Wednesday 27 February 2008

Mountain Biking - alternate training 1

It's still officially winter in Europe, but on Sunday, spring-like temperatures were forecast, with a maximum in Chur of 20°C expected. With this infamous leg injury of mine still plaguing me, I decided last week, it was time I started doing so-called cross-training - i.e. other forms of training that will not have an adverse effect on my Iliopsoas tendon. Having bought the mountain bike, in the photo to the left, in 2006, and having not ridden it since October 2007, the warm weather predicted was quite conducive to training the body on wheels.

I set off about 11 o'clock on Sunday morning, heading in the general direction of Liechtenstein. Infamous for my over-doing things - allegedly - I thought I'd best not go too far the first day of cycling this year. However, when I set my mind to something, not much can change it, and I found myself deciding to do that which I really wanted to do. A while ago, when my leg started playing up, I decided to plan out a route for a long run from the north of Liechtenstein back to Chur - this is/was to be my first long run, at a distance of about 52 km. Of course, the run itself has had to be shelved until my injury heals, but I was pretty keen to cycle the route on Sunday. When I actually run it, I'll take the train to a place called Haag, just across the border in Switzerland, opposite Leichtenstein, across the Rhein. On my bike, though, I set off along the Rhein from Chur, along a track I have run and cycled before many times. It follows the Rhein through places like Zizers, Landquart, Bad Ragaz and finally Sargans, before turning northwards still along the Rhein towards canton St. Gallen and Liechtenstein.

The promise of perfect weather was fulfilled, and I was dressed in my summer running gear, complete with Garmin GPS wrist set, and my new and yellow wrist weather station. Here is a picture of the weather station:


and was thus closely monitoring all conditions, both bodily and atmospheric.
My Garmin GPS looks like this:


My bike's computer was also working, and I had my small digital camera with me. I had my iPod with me as well, but decided against using it, as I so enjoyed the sounds of nature, as I whizzed along the tracks and roads towards the small principality of Liechtenstein, currently rocked by a bank scandal!!!! I felt on top of the world, and had not one ache or pain.
In parts, the cycle track was tarred, and headed slightly downhill. I was able to increase my speed to about 50 kph at one stage, which felt invigorating, but I prefer not to ride so fast for fear of hitting a rock, or something, and taking a tumble - I do not want anymore injuries!!!!!!
As the track turned north, I decided not to ride all the way to Haag, but, instead, to cross the Rhein from Switzerland to southern Liechtenstein, where lies a beautiful village called Balzers, with its landmark being a majestic castle (by the way, all the photographs can be seen on my Flickr.com website). I crossed into the mini-country, and had a short rest, while admiring the view. There are no border formalities between the two countries, as Liechtenstein's foreign affairs and defence are conducted by the Swiss authorities (in fact, all of Switzerland's borders with neighbouring countries will be eliminated on 1st November this year; although not a member of the EU, our country has signed the Schengen Agreement, and the borders will come down in autumn. It will be interesting to see if the feared invasion of hoardes of eastern Europeans will actually occur then!!!!!).
Once in Liechtenstein, I headed towards the track which forms part of my planned running route, and, from then on, I was on it all the way back to Chur. This track goes across the border again back into Switzerland, just outside of Blazers, and then over a pass known as St. Luzisteig, which is quite an active military area - not quite the French Foreign Legion, but the Swiss Army will do for now.

I've travelled over this pass several times by car, but had forgotten how steep it is, especially by bike and/or foot. Nevertheless, I still maintained a steady pace as I made my way up the pass, taking a few breaks on the way - to admire the scenery!!!!!! When I finally arrived at the top, I was sweating profusely, and was glad of the summer clothes, and the temperature up there of a few degrees less than the 27,2°C I recorded in Balzers!!!!!!
From here, I set off along tracks and side roads above the picturesque village of Maienfeld, through the region where the legendary Heidi is purported to have lived (it's now a huge tourist industry, with hotels, restaurants and a million Japanese tourists a day (almost)). Along the undulating track, I cycled through the vineyard area of our canton, places like Jenins and Malans, and finally behind Landquart to Igis, where I had a break of about ten minutes to massage my right thigh, which had become subjected to an annoying bout of cramp.

