Piriformis is a pain

Image from Sports and Spine Rehab

Piriformis Syndrome is literally a pain in the ass. Really.

There is a muscle that runs kind of sideways and crossways across our hips that helps control the swing and general action of our hips. And apparently if you aggravate it, it can cause all kinds of discomfort. To make matters worse, it runs very close to the sciatic nerve and can make that very unhappy too, leading to a lot of general unhappiness all the way around.

I didn't even know what it was but the effects of "Piriformis Syndrome" started bugging me over two years ago (2013). I noticed it mostly when driving - my right butt/hip would ache. If I had to drive a long distance I would become very uncomfortable and I'd have to stop regularly to stretch. It didn't bother me during my MCM marathon training, but it was there. Then, about a year later it started to affect my sciatic nerve, and I just thought it was a leg issue. I learned a few stretches that helped, and for the most part tried to ignore it.

Late this summer, August of 2015, along with an ankle issue, my pain-in-the-butt thing got worse - really uncomfortably so. It was a sharp, focused pain deep in my butt cheek whenever I tried to do speed work. And I still didn't know what it was. It was only by accident that I finally stumbled on what my issue was by reading a lot of posts on the runnersworld.com forum.

That started the process of getting myself rehabilitated and repaired (or is it repaired and rehabilitated?). And it's a long process before full happiness ensues...

I've learned that Piriformis Syndrome can be brought about by either too much sitting or too much running (on hard surfaces). Well, I don't sit very much, and while I run a lot, I don't think that I qualify for "running too much". So what else? It turns out that weak glutes and/or ankle issues can also contribute to Piriformis Syndrome - and while I didn't think that I had weak glutes, it is certainly a possibility. And I certainly have ankle issues (seems to be a recurring issue for me).

So with that in mind, I've begun doing exercises to strengthen my glutes and have some new orthotics for my feet. And I'm experiencing positive results. Lots of lunges. Lots of deep knee bends. I also learned about the "Myrtl Routine", basically a series of exercises that focus on your hips. The Myrtl Routine runs through clams, lateral leg raises, donkey kicks, and so on. Do an internet search for it. Good stuff.

With regards to running, I had to cut down my miles substantially, partly because it hurt, but also because I did not want to cause further damage. My initial focus was two-fold: relieve the discomfort, and to strengthen my glutes and legs.

My morning routine involves a lot of easy stretching, all of them are yoga positions that I've been taught - I'd list the names, but I haven't got a clue. I know that one is called "Pigeon"...?  Deep knee bends, some on toes, some flat footed. More lunges. Donkey kicks and what I call "Kraut walking" (high steps). I also run through a Myrtl Routine.

Unfortunately, as I get older, I loose endurance quickly, so I wind up having to re-build my miles, starting with 2 and 3 mile runs for a while before graduating to 4 & 5 and ultimately 10 and 15 miles. I also lost any element of speed (not that I had a lot...). With a faster pace comes longer strides, which means that I'm stretching out my hamstring, and by connection, the piriformis muscle. I'm having to re-train those muscles to accept the stretch and the muscle turnover tempo.

At this stage, I am still in the 3 mile run stage, and I'm wanting to feel confident and strong before running further and faster. This is running season in FL and the weather is awesome. It is a shame to not be able to take advantage of it! But I I want to run when I'm 88, I better take care of my body while I'm 58.

Mind over matter

At what point are you really tired? Our bodies seem to always be able to do and go just a little bit further, so how can we tell when we're really "done"?

The answer to that is part physical and part mental. Yes, there is the necessary endurance and stamina that comes from training and running many, many miles, but it's the mental part that I think really does it.

We train our bodies to be able to endure many miles and to run at a pace that we want to hit. But physically, things begin to happen, things begin to hurt and get tired. As we chug our way through the miles and as we stress muscles and bones, at least two things start to happen: 1) we start to feel "tired", and 2) something somewhere will start to hurt or ache.

And this is where mind over matter comes in. We start to feel fatigue as a result of the release of lactic acid from our muscles (which is a natural result of the energy release from muscle action). Lactic acid works as a basic signal to the brain to back off the level of exertion. In extreme cases, lactic acid build up will create a sense of nausea, which pretty much forces the body to ease up on the level of exercise intensity.

So the trick here is to recognize that muscles are releasing lactic acid, thus the indications of fatigue, but know that there is still muscle endurance left. It's almost like "ignore that flashing red warning light - full speed ahead!"....  The fine line to consider is being able to recognize when you are truly red-lining your capability and it's time to back off. And where ever that point is, it is different and unique for everyone.

