Focusing on Form

I've now been running for 3 weeks after taking 8 weeks off for my Osteitis Pubis and torn adductor. As I said in my last post, I am using the run-walk approach to gradually get back into my normal routine. So far my longest run has been 5 x (9 minutes running, 90 seconds walking). That adds up to 45 minutes of running total.

I'm probably at a point where I can start to get rid of the walk breaks but I like them because 1) it's crazy hot and humid and I need my heart rate to come down and 2) I'm 100% focused on my form and stride and I need a mental break from that. It's also good to check in to make sure everything is feeling good and nothing is hurting. I would hate to finish a run and realize I made the injury worse but didn't get that feedback immediately.

I went to the doctor last week and she was pleasantly surprised at how quickly I was recovering. She gave me and exam and tested my strength as was impressed that I had made such progress. It wasn't a guarantee that this adductor tendon would heal on its own, but thankfully it's most of the way there and I won't need surgery or any other kind of procedures. Just the dry needling which I stopped about a month ago.

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Issues with my running form
Back to the topic of this blog. Fixing my stride will not only prevent this injury from coming back, but it will make me a stronger and more efficient runner. 

I have always been a "shuffle runner". I wouldn't pick my feet very high off the ground and drive forward with the knee. My stride was short, partially due to limited range of motion in my ankle. In order to offset

Drills before running

this and still run fast (like a 5:52 mile) I adapted by having a very high cadence. Most runs would average 200 steps per minute and speed work would sometimes average 210. My feet would stay super close to the ground and move very quickly. Like shuffling!

Another form issue was that when I landed on my left foot, my right hip would drop down, making the pelvis unstable and uneven. This is a common issue with runners and can lead to injuries. It indicates instability and lack of glute activation. I also had this issue on the other side, but it was not nearly as pronounced. It makes sense that I tore the left adductor because I wasn't activating the left glute when I landing -- the right hip was dropping.

I have known about this hip drop issue for over a year now and have been working on it with my strength training coach. I have strong glutes! The problem is that my body doesn't naturally tap into that strength when running. It prefers to use the adductors. If I were able to access that power, I would be a more efficient (faster) runner and be protected from re-injuring my pubic bone.

Changing movement patterns
Working with my Osteitis Pubis specialist in Australia, live video feedback or mirror feedback has been essential. The focus is on doing all the PT exercises 100% correctly. It's not about doing them to get strong (although some of them build strength). It's about teaching my body to have a stable pelvis when put under different types of stress. There are literally over 100 exercises. I am not exaggerating. When I say "literally" I don't mean it like a millennial. I mean literally over 100 exercises. It would be overwhelming to do them every day, so the point is to progress through them one step at a time adding more stress and complexity while keeping a stable center of gravity and a pelvis that is controlled.

There is a huge focus on deadlifts, bird dogs, downward dogs, and side planks. There are many variations of each that challenge pelvic stability in different ways. Being able to see myself on video or in the mirror has enabled me to ensure I am doing the movements correctly, which ultimately translate to running. 

Greg has been recording videos of my running so that I can analyze my stride afterwards. He records some of them in slow motion so I can really see where I need to pick the legs up higher or keep the pelvis more stable. Drills have also been important in reinforcing the correct movement patterns, provided that I am doing the drills correctly. 

Here is what my hip drop looked like last summer:

Here is what it looked like yesterday:

And here is a back view, which is much more noticeable, taken last summer:

This was taken on Saturday - notice the difference:

My knees still come together, but that's just my anatomy. When my feet are pointed straight ahead, my knees go in. When my knees are straight ahead, my feet turn outwards. My PT said that was fine and you can't fix your anatomy! The important thing here is that the line of the top of my shorts is straight across rather than slanted down, like in the green shorts from the previous photo.

What I think about
As I said earlier, I need the walk breaks because focusing so much on my form is mentally exhausting. There are only so many mental cues you can give yourself at a time. Here are a few of them:

• Feel the glutes working
• Engage the core to keep stable
• Keep the spine elongated
• Shoulder blades down
• Lean forward from the ankles
• Drive forward with the knee
• Use gravity to fall forward
• Most of the weight in the forefoot
• Stable foot "tripod" when landing
• Remember deadlift form

I hope this way of running becomes automatic. I honestly have trouble running slowly when I do this. It's easier to open up the stride when you are running fast. This normally wouldn't be a problem but I don't have the cardio fitness to support the faster paces, and it's crazy hot and humid! My heart rate has been averaging in the 170s for the run segments because I am out of shape and it's hot. My paces range from 8:10-8:30 once I get going. That used to be my easy pace but it's not my easy pace right now, and it's definitely not my easy pace in the heat. So hopefully I will get the hang of it and be able to run in the 9:00's so I won't be dying in the heat. 

