working for me.

In the end, I feel that what matters most in pool-running is the fact that you're doing it at all.  Debating the nuances of one form variant versus another is like debating whether a tempo run at x pace for y distance is better than a tempo of p pace for q distance.  The details aren't negligible, but the big picture is still the big picture.   If you're out there and pool-running and pushing the effort, then you're getting some benefit.

[even if you're doggie-paddling].

Monday, February 21, 2011

Why you do it

So, you're injured, and sentenced to the pool.  You run in small circles for hours on end, wondering why.

This is why you do it.

So that when you're on the mend, you can do long progression runs on the Towpath on a holiday morning in perfect conditions.

Split paces for my 10 mile progression were 9:20, 8:37, 8:15, 8:12, 7:56, 7:21, 7:10, 7:01, 7:00, and 6:41, followed by 2 mile cooldown at 8:39 pace.  Averaged 7:45 over the ten mile progression; 7:55 for the entire 12 mile run.

But if you're focused on the splits, you're missing the big picture.  Lemme give you the big picture again.

this is a big picture
Yes, I'll grudgingly admit that "every day's a good day for a run."   But some days are REALLY good days for a run.

[edit: I realized from the comments that some may think I took photographs of the canal -- nope -I ganked them from another site dedicated to the canal.  I've now made that clear, with credit]

Sunday, February 20, 2011

Training log - Week ending 2/20/11

This week was 23 miles of “real running” and 65 “miles” pool running (per my conversion below) -- training log is here. The week was a bit in flux, as I had a business trip on Wednesday-Friday, meaning that I ran my tempo during a very windy race on Saturday (report here) and pushed back my "long run" to Monday (hence the lower mileage).

I'm feeling like I'm continuing to progress and regain my fitness. It seems that where I'm weakest right now is stamina, both mental and physical. I've got speed, and I have good basic endurance. But sustaining speed over distance is hard, both mentally and physically. This has always been my weakness, and pool-running isn't the best way to address it. In the past, I addressed this issue with high mileage and workouts with longer repeats and long warm-ups/cool-downs. Of course, right now with the sharp restriction on my running mileage, that's not an option.

I believe that the answer here will be my long run (run as a progression run) and weekly tempo. I need to make sure that I prioritize both of those runs, including resting and recovering properly on the other days.

Related to this, my coach and I have agreed that for now I'm going to be keeping my "track interval" workouts in the pool. Thing is, I historically haven't gotten that much benefit out of short repeats on the track, and they're also the highest-risk, in terms of reinjury. I'm not crazy about continuing those workouts in the pool, but it really makes much more sense that way. We will do a standard track intervals workout from time to time, but they're not going to be a weekly thing for me.


Monday: In the morning, "12 miles” of easy pool-running – 2 hours. Did a "mat pilates" class that ended up being more of an abs class at night, followed by "2 miles" – 20 minutes easy pool-running.

Tuesday: In the morning, 9 miles of easy land-running outside (8:32 pace), followed by “5 miles” of easy pool-running – 50 minutes.

In the evening, a weights session with a personal trainer, followed by 40 minutes easy pool-running for “4 more miles."

Wednesday: In the morning, “14 miles” of pool-running, including a “track 800s workout” of 10x3:00 at hard effort, with 1:00 recovery, followed by full recovery, and then 30 minutes at aerobic effort. Drag luggage through train stations in afternoon.  (In the evening, dinner with online friend Races Like a Girl)

Thursday: In the morning, 10 miles easy (8:40 pace) outside on somewhat uneven terrain (tried to stick to flat areas, but hard to avoid hills in the area of northern Westchester County where I was).

Friday: In the morning, light strengthtraining followed by "7 miles" easy pool-running in hotel pool (70 minutes). Drag luggage through train stations in afternoon.

Saturday: In the morning, a 1 mile warm-up plus a 5K race as a tempo (21:05 for 6:47 pace, in horribly windy conditions). Followed with "10 more miles" in the pool (1:40 hours easy pool-running), and then a yoga class.

Sunday: In the morning, upper body strength-training; "10 miles" of easy pool-running (1:40 hours) in the afternoon.