The same holds true with aches and pains that develop during a run. Which ache is normal and which one needs to be tended to RIGHT NOW?  After running a bunch of miles, it's only natural for different parts of your body to start to complain. You can run through most of them, but you've got to be conscious that there are some that you shouldn't run through. And again, there is no one answer since everyone is unique.

For me, sharp pains are usually not good. Ditto knee discomfort. Knee discomfort at any level is usually a big DO NOT RUN sign for me. But general aches and soreness I can, and will, run through, and oddly enough, they often dissipate before my run is over - sometimes only to bite me in the ass later in the day or the day after... but that's a different story.

For me the key is to focus on whatever my goal is for that day's run. I won't pick a distance that I haven't been adequately or properly been training for; for example if my long runs have been 10-15 miles I won't suddenly decide to do 40 or 50 miles on a given day, but I might do 20... With that goal in mind, I just start grinding through the miles, and as I've probably mentioned in other posts, mile by mile they click off until I'm done. At some point during a long run, something in my body will start to complain and I'll do a kind of "how bad is it" analysis, maybe adjust my stride, slow down, or something, but I'll try to keep running. I used to hate stopping for any reason (hey, the clock is ticking... can't stop for nothing...) -like, I would put up with a loose shoestring or a pebble in my shoe for a long time before I'd force myself to stop to take care of it - really stupid of me...  But I've grown up now (58) and I'll take the time to stop to take care of things so that I can have a better and more productive run.

But as the miles accumulate I find that I have to concentrate harder on maintaining pace and form. As I get tired, my posture can get sloppy, and as it gets sloppy, I'm not running as efficiently as I could. The better my posture, the less likely it is that I'll hurt something else. And this can take a lot of mental effort.

It's hard for me to remember exactly what is going on in my head, but I know that I'm trying hard not to think of how many more miles I have left, but rather focus on running smooth. Of course, I've also gone through runs where I'm thinking "5 more miles... "x" more minutes (depending on my pace that day)... if I run faster I'll be done sooner", which can make the end of the run very hard...  To focus on running smooth, I have this mantra that I think I picked up from Arya in Game of Thrones: "light as a feather, quiet as a millpond"... and I try to translate that into my footfalls, as in "land softly, land gently"...  and not let my feet just "plop" because I'm getting tired and/or my legs/feet hurt.

If I'm really getting uncomfortable, I'll start going through the routine of telling myself that the discomfort that I am currently feeling is temporary and expected, and that it will be over as soon as I cross my designated finish line.

But probably the mental thought that gets me to the end of my run when I'm getting tired and I'm hurting is the thought that I've not yet completed the goal that I set for myself that day. And only when I hit that mile number, whatever it may be for that day, do I feel like I can stop to lick my wounds.

I do find it interesting that we as humans can develop our muscles to do amazing things, but it takes that grey mush between our ears to bring it all together... It's pretty amazing!

That long run

As a beginning runner six short years ago, I was very intimidated by the thought of the “long run”. Anything over 3 miles was “long” to me. And it turns out that I was not alone. The punch line here is that my intimidation was only because I knew nothing about endurance training and had absolutely no appreciation for what the human body can accomplish when properly trained and conditioned.

But without a doubt, the mere thought of doing a 10 mile run was daunting to me, never mind doing a 20 miler in prep for a marathon. I might as well have been contemplating a trip to Jupiter. It wasn’t going to happen. How is it that anybody could run that far?  Ultra-marathoners were some kind of super-freakazoids to me. How could I ever possibly run 10, 20 or 26.2 miles, particularly given my very late start to my running career? I was convinced that you had to have been born with a special gene that enabled you to run far and survive it. I was in awe of marathon runners.

It all kind of came together for me after running my second Half Marathon. I finally realized that it was all about the training. I also noticed the numbers of runners that participated in these HM’s – and they came in all different shapes, sizes, and abilities. They weren’t all “super-athletes” – they were normal guys and girls living ordinary lives. Some were older than me (a helpful omen), most were younger, some were heavier than me, and so on… and for the most part, they all were able to go the distance, albeit some faster than others. It seemed possible for mere sub-mortals like me to run distance.

However, having said all that, I was only slightly prepared to accept the necessary training plan for my first marathon. As I reviewed my plan and realized the reality of how many miles I was going to have to run to build up my endurance, my reaction was: “I’m going to do what??!!”  No way. It’s not possible.

