I'm Training for the Marine Corps Marathon

I officially announced on my Instagram that I am training for the Marine Corps Marathon (MCM) but I am not sure how formal of an announcement I made here. Even though I live 25 minutes from the start line and I love this marathon, I have only run it one time! Out of 33 marathons, only 1 of them was my hometown marathon.

Marine Corps Marathon 2006

I ran the MCM back in 2006. It was my second marathon. I loved every moment of the race and finished in a time of 4:24:39, which was a PR by over 20 minutes from marathon #1 in Delaware. This was before I had a Garmin. Before I had an Instagram following. Before I had a husband. Before I had adidas carbon fiber plate running shoes. A different world, indeed!

The reason I never returned was twofold. 1) I wanted to experience a variety of marathons and locations. 2) I typically prefer later fall marathons so I don't have to train in the heat as much, and there is a greater likelihood of cool weather. The Richmond marathon is two weeks after Marine Corps so if I was going to run something close to home, that race always seemed like a better target. 

But now that I have successfully run a warm marathon (Houston in 65-degree weather) I know I can be okay if we have an unseasonably warm day in late October. Plus, I have always wanted to run MCM again and it feels long overdue.

I do consider Richmond a fallback if the MCM weather is forecast to be over 65 degrees or if I get sick. I am going on a cruise two weeks before the marathon, which is just a breeding ground for germs. Not to mention the flights. The timing of the cruise isn't ideal, but a few family members had already booked it and invited me. I don't often have the opportunity to vacation with family. I'll do whatever I can to prevent getting sick, but if I do, I'll deal with it and then run Richmond.

My goal is to run a faster time than I ran in Houston so I can have a lower bib number in Boston next Spring. I feel like that's such a superficial, petty goal-- to care about a bib number and a corral. But it's motivating for me! A sub-3:26 is also a low bar for me given that I have run many marathons faster than that. So ideally I would run faster than 3:20. It will mostly depend on how training goes and how cool the weather is. 

Training Progress
As I mentioned in my previous post, I am coaching myself for this one. So far it's been going really well. I have written myself a plan that goes all the way to race day and making minor adjustments here and there. I am always asking myself "does this workout make sense for where I am in training?" and twice the answer has been "no" so I made modifications.

I turned a six-mile steady state run into a 2-mile tempo followed by 2 x 1 mile at 10K effort. A six-mile workout seemed like a big jump and I think I generally get more benefit of running at 10K effort than steady state, which is slightly slower than Lactate Threshold. Self coaching involves knowing what works for me, being aware of the stage of training I'm in, and adjusting for the weather if needed.

It wouldn't be a training update without a graph. So here's mine:

As you can see, I have steadily increased my volume this summer. I am planning a "down week" for the week of August 14th to allow my body to recover and absorb all the work I've been doing. So far, my longest run has been 14 miles and I plan to run a 15-miler this weekend.

One of the foundations of my plan is that I don't want to do a lot of runs that are longer than 16 miles. When I was training for Indianapolis/Houston at the end of last year, I started to dread my long runs. I felt burnt out on them. I was perfectly fine to run speed work or easy runs - but long runs felt treacherous. And looking back on my training log, I have found that I don't need a ton of long runs to run a fast marathon as long as I have high volume. It's preferable to spread the mileage out over the week instead of lumping it all into one run. 

My first 16 miler will be 9 weeks out. And then I will run longer for all the subsequent weekends, except for the week in which I race a half marathon. With only two months of 16+ milers I think I can run a strong marathon and avoid the mental fatigue of too many long runs. Another benefit of this approach is that by the time I get to 16 miles, the weather should be a bit cooler, even if just by a few degrees.

