Hi, I would be really grateful for some coaching advice because I had a setback and I'm not sure how to adjust the training schedule. I'm not sure if I should post this in the medical forum or here, but am posting here since the medical questions are taken care of and I need coaching help. I run in the red group and followed the schedule with no problems all the way through Helvetia and the 8 miler on Week 11. Then I got married and went on a honeymoon, essentially missing 3 weeks of training (although I was able to fit in a few scattered runs and lots of hiking and swimming). I came back and it was time for the 25K benchmark. I wasn't sure whether or not to run it, but figured I would try, just taking it easy. The run felt great- better than the half, even, with no pain. I took it easy during the run, walking when needed, and ran slower than my pace (11:30 instead of 10:20)), with no pain or fatigue during the run-- really, it felt awesome, and I used Cliff Shots during the run and a protein/ recovery shake after. But by that night my left knee was hurting really bad and I couldn't walk without pain and a limp for the next 2 weeks. The problem was tendinitis and a groin pull, which have for the most part resolved. But I am really afraid I'm not going to be able to get back on track for the marathon.

I went to a sports medicine doctor who cleared me to run, advising starting at 3 miles. I ran a slow 3 miles on Tuesday and it felt okay (groin/ quad ached a little and felt tight despite stretching but no knee pain). Last week, I joined a gym and have been doing core and leg strengthening exercises per the doc's instructions for rehab (and I've been doing the CSS exercises from youtube since the 2nd week of Portland Fit). The doc also recommended running in the pool, which I did (I felt pretty dorky but stuck it out). I've been doing yoga and using the elliptical for the past week, too.

So these are my questions:

1. How do I modify the training schedule now that I'm solidly 5+ weeks out of the program? I'm disheartened but I really think in my heart that I could come back as long as I follow a coach's advice and don't just overdo it like I did by jumping right back into the 25K. The sports medicine doc felt like I should be able to run the marathon, too, but he advised I get a coach to set up a plan.

2. Should I hire a running coach for this, or can I work with my red team coaches? I haven't been coming on the weekend because it would be tempting to run the full run with everybody even though I know it would land me right back in Tendinitis City.

3. How do you do the pool running? I don't think I did it right- it didn't feel enough like a workout. I looked it up online and it said something about using a flotation belt and resistance shoes. I can order those if you think they would be a good idea, but I'd appreciate info on the technique.

I apologize for the length of this, and for how many questions I'm asking. If I should post this on the medical forum instead, let me know. I would be really deeply grateful for some coaching advice. This program has really changed my life, and I miss the joy of running along with all the great people I've met.

Thanks,
Madeleine

Madeleine,
Congrats on your wedding. (Ah to be newly-wed again......) Although I am sorry to hear about your injury. With six weeks to go until the marathon you should be able to complete the race. Most injuries you should be able to heal from in six weeks. Trying to train through an injury is definitely the hard part of recovery, as you know. It seems that is what our Clearwater clinic does a lot is help people train through injuries. Normally when getting back into training or starting a program you should only be increasing your mileage by 10-15% per week. This method would not give you enough time. Instead of the benchmark this weekend you should try for an 6 to 10 miler (try for 8) and see how you feel. Try to stay close to the house or the car so if something flares up to painful you can stop. Don't leave yourself stranded. If you can add on 2 miles a week you should catch back up by just making the marathon. Your 21 miler would be the week after Pfit ran theirs. This is extremely aggressive and not recommended to everyone. You will probably need in-office help to reduce the injury flare ups. Things that will help are E-stim, massage, Ultrasound-stim combo, and chiropractic adjustments. All of these things help to speed up healing time, manage pain, and increase function. To do the pool running (aqua-jogging) you really should have the equipment, although running underwater in sweatpants can help to increase the resistance and make it more effective. Other good low-impact cross-training techniques are elliptical and cycling. These increase cardio and strength without flaring up your injuries.
In short, you probably are going to need outside help to complete the training in time for the Portland marathon this year. That is what our clinic does. Remember that there are many other races out there and staying healthy and happy are the most important things. Maybe just getting a 1/2 marathon done this time and doing a full in the spring would be your best solution. Keep that in mind. There is always next year.
Whatever you decide we are here to help.
Cheers,
Dr Jake

Madeleine:

Jake is given you some great advice! Use Clearwater as a resource to get you back on track.