Tuesday, February 15, 2011

Poor woman's waterproof iPod

This first picture, to the right, is my beloved waterproof iPod Nano case.   You will note that there is no Nano inside.

This second picture is of my Nano, inside a plastic bag with some rice (because that's what you try to do to save a Nano after you forget to close your waterproof case and don't notice that it's open and your Nano is floating in chlorine water until 20 minutes into your pool-run.)

[and no, the rice didn't work]

Fortunately, I have a "no questions asked" 2 year replacement warranty on the Nano.  Unfortunately, Apple's since come out with a new generation Nano, with a different shape that won't fit my case.  So, I need to order a new case.   In the meantime...

Here are the components of my "poor woman's waterproof iPod" -- a swim cap, a plastic baggie (preferably with one of those zipper seal enclosures), and a iPod shuffle (smallest capacity, so it's cheap).


You take the shuffle, place it in the baggie, and zip the baggie as shut as you can (it won't be perfect, since the cord protrudes).

Then you fold up the baggie, being careful to fold the plastic behind the Shuffle (so you can still press the controls through the plastic.

 And then you place the whole thing in your swim cap (again with the control side facing outward, so you can operate it through your swim cap), and place the swim cap-with Shuffle combo on your head.   Do NOT look in the mirror - you won't like what you see.

You looked. 

Yes.  You look like a conehead.  But recall the central tenet of pool-running -- you sacrifice dignity for fitness.   This is simply one more aspect of that.   And having music in the pool is worth it.

[disclaimer: I am certain that I am not the first to do this, and I believe I've read references to using a plastic bag to waterproof an iPod before.  Heck, if you Google it, you'll probably find a better way to do it. But this has worked for me.]

Sunday, February 13, 2011

Training log - Week ending 2/13/11

This week was 25 miles of “real running” and 91 “miles” pool running (per my conversion below) -- training log is here.

A good week, I think. I've been trying to be careful about coming back – a few examples.

- decision 1: I debated trying a track workout on Tuesday (in my defense, I was debating it, not certain I was going to do it). Coach nixed it, and it was the right choice. So this week, I did my tempo outside, but my "intervals" in the pool. Not as satisfying, but smarter.

- decision 2: on Wednesday, I felt my right calf tightening up (probably because it was 20 degrees outside). Not enough to stop me running, but enough that I would have second-guessed speedwork. So, instead of pushing through my schedule, I scrapped my planned yoga class for Wednesday evening, and got a sports massage instead. Right decision – calf felt great for Friday's tempo.

- decision 3: it was nasty cold on Friday morning (22 degrees), and I was still stiff and tight even after a 20 minute jog + strides and drills. So, I intentionally started my 3 mile tempo off pretty slowly. It worked out beautifully – I ended up running the tempo at the proper effort level, opening up a bit more each mile and finished feeling tired, but relaxed and strong. Great confidence boost – more so than last week, even if the pace was slower.

I just wonder why smart decisions are so easy to note in retrospect, but so hard to recognize at the time.


Monday: "12 miles” of easy pool-running – 2 hours.

Tuesday: In the morning, “14 miles” of pool-running, including a “track 800s workout” of 10x3:00 at hard effort, with 1:00 recovery, followed by full recovery, and then 30 minutes at aerobic effort.

In the evening, a weights session with a personal trainer, followed by 30 minutes easy pool-running for “3 more miles”.

Wednesday: In the morning, 7 miles of easy land-running outside (9:00 pace), followed by “7 miles” of easy pool-running – 70 minutes. In the evening, 30 minutes of easy pool-running post sports massage for "3 more miles".

Thursday: In the morning, upper body strength-training and then “12 miles” - 2 hours easy pool-running; in the evening, "4 more miles" – 40 minutes very easy pool-running.

Friday: In the morning, 5.5 miles on land. 2.25 miles warm-up, drills and strides, then a 3 mile tempo, starting slow (because it was 22 degrees and nobody felt warmed up) and opening up each mile (splits were 7:11, 6:45, 6:39, for average 6:52 pace). The whole thing felt very fluid and under control – huge confidence boost. Quarter-mile cool-down, then hopped in the pool for “7.5 more miles” – 1:15 easy pool-running.

