Medical Check-Up

I had the chance to meet my orthopedic doctor when I requested a Medical Team and Ambulance for the conduct of the latest Tagaytay To Nasugbu 50K Ultra Run on the first week of December 2013, last month. I asked him to make an schedule of an appointment for medical check-up on my knees after my participation in the 3rd Taklang Damulag 100-Mile Endurance Run and after taking a break/leave from running during the Holiday Season. The doctor readily told me that I could see him either on the last day of the year (december 31) or on New Year’s Day.

Fast forward. After the TD 100 where I DNFd at Km 110, I have observed that there was swelling on the upper part of my right knee and felt some pain after I did a recovery hike and run for about two hours two days after the TD 100. It was a good reason to really force myself to go on a rest period on the following weeks & days before my appointment to my orthopedic doctor. So, from December 17 to December 31, I had only two “outings” on the trails which are mostly hiking in nature. But the swelling and pain were still there until before I finally met my doctor.

On the afternoon of December 31st, I went to my orthopedic doctor to have my knees for medical check-up. My meeting had also served as my maintenance check on the results of my bi-monthly rehabilitation on my injured knees on the early part of last year (2013). The doctor immediately made an ocular check on swelling part of my right knee and he recommended me to have my knees to be x-rayed.

I could say that one of the most important benefits of being a retired military officer and a Major General at that, is that I have lifetime free medical service from the Armed Forces of the Philippines. The Philippine Army’s Hospital & Medical Center has all the services and facilities that I need to support my passion in running. With a written slip/order from the doctor, I was brought to the Radiology Department and in 10-15 minutes, my X-Ray was done and the films were developed for the immediate analysis of my orthopedic doctor. Very fast and efficient as there was only ONE soldier-medical technician who did all the works.

The doctor analyzed and read the films as he flashed the films on a lighted monitor. The following are the findings:

Left Knee: It is healthy, normal, and strong with minimal “spurs”.

Right Knee (Swelling One): There are “pointed spurs” which are causing the pain inside my knee and these “spurs” should be flattened immediately.

X-Ray Of My Right Knee
X-Ray Of My Right Knee

The doctor asked me if I have a stationary bike and I said, yes! He advised me to immediately include a stationary bike workout, at least, 30 minutes every day without any force or weight that would make my leg muscles exert any effort. He said that my legs should be made to move on a circular motion in order to maximize the full movement of my knees. It is due to my running, in quick and small strides, that the full motion of knees were restricted. He made a personal guarantee that the “pointed spurs” will be removed, if not, flattened, if I will do my stationary biking regularly.

On the night after I left the hospital, I was able to manage a 20-minute stationary cycling without any force but I have to cut short with my workout due to my butt being in pain as I am no longer used to using my bike.

Stationary Cycling Without Any Force/Weight
Stationary Cycling Without Any Force/Weight

After 4 sessions of 30-minute stationary cycling, I was surprised that the swelling had greatly reduced and I could no longer feel any pain on my right knee.

The doctor’s advise is very good and my orthopedic doctor is the best doctor that I really admire! He deserves to have that wine which I gave him as a present for the Holiday Season.

This is a testimony that any runner, old or young, marathoner or ultra marathoner, needs to have a medical check-up to his/her knees and be able to expose themselves in cross training. As I am getting older and my the full range of motion of my body parts are being shortened and restricted, there is a need to do other forms of exercise which will serve as “cross training” to one’s main sports.

So, lace up, get out of the door and run!


The Doctor Has Spoken

I had a running-related injury during my last long run before my participation to the 2011 MIWOK 100 Trail Run last April 2011. There was pain on my left knee and it did not improve until the race day. Since that time, I was in denial that I am injured and caused my lesser time to do my daily runs and easy long runs. Instead, I opted to take some rests, do some brisk walking and until I thought of joining the last year’s RIZAL DAY Run, 2012 CONDURA Skyway Marathon, and the 1st Mt Ugo Trail Marathon in Kayapa, Nueva Vizcaya. On my way to Mt Ugo for a recon run weeks before the race day, I started an alternative activity which is peak bagging and the rest is history.

You might be wondering why I was able to finish the Rizal Day 32K, Condura Skyway Marathon, Mt Ugo Trail Marathon and Adventure Run along the Circumferential Road of Guimaras Island (110K) and did more peak bagging activities despite my left knee pain and injury. The explanation will be provided  in detail in another blogpost.

