APPALACHIAN TRAIL ADVENTURE RUN

   
       

 

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Runtrails' 2005 AT Journal
 
 
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POST #18:  SUE'S PHYSICAL ASSESSMENT     
DURING & AFTER THE A.T. RUN  
 
NOVEMBER 20
 
"Since you are asking for questions, I'm curious about your feelings on over training.  I'm reading Tim Noakes' Lore of Running and he continually hammers over training and short recovery times between events as hurting performance and sometimes causing permanent muscle damage, at least to most of us (there are exceptions).  He cites a lot of studies and examples. 
 
Just wondering what your take on this might be.  Would more rest/recovery perhaps have made things easier for you?"

- Jeff, an ultra runner and journal reader

 


Trail hazards causing some of my falls, above on Mt. Moosilauke on Day 116,

and below in the Kinsman Mountains on Day 117 (some "trail," eh?).

Most definitely - but then I'd still be out there eight weeks later!! (I can't believe I've been off the Trail  for eight weeks already. Seems like only yesterday . . . )

Last spring, I talked with David Horton about his recovery after both of his epic runs, his 1991 AT speed record and 1995 transcontinental run on roads. I assumed it would take me even longer to fully recover physically from such a monumental effort as running and hiking the Appalachian Trail since I don't have the mileage base he does and I'm not built as sturdily as he is.

It took David several weeks or months to fully recover from those efforts in the '90s. He still has some residual fatigue from his PCT run this summer, too. Although he's only a year younger than me, he's a much stronger athlete than I am.

David recently wrote to the ultra list serve that a few days ago he would reach 100,000 lifetime running miles since 1977. He has run more than 3,000 miles every year except one.

Whew! Not many runners, especially ones in middle age, can put in that kind of mileage year after year. Most of us don't have the physiology to do that.

For the last couple weeks I've been wondering why I'm still don't have my normal enthusiasm for running back yet . . . I mean, I've been done almost two months. I should be rested up by now, right?

Wrong!!

I need to give myself more permission to rest. After all, here I am at 56 and this is the FIRST year since I began running in 1980 that I've done more than 3,000 miles! At the end of last year, my lifetime mileage was just over 40,000 miles. I'll have another 3,400 miles this year to add to that.

My previous high mileage year - twenty years ago when I was only 36 years old - was 2,403 miles. That means I've run and walked about 1,000 miles farther this year than ever before. Ever.

And I wonder why I'm still TIRED and need nine or ten hours of sleep every night??? Well, duh. I think I'm doggone lucky to have been able to complete the AT considering the mileage base I had!

Some days I don't even want to run. I feel like I "should" so I can retain a decent level of fitness, but it's hard to get motivated and out the door. I'm not much interested in cross-training, either. My legs are doing fine; my heart rate and breathing are not. Although my resting heart rate is still very low (mid- to upper 30s), my HR quickly sky-rockets when I'm running, even after a lengthy warm-up.

So yes, Jeff, I'm sure I still have muscle damage that's healing and even though I haven't run much in the last eight weeks since I finished the adventure run, I know I shouldn't be trying to ramp up my mileage too fast. I entered a low-key 50K trail race in mid-January to give myself a short-term training goal so I wouldn't be a slug all winter. I plan to build my long runs up to about 25 miles by the end of December (I'm up to 15 miles now).

I wish more folks who run or hike long trails and do other types of journey runs would address the after-effects in more detail in their journals. Most folks' journals end rather abruptly, and I'm left wondering how their recovery went, both mentally and physically. I encourage those who have done such runs or hikes, even if it was several years ago, to update their journals so other folks have fewer surprises when they're done.

I've probably lost a lot of readers by now since my adventure is over and I'm posting entries more sporadically, but in the interest of educating the ones who are left, I'll continue to give information that I hope will be helpful to future long-trail hikers and journey runners.

Of course, YMMV - we're all an experiment of one, so each person's recovery is going to vary. For example, I assume someone younger and/or better trained than I was would recover faster than me.

In this entry, I'll describe what measures I took before the run to prevent likely injuries, what body systems "broke down" during the run, and how my recovery has been so far.