Also did a Pilates class in the afternoon.

Saturday: "19.5 miles" as a “long run” of 2:50 hours in the pool, including 2:30 of alternating 5 minutes at tempo effort and 10 minutes easy. Followed with strength-training.

Sunday: In the morning, 12.5 miles outside as a long run (averaged 8:18 pace – we started slow and then opened up, finishing with two miles in 7:18 and 7:09); I followed with “9 miles” in the pool – 1:30 hours easy pool running.

Wednesday, February 9, 2011

Structuring workouts in the pool

Whenever I discuss how I structure my pool-running-as-a-replacement-for-land-running, I usually say something along the lines of "I stuck with my regular training schedule, and just did the equivalent by time of my land workouts".

In point of fact, this isn't the full story.  You can definitely preserve a lot of your fitness in the pool, but the brutal truth is that you will be working harder and longer for equal or slightly less benefit.

I have generally stuck with a traditional training schedule -- a weekly interval workout of 800m repeats (each would normally take me about 3 minutes), a weekly tempo run of 20+ minutes, and a weekly long run).  But I have found it necessary to modify it slightly to keep the same level of effort.  These changes are listed below.

  • Recovery: The pressure of the water assists your heart in pumping blood, and the water itself cools you down rapidly.   As a result, you recover much quicker in the pool than you would on land.  On land, if I were doing 800m repeats in 3 minutes each, I would take about 2:30 recovery -- this would give me enough time to catch my breath and regroup, but I would NOT be fully recovered before the next interval (in VO2Max training, that's the point -- you want to be a bit more fatigued as you start each interval).  

    But in the water, 2:30 rest gives me full recovery.  It's way too much.   In my experience, about 1:00 recovery in the water is equivalent to 2:30 on land, and so that's what I use (for other recovery durations, I just use a formula of 2/5ths of my land recovery duration for the water).
  • Perceived Effort: I'm not sure quite why this is, but perceived effort is not accurate in the pool.   For some reason, what should be an equivalent level of effort seems to result in much more suffering in the pool (this has been my experience, and also the experience of many other successful pool runners that I have discussed this with).   10K effort feels like 5K effort, etc.

    Thus, in order to get the equivalent workout, you have to brace yourself to hurt MORE in the pool than you would on land.  3:00 minute repeats really should be quite painful (much more than they would be on the track), and shorter intervals near-excruciating.   Yes.  It sucks.  It really sucks, sometimes.  But one plus is that this develops mental strength incredibly effectively, which should convey well to land running.
  • Duration: You'll try and try to correct for the difference in perceived effort in the pool, but the truth is, you'll never quite get it.  So, you have to address the issue by also extending the duration of your workout.   For me, I've found that the best rule of thumb is to nearly double the length of the workout.  A track workout of 6 800m repeats on land becomes 10 intervals of 3 minutes each in the water; a tempo of 20-25 minutes on land is 40 minutes in the pool.

    How do I know that this is the best conversion?   Well, I honestly don't.  But I can observe that the fatigue I experience in the afternoon after a morning pool workout of 10 repeats is very close to what I would feel after 6 intervals on land (ditto for tempo duration), and that's enough for me.

    On a similar note, I've noted that I do 3+ hour long runs in the pool, but I don't feel anywhere near the same post-workout fatigue from a "long run" that I would feel after a long run lasting 2-2:30 hours outside.  Again, you have to go longer to get the same results.

    [and no, I don't do 4:30 hour long runs in the pool -- I don't have that much time.  At some point, real (non-running) life does control.]
So, in a nutshell: pool-running is a substitute for land-running, but an imperfect one.  You have to do more intervals with shorter recovery and greater perceived effort to get something slightly less than what you would get on land.  

And this (among many other reasons) is why land-running is much more fun than pool-running.  But the pool-running can work.  You just need to work to make it work.

Sunday, February 6, 2011

Training log - Week ending 2/06/11

This week was 20 miles of “real running” and 90 “miles” pool running (per my conversion below) plus 30 minutes on the arc-trainer  -- training log is here.