Pain management had contributed much in my ability to run and continue on my running in races and peak bagging activities. But there is a need for medical attention as I am no longer young like the other runners out there.

Yearly, I always make it a habit to go to the United States to visit my family, recharge and rest, do some chores in the house, and buy some books about running. But my main reason of going to the US is to have my yearly medical check-up! Last year, I passed all the medical tests to include my uric acid level, prostate test condition, and others but I did not include some tests/exams for my knee pains.

This year, my medical tests included an examination on my two knees through X-Ray. During my initial consultation with our family doctor who happens to be a former marathon runner and also a Pinoy, he said that the symptom on my knee pain is an indication that I should stop running. Like him, he stopped running and joining marathon races after he started feeling some pains on his knees. He warned me that if I force myself to continue running, there will come a time in the near future that I will be walking with the aid of a cane or walking stick and the pain on my knee will be unbearable that I need to take some big dose of pain-killer medications.

I felt like I was going to have a heart attack/stroke when I heard the doctor’s advice! So, I said to myself, this is it, this could be the end of the Bald Runner!

But having that kind of a fighting spirit in me of being a warrior, I mean, an old warrior, I asked the doctor if there are alternative means where I can still be active and maybe, one day I could go back again to serious running. I asked him if I can bike and he said that I could not bike because the knees are the main source of force in such endeavour. I asked the doctor if I can hike and brisk walk and he said yes. Later during the consultation, I asked him again if I can do some swimming and he said yes. Swimming is the best sports that I could do to relieve the pain from my knees.

On that consultation, the doctor took some of my blood for my medical exams to include a test for my prostate and he advised me to have an X-Ray session with my two legs and chest to another clinic. On this consultation meeting with my doctor, I registered 110/70 blood pressure; weight of 145 pounds; and a Heart Rate of 50 BPM. If my computation is correct, I might register a BMI of 21.5.

On the next day, I went to an X-Ray Clinic and I had relaxing moments with the secretary and technician because the Clinic is being manned by Pinoys. After I finished with my chest x-ray, the technician commented that my lungs and heart are very healthy and powerful for my age! Of course, it is a given and not surprised with the comment of the technician. I usually have that same comment when I was still in the active military service. However, the knee X-Ray took so much time as there are 3 positions needed for each knee! In all, six positions! And to top it all, the technician had to repeat my right leg X-Ray shots! So, I did 9 shots for my two knees!

After a week, I got the results. First, the bad news! My cholesterol is High (too much Pork/Chicken Adobo, Bulalo, and Lechon!). My sugar is also High (too much Starbucks Coffee, Krispy Creme donuts, cakes, Magnum, and Coke/Sprite) and I am about to be a candidate for Diabetes. My Knee X-Rays showed that I have Bone Spurs on my both knees! The good news is that the prostate is A-OK and my uric acid is at a manageable level. My immune system is strong and healthy!

I said to myself, what the fuck are bone spurs? The Internet provided me with the answer to my question and I did not want to hear again the advise from our family doctor because I knew I will be hearing the same shit! So, all my activities right now are geared towards the solution to get rid of these bone spurs!

Surgery? No way! I pity a young officer whom I’ve met lately at the Philippine Army Swimming Pool who was having his water exercise therapy after undergoing a surgery due to bone spurs on the bones of his feet. He was walking with a cane and he is in his late 30s or early 40s! I also know of a senior officer (retired already) who had a knee surgery and he is still swearing/complaining up to this date that he made a wrong decision to have undergone such surgery.

Medical injections of steroids or any “thing” that will lessen or temporarily remove the growth of this bone spurs or prevent the rubbing of these spurs to my ligaments and tendons? I have yet to see and find out about this solution and decide to try this treatment. However, I know of some people younger than me who have undergone this kind of treatment and they are still running well.

At this time, I am administering the old-fashion rest, ice and hot treatment, deep-tissue massage, fish oil/Vitamin D & B-Complex supplements, some “voodoo”/organic herbal drinks and cross training regimen. I hope I will not be bored with my home-made solutions to my bone spurs! Patience and Consistency are the factors that are neded for this kind of treatment .

So, if you see me out there hiking, or maybe running, stair climbing, or doing some cross training activities, you know that I am trying my best to get back into my best shape as a consistent runner!