Injury watch-outs
At my age, injury prevention is more important than ever. I am doing strength training twice per week and having physical therapy appointments as needed. Here are the three areas that I am watching closely:

• Achilles. I'm pleasantly surprised that my Achilles tendinopathy has not flared up. Even after some pretty intense hill workouts my Achilles felt okay. And the long runs haven't been irritating it too much. I always have some tenderness when walking downstairs, but overall my Achilles feel better than they did throughout all of 2022. I hope this continues!
• SI Joint. I somehow got out of alignment (probably by squatting or deadlifting weights) and for about two days my SI Joint was irritated. I went straight to physical therapy to get it adjusted and that worked wonders. I didn't have to take any time off for it! If only I had gotten an adjustment sooner in the spring of 2022, I wouldn't have had to take 9 days off, get an MRI, freak out right before Boston, etc. The pain is now completely gone.
• Morton's Neuroma. This problem reared its ugly head again for the first time in five years. I didn't waste any time. As soon as I started to feel pain I went to my podiatrist to get alcohol shots, which have shrunk the neuroma in the past. That pain has also gone away. 

Aside from these minor issues, I have been feeling great. My runs have felt energized despite the steamy weather. I've been getting plenty of high-quality sleep and I've been tracking my daily water intake. I drink anywhere from 55-70 ounces of water a day. Often with Uppermost hydration mix.

So, that's my update! I am really excited about running the MCM for the first time in 17 years! It will be interesting to see how 44-year-old Elizabeth compares to 27-year-old Elizabeth.

11 Days To Boston: SI Joint Injury Update

I'm back again with an update, with a little more clarity than I had in my previous update.  I'll first provide a brief overview of the situation, then a detailed timeline (more for my own sake to remember how this progressed) and then I will do a little rant about of navigating the healthcare system. Feel free to skim, as this is admittedly a boring post. 

What I've learned since my last blog post:

• MRI showed healthy discs. I have minor bulging, but nothing that would cause this type of pain
  
• The root of the problem is very likely my SI joint 
• That said, I do have some tendinitis around the left hip and a tight Piriformis, which are likely compensatory issues from bracing the SI Joint pain. It's one big chain reaction.

Progress since last blog post:

• Walking is now pain-free 75% of the time, and during the other 25% it's slightly noticeable
• I was prescribed a 6-day course of MethylPREDNISolone, and I have no idea if the improvement is from that or from my time off running. I finished it today.
• I took 9 complete rest days from running, but I did do PT exercises and foam rolling
• I didn't try to cross train because certain movements aggravate the area that aren't running, like leaning forward. Healing was my top priority; not maintaining fitness.
• I received a cortisone injection into the SI joint today

Timeline
After seeing my doctor on Tuesday, March 29, I scheduled an MRI for the following Tuesday (which then I was able to bump up a day to Monday April 4). I wanted to rule out a bulging disc. 

March 30-April 3
I had zero change, zero pain relief Wednesday-Saturday, which was discouraging as I had stopped running entirely. My doctor prescribed a prescription for 1000mg a day of Naproxen, but that didn't help at all.

On Friday, I decided to get a second opinion from another doctor who ideally would be able to give me a cortisone shot, as I wasn't getting any relief with rest or with Naproxen or with PT/dry needling. This doctor was not at all helpful, but he did tell me to stop taking the Naproxen and instead start a 6-day round of MethylPREDNISolone. Those are steroids, which I started on Saturday, April 3 and finished today.

During this time I refrained from running and did minimal walking. But I did some light PT exercises for the hips and glutes, along with stretching and foam rolling. I also used my RapidReboot hip attachment for compression therapy. I didn't want to go too crazy with the PT exercises because I hadn't been prescribed any by my PT and I wasn't sure it was an SI Joint issue. I just did some common sense stretching and strengthening that didn't cause pain.

April 4-6
Monday was the first day I noticed some relief. Finally it wasn't painful with each step, so I figured the rest + steroids were working. Monday was also the day of my MRI. I actually somewhat enjoy having MRIs. It requires you to be alone with your thoughts; no distractions. A great mental toughness practice.

On Tuesday, April 5, after taking nine consecutive rest days, I decided to go for a test run. Pain with walking was almost entirely gone by this point. I ran with an SI Joint belt, which had been recommended to me by a few people on Instagram as well as a doctor friend. I don't think the SI Joint Belt helped, but I do like the support it provides while doing my daily activities. On Tuesday's run, I did a run/walk series, with the run portions getting progressively longer (2 mins, 3 mins, 5 mins, 7 mins) to see how things were feeling. Pain around the SI Joint kicked in about 15 minutes into the run. And then it quickly spread to the glute and hip and I ended up stopping at 22 minutes. This was extremely discouraging.