I'm on track with my plan to build a base in July and start marathon training in August for Richmond!

Back on the Roads!

After 8 full weeks of zero running, I have started back up again. Very gradually!

I was not exactly sure when it would be safe to return. My physical therapist cleared me to run after 7 weeks, but I felt like I needed an extra week. I still felt the injury with certain movements and I wanted more confidence that I wouldn't hurt myself. Meanwhile, the Osteitis Pubis specialist I am working with in Australia doesn't advise running until stage 8 of his program- which I won't reach for another few weeks.

The physical therapist tested my strength and was confident that I was far enough along in my recovery

that running would be ok. My adductors, glutes, abs, hamstrings -- all have a healthy amount of strength to support running. He gave me a return to running program that seemed too aggressive so I decided to use a more conservative program from my strength coach, Angela. I'll use her program at least initially, and if I feel like I can progress faster then I will switch back to the PT's plan. 

Monday, June 7
For my first "run" back, I did 6 sets of 0:30 running, 4:30 walking. Essentially this was a walk, with six 30-second jogs thrown in. This was discouraging. I felt the injury more than I expected to. I tried focusing on my form and just being really purposeful about my movements but I still felt irritation in the pubic bone area. I did have some hope, however, in that a few of the reps felt decent. I would say about half them felt pretty good and the other half did not.

Did I do too much too soon? As soon as I stopped the running portions, walking felt 100% pain free. And I didn't have any hints of the injury for the rest of the day or the next day. What a relief. This means that my 3 total minutes of jogging didn't make things worse and I could proceed with the plan,

Wednesday, June 9
Building on Monday's session, this time the 5-minute blocks were split as 1-minute run, 4-minute walk. Twice as much running! I was a little nervous heading into this but I was pleasantly surprised that I had very little pain. I felt WAY better than I did on Monday! I was very encouraged by this. So what made the difference between Monday and Wednesday? I think it's a combination of:

• 
  I focused more on my posture and pulling the shoulder blades down. This was feedback I got from the Australian specialist when doing a Bird-Dog exercise during our Tuesday session.
• My body needed to get the message "Hey, we're running again, and it's okay" and shake off some of the cobwebs
• My body needed to recover from a run and realize "that didn't cause an injury"

I've learned that the mind-body connection is REALLY important in recovering from an injury. The brain becomes used to feeling pain with certain activities so you need to train it to not feel pain once you can do those activities properly.

Friday, June 11
No injury flare ups or pain all day Wednesday or Thursday, so I advanced on Friday to 1:30 run/3:30 walk. This was also encouraging although not perfect. I would say that maybe 5-10% of my steps triggered a mild pain sensation around the pubic bone, but the rest were fine. Some of the reps felt much better than others. Once again, I really focused on my form. Several key items:

• Fall forward as you run - let gravity help
• Keep a straight spine with the shoulder blades down
• When landing, ensure that the toes are spreading to form a stable platform
• When pushing off, observe the firing of the glutes
• Breathe through the core to help engage the core

I am encouraged by all of this and I continue to work with the PT, the Australian specialist, and my strength coach. I think my biggest issue is stability, which can be improved by glute activation. My lack of stability causes my pelvis to move too much, which is not good. My PT also discovered that I have extremely tight glutes and I fail his strength tests before massaging them out with a lacrosse ball. After the massage, my glutes start to work. So I should be using my massage ball on my glutes before each run.

I continue to swim 3-4 times a week, and I have gotten my swims up to one mile. Last week I swam 4 miles! I joined an outdoor pool so even once I am back to running full time, I plan to incorporate swimming. We also bought a rowing machine which is also great for cross training.

Long term plans
In an ideal world, the next six months will look like this:

• June: Run/Walk, be able to run continuously for 40 minutes by the end of the month
• July: Build a mileage base, introduce strides and some introductory faster workouts
• August: Begin training for the Richmond Marathon, include long runs and tempos, run a 5K
• September - October: Richmond Marathon Training, run a 5K and a longer distance
• November: Richmond Marathon

My physical therapist is confident I can progress at this rate and so am I. As for the Boston Marathon, I plan to use my Two Rivers Marathon time to qualify for the April 2022 race. I have a cushion of over 20 minutes, so I'm confident that I will be accepted!