“Uh-Oh! I Did It Again”

Two days after the 2nd Quezon City International Marathon, I went to Camp Aguinaldo to have my recovery run. I planned to have one loop of the 7K-loop course with a slow pace. However, after running for about 5 kilometers, I slowly increased my pace up to the finish line. But my workout changed when I felt my 7K run was not enough. So, I decided to continue my run with a goal to finish 10K for the day. Continue reading ““Uh-Oh! I Did It Again””

“Back To The Slope!”

1. When I was a cadet at the Philippine Military Academy, I always hear this statement or command from my Tactical Officers if they want the cadets to repeat a practice on our Parades and Ceremonies after doing one or two rounds. The start area of our parade and drills is a sloping/downhill road towards the Borromeo Field, the Parade Ground of the Academy. Figuratively, if this phrase or statement is uttered, it means that you have to repeat from the start what you have done in order to correct a mistake or error.

2. After five weeks of rest & recovery due to an injury, I am going “back to the slope!” and have started to follow a training program as a guide for my future marathon and ultramarathon races for the year 2010 and beyond.

3. The first step in my training program is to abide and recall the most basic principle in training for a running event—base training. I always say in my running clinic lectures that preparing for a running event is like constructing a building or a house where you need to have a durable and stable base/foundation. In running, base training  means building a base of aerobic endurance.

4. So, early this morning, I had my first “base training” at the ULTRA Oval Track completing a distance of 10 kilometers, running along the outer lane. I did my stretching exercises before and after the run. In addition, I did some running-related “drills” during and after the run. I finished my 10-K run in 1:09:13 hours with an average pace of 6:55 minutes per kilometer. I was so happy that I was able to breach the 7:00-minute per kilometer pace. Slowly, but surely, I could run within my base training pace.

5. To give a full description of the drills I’ve done during/after my run, I am posting the following pictures with the hope that other runners would also adopt them to make them stronger and faster.

"Running No Arms"
Front View of "Running No Arms"

To do this drill, a runner must lace his fingers and form a big circle with his arms at shoulder level. Run 100 yards at moderate fast pace with arms in this position. Return to your running form after 100 yards and repeat after running another 100 yards. I did 10 times of this drill while I was running around the track.

This drill forces my inner abdominal muscles to maintain an upright posture and activates such muscles while running. It also eliminates unnecessary swaying or rotation of my shoulders from my waist while running.

"One-Leg Hop"
One-Leg At A Time

To do this drill, one has to run as fast as possible with one leg for 20 seconds or approximately 20 leaps/bounce or more. This drill will increase one’s push-off power of the feet and will enhance the stability of the hips, pelvis, lower spine and knees on impact of the foot to the ground by forcing the muscles to stabilize the joints for a short period of time.

Lesson #1: In a training cycle, first phase is to develop your aerobic endurance base.

(Source/Reference: “Brain Training For Runners” by Matt Fitzgerald)

Finding The Culprit

1. On December 8, it will be one month sice I finished the PIM Pasig River Marathon where I had an injury. “Purists & Hardcores” in running are not supposed to be talking or discussing much about their injuries related to running but for the benifit of the “newbies”/beginners who are reading this blog, I don’t want them to experience what I am going through right now. The way I look at it, it will take weeks for me to rest and recover to give ample time for my muscle strain to heal.

2. Age—At my present age of 57, I consider myself as a strong and seasoned runner but my age is trying to catch up with reality. Various studies indicate that those runners who remain highly fit and avoid serious injury or illness will average at least 0.5 percent decline in performance per year from age 35 to 60 years old. After the age of 60, performance dropoff tends to increase. I think this is the reason why running-related injury is starting to show up. I hope that through my running, I would be able to slow down the aging process.

3. Ample Time For Rest & Recovery—I have to re-evaluate my road races in the coming months as I need more time to rest and recover in between road races. At least, one ultramarathon race and two marathon races per year would be a good quota for a year.

4. More Stretching & Warm-Up—Before my races for the months of October and November, I shortened my stretching “rituals” and warm-up exercises. I was too confident that the early kilometers of the race with a slow pace would “warm-up” my running legs but I was wrong! I should have made some extended warm-up jogging and stretching exercises before finally going to the coral in the starting area. At least, I would be able to sweat a little before the start of the race. It would be more effective if I did some “drills” before the race. The older you get, you need more time to warm-up and stretch before a major road race.