I would also encourage you to make appointment with Dr. Nelson at Clearwater to get a VO2 test completed. The VO2 test will determine what intensity to complete your training runs at. You will be able to relax and have confidence that you will be training at the correct intensity and have less risk of un-doing whatever Dr May fixes for you. You want to make sure that no other injuries occur because you are trying to ramp up your running too fast. A heart rate monitor and your VO2 test will keep you in your optimum training range!

You can borrow a loaner Polar heart rate monitor from the StressThenRest.com canopy for your Saturday morning run at PDXFit. Email (Eric@StressThenRest.com) to reserve one.



If you are using one of the Tualatin Hills Parks and Recreation (THPR) pools in Washington county, they usually have floation devices available for anyone that wants to use one. I don't recommend the resistance shoes. They are for people that have been pool running for a while, not for first-time injury re-hab patients. At THPR pools, there is usually a lane available for pool runners during normal lap times. Pool running is done in the deep end of a pool, so your feet do not touch the bottom. It is a great way to improve your running for a couple of reasons:

1. Your body has no gravity to help you, so your leg muscles must work in a full range of motion.
2. The water actually helps with the blood circulation by applying pressure to your skin. It is like a light flushing massage that cleans out the muscle waste and helps bring in muscle nutrients to repair the muscle damage.
3. You can adjust your heart rate by moving your legs faster or slower without the normal pavement pounding.
4. You should feel refreshed after a pool run, not hammered like a regular run. It is common to get out of the pool and feel like you didn't run. Enjoy it, your body will thank you in the morning!

Here are some tips for making the pool running more effective:

• Focus on using your legs in an exaggerated running motion.
  1. Lift the knee to at least your waist height using only your hip flexure muscles not your hamstrings (your foot should be directly under your knee at the end of #1),
  2. Straighten your first leg,
  3. Gently pull your first leg down and back, when your legs pass each other, start your second leg with step #1,
  4. Bend your first leg so your heel goes toward your cheeks, while your second leg completes step #2 & 3,
  5. Pull your first leg's knee forward (with your first leg bent) to waist height, while your second leg completes step #4
  6. First leg goes to step #1 & 2, while second leg completes step #5
  7. Continue steps 1 through 5 with both legs.

The motion may feel uncomfortable at first, because you are using a larger range of motion than you would running, but it will help you recover with full muscle range.

Move your arms under the water, just like you are running. Left arm goes back with right leg back. Right arm goes back with left leg back.

Use your heart rate monitor (make sure that it is "water-resistant"). Stay in your FatUtilization heart rate range for the maximum fat burning or in your aerobic range for improving your endurance.

You should not feel any pain or muscle cramping. If you do, reduce the effort you are using until the pain goes away. If the pain does not go away, then you were not ready for a pool run. Go back to see Dr May and/or use the RICE method. (Rest, Ice, Compress & Elevate).

Enjoy the workout. It will help you recover quickly and fully.

Eric

Thanks so much, Dr. Jake and Eric! I will call Clearwater today to make an appointment. I really appreciate the advice. I ran 6.5 miles Saturday and appx 3 miles twice this week with no problem, so I'm feeling very hopeful that 10 this Saturday will go well (but will keep the run close to home just in case). I have had to slow down my pace to keep my HR in range, but this is not upsetting to me since this is my first marathon and I don't have any goals about the time that I run-- I just want to be able to finish and to do so safely. And thanks for the advice about the pool running! I've been doing the CSS exercises from P-Fit's youtube postings since the first or second week, and I think that's helped preventatively- this could have been a worse injury if I hadn't been working on my core per your instructions. I've added in more leg strengthening since the injury which seems to be helping, too.