From Igis, it was back to Zizers and down to the track along the Rhein again, for the finally leg back to Chur. Feeling ecstatic, I arrived at home around 15:45 hours (3.45 p.m.). I had travelled almost 70 km (so much for a short ride on the first day!!!!!), and had expended 3084 kcals of energy. It had really been a fantastic ride, and I felt great. My rear end did feel a tad tender, but that will improve, the more I ride. There was no apparent effect on my Iliopsoas tendon, although the dull ache from the injury was ever-present.
I have done rides like this before, even once from Zürich back to Chur (125 km), and down in Carona, we often do the 70-km giro del lago (route around the lake, through Italia). I shall try to use every opportunity I get to go for long rides, especially until my leg heals and I can run again. I do enjoy riding very much indeed; it's just that my greatest passion is getting around on my own two feet.

4 comments:

Unknown said...

AMAZING !!!
I am so happy that I have met someone that has such a similar injury to mine that while I was reading your blog I was feeling that I am the author, not you. I have just read your entire blog and I will soon write to you in very detail about my injury and, hopefully, our experiences will help us alleviate this bloody iliopsoas inflammation that keeps us from running. This was just an introduction of myself, and I’ll write here in the next day or two.

Arben

Craig B. said...

Looking forward to hearing from you!!!!!!!!!!

Unknown said...

Firstly, I want to tell you that I feel sorry that you had to cancel your upcoming marathons—I know exactly how it feels. But the good thing about it is that your doctor has convinced you that you will be able to start running in July and, consequently, run marathons again.

I will start my story by telling a brief history of my sporting activity, when the injury set in, how I am dealing with it, and what some of the doctors have suggested.

I am 33yrs old male, 181cm /80kg (was 76kg before injury), from Kosovo. 11 years ago I had a pretty bad car accident in which I have torn my left knee’s ACL, broke my hand and a couple ribs, and experienced groin pain. The groin pain went away after 2 weeks of full resting and did not come back ever since. I did not participate in any sporting activity until 3 years ago when I started cycling. From cycling I gradually moved to running and before the injury set in I was running around 10 km every other day, mainly uphill (climbing around 500-550m for 6-7km, rest was straight and slight downhill), cross-country, uneven terrain.

One day, a year ago, after I came back from my daily run, I started to experience left side groin pain. I do not remember any traumatic injury on that day, or any other day before that. The pain originates in the left groin area but it also radiates down the anterior of my thigh. Pain occurred(s) in almost every leg movement that involves lifting of the knee, such as: lifting my knee to sit cross-legged; putting my pants on; and getting into the car. The pain is at its worse when I sit down (on the floor) with my knee fully extended and lift my heel up. Pain in this position starts immediately after lifting the heel for about 5 degrees. Another symptom, which is not repeating lately, is thigh pain when I stand erect for longer periods, or lying supine with hip and knee fully extended for longer periods (for example, while undergoing MRI test). I can also sometimes feel groin pain when slightly hitting my groin with my fist or when I lay down in a prone position over a tennis ball situated right under my groin area. Pain in this position only occurs when the inflammation is at its highest level. All of these symptoms completely fit the description of the iliopsoas tendonitis and bursitis described in the publication of Doctor Joseph P Garry, MD (http://www.emedicine.com/SPORTS/topic52.htm).

I did not pay lots of attention to this injury at the initial phase, thinking that it’s a simple muscle strain and it will go away in several days. I did pause from running for about 2 weeks and the pain completely went away without using NSAIDs or any other medication—pause from running appeared to cure it. I was convinced that it’s all cured and now I am going to be able to run again. After around 5-6km on my next run, I started feeling a dull ache in the front of my left groin, but, foolishly, I decided to continue and finish my lap. A few hours after I returned home, the groin pain came back to me like a boomerang, and this time it really appeared to be serious.

I already had arranged an ACL reconstruction surgery in an orthopedic hospital in Ankaran, Slovenia, which was about to take place around 2 months after my second iliopsoas injury. I did not tell the doctor (Dr. Ambrozic) who was going to operate my knee about my groin pain, as I was still convinced that it is a slight problem that will resolve itself in a matter of weeks. In the mean time, while I was waiting for the surgery, I abstained from running but I did lots of hiking and other uphill walking. The pain just did not go away. (By the way, you have mentioned that you will be able to do hiking…are you sure about that? I thought iliopsoas muscle group is very active walking uphill?!...anyway, we’ll discuss what we can/can’t do in other posts.)

