Year: 2017

Physical Therapy

Some things I learned today at my physical therapy appointment:

• I have a high tolerance for pain, according to my therapist.
• I am particularly proud of the fact that I have a high tolerance for pain and I’m not totally sure why or if I should be proud.
• I have an extra bony anatomy which makes me prone to subluxation of the kneecap.
• My kneecap will probably be partially and temporarily dislocated again. And maybe again after that.
• My first injury almost 2 years ago, was probably not the result of a bone spur, but a subluxation.
• I should not run for the rest of the week.
• I should not run through pain, even though my doctor told me I should.
• My doctor and physical therapist have very different approaches.
• My kneecap is pissed off at me right now. Strangely, I am not pissed at my kneecap. I’m not sure what I feel towards my kneecap. Concern? Love? Acceptance?
• It typically takes about a month to recover from a subluxation of the kneecap.
• Right now, I’m at two and a half weeks. If I have to wait a full month to run again, that would be September 4th, just four weeks before the marathon.
• I might still be able to do the marathon. I might not.

Subluxation: partial dislocation
dislocation of the patella/kneecap
sub (nearly, slightly, partly)

dislocation: disruption, disturbance, disengagement, disconnection

A new fear introduced: subluxation. It could come back, you know. It’s possible this episode was not even the first. Perhaps my injury, a year and a half ago, was two injuries, two separate instances of subluxation?

Subluxation.
A sub par performance with no
sub-8 minute miles.
A substitution: speed out, stability in.
Now subject to more delays and derailments.
Submitting to the will of an extra bony anatomy.
Subliminal arguments between my right kneecap and the running path.
Subtraction and Addition: less grip and more gripe.
A subdued soul,
A submerged spirit.

A partial and temporary dislocation.
Out of the groove. The patellofemoral groove.
The fall to leap more groove.
The let a flap or a mole groove.
The poor tall female groove.
The fall poem or tale groove.
The tell a floor map groove.
The late morale flop groove.
The poet, leaf or mall groove.
The located on your femur bone between two bumps (femoral condyles) groove.

Recovery mode.

Day Sixteen

Swim: 2750 yards
Bike: 8.5 miles

I biked to open swim and then swam 2 loops (2400 yards) with a wetsuit and then an extra 350 yards without one. I was even able to kick with my right leg! A week ago, I never would have imagined that I’d be able to swim again this summer. I feel such gratitude.

Sunday open swims are tough because you have the sun in your eyes when you’re swimming out to the little beach, where there aren’t any big landmarks. Today, I swam blind for probably 200-300 yards. By blind, I mean that I couldn’t see anything but water. No big orange buoys. No sandy shore of the little beach. Just blue-gray water and an endless tree line. But I was fine. I didn’t panic or get upset or stop and try to get my bearings. I just swam straight, like I knew that I could, and eventually I saw the orange buoy, 20 feet ahead of me.

Was able to lift my straight leg off of the ground a few times. Very hard.

Recovery mode.

Day Fourteen

Now that I know it’s okay to feel pain, I’m okay pushing myself more. I’m realizing that sometimes I’m too cautious. I was so afraid that I would injure it more that I wasn’t willing to push it at all. Pushing through the fear is such a good thing for me. I don’t mind feeling pain, pain I can handle, as long as I believe that it’s not damaging me and that it will go away. Random: I use the word “that” a lot in my writing. I’m noticing it as I memorize poems by Mary Oliver. She hardly ever uses “that” but I frequently insert it in her lines as I recite them from memory. I want to eliminate unnecessary thats.

Repeat, minus the “thats”

I know it’s okay to feel pain now, so I’m okay pushing myself more. I’m realizing sometimes I’m too cautious. So afraid to injure it more, I was unwilling to push it at all. Pushing through the fear is such a good thing for me. I don’t mind feeling pain, pain I can handle, as long as I believe it’s not damaging me and it will go away.

Repeat, more refinement

It’s okay to feel pain. I know this now. So I’ll push myself more. I’m too cautious, too afraid, too unwilling to push past what’s seems safe. Pushing through fear is good for me. Pain is good for me, as long as I believe it’s not damaging, I believe it won’t stay forever.

Repeat

Pain is okay, sometimes. Like now. My pain doesn’t signal an injury, but muscles complaining as they wake up again. I won’t be afraid of it or tiptoe around it. I’ll embrace it, work though it, live with it. Pain is a part of living; it will end eventually.

I did the straight leg raise! I did the straight leg raise! Damn, it was hard. Hard to believe, but it took all my effort. And it hurt. A lot. Not a sharp pain, but a steady, uncomfortable one. But I did it!

Did a 2 mile walk with Delia the dog—my new favorite way to write her name. Tried to walk as briskly as I could. The one mile I timed was 20 minutes, although probably slightly faster if you don’t count the stops at corners to cross and the few times I let Delia the dog sniff something. Still slow, but progress.