Wow. So far, it appears I haven't lost that much. Highlights of the week include my first speedwork since November – 3200m at tempo effort for 6:40 pace, and my first (sort of) long run – 10 miles at 8:30 pace. I'm pleasantly shocked.

Interestingly, it seems that I've retained most of my aerobic fitness, and most of my strength; what I've really lost is neuromuscular conditioning. I grow mentally fatigued of running far before I feel physical fatigue, and even the slightest uphill incline is a real challenge. I see hills and strides in my future. But, I do know that neuromuscular fitness is the quickest to be recovered, so this isn't much of a concern at all. Yay!


Monday: In the morning, “13.5 miles” of pool-running, including a “track 800s workout” of 10x3:00 at hard effort, with 1:00 recovery, followed by full recovery, and then 25 minutes at aerobic effort.

In the evening, a weights session with a personal trainer, followed by 30 minutes easy pool-running for “3 more miles”.

Tuesday: In the morning, 7 miles outside, followed by “9 miles” – 1:30 hours easy pool-running. The running was a “faux” workout – I warmed up for 20 minutes, then did some running drills and strides with others. However, I then skipped the actual workout that they were doing, and instead spent another 40 minutes running, including jogging circles up and down a hill (for the DC peeps – I did this loop). I averaged ~8:30 pace for the 7 miles.

Wednesday: In the morning, “14 miles” of easy pool-running – 2:20 hours. In the evening, 30 minutes on the arc-trainer plus a yoga class.

Thursday: In the morning, upper body strength-training and then “12 miles” - 2 hours easy pool-running.

Friday: In the morning, 3.5 miles on land. This was my first land speedwork in 3 months – 1.25 miles warm-up, drills and strides, then 2 miles at tempo pace (13:19, for 6:40 pace). It was tempting to do at least another mile repeat, but I didn't want to get greedy. So I did a quarter-mile cool-down, then hopped in the pool for “9.5 more miles”, including finishing the tempo workout with 2x15:00 at tempo effort with 1 minute recovery (1:20 total time in water).

Also did a Pilates class in the afternoon.

Saturday: A “long run” of 3:15 hours in the pool – did most at easy pace, but did 25 minutes at aerobic effort towards the end. Followed with strength-training.

Sunday: In the morning, 10 miles easy outside (8:29 pace); in the afternoon “9 miles” in the pool – 1:30 hours easy pool running.

Saturday, February 5, 2011

And so it begins.

At some point, we all have to wake up.  Shake off remnants of dreams and nightmares, and squint into the bathroom mirror, noting the blemishes and gray hairs that have erupted overnight.

This week has been equivalent to that.   In early November, I broke my foot, and commenced my poolrunning saga.   All of my long runs, tempos, interval workouts, etc, were replaced by their equivalents in the pool.   I no longer tracked how long it took me to cover a set distance; my workouts were perceived effort over a set period of time.  No numerical feedback, just my sense of how hard I was working.   And who is truly honest with themselves about their effort level?

I could fantasize about the superspeedy workouts I was cranking out in the pool, and who would know the difference, or even care?   Certainly not the lifeguards (who just wanted to be sure I wasn't drowning), or the swimmers (who would rather have me gone).

In my fantasy pool running world, I hit every split.  Every time.

Even after I started running again, the dream continued. I could jog around, and watch the other runners crank out their workouts, convinced that if I really wanted to, I could hold my own with them (I just wasn't going to, because I was protecting my foot, of course).  My hard workouts continued in the pool, where I crushed every single one.


I did a "faux workout" outside this Tuesday (warmed up, did drills and strides, and then skipped the workout and just ran easy).   I had no excessive stiffness or soreness during the two days after, so Thursday afternoon I emailed my coach, and suggested that I show up for the Friday morning tempo.  The group workout was scheduled to be 2 or 3 repeats of 3200m at tempo pace.  My thinking was that I'd warm up, do drills and strides, then maybe 800m or so at tempo pace, and see how the foot handled that.

And of course, since it would only be half a mile, it wouldn't be very hard at all (and I could run that half mile too fast, then proclaim that pace my tempo pace, and the dream would persist a few more precious days).