As it turns out, it’s not really so bad. Those long runs turn out to be (almost) a piece of cake, and I actually look forward to them.  Three reasons:

First of all, I didn’t have to jump from running 3 miles to doing 12 or 18 miles -  

The training plan edged me up mile by mile – there was no surprise and I had slowly built up the endurance to do so. So when the day came for me to do longer and longer runs, I actually had the ability to do it. Three miles became 6, became 9, became 14, and so on. This of course, was the point of the training plan. Improve endurance, get stronger, build stamina, run further ….  Amazing how that works, eh?

Secondly, I found that the miles just click by.  I get myself into a groove and just chug. It literally involves getting myself into a mental state of accepting the fact that I am going to run “x” miles today – that’s my mission, that’s my goal, and I’m going to accomplish that goal. Period. Having arrived at that “mental state”, I just go, and yes, the miles just click by… And I like it!

Thirdly, that feeling that I get after completing that long run is awesome –

Really - it is a feeling of tremendous satisfaction. I may not have the opportunity to tell anyone that I just ran some silly distance, but inwardly and to myself I’m wearing a sly self-satisfying grin. And there is no better feeling. This is something that only another runner would understand.

I do, however, have a few requirements for my long runs:

a)      The route needs to be interesting or at least attractive (no highways or traffic),

b)      If I’m running solo (which I usually do when going long) I need to have good music or a good podcast,

c)       It’s important that I anticipate my fuel and hydration needs and prepare for handling them accordingly. Most of the time I carry everything I need, which can be a pain, but it’s also amazing how good it feels to be self-sufficient.

I’ve done most of my long runs as early in the morning as I can get myself up for, as close to first light and sunrise as possible. In fact the best time is before dawn, when there is barely a hint of the sun coming up. I do this mostly just because I like the freshness of dawn and the fact that there are so few people out and about at that time of day. It’s calm and quiet, and the day is new. But I do it early also so that I have time to recover afterwards and still be able to do things later in the day with my family.

The first half mile is always the hardest for me, probably because I’m not 20 years old anymore and so it takes a little while for me to get loosened up. And then once I get past the first mile I get myself into a zone and I am able to just chug, and the next thing I know I’m at mile 10 or something. 

For my long runs my preference is to pick a circular route. Ideally, I have never run that route before which makes it a bit of an adventure. Alternatively, and actually more realistic, are out-and-back routes… in other words run a bunch of miles out, turn around and run back. The tough and good part about out-and-backs is that once I get to the turn-around spot, the only way to get home is to run all the way back to my truck… so there is a pretty good incentive to get it done. Then finally, there is the multiple loop routine, which fortunately I’ve only done a few times. While prepping for the 2013 Marine Corp Marathon I did a 6 mile loop 3 times so that I could get 18 miles in, and it really fell into the category of “work” – it was no fun and I got no pleasure out of doing it.

I do find that I negotiate with myself about the distance, like for example I’ll tell myself that in 3 miles I can suck down a GU or a banana, or in another mile I can turn around and head back, or I’ve only got 5 more miles to go, so if I run faster I’ll be done sooner, and so on! I never think about the time, i.e. how long I’ve been running, only the distance. The amount of time that I’ve spent on my feet doesn’t register with me until later, which helps me explain away why my feet might hurt. I do remember situations where I’ll promise myself a extra long Epson-salt foot soak, or (ever since my wife introduced me to it) promise to take myself to get a pedicure. [Side note here: my first time was after a particularly hard 19 mile run my wife encouraged me to go with her for a pedicure and I absolutely loved it – it was the best thing that I could have done for myself and I highly recommend it!]

The only caveat I have with long runs, particularly in prep for a marathon, is that I’m convinced that running for longer than 3 hours, or at the max 3:30 hours, is not beneficial.  I’ve done several 4hour runs because I was sure that I needed to be “able” to do it, but the truth is that those runs just beat the crap out of me. Recovery was tough, and I’m not sure that I actually helped myself or improved by conditioning.

The punch line here is that you shouldn’t be intimidated by that long run. It’s an adventure that you’ve been preparing for and now you are going to prove to yourself that you are good for it. The feeling afterwards is very satisfying and confidence building. When someone asks what you did this weekend you can say that, yeah you mowed the lawn, went to a party/dinner, and oh yeah by the way, also ran 15 miles…

Plan A, no Plan B, ok.... Plan C

All runners go through this at some point:  Get up and out for a modest run before the day gets started and the sun gets things too hot.  That’s the plan -  no waivering.  Except that energy levels are really low, and I mean really low. It’s been a tough week, lots of miles, the house kind of has a lazy feel about it, and the resolve to get out for a run is crumbling. 

So Plan B begins to form in your mind… How about taking a “rest day”? After all, you deserve it, and your body will no doubt appreciate it. It’s a nice warm day, perfect for floating in the pool with a cool drink and a book.  Plan B sounds really good! Oh, and a sandwich. Something tasty and juicy. Key on tasty. Ohhhh yeahhhhh.

But then you remember your resolve to run… The sandwich sounds good, but then the guilt thing comes in, like maybe you should “earn” it first… So after pondering all of this for a while (and the sun continuing to rise along with the temperature) you finally decide on Plan C:  do a run, a couple of miles at least, and then follow it up with a guilt-free sandwich while floating in the pool with a book. But for the love of all that is good, get out there!  (remember it’s all about “showing up”….)_

That was me yesterday – I really struggled to get out for my run. All of my household members were being lazy and proud of it and I was getting sucked into their very comfortable aura. The day was beautiful: a clear, hot, Florida day. The allure of floating in my pool with a book and cool drink was intoxicating.

But what got me over the edge was two things:  I was hungry and I didn’t want to eat anything without having burned some c’s first (I don’t always feel this way, but I did yesterday) and secondly and most importantly, my insistence on “showing up!”.

As it was, I chugged out 6 miles in brutal heat. I started on the asphalt road but the heat from the road was getting to me, so I drifted to the cement sidewalk where there was some shade, and then tried to run whenever possible in the grass because it was so much cooler than the sidewalk. Unfortunately, the grass here is so thick that it is hard to run in – it’s like running through a sponge; I have to literally lift my knees up so that my foot can clear the sod – it really screws up my gait!

Nonetheless I did it, plopped into my pool afterwards, and thoroughly enjoyed a sandwich and cool drinks. Ahhh… oh yeah, now we’re talking!  I showed up, I did my best, and I felt great for having made the effort.

Show up...

Reminders:

1) Show Up - get out there
2) Be Honest with Yourself - Be honest about your current fitness
3) Pay Attention - Be aware of your body
4) Do Your Best - Anything less makes the run a waste of time
5) Don't be too Attached to the Outcome - It's always different later

I found these 5 points somewhere some time ago and I think they are worthy of posting. Items 1, 2, 3, & 5  were authored by Angeles Arrien (a cultural anthropologist), and I suspect that item 4 is an extrapolation that fits really well with the others.  I think that item 2 was originally "Tell the Truth" by Arrien, but while an excellent axiom to live by, for a runners list of goals I like the being honest phrasing.

This is how I see these items fitting in to running:

1) Show up - Get your shoes on, and get out there. Your fitness and health will not happen unless you make the effort to get out there. We do not get stronger or better by sitting back.  It may be a drag to get out the door - that first half mile may be hard, but after that you know that you will be glad that you made the effort. More importantly, not showing up is worse than defeat. What's that line from the movie The Shawshank Redemption: "Get busy living or get busy dying" ?  Very apropos. If you don't show up, you deserve what you get (or not).

2) Be Honest with Yourself - Don't kid yourself about your capabilities. And this actually cuts both ways: being overly optimistic about what we "want" to be able to do as well as being too humble and modest about what we "can" do. But this can be hard because we all aspire to be more than we are - be able to run faster,further, better... Genetics, fitness level, and more, create the reality is that is each of us. It's important to have goals and stretch goals, but they have to based on reality, a starting point. Recognize your reality and do everything you can to improve that.

3) Pay Attention - Don't ignore the little injuries, and the corollary to that, take advantage of when everything is right! Pay attention to things that hurt so that they don't turn into debilitating injuries that will keep you out of your running shoes. If something doesn't feel right, figure it out and fix it. And having said that, when your body feels like it is perfect, take advantage of it.

4) Do Your Best - It's a mind set, and it should actually apply to everything that we do. Running is weird in that we tend to have different goals for each of our runs. The point is, whatever the goal is for that days run, focus on doing your best to accomplish that goal. Sometimes it's pace, or form, or breathing, or gait, or distance, and so on... If you are not going to make a serious effort at it, then don't bother doing it. Anything less makes the run a waste of time.

5) Don't be too Attached to the Outcome - Having a great or bad run or race is just one event in a lifetime of events. Savor or admonish yourself for the moment, and then move on to the next one. Having a great run or a great race feels awesome, and yes it does wonders to increase confidence, but it's just a small part of the bigger picture. Think "what's next" and what can you do to get better. Just because you had a great race does not mean that all races will be great. Likewise with a bad run or race - it sucks and can be draining if you let it, but that is all the more reason to move ahead. Again, think "what's next".

But it all starts with SHOW UP !!


Show Up
Be Honest with Yourself
Pay Attention
Do Your Best
Don't be too Attached to the Outcome

It's really about the Newton's

During a St Paddy’s Day 5K event one of the 5 lugs on the bottom of one of my Newton Motion III’s ripped off.  Somewhere around mile 1 I could hear this “flapping” sound, but of course since this was a race I wasn’t about to stop and investigate.  After all, I was neither in pain nor bleeding profusely, so I kept on running. I ran the rest of the race with that “flap” sound at every step until I crossed the finish line, and then realized that one of the lugs on the bottom of the shoe was hanging by a thread (the “flap” sound with every step was the sound of the lug slapping the pavement), and then within a few steps while getting some water, ripped off completely. Ok, no biggie I thought, I still had 4 lugs left…  I took a picture of it and called it good.

I love these Newton’s… really. I’ve flirted with other brands, but I always come back to Newton’s. I’m on my third pair, if that is saying anything… In a crazy way, they help me run faster, they encourage me to run stronger, and I believe, they help me run more efficiently.  I just wish that they weren’t so damn expensive… I’d try other styles of Newton’s if I could afford them…

When I get lazy during a run and my form starts to droop, somehow the feel of the Newton’s prods me to pay attention. Other shoes don’t do that for me. I’m not exactly sure how it happens, but there is a subtle feel in my midfoot whenever I start to lose my form, coupled with another odd feeling in my core-area.  And as soon as I fix it, I start running more efficiently.  Best of all, when I get into the groove I can easily out-run my intended distance for that day – which has good and bad ramifications...

But I do find that in order for me to run in the Newton’s “properly”, i.e. get the efficiency of form out them, I have had to build relatively solid core strength as well as well-conditioned hams and quads. I’m not talking about going crazy with core exercises, squats, and so on –I’ve just been doing general routines – and I can both see and feel the difference. But it turns out that this is pretty important, because the stronger my core and legs feel, the better my form, pace, and endurance are.  And better yet, the more confidence I have. And I think that running with Newton’s has had a lot to do with it.

I’ve had situations where during a run, perhaps within a mile or so from being done, I’d run into an acquaintance running the other way, and on a whim I’d spin around and join them (of course, I always ask if they want some company or a pacer… after all, sometimes we run because we want the alone-time…). My point here is that I couldn’t do it if I didn’t have the confidence that I had the endurance to extend my run. And I think that the Newton’s have done a lot to give that to me.

Oh, and by the way, I placed second in my age group on that 5K, flapping lug and all…!  I missed first by 27 seconds !  If I had paid a little more attention, maybe I could have claimed 1^st Place !  But I should also note that this was a very casual event – yes it was timed event, but it was a gun start (no starting line mat) and the start itself was somewhat very half hazard.  For all I know, the guy that beat me had lined up way in front, whereas I was way in the back with my wife and son and had to bob and weave my way up..  Once clear of most of the starting area pack, I ran pretty hard, despite the fact that it was very hot (yes, this was a Florida event!).

I narrowly missed destroying my ankle while cutting a corner though: the course ran along an asphalt trail and just before the finish had a 90 degree turn onto a sidewalk. I was in the process of passing another runner at that moment (bad timing on my part – lack of patience) and he suddenly bobbed out towards me causing me to miss the sidewalk and land on a rocky edge. It’s amazing what goes through your mind in a situation like that. I remember simultaneously thinking that this had disaster written all over it for me, while at the same time calculating where could I place my left foot to take the weight as soon as possible. As it turns out I was able to get my left foot firmly on the sidewalk right about the time I felt my right ankle complain. Fortunately nothing bad happened (I have a history of ankle injuries) and I was able to finish strong. But that little tiny event, a duration of perhaps 3 seconds,  reminds that I ought not take this stuff too seriously – this is supposed to be fun and I want to be able to run for years to come. I could so easily of destroyed my ankle in my desire to pass somebody at the worst possible time and that would have sucked big ones!

But the best news of all is that I'm getting new Newton's !!! Yea!!!