Did you know that elite race walkers, the women and men, can walk much faster than I can run? My best 5K time is 24:54/8 minute pace. While racing for 20K or 50K, their 5K splits are 19 (men) and 22 (women) minutes. Wow. I had no idea. I know I’m not that fast, but under 25 minutes for a 5K is not slow. Can you imagine running a race while they walked it and having them lap you? What a sight! I almost want to see that.

Pain will you return it
I’ll say it again – pain
Pain will you return it
I won’t say it again (Depeche Mode, Strangelove).

Other words for Pain:

• ache
• irritation
• discomfort
• soreness
• strain
• burn
• tenderness
• twinge
• crick
• distress
• pang
• annoyance

I like pain when it gives off a slight warmth, when your muscles ache from use. This type of pain is not irritating or unwelcome. I like it and long for it, when it’s missing. Swimming is the best way I’ve found, to achieve this sort of tender, gentle burn.

Thinking about pain and reading Eula Biss’s essay “The Pain Scale.” When I first started teaching, I’d ask my students at the beginning of class, “How are you feeling, on a scale from 1 to 10?” I stopped, after one student said, “Can we not do the 1 to 10 thing? It reminds me of when I was in the hospital and the nurse would ask me that every morning.” I can’t remember what, if anything, I did after that to gauge people’s moods. Maybe nothing. Maybe I shouldn’t have stopped.

When the doctor told me that fear of pain was preventing my brain from sending the proper signals to my quads to activate, my first reaction was “wow.” Mind blown. I never would have expected my brain, and not my knee, to be the real problem here. So much to think about in terms of the relationship between the mind, the brain and other parts of the body. At the outset of my Run! writing project, I wanted to experiment with how I imagine and experience the relationship between mind and body. I wonder where, if at all, the mind fits into my current quad problem? Is there a conscious element to the fear of pain and the brain? Or, is it unconscious? Is a lack of will the problem, at all?

“During your recovery period your brain has mapped out a new neural network for pain-free walking, which has become a habit.” Uh oh. Is that why my brain has done? Is that why I can’t lift my leg? I don’t want a new neural network, I want the old one!

“When you run your brain creates a ‘neural map’ that, through repetition, will dictate your ‘natural gait’.” There is nothing natural about my current gait, with my right leg that won’t quite bend (source).

Search words to use: “neural map running injury” “running injury body maps”
another source.

Neural map
/Body Maps (the virtual body): “When you practice a movement, the body map representing the physical body part involved grows in size. However, if you stop using a particular body part, e.g. when you are injured and/or in pain, the body map for that particular body part becomes ‘blurred’ (also referred to as ‘smudged’).”

Biked for 30 minutes in the front room then tried to lift my straight leg again. Did it, but just barely. So difficult! Not just pain, but something more. A strongly resistant body. I’m sweaty and out of breath from effort.

A few hours ago, I figured out when I swing my right leg forward, it’s not straight and the knees not locked, which is what it’s supposed to do when you walk. When you run, your knees are bent, but when you walk, they should be straight. I do not know this because I’ve noticed it when I walk. I know this because I researched the biomechanics of walking a few months ago. And because I watched a replay of the 2016 Olympics 20K race walk a few days ago and the announcers kept talking about how the swinging straight leg was critical for a legal gait. No straight leg earns you a penalty and, eventually, disqualification.

Took another walk with Delia the dog. Rosie joined us this time. Then drove over to the lake and swam half a mile. Then went shopping with Scott and Rosie and walked a lot. I’m tired and sore.

Before going to bed, tried to do raise my straight right leg off of the ground again. Almost did it once.

Knee injury.

Day Thirteen

Today is the day that I hopefully find out what is wrong with my knee and how much longer I will not be able to exercise. I’m really nervous.

To help with my nerves, decided to write a poem. Today I’m trying out a ballad. Before writing my own, started to memorize “Casey at the Bat.” Only made it through the first stanza:

“The outlook wasn’t brilliant for the Mudville nine that day.
The score stood four to two, with but one inning more to play
And then when Cooney died at first, and Barrows did the same,
A pall-like silence fell upon the patrons of the game.”

Went to the doctor and I’m feeling much better. Got the best news I could hope for. I can start exercising right away. Swimming, biking and running. Yes, I can start running right now, as long as I can handle the pain. I begin physical therapy on Tuesday.

Decided to finish my ballad, combing stuff I wrote before and then after:

Before

She sat there in the waiting room, staring at her book,
wond’ring what would happen, when the doctor took a look.
Would he watch her as she entered, walking with her limp
and notice that her knee was swollen, blown up like a blimp?

