Like every endurance athlete, I have not been immune to injuries over the years. Last year I wrote about some patella-femoral pain. A few ski seasons ago, I suffered through 3 weeks of very painful peroneal tendonitis (pain in my outer ankle). Otherwise most of my aches and pains that have subsided relatively quickly.
|Racing the Noquemonon circa 2006. It was a crappy snow winter in the UP. Photo: good ol' Bud Hart!|
This shoulder pain has briefly crept up now and then but has always been short-lived.
It came back with a vengeance around the beginning of April this year. I’m not exactly sure what set it off. I was fine skiing and canoeing at the end of March and then it started. I fell on ice on my bike but don’t recall the pain starting then. After thinking about this more, maybe it was crossing between a couple ponds on some logs during an Orienteering Meet where I was using a stick for balance and then near the end lost my balance and fell onto the stick kinda hard. That’s the best mechanism of injury I can come up with.
Anyway, the pain was again located in my right anterior shoulder. Unlike previous times, I didn’t have any pain with raising my arm above my head or hanging on my pull-up bar, but as soon as I started lifting myself up to do a pull-up, the pain occurred. I also got the pain when biking- when starting out of the saddle and cranking down on the pedals. I felt it a few other times with internal rotation and pulling force directed away from my body.
Given that I’m a health care professional who frequently sees shoulder pain, I did some self-diagnosis. This was definitely anterior impingement. Physical therapy was in order, but I deferred, hoping it would get better, and did 400 painful pull-ups throughout April. Stupid, I know, but I’m headstrong and too determined for my own good half the time.
When we got that April snowstorm I got pretty down as I realized poling, especially the double pole, really caused pain. I hadn’t had pain skiing with my previous shoulder injuries.
May 1st was time to start rollerskiing. I did, painfully and knew it was time for rehab.
Anterior shoulder impingement is at least partially caused by overworking the “beach muscles.” Now, I don’t intentionally build up my pecs, it just sort of happens with push-ups, pull-ups, and skiing. Upper body strength is one of my natural powers as an athlete. Maybe I shouldn’t be so proud that I can walk into a weight room any day and bench 100 pounds without training. I may never run a sub-six minute mile, but I can hold my own on the bench press. Since my first shoulder injury, I’ve also noted that my shoulders tend to naturally be in a more forward position. This further exacerbates the problem.
|My shoulder position. On left, I'm squeezing my scapulas together to try to get my shoulders back. You can see from my chin that I'm consciously thinking about this. On right, my natural relaxed forward shoulder position. Photo: Erik|
First, I quit doing pull-ups that were causing me pain. Time to let my pecs atrophy a bit. To maintain some strength, I did keep doing push-ups since they didn’t hurt. Next I started doing pec stretches more diligently and a squeezing the scapulas (shoulder blades) together exercise. Then I added in strength exercises for the posterior shoulder muscles with a Thera-Band.
Finally, I put our Total Gym to good use.
|Using the Total Gym like a rowing machine to work on my posterior upper back muscles. Photo: Erik|
It took a couple weeks to no longer feel the shoulder pain but boy, I sure did appreciate being able to open doors and bike without the pain. Next up was a trial of rollerskiing. I told myself I had to be able to double pole before I could even attempt pull-ups. I didn’t have pain with rollerskiing but noticed that after an hour of mostly double poling I had slight pain. I continued doing my shoulder physical therapy and after a couple more weeks I didn’t have any pain at all from rollerskiing.
After an entire month hiatus from pull-ups (it’s been several years since I’ve taken that long off from pull-ups) I gave them a try. Most of my pain during pull-ups occurred in the initial pulling myself up to the 90 degree bend in my elbows. Hence, I tried starting in maximum pull-up position and then lowering myself to 90 degrees. This caused pain so I gave up for a couple weeks. When I tried again I had success with this partial pull-up but wanted to ease myself into it so only did 2 x 5 sets. Well, OK, I did like 6-7 at a time and then gradually used different hand-holds to vary my pull-ups.