When I went to Slovenia for the knee surgery, Mr. Ambrozic refused to repair the ACL without having a correct diagnose of my hip problem. He ordered a CT scan which came back with a ball-shaped calcification along the iliopsoas muscle group. He then ordered a bone-scan which came back with “increased perfusion” in the acetabulum region. Unfortunately, I could not get an MRI scan while I was in Slovenia because of the long waiting line (2 weeks), but I did take one at home.

The problem at home is that we don’t have experienced and well-trained doctors to deal with complicated situations, such as this one. For example, they have MRI and CT scan machines at hospitals here, but they don’t have professionals to read the images—they take images to neighboring countries to be read by professionals. When I took my MRI test at home, the radiologist asked me to see the CT scan report from the Slovenian doctor, and 5 minutes later he came back with the exact same conclusion as my CT scan. Luckily, I have my MRI scan in a CD (and all other tests) so I can give it to a professional, when I meet one. Also, don’t forget that you are very lucky to be able to have access to highly professional doctors to deal with your condition.

Four months ago I decided to completely rest my leg, take NSAIDs for around 2 weeks, and see if the pain goes away. I could notice that the pain was subsiding on daily basis, and around 2 weeks ago I was left with very little pain, which mainly occurred in some extreme leg movements. Mentally, I was feeling great and I was totally convinced that this time I am cured. I decided to start my exercise regime gradually and I joined a local gym (I hate gym but I though treadmill will offer a more pleasant surface for my legs because it absorbs impact). I promised myself that I will only do walking and stretching on the first day on the gym, and if the hip feels OK, I would start running in about a week or two. I got on the treadmill and set it at 5 km/h, and I was walking slowly. My desire to start running suddenly started to build, up to the point that I found myself running at 9km/h and raised the surface to level 5. I continued to run for 45 minutes with no pain whatsoever, and I was feeling GREAT. I was feeling so good that I was convinced I would be able to run a full half-marathon easily. This was my first run after several months, and you can only imagine how it felt, even though it was in a gym. I left the gym as happy as I could be, and I walked to my car. I opened the door, put my right (uninjured leg) in, sat down, and while I was lifting my left leg to put it in the car, I felt a crack/snap and a sudden sharp pain in my groin/thigh. EVERYTHING BACK TO ZERO. I cried ! Not because of pain, but because of the effort I’d put in to reach this level of painless state, just to ruin everything with a single small run. It is amazing how the iliopsoas injury fools us—we feel no pain while running and keep injuring the muscle in the process, but the pain starts setting in only after the run (or other strenuous activity). And we still don’t get it !!!

Back to (mis)diagnose. Assuming that MRI report is correct (I have a strong belief that there is definitely more information on that MRI), there is a ball-shaped calcification along the muscle (I think it’s more along the iliacus than psoas). Both radiologists suspected that calcification came from a previous hematoma in my groin. Hematomas in this region occur after a serious traumatic injury (such as my car accident 11 years ago), or, as one doctor suggested, by micro tears of the muscle which usually occur when overusing the muscle. Bleeding that occurred in my case, was, for some reason, not absorbed by neighboring tissue and it gradually coagulated and ultimately turned into a calcification. According to this doctor, calcification causes pain because it does not allow the muscle to fully stretch, thus, causes constant inflammation.

The million dollar question is: how old is the calcified abscess in my muscle? I think that if I am able to answer this question, I will definitely know where the calcification came from. I also think that doctors would be able to tell this from the MRI (maybe I am wrong !)
Theory 1: Calcification is the result of my car accident, in which case, the question is: why did I not have any symptoms during the previous 11 years even though I was physically very active during the last 3 years? (I ran a half-marathon 8 months before the injury). If this theory is correct, calcification is not what is causing my iliopsoas problems…there is something else in there!
Theory 2: Calcification is the result of overuse. Ilipsoas muscle suffered micro tears which caused minor bleeding, which consequently turned into calcification. But, to my understanding, calcification does not form overnight—time needs to pass by before bleeding turns into calcification.

What none of the doctors have suggested is: what to do next? They say it’s calcification, it’s iliopsoas, it’s inflammation, but none of them has suggested a proper action.

What I know for sure is that my iliopsoas muscle is inflamed (I don’t even know the location of the inflammation) and it is causing me pain, both physical and mental. This time I am really determined to take this issue all the way and find a cure or at least a confirmation that this problem will stay with me throughout my life. At least then I will have a peace of mind!

I hope that other people will join this thread and contribute their experiences!

Craig B. said...
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