Blimp is not quite true, I’d say, but swollen nonetheless.
Just enough to make it hard to walk without distress.
She would tell this when he asked, and others things as well
like all the times her knee gave out, and when she almost fell.

By all the times, I might add, she just means one or two
.
Sometimes when she tells a story, facts aren’t wholly true.
This happens when she’s nervous or is trying to make a rhyme.
Besides straight stories bore her, she hears them all the time.

Would he tell her to lay down and do the straight leg test?
Would she fail again and he’d say, “1 year of bed rest!”?
Oh, that dreaded straight leg test, haunter of her dreams!
Surely failing it cannot be as bad as seems?

After

She just met with the doctor, and could you even guess,
the outcome of the visit was almost pure success?
Her kneecap had slipped out, but then slipped back in place.
No lasting damage happened, she only needs a brace!

Things she heard were not all good, like the part about pain.
And how the quad’s not firing due to fear and the brain
refusing to send signals to tell the quad to move.
She’ll have to do lots of work to get it to improve.

She isn’t bothered by this news, she can take the pain.
All she cares is that the doctor told her she could train.
She won’t be running fast, or even every minute,
but, ‘bout the marathon, she still gets to be in it!

I swam a loop at open swim! I swam a loop at open swim! It was very windy and choppy. At one point, it felt like I was being lifted into the air. Pretty cool. I love swimming in rough water. Some day, I’ll have to swim in the ocean.

What I did today after finding out that my knee was okay and that any pain I felt was normal and not a warning of further injury:

• Took Delia the dog on 2 walks.
• Swam almost a mile.
• Walked up and down the steps at full speed, and without bracing myself on the railing.
• Walked over 4 miles total.

Answers to the questions I asked yesterday:

When can I start running again? NOW!
When can I start walking for more than a few blocks again? NOW!
When will I be able to swim again? NOW!
When will I be able to be outside again? NOW!
When can I walk my dog again? NOW!
When will I be able to stop reminding myself, every time that I get up from a chair or the couch: “nice and slow, Sara”? MAYBE NEVER, WELCOME TO 43 SARA.
When will I be able to write about more than injury or how stiff my leg is or how I failed the straight leg test again or about how long it’s been since I ran? NOW!
Is there any possibility, that if I walked most of it, that I could still do the marathon on Oct 1? YES!

Knee status: Much better. Feeling more pain because I’m pushing it harder.

Treatment: no RICE, just a brace and physical therapy starting next week.

Knee injury.

Day Twelve

Woke up a little sore, as usual, but managed to walk down the steps using both legs. Progress.

Had difficulty deciding which poem to memorize this morning, finally settled on the one I had intended, since yesterday evening in the car, to memorize: “Luke” by Mary Oliver. My method for memorizing is not to pick the most important poems ever!, but the ones that I want to keep. Tomorrow, I think I want to memorize another dog poem, this one by Jane Kenyon: “After an injury, walking the dog” (https://poetrying.wordpress.com/2011/05/27/after-an-illness-walking-the-dog-jane-kenyon/)

I love all of “Luke,” but especially:
and easily
she adored
every blossom,

not in the serious,
careful way
that we choose
this blossom, or that blossom—

the way we praise, or don’t praise—
the way we love
or don’t love—
but the way

we long to be—
that happy
in the heaven of earth—
that wild, that loving.

I have not run in 13 days.

Biked for 26 minutes. Felt pretty good. If I can’t run, hopefully I can keep biking.

Questions I’d like answered by my doctor, my body or both.

When can I start running again?
When can I start walking for more than a few blocks again?
When will I be able to swim again?
When will I be able to be outside again?
When can I walk my dog again?
When will I be able to stop reminding myself, every time that I get up from a chair or the couch: “nice and slow, Sara”?
When will I be able to write about more than injury or how stiff my leg is or how I failed the straight leg test again or about how long it’s been since I ran?
Is there any possibility, that if I walked most of it, that I could still do the marathon on Oct 1?

I’m hopeful that my drs appointment will go well tomorrow. My leg does seem to be getting better. What’s wrong with it, I wonder? Why can’t I pass the straight leg raise test? I’m sure it’s something that I couldn’t even imagine, something that I’ve never heard of or thought of.

Knee status: stiff, but better. can walk, mostly. failed straight leg test again.

Treatment: RICE

Knee injury.

Day Eleven

Seems like the rest helped some yesterday. My leg is feeling better. I think I might be getting a bit bored of writing about injury, since not much is happening with my leg.

I have not run in 12 days. 
I have not swam, more than a few hundred yards, in 14 days.
Will I be able to swim across the lake, at least one more time, before the end of the season? I hope so.

Memorized Robert Frost’s “Out Out” after randomly encountering it while browsing poets.org. Reading the first line, “The buzz saw snarled and rattled in the yard” I remembered that I had memorized this poem in high school. Was it for English class or just on my own, during the summer when I memorized poems and then recited them in the Iowa cornfields while detassling corn?