After the run/walk I foam rolled, stretched, used a massage gun, and took an epsom salt bath and things calmed down and were back to normal. 

I got the MRI report which I didn't quite understand, but my doctor friend told me it was all clear and that the pain was not disc-related. I have some slightly bulging discs, but they aren't causing me problems. 

My run the following day, April 6. was SO MUCH better! I ran for 4.4 miles, including a few short walk breaks. No SI Joint pain, but my hip did tighten up on me a few times, and I had to stop and stretch. This could be because I did not wear the SI Joint belt, and my PT told me later that day that I probably didn't need one because my pelvis didn't need additional stability. During our session he did an adjustment to help the hip, and he also performed dry needling on my back, glute, and hip. It was painful.

Later that evening, I had a virtual visit with my favorite medical provider, a sports chiropractor who recently moved across the country. He was my go-to for ten years and I trust his opinion entirely. I probably should have done this virtual visit two weeks ago, but I was skeptical that virtual would help much. In hindsight, I think he would have provided the clarity I needed sooner rather than a lot of the ambiguous answers I had been getting from other providers. 

This sports chiropractor has helped me overcome everything that has popped up over the years. Talking to him was very reassuring. I was on the fence about getting a cortisone injection and he was in favor of it. He told me what to expect, gave me some exercises and advised on how to proceed. 

Today, April 7, I ran 6.6 miles 100% pain free thanks to the PT session the day before. No hip tightening, no SI Joint pain. I ran it as a progression run because I had a ton of energy and threw in some strides. It felt amazing to be back out there again. I still decided to get the cortisone injection because I didn't want the pain to return, and today would be my last chance before my doctor left town. I learned that there are very few risks with cortisone in the SI joint, and the potential reward was high. 

I've had two cortisone injections in the past, but they were both somewhere in the 2007-2008 timeframe and not for my SI Joint. One was the ankle and I think the other was the knee, but it might have been the hip.

My plan is to take a rest day tomorrow to recover from the injection, do a short/easy run on Saturday and then attempt a longish run on Sunday. I'll have to play it by ear and see how everything feels, but that's the plan for right now. My doctor actually cleared me to run tomorrow but in general I feel like she allows me to run when I really shouldn't! 

Venting Frustrations
I think I would be much better off if I had a cortisone shot last week; but my doctor didn't have any availability on the schedule until today. I tried to get one at my initial appointment on March 29, but she said that she didn't have time during that appointment. I wish I would have pushed harder to get the shot right then and there instead of waiting 9 more days. Then I wouldn't have had to mess with the medications or the MRI. SI Joint injections are used for diagnostic purposes because if the pain goes away, then it was definitely SI Joint.

Instead, it was a roller coaster of trying different medications, scheduling an MRI and trying to get insurance to approve it (they did not), and not really knowing what the issue was or if I was going to be able to finish Boston. And it took a full week since my initial appointment to get real pain relief. 

I've spent so much time on the phone trying to schedule PT sessions, trying to get an earlier cortisone shot (without success), working through the MRI scheduling and insurance, trying two different prescription drugs. Basically feeling helpless, frustrated and uncertain!

It's much easier when you know what your injury is, how long it will take to recover, and clear instructions on how to proceed. (Like a stress fracture, for example). It's also easier when it doesn't pop up three weeks before the Boston Marathon. So while I handled Covid pretty well, and while I handled my groin injury pretty well, I really struggled with the uncertainty on this one. It was difficult to stay positive.

BUT, I think I am finally coming through to the other side and I'm done with the worst of it. I have the cortisone shot, I have two PT sessions set up for next week, I know I'm not dealing with a disc issue, I have guidance on how much to run and what PT exercises to do, I'm no longer taking medications, and I had a 6-mile pain-free run this morning! I had none of this on Monday of this week.

My primary goal is to get to the start line feeling good so I will prioritize that over trying to salvage my fitness. At Boston, my main goal is to finish the race and ideally be able to walk when I am done (or at the very least, to be able to walk later that day!)  I've already been to the Boston medical tent once and I have no desire to return. I also want a good finish line photo. I haven't been happy with my finish line photos from my previous Bostons!

If you read all of this. . . you're a real trooper! 

3 Weeks Until Boston and OUCH!

With less than three weeks until the Boston Marathon, an injury has popped up, bringing my training to a complete halt. I'm going to document all the details here, mostly so I can go back and reference them, but the punchline is that I am having issues with SI joint inflammation; something completely new to me. The joys of growing older! 

How it started
On Tuesday, March 15, I was doing deadlifts with the hex bar during a strength training session with my coach. I have done these many times in the past and I was using a slightly lighter weight than I had used in my previous session. As I completed the set of 5, I noticed a crunchy/pinchy sensation in my lower back/left upper glute. It was so minor that I didn't even tell my coach! When I do strength training I get little things like this a lot. I did a little jog-in-place to shake the legs out but the weird sensation remained. 

Ever since that session I have had a mild pinching sensation around the left SI joint. I didn't even realize this was my SI joint because I have zero experience with back injuries. I continued to run without any problems or pain. The following Saturday, March 19, I ran 18 miles with 10 at marathon effort (pictured). Even though I felt a little pinch the whole time, it didn't impact me at all and seemed totally minor.

How it progressed
The first red flag was on the following Tuesday, one week after the deadlifts (March 22). I ran a very challenging workout that combined track intervals (1600, 1200, 800, 400) with road miles in between each interval at tempo effort. The workout went really well and I had no pain whatsoever. I hit all my desired paces. Greg took videos and my gait was totally even and balanced. 

When the workout ended, that minor pain in my lower back became much more prominent. In fact, it hurt to walk! I walked a little bit and then I began my cooldown. My cooldown was very uncomfortable. I noticed that the slower I ran the more it hurt, but I obviously wasn't going to run super fast on a cooldown. So I cut the cooldown short because my lower back/SI joint was painful. 

I told my coach about it and we had a zoom meeting to discuss it. At that point it really seemed like it was a tight glute medius. That seemed to be the bigger problem than the pain around the joint. I'm guessing that the joint pain was exactly the same but that the running caused all the surrounding muscles to tense up, so now I had muscular tightness as well.

March 22 track/road workout

I went to physical therapy the next day and my PT said that my glute medius was extremely tight and also that one leg was slightly longer than the other. He did something to get the legs the same length again and did deep tissue massage on the glute. We also did some exercises to get me using the glute normally. I told him I had a hill workout the next day and he said as long as it didn't bother me while running, I would be fine.

So the following day, Thursday, I ran a hill workout with tempo runs in between the hill sprints. Running up and down hill felt fine. The tempo run felt fine. I could feel a slight pinch, but it was totally mild. BUT - just like Tuesday, the cool down run was very painful. I was stiff and it was hard to move. 

By Friday, my glute muscle seemed to be in good shape but now the lower back pain around the SI joint was more prominent. That's when I decided to see a chiropractor. In retrospect, I should have gone to the chiropractor the day after I deadlifted (9 days earlier) but I didn't think to do that because it was such a minor issue. He told me my SI joint was out of place and he gave me an adjustment to put it back in place. I unfortunately didn't feel any relief from the adjustment but he said it worked so I assumed everything was ok. 

The final straw
The next morning (March 26), it was time for my longest run of the cycle: 23 miles. My plan was to run from Leesburg to Falls Church on the WOD so that the run would feel like it had a purpose vs. an out and back. Greg and I would drive to Leesburg, he would run the first 8 miles with me, turn around, get the car, drive to Falls Church and pick me up. 

I was nervous about this run and I was debating if I should even do it. On the one hand, I had visions of the run making the issue so much worse and having to stop on the trail. On the other hand, things felt fine and I really wanted to do the 23-mile run. I was totally looking forward to it and once that was complete I told myself I could take a few days off if needed. I wish someone had told me that you should take it easy the day after a chiropractic adjustment. But I hardly ever get adjustments, so this is all new to me. Also, if I knew that was the case, I may have delayed the adjustment until after the long run!

Greg and I ran 8.5 miles together and then it was time for him to turnaround. I did feel the pain around my SI joint, and it was slightly worse than it had been on the previous weekend's long run. But still manageable. When he turned around, I was fairly confident (let's say 80% confident) that I would be able to make it to 23 miles. Or at least 20, which would still be plenty. 

I continued on my own and I stopped briefly at mile 10 to toss my water bottle in a trash can and take a gel. I noticed that my glute and hip were a little annoyed, and the first few steps after the stop were difficult. But once again, totally manageable. But after another mile or so, things really started to go south! My hip started seizing up, my glute was in pain, and my lower back hurt even more. Over the course of 5 minutes, everything started going crazy until I was forced to stop. At 12.09 miles.

I was about a mile away from a shopping center where I could sit inside a Starbucks, call Greg from my Apple Watch and wait for him. But I couldn't walk! I just stood there on the side of the trail feeling paralyzed. Lots of people asked me if I needed help but I told them I would be fine and I was going to call for help. Thankfully, I was very close to a break in the fences/grass/trees that surround the trail and was able to slowly get myself into the back of a parking lot of an office park. If this had happened at mile 15, 16, or 17 I would have been screwed because that's "no-man's land" and there are very few trail exit points.

The pain got pretty bad and it brought me to tears. I knew that Greg still had to run 4-5 miles back to the car in Leesburg so I called my friend Cheryl who lives in Reston. I knew I was in Reston (it was technically Herndon) and I gave her the name of the of the business I was standing in front of so she could find it on Google and come to me. The main reason I needed Cheryl was because it was 49 degrees and I was wearing a tank top and shorts. That's perfectly fine attire if you are moving, but it got cold very quickly when I stopped moving. She found me shivering with blue lips and gave me her jacket as I sat in her warm car. There, she gave me tons of info on SI joint pain (she's dealt with it) and we waited for Greg to come pick me up. Greg called the chiropractor who I had seen the day before and got me in to see him immediately. Thank goodness!

The chiropractor said the SI joint was still in alignment but now the hip was out of alignment and all the muscles around the glute and hip were extremely tense. He corrected the hip, but I still had a ton of difficulty walking around the rest of the day. 

Recovery
I spent the rest of Saturday and all day Sunday icing the area, taking Aleve and using my Rapid Reboot compression system for the hips and glutes. I already had a massage scheduled for Sunday and she did deep tissue work and cupping. Most all movements were difficult. Especially going up stairs, bending over and sneezing. Sneezing was the worst of all. 

On Monday I was back in my PT's office for dry needling and a walk on the Alter-G anti-gravity treadmill. The walk was to help my brain realize that everything was okay, I could walk normally, I didn't need to tense up and brace for pain. On Tuesday I was able to get in with my sports medicine doctor who finally provided me with some clarity on the situation. 

Official Diagnosis
According to my doctor, it's most likely SI joint inflammation with tension of the surrounding muscles and inflammation around the hip (trochanter). She said there was a slight possibility that I had a bulging disk, which could only be ruled out through MRI. I definitely wanted to rule out a bulging disk, so I am getting an MRI next week.

Because it's most likely inflammation and muscle tension, she prescribed a therapeutic dose of Naproxen (NSAID) and continued PT. If my symptoms don't improve within a week I will go back for a cortisone injection. Normally I would try to avoid an injection, but with Boston coming up, I will do whatever is needed to get to the start line feeling good.

So for now it's rest, PT, and NSAIDs. Once I start to feel better I will attempt running again. I'm going to be fairly conservative, as my goal is to get to Boston feeling good. I don't think I can salvage much training at this point. Most likely it will be a full week off of running and then short, easy runs as I gradually return. 

I can now walk with a normal gait and the pain isn't anywhere near what it was over the weekend. I am seeing dramatic improvements each day and I hope this trend continues. This certainly sucks, but I wasn't trying to PR at Boston anyway. I just want to be healthy when I get there.