Coach's response?  "Great!   Let's have you do the first 3200m at tempo pace, then a short cooldown and call it a day."



We all have to wake up at some point.   And for me, that awakening started with a 4:45 am alarm on Friday morning.  Inhaled my oatmeal, grabbed my handwarmers and mittens, and headed for the track.

My warm-up jog was simultaneously familiar and strange.  As with all my post-injury runs, my legs were strong and bouncy, but the coordination was also ever so slightly off -- much like one's legs feel when one first stands on land after an extended period on a boat.

Then, the other runners and I started our drills and strides.  I felt like a bit of an interloper, a sham.   They were real runners, and I was a pool runner, literally out of my element.

And then we clustered around coach for our instructions, discussing the pace that each of us wanted to hit.  When he looked at me, I just shrugged my shoulders.   I could fantasize that I could hit certain times -- I had been doing that a lot over the past few months.   But in reality, I had no freakin clue.   We agreed that I'd just try for a certain effort, and "work with" my running friend Cheryl.

[this, of course, raised another conundrum.  I have always been self-trained,and so my track workouts have always been solo.  I have very rarely paced a friend through one of their workouts or race, and I have NEVER had someone help me during a workout, or "worked with" someone.   And now, if I really screwed up, I'd be potentially screwing up someone else.]

And then, we gathered at the line. Still certain I was the poseur, I placed myself at the back, prepared for the pack to leave me far behind.

And then we started.  And the pack didn't leave me behind.  And my legs wanted to GO and to feel free, and I found myself growing claustrophobic in the group, and swung wide to give myself more space.

I realized that we had 8 laps of the track to run, and I couldn't wait to run each of them.

And the pack spread out, and we had room to move, and my breathing and the rhythm of my legs came back to me, as old friends.

I think I was supposed to be paying attention to the splits that coach called out each lap, but I didn't.   Instead, I just held that steady tempo pace and effort.  And I slowly began to understand what it meant to "work with" Cheryl -- I visualized a bungee cord between the two of us -- when she surged ahead, I would let the cord pull her back to me.  And when I flowed ahead of her, I'd mentally urge her to catch-up.

My old mantras and habits came back to me. Relax those shoulders, keep those hips square, engage those lower abs.  Stay easy and glide, work hard but never forcefully.  How is your breathing?  Running still felt slightly odd -- my mind was growing weary of coordinating my stride, but my legs and my breathing felt well under control.

And then we hit the last curve and I flowed to the finish, and hit my watch.

13:19 for the equivalent of 2 miles - 6:40 pace.   Not far at all from what I would have run in November.


For a few minutes, I was tempted for a second repeat.  At a minimum, I could try another mile at the same pace.   And then I remembered that this was my first running at speed since November, and I stuck with the plan, heading to the pool (conveniently adjacent to the track).

Hopped into the pool, indulged in 20 minutes of easy poolrunning to regather my emotions and thoughts and elations, and then cranked out the equivalent of the rest of the workout in the pool (2 intervals of 15 minutes each at tempo effort; 1 minute recovery).

During each interval, I relived the tempo 3200m outside.  Sometimes waking up ain't such a bad thing after all.

Wednesday, February 2, 2011

My Little Bone Stim

I've made no secret of the fact that I think the bone stimulator I used was responsible for the accelerated healing of my fractured metatarsal.  When buying mine, I did a lot of research on these things -- I've compiled my experiences here, in case it's helpful to others.

I note that my experience is limited to one brand of ultrasound bone stim - the Exogen 4000.  I don't know that much about any other ultrasound bone stims.   I have heard of several electrical bone stims, but I haven't had any experience with those either.

The Basics:

The Exogen 4000 is a LIPUS device -- Low Intensity Pulsed UltraSonagraphy.   It comes with a) a strap with a little hole in it; b) the unit, which has a black circular transducer attached by cord, and c) two bottles of gel (which is WAY too much).  It comes with a limited # of "charges" (more on that later), with each charge being a 20 minute session of ultrasound treatment to your injury.