Biked for 16 minutes in the front room, with my bike on a stand. Watched the 2009 5000 meter women’s world championships. Felt good. After I was done, walking seemed a bit easier. Still trying to avoid walking too much today. I’m planning to try swimming again this afternoon.

Went to the lake to swim. Hard to kick, still. Managed to swim 400 yards by kicking with one leg and dragging the other. Not sure if my knee will be okay before the end of open swim season, but even if I can’t swim, I can go to the lake to walk in the water. I can almost walk normally in the water. It’s calming, even when it’s freezing, which it was yesterday. Reminds me of the lines from Mary Oliver’s poem, “Swimming, One Day in August”: “It is time, now, I said/for the deepening and the quieting of the spirit/among the flux of happenings” and “I went down in the afternoon/to the sea/which held me, until I grew easy.”

Knee status: walking must closer to normal, still slow but even less limp-y than before, can’t do a flutter kick in water without pain, failed the straight leg raise again.

Treatment: RICE.

Knee injury.

Day Ten

3 days until my doctor’s appointment.

This morning, I memorized two more of Mary Oliver’s poems: “Swimming, One Day in August” and “Invitation.” I’m currently enamored with Oliver and her focus on attention and the natural world. Both of these poems come from her collection, Red Bird, which I love.

I’m hoping to do more resting and less walking today, especially stairs. I wonder, could this help me to heal faster? It’s so hard. How does one sit still and not go crazy?

Right now, I have too much
Energy.
Sitting still is so hard. I
Twitch my
Left leg, the non-injured one, repeatedly.
Every part of my body wants to move. I want to jump out of my
Skin! Who can just
Sit in a chair without moving?

This last acrostic poem is brought to you by restless legs, a little bit of anxiety and a lot of coffee. Maybe I would be less restless if I didn’t drink coffee in the morning?

I’m trying not to walk too much today. Finally am forcing the kids to walk the dog. Spent the morning on the couch with my leg straight. Reading Sophie Hannah’s Agatha Christie murder mystery, Closed Casket. Now, it’s the afternoon and I’ve moved upstairs. Sitting on the bed, with the computer on my lap. Writing and then reading. I hope this helps, because it’s no fun.

Knee status: still a bit stiff, doesn’t hurt at all. Continuing to walk slowly. Failed the straight leg raise again.

Treatment: more RICE (rest, ice, compression, elevate), with an emphasis on the rest.

Knee injury.

Day Eight

Fluctuating mood. Fear and resignation, then optimism. It’s a rupture. It’s a tear. No, it’s neither. Something worse? Something better?

Memorized Shel Silverstein’s poem, Sick. So fun! I’m surprised at how much it has improved my mood and my energy level. I think I should memorize a new one every day.

Scott is running his 18 miles this morning. He’s almost done. I know this because I’m tracking him on my phone and because he’s been posting pictures to Instagram every time he stops to walk. I love his pictures. I’m slightly jealous, but only slightly. Those really long runs were never fun for me. Always a struggle. I’m a little relieved that I don’t have to run one this weekend or next weekend or until…? I’m also relieved that I can just appreciate and celebrate his effort and not worry about how my runs compare to his.

Walking feels scary. Like every step could do irreversible damage. Could it or is that just my overactive imagination? Thanks google and all of your “helpful” search results. Is there a word or a phrase for the hypochondria that is fueled by looking up conditions on google? Why yes, there is: cyberchondria. Wikipedia defines it as: “the unfounded escalation of concerns about common symptomology based on review of search results and literature online.”

Are my concerns unfounded? No, but they could be a bit exaggerated due to the number of times I’ve read over and over again that not being able to raise your straight leg while sitting on the ground is really, really bad news, which is something that I absolutely cannot do right now.

Decided to text my good friend, who happens to be a doctor, and get her opinion on my knee. She doesn’t think it’s a quad tendon rupture. Very relieved. Could be something with the patella tendon, which is not great, but doesn’t seem as bad as a quad rupture. She did not tell me to drop everything and get to the emergency room, which is all I care about right now. My doctor’s appointment is for this Thursday. I’m fine waiting to see a doctor until then. I feel instantly better knowing that it most likely is not a quad rupture.

Straight Leg Raise

• rise starlight age
• arise, great slight!
• large tight raises
• I light a grass tree
• I get light as tears
• eight large stairs
• sigh, great art lies.

Knee status: most likely not a quad tendon rupture, still sore and stiff, occasionally gives out, can walk very slowly, still can’t do the straight leg raise.

Treatment: Chill knee with ice. Chill anxiety with bad television. Avoid Dr. Google. Keep reading, crafting and memorizing poetry.