5. Supplementary Training/Weight Training—For almost six months, I stopped going to the gym for my supplementary weight training and concentrated more with my tempo, interval and long runs in preparation for the MILO Finals, QCIM Half-Marathon, SIM and PIM Pasig Marathon. I was wrong! Some of those tiny muscle groups in my legs were not strengthened by just running only. I still believe that there is a need for strength training to complement one’s running workouts. Pilates and Yoga are also recommended as additional supplementary training for older runners like me.

6. Deep-Muscle Massage With More Time To Heal—I always find time to have a regular deep-muscle massage before and after marathon races. After a satisfactory performance in the Subic International Marathon, I had a massage because of the occurrence of a muscle cramps on my left lower leg on the last kilometer before the Finish Line. I did not wait for my muscles to recover and immediately had a long run a day after the race. After the run, this was where I started to feel a muscle strain on my calf muscle. Instead of resting, I went out again to do my long runs. More massage was done on my legs but I was not able to have my affected muscle to heal for a longer time until I joined the PIM Pasig River Marathon. It is then advisable not to run a distance of a marathon race when there is a pain (even a slight pain!) that recurs whenever you have your running workouts at least two weeks before the actual race. 

7. Combination of Everything—The way I look at what had happened, the cause of my injury is a combination of what I’ve stated above—old age (ha! ha! ha!), more time to heal & recover after major races, more time for pain to heal after massage, and lack of supplementary weight training & warm-up/stretching.

(Note: Next post will be “Finding The Cure”)

Post Injury Analysis & Treatment

To get a full appreciation of what happened to me last Sunday’s PIM, I tried to look for charts and pictures of specific muscles of the lower leg. Having finished two years of BS Pre-Med before entering the Philippine Military Academy, I had the chance to dissect the different body organ systems of frogs and sharks in our Basic Anatomy & Physiology classes. And with the advent of the Internet, anybody could immediately research on certain topics about the human body. I downloaded and copied the following charts/diagrams of the human lower leg muscles groups from the Internet to give a full description of what happened to me last Sunday’s marathon race.

Lower Leg Muscles
Lower Leg Muscles

After a “back-to-back” Subic International Marathon on a Saturday early evening and then a Sunday early morning ADIDAS KOTR Half-Marathon, I felt a “pain” on my upper Gatrocnemius, which is about two inches below the back of my left knee. I had this part of particular muscle to be exposed to “deep-tissue” massage, every other day. After resting my legs for a day, I would do my slow long runs with a slow pace after warm-up and stretching and the pain would be manageable. More massage and rest for my legs for the two weeks in between SIM and PIM but the urge to build-up more mileage was so tempting that I had to do my long runs and a single session of tempo run. In these runs, I would observe that the pain would just disappear the longer I do my runs.

Leg Muscle Anatomy
Lower Leg Anatomy

 However, during the PIM, at Km 15, the pain at the same spot on my Gastrocnemius started to appear but I still tried to maintain my pace with the hope that it would slowly disappear. At Km 19, the pain on my Gastrocnemius started to spread to my Petronius Longus and later to my Tibialis Anterior. With the diagram/chart above, the Petronius Longus muscle is connected to a tendon that goes all the way to the ball of my foot. This was the reason why I could not force my foot to spring up from the ground and maintain my running pace/form as pain would spread to the whole left leg. There was no way that I could run continously with the unbearable pain on my lower left leg as my foot strike the ground. And the rest is history.

Few hours after finishing the race, I could no longer stand on my two legs without being helped by my staff/assistant! I could hardly walk without somebody supporting me and could not even lift my left leg for a few inches from the ground. It was the most painful experience in my life after a Marathon Race! But being a seasoned runner, I just relaxed and thought of applying the “time-tested” R-I-C-E treatment. I took a cold shower; had my left lower leg massaged lightly; elevated my affected leg with an ice bag placed on the affected muscle while sitted or lying on my back; and rested/slept well during nighttime and daytime! Drank a lot of my Ensure, Milk, Gatorade and Water and Ate a lot of Carbohydrate & Protein Foods! After 36 hours, I could walk without any support or assistant and the muscle soreness slowly disappeared. And the pain was already manageable.

I need more time to rest and recover.