Sunday, May 19, 2013

More on Sacroiliac (SI) Joint Dysfunction and Running

I've been getting a lot of questions about SI joint dysfunction lately. Before I post,  I just want to explain that I am not a doctor nor do I consider myself an expert in sacroiliac joint dysfunction. I am simply explaining what I know (scratch that, what I think I know) about my SI joint problems and what has worked for me. Also, I think its important for me to write that I have had this same injury for 12 years and was misdiagnosed most of the time. Keep in mind that what works for me may not work for you for a number of reasons. Read on for more.

What is the sacroiliac joint?

The sacroiliac (SI) joint sits between the sacrum (lower end of the spine) and the iliac bone . It is one of the largest joints in the body and the surface fits together like lego. A very small amount of motion should occur at the S.I. joint. The motion of this joint is typically so minimal that it might only slide a couple of milometers and it may only tilt and rotate a few 2-3 degrees. The primary function of this joint is shock absorbency and to provide enough motion and stability to protect the pelvis and spine from constant motion like running.

What is SI joint dysfunction

From what I have been told and from what I have read, SI joint problems develop when 1.) The joint doesn't move enough (hypomobility), or  2.) The joint moves too much (hypermobility). Keep in mind that there are actually two joints (one on either side) that are designed to move together as one.

Hypomobility (The joint doesn't move enough)
The joint locks up and doesn't have enough motion. This typically happens when the joint wears down due to age. 

Hypermobility (the joint moves too much)
If the ligaments surrounding the joint are weakened, maybe by pregnancy, a car accident, or another high impact injury (such as a bad fall from a steeple barrier, in my case). When the ligaments become weak, the SI joint moves too much and causes all sorts of problems, and pain. The locking sensation that can sometimes occur (for me between mile 4-8 of every race) is because the joint has over rotated. SI joint problems (for me) get worse as the race shortens and the pace gets faster (I.E. 10ks are a terrible race for SI joint problems)

Hypermobility can be quite tricky, especially in runners. Because there are essentially two SI joints, one side may actually move too much while the other may move just enough or not enough. This can make you feel off balance, like one side is tight (or needs to be pulled on or pulled out) and the other is loose. Its very annoying, believe me, I know.

What doesn't work for me
Chiroractic can work for people with hypomobility because it can return some motion into the joint. However, I have never had any relief from the chiropractor for my SI problems because while one side might move just right, the other side is hypermobile. Chiropractic care creates more motion in the joint, which in the beginning may be relieving if the area around the joint is inflamed, but over the course of a few weeks or months, might actually make your problems worse. My suggestion, make sure you understand just what your SI joint problems are before you consult a chiropractor.

Anti-inflammatory medicine, incline tables, acupuncture,  I've done all these things in excess. Thought they initially will give you some relief, over time your problems will return without strength exercises and a good physical therapist that understands your SI joint problems.

What works for me
A strength and exercise routine that is designed by a physical therapist. Simply massaging the joint never worked for me, however, the combination of physical therapy, massage, and exercises (at home, on my own, every day) have helped and continue to HELP my SI joint problems. Keep in mind that the flare-ups (locking episodes) will still happen if you are like me and genetics also plays a large role in your issues. Also, the more children you have, the more problems you will likely have with your SI joints. And before you start searching the internet for "strength exercises for SI joint dysfunction" you need to find out what kind of SI joint problems you are experiencing.

Ok, the really bad news
Sometimes the solution to the problem actually make the problem worse before it gets better. I have been working really hard on my strength all spring and sometimes over do. Thus I have dealt with major inflammation around the joint causing more "episodes". Also, if you get a good deep tissue massage, don't expect to do a workout a day later (or in some cases 2 days later). Taking two days between workouts and limiting yourself to one run a day will help when things are going really bad.

And, in closing:
If you think you are experiencing problems with the SI joint, see a doctor and get a referral to a physical therapist that has experience with sacroiliac joint dysfunction. If your therapist doesn't have much experience with dealing with SI joint dysfunction, see someone else or ask around your running friends. Someone you know has bound to have had some SI joint problems.

The end, for today.



Monday, May 13, 2013

Change of plans.

After battling sacroiliac joint issues all spring, along with insomnia/sleeplessness for the past few weeks, I have decided (after many conversations with Houston) not to run the Ottawa marathon.

This spring I have gotten really strong, but I have yet to get fast. I have logged more miles and put in more work then ever before. But, with what I have been dealing with these past 4 weeks, it looks like I need another 5-6 weeks to train, rehab my hip, and find out what is keeping me up at night. I can't run another race after a sleepless night, and I don't want to attempt 26.2 miles off of 0 sleep. Maybe a half, maybe a 10K, but not a marathon.

If I run Ottawa, I predict a 2:55 and I've worked too hard to settle for that. With more time to prep I have the chances to replicate the last five weeks of my most successful marathon, and potentially PR or get extremely close to it. I've decided to run Grandma's marathon on June 22.

Though I will miss the Canadian Marathon Championships, I want to give myself the best chance possible to run well. I've done really well with my strength, recovery, and building up my miles. I've done more long runs over 13 miles at marathon pace then any other marathon training cycle. I just need a few more weeks to deal with these issues.

Looking forward to the next 5-6 weeks.

Thursday, May 2, 2013

2nd track session of the year

I forgot to mention yesterday that I suffered terrible friction burn on my feet and could barely walk after the race. It took a couple hours before it stopped hurting and rubbed my feet raw. Unfortunately Monday's 20 miler never happened.

I cross-trained Monday and ran 80 minutes Tuesday. Wednesday I asked Houston to pace me through a speed session on the track thinking that it might help boost my confidence before this weekends tempo/long run double.

40min w/u, 15 min c/d
8x800m w/90-2min rest
2:45,2:43,2:41,2:41,2,41,2:41,2:38,2:38

This workout went fine. I never struggled, I negative split most of them. I even had a cheering section for the last two (thanks Ladies). I'm in shape, I know this. Still trying to prove it on the race course.

Wednesday, May 1, 2013

Canadian Half-Marathon Champs Results

Canadian Half-Marathon Champs Results: 1:22:17 (8th)

(Fail.)

My first official race of the year turned out to be a huge disappointment. I felt fine Saturday before the race, but didn't sleep AT ALL the night before. Maybe it was nerves or an uncomfortably hot hotel room, but if I got any sleep it was a few minutes between 5:58am and 7.

I have never not slept the night before a race, therefore the 5:44 opening mile felt more like 5:35, and after three miles at about 5:45 pace I fell apart completely. I never gave up, if anything I pushed as hard as I could, hurting as much as I possibly could from 10k until the finish. There was no strength in my legs and I had to fight to maintain my position. Finishing 8th was not something I was proud of, I didn't travel all the way to Montreal to run a 1:22. If there is anyone out there that has really read my blog then you will remember that I just ran a 13.2 mile tempo in 1:22:11, feeling wonderful in the middle of a 90-95 mile week. This was slower than my recent tempos of 10-13+ miles.

My first thought was to throw in the towel, however it was just one race (and one badly executed after a sleep-free night.) when I returned home Monday, I had Houston review my last four months of training to see what "I was missing". His response was "this might be the most impressive 4 months of training I have seen. There is no way you are not in shape."

That gave me a little confidence and we talked about why I felt the need to go out at a 5:45 pace versus a 6:05. He once again pointed out that I did not execute the race correctly and should have known better. I know this. I don't know what I was thinking.

But, It's over now and I've moved on.