INITIAL PREVENTION MEASURES

I'm clumsy and injury-prone. At my age, I don't heal as fast as I used to. Besides training as sensibly as I could in the time I had before this adventure run, I knew some preventative measures would be necessary in order for me to complete the whole AT.

I am completely convinced that "maintenance" chiropractic care and therapeutic massages every three or four weeks have helped me prevent some injuries since I began running twenty-six years ago. I made sure I continued them as I trained for this run, and during it. I had two "maintenance" spinal adjustments and two "maintenance" massages during the AT run, plus three additional adjustments and another massage to treat the piriformis/sciatic problem I developed midway through the run.

The two most obvious "weak links" I had were surgery sites in my left ankle and right foot. I figured if anything prevented me from finishing this run, it would be one of these two body parts. Happily, neither was a problem!

ANKLES:  In 2001 I had surgery on my left ankle after rupturing the peroneal brevis and longus tendons. Despite physical therapy, my left ankle will never be the same. I can't raise up on those toes and the ankle is not as stable as the right one. My foot plant is also different. Custom orthotics help, but they don't prevent sprains.

Since that surgery I've been wearing lightweight-but-supportive nylon ASO supports on both ankles when I run on trails. Yes, they probably weaken my ankles further, but they have totally prevented any further ankle sprains. I've trashed both ankles so many times over the years. I wasn't about to let an ankle sprain prevent me from realizing my AT dream.

Bottom line: the ASO braces prevented any ankle sprains on the AT.

RIGHT FOOT: Last October (2004) I had surgery for two torn tendons in my right second toe. The pain went undiagnosed until the toe finally "crossed over" the big toe. I started wearing a metatarsal pad on my right orthotic to alleviate the pressure on the met heads. I kept one on the entire AT trek, and even though my orthotics self-destructed two-thirds of the way through the course and I resorted to using OTC shoe supports, that toe never gave me any problem. Prevention.

BLISTERS: I also took several measures to prevent blisters, although those are more of a problem to me on gritty surfaces, like trails out West, than on trails in the East.

First, I got my shoes in a half size larger than normal. I do this for 50- and 100-mile races because my feet swell after many hours on the trail. Larger - but well-fitting - shoes can prevent blisters and black toenails. Prevention.

Second, I purchased several Injinji "tsoks," socks with individual toes to reduce the chance of blistering. When I've worn them alone they get holes pretty fast. That's not good because they are pricey. I learned on the ultra list that wearing thin synthetic socks over the toe socks helps them last longer. It's true. I wore five or six pairs of Injinjis all summer and none got holes. AND I had only two blisters the whole trek.

Last, I had my "foot care kit" with me in the camper and took a little baggie with minimal blister products with me in my pack every day. I used several packages of Blist-o-Ban bandages to prevent blisters and occasionally put Hydropel lubricant on my feet. I never had to tape my feet but had the products I needed if that had been necessary. Prevention.

FALLS:  Most days I used one trekking pole to help me retain my balance through creeks and on rough terrain. It helped prevent a lot of falls, but not all of them, as you'll see. It was also useful for lot of other purposes like weed-whacking and getting spider webs before they got me. In New England I often used two poles through rivers, down steep inclines, and over slick bog boards.

PROBLEMS DURING THE ADVENTURE RUN

The injuries I had during the run can be broken down into two causes: over-use injuries and injuries sustained during numerous falls.

OVERUSE INJURIES: These can be attributed to the sudden increase in miles and mountains. I tripled and quadrupled my average weekly mileage on the AT. Even though 50-60% of the miles the first half of the AT were walking, it was still considerably more distance than I was used to. Having foot surgery six months before the trek began didn't help, either. I wasn't able to build my mileage back up again until only four months before arriving at Springer Mountain.

1. My quads were the first to protest. I started having problems with first one, then the other, lower, outer quad near the knee within about seven days. This photo with Lynn DiFiore on Day 10 shows both of us with knee supports!

Downhill running, my strong suit, was excruciating. Within the second week I started avoiding steep downhills by going southbound occasionally so I could go UP some of the worst hills - it was easier on my quads. After about three weeks, my quads were fine for the rest of the trek.

I attribute this problem to insufficient hill training prior to the trek. Although I put in as many miles as I safely could after surgery, I should have done more long, steep hills in training and maybe I wouldn't have had quad problems right off the bat.

I saw a doctor in Franklin, NC about this problem, mainly to get something stronger than Ibuprofen for the pain. Celebrex worked wonders but was too expensive to buy even with insurance, so I ended up taking Naproxen most of the adventure run. It worked better to alleviate my various aches and pains than Ibuprofen.

Ice and cold water therapy helped with various sore muscles. I learned about sitting in cold creeks to relive sore muscles at Coach Roy Benson's running camps in the early 1990s -- it really does help! Cody thought sitting in this creek was a lot of fun on Day 8, so he gave me a puppy kiss:

2. I had two blisters in the first couple weeks. One was under a callous on a slight bunion I have on the side of my right big toe. I eliminated it by filing the callous down more often and using a Blist-o-Ban bandage on it for a couple weeks (these are very thin two-layer bandages that reduce friction). A second blister developed on the side of my other foot, halfway between the heel and toe. The Blist-o-Bans worked well there, too.

After the third week, I had no more problems with my feet until I got to Maine. My right little toenail was swollen and sore. I'm not sure if it was a blister or an infection from all the mud and swampy water I was running through. Cutting a slit in the side of the three pairs of shoes I was alternating relieved the pain when I ran, and soaking in Epsom salts in the evening made the swelling go down.

Considering how far I went and under what conditions (weather, terrain, etc.), it's a miracle I didn't have more foot problems.

3. The next problem, about four to five weeks into the run, was swollen, sore lower legs. They hurt on the outside of my leg, just above the ankle joint, and toward the center. Again, it was one, then the other, not both legs at the same time.

On one of our trips home I saw my orthopedist. He ruled out a stress fracture (my worst fear) and shin splints and determined the pain emanated from a nerve ending. He diagnosed inflammation or herniation of soft tissue. I was relieved. After a few days of icing and elevation in the evenings, each swollen leg/ankle got better. I didn't take off time specifically to let these injuries heal, but kept on running.

This photo is from Day 90 when my ankle was sore enough to need some ice again:

4. What I would consider the next overuse injury was sore knees caused by the steepest climbs and descents on the entire Trail in the Whites and Mahoosucs in northern New England near the end of the trek. I have osteoarthritis in my knees (and probably every other joint in my body). I'm lucky my knees didn't hurt before then. Even young hikers in their twenties complained about their knees in the Whites!

I again went southbound some days so that I climbed up the worst grades instead of going down them. I resorted to using various other, um, interesting techniques to take the pressure off my knees when I had to go down steep inclines, like sometimes going down backwards. It wasn't elegant but it saved my Granny Knees!

When the terrain was conducive to running my knees didn't hurt. And they stopped hurting within a week or two of my return home. I'm relieved they hurt only the last six weeks on the Trail and are pain-free now. This was the area of my body where I thought I might do the most long-term damage. Hopefully, I didn't.

5. The most unexpected overuse injury I incurred was to my arms and shoulders! I've been doing weight work for 24 of the 26 years I've been running. Although my arms are thin, I thought they were pretty strong. Apparently not! There were several factors causing the weakness and pain.

When I encountered those steeper mountains in New Hampshire and Maine the last five weeks I relied more and more on one or both trekking poles for stability. I used the right one every day, the left one only occasionally. I joked that I had a "death grip" on the poles. My right wrist sometimes hurt like I would imagine carpal tunnel syndrome would feel (I haven't noticed that at all since finishing, though). That whole arm was weak and sore.

The northern half of the AT has more rock climbing than the southern half. I frequently had to hoist myself up large boulders or find hand holds in near-vertical slabs. The very worst was in Mahoosuc Notch early in Maine. I wasn't used to pulling up my entire body weight and pack with my arms.

Then eight days before the end (Day 141) I had to use my arms and shoulders to brace myself going through four waist- and chest-deep raging streams. I clung to a rope across the worst one. After that, my arms and shoulders were sore enough to make both running and sleeping uncomfortable. That continued for at least seven weeks afterwards, too.

Bottom line: something, somewhere hurt at least a little bit almost every day I was on the Trail!

INJURIES FROM FALLS

I kept track of the worst falls in my journal for a while, then it became tedious and I quit mentioning it because I was falling nearly every day at least once! Most falls occurred when I was running, sometimes on pretty smooth trail. The faster I was going the harder I landed. Nine times out of ten I landed on my right side, usually on my arm. I bloodied up my knees a lot, too, as below on Day 4 before I even got out of Georgia!

When I hit the rocks in Pennsylvania and was walking more, I still fell down even when walking. I was getting more and more tired, and more and more clumsy.

The worst injury I incurred on the whole trip was somewhere in Pennsylvania in mid-July. I didn't realize how badly I'd knocked myself out of alignment until Hank Glass, my chiropractor friend from Atlanta, diagnosed the problem during the Vermont 100 race. It was so bad that I had a 2-inch leg length discrepancy. It's a wonder I could walk!

In fact, during the race I got to the point where I could NOT walk. My right leg hurt and then became numb. I recognized it as "sciatica" from descriptions of the pain that I'd heard and read. After I dropped from the race Hank gave me an adjustment and explained that the piriformis muscle was strained and irritating the sciatic nerve.

I saw another chiropractor when we returned to the Trail in Pennsylvania (photo below). He said I still had the 2-inch leg discrepancy. After two adjustments and wearing a lumbar support for a week while walking on the Trail, the pain resolved, my alignment was OK (despite more falls), and I didn't have any more sciatic pain. When I returned home my own chiropractor said there was no more leg length discrepancy. That one incident is the only time in my life that my sciatic nerve has hurt.

Soon after this I fell backwards in a muddy, black creek in New York. My butt landed in soft mud, but my lower right arm hit a rock hard enough to cause an immediate "hemotoma," swelling the size of half a golf ball. See photo below that I took (that's why the angle is so weird!) One of the hikers who is a nurse warned me to see a doctor that day because I might get a clot that could be life-threatening. I've had this happen before but never knew the potential danger.

So I bailed out after only 15 miles on Day 97 and Jim took me to a clinic where an osteopath checked me out. Nothing was broken and since the swelling was gone she determined I hadn't ruptured an artery and shouldn't have to worry about a blood clot. I never did need the antibiotic prescription she gave me.

A few days later, my right middle finger went completely numb. I wondered if I'd injured a nerve or blood vessel that supplies that area when I got the hematoma. I just lived with the numbness and it eventually went away after I'd been home about six weeks.

Farther up the Trail, I continued to fall mostly on wet rocks, roots, and bog boards (photo farther below in text). Occasionally I fell backwards, but mostly on that right side. Here's another bloody arm photo from Day 127 in Maine:

I'm darn lucky I never broke anything (arm, ankle, glasses, etc.). I have thin but very strong bones.

There are several reasons I fell so often: I encountered more rocks and other obstacles than I'm used to, even running in Georgia and Virginia as much as I have. I became more and more fatigued the farther I went and was falling even while walking. And my eyesight deteriorated during the summer.

Huh?

It's true. I noticed that it was getting harder and harder to focus on the Trail. Some of that may have been fatigue, but I'm convinced my eyes took a sudden turn for the worse during this trek. I get them examined every year because of my family history of glaucoma and cataracts. In July of 2004 they hadn't changed enough the previous year to warrant new glasses. By this July, they had. But I wasn't anywhere near home to get them examined. So I kept going, even though I couldn't see real well.

I had them checked soon after returning home. The difference is significant. My current ophthalmologist and optometrist agreed that it is fine for me to resume wearing contact lenses instead of glasses (not what I heard while living in Billings). I wore hard lenses and gas perms for thirty-six years, then glasses the last four. I missed my peripheral vision wearing the glasses, especially on trails and driving.

Now I'm comfortably wearing soft contact lenses, I have my peripheral vision back, and I can SEE better! Hopefully I won't fall so doggone much any more.

RECOVERY SINCE RETURNING HOME

I finished the Trail eight weeks ago. As expected, I was very tired and happy to take some rest days. But there were some totally unexpected things, too.

The last day on the Trail I had an abundance of energy despite the fatigue I'd been feeling. That was unexpected. Day 148 started with a late start, I had the steepest climb and descent on the entire Trail up and down Mt. Katahdin, and then I had to run and hike ten more miles to finish up the section between Abol Bridge and the mountain.

But I felt great that day! I could have run more than I did the last ten miles but I deliberately chose to hike with "Kokomo" for several miles. I knew I'd finish by daylight so I didn't have to hustle. I was enjoying our conversation, the longest one I'd had on the Trail with anyone, and I was savoring my last day. I waited until the last mile or two to run.

Where did all that energy come from?

I'm sure it was adrenaline and the satisfaction of knowing I had realized my dream. I was finished!!

Then I stopped almost all aerobic activity and my body went haywire. I got all sorts of unexpected symptoms.

Big mistake.

First off, we sat in the truck driving home for two solid days from northern Maine to southern Virginia. You know the dangers of blood clots after an ultra, the warnings not to sit too long in a vehicle or on an airplane? We stopped to go to the bathroom and walk the dogs every couple hours, but that was about the extent of our "exercise" those two days. Fortunately, I didn't develop any blood clots.

When we got home there was plenty to do to catch up: get everything we'd been using for almost five months out of the camper and into the house; do laundry; clean up and reorganize several boxes of running gear and supplies; clean the house we hadn't been in for three months since our last time there; buy groceries and restock the pantry; catch up on yard work (it took me several weeks to tame the weeds); schedule several doctor appointments; and so on. Up, down, up, down the stairs in ad finitum the first several days.

I had little energy for running or even cross-training. That didn't surprise me as much as the realization that I didn't even miss it all that much!

The lack of desire to run was unexpected. The very most I wanted to do was get out and walk at a leisurely pace and enjoy the beautiful late September weather. I had no interest in cycling, swimming, pool running, or using weight machines.

And half the time, eight weeks later, I still don't! I didn't expect that at all.

The first eight days I walked a grand total of TWO MILES. The second week I really upped the ante (!) to twelve miles, then seventeen and twenty-three. Much of it was just walking, not running. After two weeks, my mind sort of wanted to run again but my body told me to rest. I listened to my body. The most I've done in one week since I finished the AT is thirty-three miles.

Meanwhile, other body systems were saying, "What the heck??" My legs were relatively happy, but my endocrine, hormone, and GI systems went nuts.

Despite years of hormone therapy and no menopausal problems, suddenly I found myself crying for no reason that I could rationally understand. I was also somewhat depressed, my face broke out, and I started having night sweats. I slept fitfully. The timing and consistency of my bowel movements changed.

I had no problems with any of these things out on the Trail when I was under a great deal of physical stress. Why now?

I think the main reason was the sudden lack of activity. My body had grown accustomed to a high level of activity and it . . . stopped.

The sleep disturbances I had for several weeks were also unexpected. I had nightmares about the Trail that I hadn't had prior to Flood Day in Maine. I woke up frequently during the night, so I remembered my dreams better than when I wake up only once or twice. The night sweats were very annoying and unexpected, too.

And my arms were so sore I couldn't sleep comfortably for about six weeks. That was not only unexpected but terribly ironic. I mean, I ran and walked for 2,200 miles and my legs and feet were fine afterwards. It was my ARMS that hurt! How screwy is that??

Time for another photo. This one exemplifies how precarious the footing was on some of the bog boards I fell off in New England:

My chiropractor diagnosed the arm problem pretty soon after I got home. He tested me and said it was unlikely I had nerve damage. He said I probably had soft tissue damage that would heal in six to eight weeks. He told me to lay off the upper body weights that caused pain and let myself heal. (My arms hurt so much I couldn't even do pool running. The pressure of the water was too great.)

He was right, but I kept seeking answers because I didn't know yet that he was right.

I got a deep-tissue massage. My arms hurt even worse for a couple days, then returned to their pre-massage level of pain.

When I saw my gynecologist for my annual check-up he suggested a thyroid test for the fatigue and soreness. Blood work showed that my thyroid was fine.

There was a lengthy article in our newspaper about undiagnosed Lyme disease and its chronic symptoms. I had several of those symptoms and I was a prime candidate for the disease, which was rampant on the AT this summer. Each of my symptoms could be explained by something else, but together they made me wonder. So I saw another doctor in the same practice as the local Lyme expert (the expert was not taking new patients) and asked her to do the two Lyme tests. They were both negative. (That doesn't rule out Lyme disease entirely, though, because either test can have false negatives.)

After six weeks of pain in my arms and shoulders, I went in to see a PA in my orthopedist's office. Five X-rays showed no bone problems. But he diagnosed several other problems in my right arm, the one hurting the most: a possible deltoid injury, right shoulder impingement, and early adhesive capsulitis. I agreed to a cortisone shot and a few sessions with a physical therapist to work on my range of motion, rotator cuff strengthening, and scapula stabilization.

And wouldn't you know, that very evening both arms felt better!! I don't know if it was the cortisone or my chiropractor was right about the length of time for soft tissue injuries to heal. I was just relieved my arms finally felt better and I could sleep soundly again (by that time, the nightmares and night sweats had ended).

I saw a physical therapist three times recently and got enough stretching and strengthening exercises to keep me busy for a lifetime. In addition to the stress I put on my arms and shoulders during the trek, I also have a posture problem: I lean forward too much. It's both hereditary and environmental. Other family members lean(ed) forward, too. Running doesn't help, nor does sitting at a computer for hours. My shoulder range of motion is good but I need to loosen my pectoral muscles in my chest so my shoulders and head will line up straighter.

My mom was right - I still need to "stand up straight and tall."

So that's my homework - all those stretches. My massage therapist did another number on me last week to try to loosen up all my arm, shoulder, back, and neck muscles. I was sore for days from that. She wanted me back in a week but I cancelled the appointment. I just couldn't face the pain again that soon. I'd rather run the entire AT over again!!

Seriously, I can't complain too much eight weeks after finishing the Trail. I'm still fatigued and not able to run as much as I think I "should," but I'm not 35 any more and I accomplished so much more this summer than my body is used to doing.

I no longer have sore arms, night sweats, nightmares, strange stools, or unexplained crying. My rosacea (adult acne) is better, but not gone despite the treatment my dermatologist prescribed.

What still bothers me is my lack of desire to exercise. I can run comfortably now for one to two hours - if I can just motivate myself to get out there and do it.

WEIGHT LOSS DURING THE A.T. RUN

I didn't have much excess weight on me when I started this run. I am 5'9" tall and weighed 143 pounds at the start. I lost about ten pounds. I loved the way I looked when I got home, with muscles as taut as when I was peaking at road races eighteen years ago, but I knew it wouldn't be healthy for me to keep my weight that low - and with so much less activity, I'd feel like I was depriving myself of food.

I don't pay much attention to weight per se but to how I look in the mirror and how my jeans fit! I know muscles weigh more than fat. I'm happiest and feel the best when my tummy is flat and I don't have "love handles" on my hips. That tells me my body fat is fairly low. When I got it too low in my early running years I got sick easily. I've learned what my body should look like to feel good, be healthy, and run my best.

Since I got home I've regained three or four pounds. I'm OK with that. I don't have to starve myself to maintain this weight and I still feel "light" when I run. When I build my mileage higher again I can indulge in more food. Simple as that!

As I mentioned in another entry, it was a lot easier to increase my food intake when I started on the AT than it was to reduce it afterwards. That was no surprise.

A corollary is that it was also harder to reduce my food intake when I got done than it was to reduce the miles I was running. The rest feels good but I still crave ice cream!

It's been an interesting eight weeks. Although I'm still tired, most of my post-run problems have resolved themselves. I don't feel like I've done any serious long-term damage to my body. Time will tell just how much this run took out of me. At this point, I'm mostly pleased with how I'm recovering.

Maybe I'll be more motivated to run when I decide what my next adventure will be! (I'll write more about my mental readjustment phases in another entry.)

Happy Thanksgiving week to everyone,

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, Cody, and Tater

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2005 Sue Norwood and Jim O'Neil