It's remarkably easy to use.  Detailed instructions are here, but basically you strap it to the location of your injury, and push the one and only button on the device.  Once you do this, it runs through a system check, cycles screens showing how many times you've used the device, and then confirms that it's actually in contact with your body and has conductivity.  If it doesn't have a connection, then it turns off without expending a charge, which is nice for those times when your cat accidentally (or intentionally) steps on the button.

Then it starts its work, counting down from 20:00 to 0.  You don't feel a thing.  At the end of the 20:00, it beeps to let you know it's done.  You remove it, clean off the gel, and put it away.  Putting on the Aircast afterwards is more difficult than this thing.

I have two pro tips here:  a) mark your fracture site with a sharpie -- it will make it much easier to place the transducer correctly; b) make sure you have a paper towel or similar within reach before you strap the transducer onto your foot, so that you can clean up easily after.

How It Works:

To the best of my limited understanding, the device, by pulsing ultrasound from the transducer, applies a stimulus that causes the "upregulation" of genes, promoting faster action by the body's healing processes, including removal of dead tissue and growth of new bone, capillaries, etc.  Smith & Nephew's discussion of this process is here.   I'm not quite sure what "upregulation" is, but it sounds effective, and I suspect that there are politicians that oppose it.

The area of the pulse is supposedly about 2.5 times the size of the transducer (which is in the shape of a quarter, and is approximately a centimeter thick).   So, you don't have a large area of effect, and you need to get the transducer as close to the fracture as possible.   For this reason, the Exogen is best used on bones that are close to the surface; and those who are larger may be more limited in the areas of the body where the Exogen will be effective.   And if you have a cast, you'll have to have a window cut within your cast.

I used the device on a metatarsal bone, which is in my foot and just below the skin.   The strap to hold the transducer in place fit easily around my foot.   However, the strap is small enough that I don't believe it would fit around my thigh.   Thus, any use of the bone stim for bones other than those in hands, feet, lower leg, or arms is going to require jury-rigging something to hold the transducer in place for 20 minutes.

The clinical trials all were based on one use per day, and so that's what the recommendation is.   I've heard from different sources that most sales reps recommend using it twice a day, spaced as evenly as possible (the idea being that you apply the stimulus, and then allow the body to react, so it doesn't make sense to queue up your uses back to back).   As I note below, I used mine 3 times a day, at 8 hour intervals, with no ill effect.

Limited Charges:

The Exogen 4000 comes with a guaranteed 150 uses, aka "charges", according to their patient brochure (link to pdf).  In practice, you can likely get many more -- I'm currently on use 200, and I've read reports of others getting 250 or more uses.  But, you can only count on 150, so you want to be judicious in your use of the device.  I do note that the PDF linked above implies that you can send the device back to Smith & Nephew for more charges if you're still healing your injury, but my sense is that that only holds true if you buy the device directly from S & N (as opposed to the Ebay/Craigslist option).

I also understand that the battery life is also limited by time, with approximately a year of battery life before the device fails.   Mine is still going strong, but since it was manufactured in 2/10, I'll be putting battery life to the test shortly.

Insurance coverage:

As a general rule, insurance companies have different criteria for whether they'll cover LIPUS, based on whether your fracture is fresh, or some time has passed since your fracture.  Quite a few insurers post their coverage memoranda on-line, so that you can dig it up (albeit with some effort).  Here's a few that I found.  I do note that many distinguish between "fractures" and "stress fractures" - I'm not sure what the criteria is there.
  • Anthem - For fresh, they'll cover fractures of the middle of the tibia, a "Colles Fracture" of the wrist, closed fractures that are at high risk for non-healing due to vascular issues and soft tissue/vascular damage, and closed fractures for people that are at "high risk", including smokers, diabetics, anemics, steroid users, the obese, the nutritionally deficient, and alcoholics.  Yes, there's a bit of irony here, as well as disappointment that training-obsessed runners aren't considered high-risk. 
    Otherwise, if you wait 45 days and your fracture hasn't progressed, and you meet certain other criteria, they may cover.  Stress fracture? Specifically excluded.
  • BCBS-Delaware - looks like they'll cover fresh closed fractures, as well as fractures that have shown no sign of healing for 3 months (except for skull and spine, and see other limitations).  They don't cover stress fractures. 
  • Cigna - for fresh, they'll cover fractures of the middle of the tibia, a "Colles Fracture" of the wrist, or closed fractures where there's a high risk of not healing due to either poor blood supply or "comorbidities" like "smoking, diabetes, renal disease, or other metabolic disease where bone healing is likely to be compromised".  If you've gone more than 3 months without healing, and it's not your skull or vertebrae, then they may also cover it (see other conditions).   If your stress fracture has gone 90 days without healing, but can be seen by imaging, they should cover as well.
So, Your Insurance Doesn't Cover It.  What Now?  

