Tuesday, June 30, 2009

Nina And The Cursed IT Band: A Running History

In middle school, I had been a promising runner and had won many of the 5k-cross country races by a minute or more. I specifically remember several times looking back behind me, seeing no one at all, and feeling my shoulders relax: I had the race in the bag. I would then impressively kick it in at top speed to the "Ooos and Aaahs" of the crowd. I loved to win.

My style of racing was similar in the 800 meter race. The first of two laps were spent in the mid to back of the front pack. At the 500 meter mark I would start to pick up the pace, pour on whatever I had in the tanks, and speed ahead to win the race.

I also excelled at the triple jump. In 8th grade, I had already been jumping over 30 feet and got to go to the state comp (most other girls were jumping 26-28 ft).

Getting in shape and winning was easy for me back then. I could start the running season with no preparation at all. I'd take for granted that my body could go from no distance work (just soccer running) to full on cross country training, including hills, speed work, tempo runs, and distance runs. And stretching? Yeah, maybe I'd quickly "stretch" for a couple seconds before or after a run--you know, go through the motion of reaching for my toes or grabbing some shoelace to stretch my quads.

For three and a half years (6th-part of 9th Grades), I was able to do this no problem.

Then it all went downhill and not in a good way.

I remember the exact moment that my knee started hurting me. It was the last home meet of the cross country season in the 9th Grade and I'd done fairly well--tenth place. Post race, some people were stretching out, cooling down properly, but I was lazing about in the grass, eating Smart Food and scanning for my Mom's silver Volvo to pull into the parking lot. When I finally caught a glimpse of the car pulling up, I instantly jumped off the ground, threw my bags across my back and sprinted across the field. As I was sprinting, I gradually felt a burning sensation just below my kneecap. The pain increased exponentially and I hastily stopped, stretched out, massaged the area, and prayed to the Gods. It seemed to go away. After five minutes, I was running across the field again, telling myself that it must have been a weird fluke.

Of course it wasn't a mere fluke. It was the start of Illiotibial Band Syndrome or ITBS, a common overuse injury for runners.

At the end of the Fall running season and into the Spring track season (I played basketball during the Winter), I started to consistently feel the pain in my left knee. Instead of doing what a normal person would do--take time off, see a physical therapist, cross train, stretch...--I felt that I should just continue to push myself through the pain. It didn't seem to change my gait or running style; I could still keep my pace up; I was still getting PRs (personal records). It just became another challenge to overcome. Isn't that what running is all about: staying mentally strong, pushing yourself as hard as you can go? It didn't occur to me then that not all pain is good pain and that this injury could go on to affect me for the following ten years.

After almost a year of pushing myself through the left knee pain, the burning sensation started to travel up into my hip. And then, probably because my gait had changed without me knowing it, my right knee started to hurt. And then my right hip.

You would think that all of this pain would have been a signal to me to listen to my body and ease up. No dice. I was stubbornly stupid [back then] and convinced that these problems would work themselves out without taking time off or changing my lifestyle.

Well, mid-cross country season in 10th Grade, my body went on strike without my permission. By the time homecoming came around, I was barely able to walk. My hips were so stiff I couldn't stretch properly--yes, now I was at least trying to stretch out. I was unable to keep a good pace during the races. I was now finishing in the latter half of the race.

What a blow to my ego! No longer being able to run through the pain, and no longer being able to walk without pain, Coach Sawyer ordered me to physical therapy. I went to a local place, to a guy who specialized in IT Bands. He told me that in his entire 20 years of therapy he had never seen a case as severe as mine. Usually ITBS localizes in the knees or the hips. My entire band (from the knee extending into the hips) was tight and tender. We started with FRICTION rubs--massage meant to break up tissue, circulate the blood, and release tension. These are not nice, soothing massages. The pain was so severe that I would feel it shoot into my brain.

This did help a bit. I was able to walk without pain. Unfortunately, I was too stubborn to take time off. And I wasn't really stretching outside of the PT sessions. And I did no cross training to help build the muscles around the knee.

Junior year was a disaster. I consistently ran in the back. I physically couldn't hit good times. I became frustrated and negative. The spring season was worse. My triple jumps were an abysmal 25 ft and often I would fault out because I couldn't keep my stride consistent and mess up the timing.

I would often end these meets in tears.

In retrospect (ahhh, how nice it is to be able to look back on these events with the wisdom I've gained since then), my problems with my knee and the way I handled the situation was representative of a larger problem in my life. That is, every time a problem would arise, I would be convinced that somehow it would just work itself out. The best thing to do would be to keep plugging along, don't change how I'm going about things, and just hope for the best.

The wrongness of this line of thinking is so obvious when I'm here, sitting at my desk, contemplating my life, and trying to suss out the past. If only I didn't have to keep learning about this the hard way! As a side note, my Dad has always said that the sign of true intelligence is being able to learn from mistakes and to not make the same ones over and over again. This is a wise statement and has proven to be hard to follow through on!

Anyways, this lack of problem confrontation came to an apex in the winter of Junior year when I came down with the croup and almost died--mostly because I did too many things and didn't admit that I needed help or needed to take a break when I felt overwhelmed with life. Again, even though I felt pretty sick and overwhelmed, I kept thinking that if I just kept going and made it through this difficult time, my health would work itself out. Sound familiar? How stubborn of me!

This bent with the croup and near-death caused me to re-examine my life. I realized that my problems with my Health, the IT Band, and doing too many activities were all connected. I'm not taking action to make my life better. I just keep going forward, making the same mistakes over and over again. Not the sign of intelligence at all!

I needed to change. Easier said than done, right?

Ameliorating my knee situation turned out to be the easiest change (at least in the short term). I researched the IT Band, found out the causes and the solutions (http://www.youtube.com/watch?v=sz73i3O01d8). I ended up not doing any sports Senior year and the first semester of college--I thought this was going to be hard, but I had been so frustrated and down that I was glad to get out of it for a while. I went to PT, did the stretches for real, and focused on relaxing more.
By the time I got to college, I was ready to start running again. But this time, I was going to do things right. My first semester, I still didn't run, but I walked everywhere I went. I read that it's important to build a strong foundation before getting into serious training. Once I had been walking for 30 minutes 4 times a week, I started easy jogging--just for one mile and then walk the rest. In this fashion, I started to add on more and more mileage. A slow build up was key.

In addition, I made sure I added in stretching sessions after each run and one longer session per week (one hour focused solely on stretching and core work). This lateral and core work turned out to be a key to rehabilitation: I had learned that ITBS is not only caused by doing too much too soon, but also because the muscles surrounding the knees are not built up [in runners]. Makes sense: with all the forward motion we do, the sides of the legs are completely neglected, weak, and tight. This causes imbalances in the knee which can lead to injury.

The real test began in the Winter of freshman year at Colby: I joined the Track & Field Team. I'll admit, I was nervous. Would I fall back into my old patterns? Would my knee start hurting again? Will I ever be as good as I used to be?

I will never forget my first race back. I gave up being a distance runner and became a 400m runner instead. I came in dead last. By five seconds. Yep, Nina Martin came in dead last and could only whip out a 75 second 400. And my glutes had never burned so much! While I went on to improve my 400m time by 12 seconds over the course of the next four years, I sadly was never able to regain my triple jump skills. Indeed, I never broke 30 feet again and fouled out many, many times.

Regardless of this one negative, many good things happened for my running career at Colby. I relentlessly worked on technique and form and became one of the "instructors" of weight lifting technique to the underclassmen. Me and my workout out buddy Liz (and then later Kate), would think nothing of spending an extra two hours in the weight room before or after practice. Cross training, stretching and core work became a normal part of my everyday routine (on top of the running workouts). Also, I proved to myself that I could train hard and remain injury free: a sign of a responsible runner. My confidence and good spirit was rejuvenated as well.

These good habits and experiences at Colby not only prevented further injury, but also influenced decisions post-graduation. After college, I went on to train for the Philly Marathon AND remained injury free! I made sure I trained for this correctly and took an entire year to build up the mileage, adding in massages, stretching sessions, and lots of cross training. I followed the Runner's World Training plan. I was (am) extremely dogmatic about training safely.

My obsession with technique that started at Colby has also influenced me to become a group exercise instructor in Body Pump (weight lifting) and Spinning (great cross training for running). I feel it's very important to share my mistakes with other athletes and help them safely achieve their goals.

In summary:
*The good news: no IT Band pain since high school!
*The bad news: I never regained flexibility in my hips--they still cramp up and are rod-stiff.
*The Extra Good News: I am a marathoner with no injuries (knock on wood). I continue to be vigilant about listening to my body, stretching, and dealing with problems as they come up. I have taken up climbing and yoga to work on my flexibility and hopefully one day I'll be able to sit in the V-position and lean forward.

So, if you are serious about running, my advice is to become serious about cross training and stretching. My story turned out well because I am now completely dedicated to the well being of my body. Health comes first! This means taking the extra time to stretch and work on your weaknesses.

I learned these lessons the hard way, but at least I have proved over time that I have at least some intelligence and have stopped making the same running mistakes over and over. Now if I could only apply this to the rest of my Life, I'd be a genius!
Lessons Learned:
1) Health comes first. You have nothing without your health.
2) Listen to your body; don't ignore pain. Take action: ice, aspirin, stretching, heating...
4) If you feel bad pain, immediately take three days off, if persists, take more time off, get help!
5) Make stretching part of your daily routine
6) Make cross training part of your weekly routine; build up those non-running muscles + strengthen the running muscles! When I do consistent core work, I feel stronger when running.
7) Be consistent...my racing style used to be start off slow, then sprint the last leg. Terrible, can lead to injury! Pick a goal pace, stay with it. Never do more than you have trained for. This goes for your overall training plan too. Be consistent with your running. Don't leave off training until the last minute and expect your body to do more than it's ready to.
8) Add on mileage slowly, never more than 10%--this lets your body adapt slowly
9) Have your race pace be consistent with your training pace.
10) Be patient with your training, i.e. building a solid foundation or taking time off. Shit happens. Deal with it.
11) Have fun; don't take yourself too seriously. We are choosing to do this in our free time. Most of us will never be pro's, so why get all bent out of shape if one day you can't hit a pace or if you have to take a day off. Things that you do for yourself in your free time should be fun.
Happy Training!
Useful links:
Great YouTube Video on ITB(S): http://www.youtube.com/watch?v=sz73i3O01d8

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