This entire experience taught me that I need to be more diligent about mixing up the strength training. I know I wrote about this last year and I’m fairly good at doing a variety of cardio activities in the off-season (rollerskiing, running, biking, canoeing, hiking) but other than abs, I tend to do the same strength routines week in and week out. This made me realize I need to vary my strength workouts and in particular, pay attention to my shoulder muscle stabilizers (like the deltoids) and my posterior shoulder muscles and reminded me of the slow, but immense benefits of physical therapy. I can’t just do push-ups and pull-ups:)
All this made me come up with a new pain scale for athletes. When I’m in pain from injury, here’s my cascading pain scale:
Stage 1: Does it hurt all the time? If yes, then things are pretty terrible. Hopefully this won’t last too long. If no, then things could be a lot worse.
Stage 2: Does it hurt to do normal daily activities? This means no pain with walking, turning, opening doors, and getting around for work, shopping, dishes, etc. If yes, see above. If no, life is good.
Stage 3: Can training be modified or can I do some activities without pain? If no, I’m still in the step above. If yes, then life is really good.
Stage 4: Can I do my normal training without pain? If yes, then life is exceptional and I really shouldn’t complain about anything.
While rehabbing my shoulder, I sustained a crush injury to my left knee. For several hours, I had constant pain. The best thing I could do was to continue with my activity for the day which involved helping cut down a big oak tree. Just before bed, fortunately, the constant pain stopped. I’m a side sleeper though and it was difficult to find a comfortable position as my knee hurt on both sides with even light pressure.
|An admittedly bad picture of my knees a few days after the crush injury.|
I was able to canoe and started biking two days later but my swollen knee wouldn’t bend and so I had to exclusively ride out of the saddle. On day three I could mostly walk without any significant pain. I started rollerskiing this day and was pretty happy that I could skate rollerski without pain although I had to avoid all the cracks, even the small ones, as going over those caused pain.
After a week I tried running. It hurt badly. I’m not sure what I was thinking since fast walking was still painful. I could jump all I wanted on my toes, but as soon as my heels struck the ground I had the pain.
The Leiderhosenlauf, two weeks after the injury, went comically awful; however, 1.5 weeks after the injury, we did our usual 1 kilometer double pole and legs only time trials as part of our Vakava workout. Somehow, despite this mega crush injury that would keep me from running for over a month, I managed to log my fastest legs only time (skating without poles) over the four years we’ve been doing this. Erik hypothesized that I was so fast because I was essentially tapered from all those track intervals. Maybe the strength work of riding out of the saddle also helped.
I was just happy I could do strength and rollerski and that I was in stage 3 above and could modify my training.
It took three weeks before I could fast walk without pain. I had to constantly remind myself that my knee was getting better- I could rollerski over even the big cracks with no pain. At four weeks I ran a 12 minute mile. If I kept it really really slow, I could run pain free. Although I’m not really sure 12 minutes a mile is running. It’s more of a walk-jog.
All this became a real test of patience for me.
It took five weeks before I could do 2.5 miles at 12 min/mile walk jog pace but even then I noticed the next day my knee was a little sore. Meanwhile, I road biked 28 miles, mostly riding in the saddle, without any setbacks. Despite all this, my knee was still sore enough that if I wore tight pants it caused discomfort!
5.5 weeks and I could manage 10 minute miles running without pain for 2.5 miles. At 6 weeks I was finally able to run in the 9 minute/mile range for 4.7 miles. So it took 6 weeks to get back to running.
While I was bummed to not run and hence missed out on some training, I’ve also been kinda excited. I haven’t taken a break from running in six years. This means I maintain a baseline level of fitness that many of my Master’s colleagues don’t. Hence, those colleagues benefit from better periodization in their training. Now I’m looking forward to crawling back after this periodization. It’s what I’ll be doing with pull-ups and now what I’ll be doing with running as well.
|Finally back to rocking the pull ups:) Photo: Erik|