Well, the answer is actually pretty obvious.  EBAY!   There's generally at least 20-30 of these babies up for sale at any time.   And it's really not that bad a deal.

The Exogen 4000 is generally priced at about $4000 to the insurers -- if you have a 10% copay for durable medical equipment, that's $400 out of your pocket.  Of course, in exchange for that, you get a brand new device that's under warranty, and the peace of mind that comes from supporting our nation's pharmaceutical/medical research industry.

Or, there's the world of online auctions - the devices seem to be priced for about $200-400 on eBay.   You are taking a risk by buying a used device online, but at least the hit to your pocket will be the same or less.  There is an excellent guide to buying these things on eBay that is worth reading.  I will briefly note two things to look for/ask about:
  1. The number of charges left on the device.  As noted above, these do come with a limited # of charges.  You should be able to assume 150 charges; you may get many many more out of the specific device, but why risk it by buying a device with 145 charges?  The seller should be able to provide a photo of the start up screen showing the number of full and half uses -- if s/he doesn't, I'd buy elsewhere.
  2. The age of the device.  Supposedly, these have a limited shelf life too -- the battery ages.  Also, there was a FDA recall on these in 2008-2009; it's probably a good idea to avoid those.  You can identify the age of the device clearly by the serial #, as explained here.  Again, if the seller won't provide the serial #, don't deal with him/her.
Of course, all the other caveats about buying on eBay apply.  Look for sellers that answer questions promptly, that can provide detailed information about the device, and that have a long history (over time) of good ratings.  Even then, there's still an element of risk, and people desperately looking for any means to heal their bones faster are likely easy marks.  Caveat Emptor.

My Experience:

On November 3, I was diagnosed with a traumatic spiral fracture of the second metatarsal on my left foot -- the fracture clearly showed on x-ray, and was NOT a stress fracture as traditionally seen (stress fractures have a gradual onset, are splintery rather than a clean break, and often don't show on x-ray; mine was a sudden clean fracture that was immediately visible). 

My podiatrist recommended this device pretty strongly, and placed me in touch with a representative from Smith & Nephew who was charged with trying to get my insurance to cover the device for me.   After 3-4 days passed without her returning my calls, and I had confirmed via my own research that my insurance was very unlikely to cover, I went the eBay route, and purchased one with 29 uses on the counter for $340, plus $20 to overnight it.

As noted above, the official literature recommends that you use the device once a day; I had read multiple comments on various message boards indicating that sales reps advise to use it twice a day.  When I asked my podiatrist how often to use, he responded "the more the better."

With that advice in mind, I used three times a day, with 8 hour intervals -- 5:00 am, 1:00 pm, and 9:00 pm.  I would fudge the exact timing a bit -- sometimes 1:00 pm would be 12:30 or 1:30 -- but I consistently used it three times a day seven days a week up until the day I was told the bone was healed, and I was cleared to run.

Since them, I've still been "zapping" my foot once a day -- I don't know whether this is accomplishing anything, but it can't hurt.

I was originally projected for 12 weeks before the bone would be healed sufficiently to run; in the end, I was cleared to run at 7 weeks.  This is consistent with the "best case" predictions for results of a 38% reduction in healing time (patient brochure pdf, p.26).

Can I be sure the bone stim reduced my healing time?  No.  There's no way I'll ever know.  But I think my $360 was money very well spent, and I'd make the same decision the next time around.

Addendum -  some interesting links: