View looking at the inside of the right knee; front (anterior) of the knee is to the left. My injury is actually to my left knee.

But I have to do it.  What a difference a day makes.  Yesterday I was riding high on great news from a few different sources and today, I’m sitting at home, icing my knee and depressed about the fact that the knee is acting up again.

I say “knee” as a general term but the specific area that’s currently causing me problems is what the doctors call the “hamstring insertion,” the tendon that attaches the bottom of one of my hamstring muscles to my tibia (one of the leg bones below the knee).  The physical therapists out there are probably laughing at my description here but I’m going to try to keep it in layman’s terms.

Tomorrow is another big milestone day.  I have an appointment in the morning with Dr. Luke, my rock star orthopedist at UCSF.  Dr. Luke has treated Olympians and scores of professional athletes, so I’m fortunate to be seeing him.  I’ll have a post-appointment update soon!

Image by eOrthopod.

This is the third article in a series describing my first ever running injury in 20 years, how I’ve dealt with it heretofore, and my path to recovery.

My first few trips to see my physical therapist Nicole were a treat for my inquiring mind.  The human body is an amazing machine.  In fact, it is miraculous. In my first few visits I learned more from Nicole about biomechanics than I had in my entire life up to that point.  The fact that the solution to my knee and hamstring problem lay somewhere between my hips and my rear end was illuminating, to say the least.

Nicole earned a clinical doctorate in physical therapy from USC and has done extensive post-graduate research on knee issues just like mine.  So needless to say I was delighted when I discovered that my exact problem was something she’s been extensively studying for the last several years.

Here’s how she laid it out for me: for a long time (almost 20 years, in fact), because of my natural running form, I was able to stay injury-free save for the occasional ache, pain, or shin splint.  That changed on April 4 when I went on the run I described in the Marin Headlands.  Specifically, toward the end of the run, I ran an extremely steep downhill grade into a strikingly beautiful coastal area of the Headlands known as Pirate’s Cove.  I was at the edge of losing control, and each footfall was high impact.  This lasted for somewhere between 300 and 400 yards.

I had weak hip stabilizer muscles because, well, I hadn’t even known what hip stabilizer muscles were, much less devised a strategy for strengthening them.  The hip stabilizers, through the miraculous web of fiber, tendons, bone and muscle between them and the knee, actually help, when strong, to stabilize your knees and prevent them from buckling inwards.  Under normal circumstances, I likely would have been okay, but if you combine the steep terrain, the lack of control while running down it, and the fact that I was no longer 18 years old, what I had was the perfect recipe for an MCL (medial collateral ligament) tear.

The window into the weakness of my hip stabilizers opened up an entirely new interest for me in core strength in general, in which the hip stabilizers only play a part.  In fact, when I started running with the Endurables in September of ’08, each of our Wednesday workouts was done on the track but labeled as a “Core” workout because between each trip around the large polo fields at Golden Gate Park Rachel would have us doing any number of pain-inducing drills that worked on our cores.  At the time I didn’t investigate too closely as to exactly why our core strength was important, I just took her word for it .

Core strength is about overall fitness and ensuring that each part of your body is strong, but also, more importantly, it is about stabilizing the body under athletic stress. For me and my fellow Endurables runners, this was of utmost importance given that most of us were training for distances of either 50K (that’s 31 miles) or 50 miles. When your body is under that much stress, especially on the hilly and mountainous terrain here in the Bay Area and especially as you age, you need to eliminate as many potential causes of injury as possible.

So after my injury, Nicole prescribed a series of exercises that worked on my core and specifically targeted my hip stabilizers.  I became very familiar with what Nicole calls “clams,” otherwise known scientifically as a “Lying Hip Abduction” (insert all jokes about the kidnapping of less-than-truthful hips here, please). Clams look exactly like the mollusk they’re named after – you lay on your side with your knees bent, and rotate your knee up and down until it hurts so much in your butt you can’t do it anymore.  (Trust me, with a lot of these core exercises, you find out you have muscles in places you never knew you had them.)  Active.com has a great article on core strength with a 9-week core conditioning program that I recommend checking out.

So as a physical therapy patient, now I knew what had happened to me, and why it happened.  Following the prescription, however, which entailed a prohibition on running of any form and diligent performance of a whole new slew of exercises was another story.  I didn’t run at all for many days, until I did.   And historically, I’ve always been a one-track mind when it comes to exercise: running.  That means, I would run, and often times run a lot, but rarely stepped foot in a weight room, or did exercises that didn’t involve quickly putting one foot in front of the other.

These were lessons yet to be learned, and that saga would play out over the months of April and May.

Image by eOrthopod.  Photo by Ollie Crafoord.