Patellofemoral Pain Syndrome

So my knee pain is what is known as Patellofemoral Pain Syndrome.

Patellofemoral refers to the joint that includes the knee cap or the patella and the thigh bone or the femur. It can result from malalignment of the patella on the femur, weakness of the quadriceps muscles, or tight structures on the lateral aspect of the knee.

Pain may be felt behind or around the knee cap, grinding noises may be heard during bending or straightening the leg, the knee may feel like it gives-way without any particular reason, or some mild swelling may be noted around the knee.

Many times conservative treatment of pain relief, strengthening, and stretching may relieve symptoms. The primary goals of rehabilitation are to re-establish motion, power, and stability to the joint.

If you really want to know more about the injury, click here.

So I've been instructed to stay off the bike for a week or two and limit my runs to 5-7 miles. I'm not happy about this, but an injury now is something that I can recover from and still be in good shape for my long-distance triathlons. If I don't heal up properly, this will be a nagging injury for months.

I've incorporated some stretching and strength building (especially my hip abductors) into my routine and will be doing some weights on days that I normally bike. I also see a lot more swimming coming in the next few weeks!!

My 2010 Race Calendar

Several of the races that I plan to compete in this year have set official dates and opened up registration. For the most part, they are right when I anticipated...which is good since I've based my training plan around these dates!

Orange = date set and I'm already registered
Red = date not yet confirmed

3/6/10 - Anthem 5K (Run)

3/28/10 - Shelbyville Triathlon (Sprint Triathlon)

4/3/10 - Papa John's 10 Miler (Run)

4/24/10 - miniMarathon (Half-Marathon)

5/15/10 - Taylorsville Triathlon (Half-Ironman Triathlon)

7/17/10 - Cardinal Harbour Triathlon (Half-Ironman Triathlon)

8/15/10 - TriIndy (Olympic Triathlon)

9/12/10 - BoilerMan Triathlon (Olympic Triathlon)

10/17/10 - Louisville Marathon (Full Marathon)

This is the plan...we'll see how things shake out. Some of these are first time events for me and others are ones that I've done in the past and the goal will be to set a new PR.


TODAY'S WORKOUT:
My knee was hurting this morning so I decided to put the planned run on the shelf and head over to the Mary T. Meagher pool for some laps. To my disappointment, the full 50 meter lanes were cut in half. They had the dividers up because there were a few high school swim teams practicing and they needed the 25 yard distance. After a quick warm-up, I decided to swim for an hour straight. Felt pretty good and managed to cover approximately 2,700 meters (1.68 miles) in 1:00:33 - for a pace of 36:05 min/mile.

Sounds Like I Need a Wetsuit

So I've registered for the "Score Clinic Triathlon" in Taylorsville on May 15th. It's a 1.2 mile swim, followed by a 56 mile bike and a half-marathon (13.1 mile) run. The swim is a two lap rectangle in Taylorsville Lake. The bike course is "challenging but scenic" on rural roads passing through several small communities. The run course is an out and back with several challenging hills. Sounds fun, huh?

After talking with a few people that competed in this triathlon last year, sounds like the water is still pretty cold in May and everyone wears a wetsuit on the swim. I've discussed my view of wetsuits in the past. The rules state that if the water is at or under 78F, then wetsuits are legal. My beef with this is that 78F is warm water. The idea behind the wetsuit is to protect your body from hypothermia in cold water. Wetsuits not only keep you warm, but are also very helpful when it comes to swimming faster. This is why people wear them even when the water is comfortable (i.e. 78F).

At this point, I'm going to assume that I'll need a wetsuit come May. So which type of wetsuit is best? There are full sleeve wetsuits and sleeveless wetsuits. The sleeveless variety will offer greater shoulder flexibility, but your shoulders and arms may get cold without the added protection. You will be kept the warmest in a full sleeve wetsuit. Then there's the issue of cost. How much am I willing to dish out for a suit I might only wear a few times????

YESTERDAY'S WORKOUT:
2:25 on the bike. Pretty steady pace throughout. I didn't push it too hard considering I felt a little twinge in my knee with every pedal rotation. I completed the workout, but I paid for it the rest of the day. My knee was pretty sore once it stiffened up...looks like the bike workouts might be on hold for a while!

TODAY'S WORKOUT:
Even though my knee was still a little sore this morning, I decided to go on a run anyway. The duration was cut in half at the advice of the PT. Had a good 7.40 mile run in 0:57:15 for a pace of 7:44 min/mile. My knee felt good after about a mile or so. However, once I quit running, it tightened up pretty quick. I'm starting to see a lot of swimming in my future until the knee heals up!!

Dealing with an injury

I've been very fortunate in the injury department. I've been training exclusively for triathlons for a little over 13 months now and I've yet to have any major injuries. A shin splint and a sore shoulder are all I've dealt with and neither kept me out (running for the shin and swimming for the shoulder) for more than two weeks. This recent knee issue appears to be nothing major.
I went to see my buddy Kevin at the Rudy J. Ellis Sports Medicine Center yesterday and he checked my knee out. Looks like there's no damage to the knee itself, it's just a little stressed from the added mileage. After getting the knee warmed up, he worked it a little bit and then did a quick tape job to help support the patella (knee nap).

Most likely this recent knee pain is caused by weaker hip abduction strength than I need for running the amount of miles I've been logging. He gave me some exercises to strengthen my hip abductors and told me to try a long run with this tape on my knee and see how it felt. See results of this morning's run below...

YESTERDAY'S WORKOUT:

Plan was to get in 2hr 15min on the bike. After only 7 minutes of warmup I realized that the knee was not going to make it. I could have ridden through the pain, but since I still wasn't sure what was going on, I decided not to take a chance on turning a minor injury into a major one.

I had to improvise and after doing 45 minutes of weights (chest, arms, abs), I took out my frustration on the pool!

I swam 1.0 mile in 32:27 (my fastest time ever). I felt good and didn't really push it until the last few laps. I was pretty pleased with my time.

TODAY'S WORKOUT:

I'm a little annoyed that my iPhone battery died before I finished my run. This means that my RunKeeper data was all jacked up. This is why I still wear a watch! I had to go old school and map my route once I got back using MapMyTri.com.

Ran 14.12 miles in 1:52:15 (7:56 min/mile). I'm real happy with this time considering there were lots of hills. As a side note...no knee pain whatsoever!

Avg HR - 154 BPM

Max HR - 167 BPM

Injuries...

So after my 10 mile run on Tuesday morning I noticed some slight pain in my right knee. I felt fine during and immediately after the run...it was only when I got to work that it began hurting. I went on with my day and put ice on it for about 10 minutes that night. It was a little tight when I woke up yesterday so I was sure to do a good warm-up before running my intervals. Knee loosened up and I was pain free during my run and swim. Started hurting again during the day yesterday, so I iced it again last night. This morning it was worse...and it hurt for the entire 135 minutes I was on the bike.
The only part that hurt is my knee cap. No pain on either side of my knee and it especially hurts when I bend it (thus the pain on the bike). So do I have a serious injury or is it something that I can work through? I plan on stopping in to see my PT buddy tomorrow to find out!

This sudden knee pain got me to thinking about treating injuries. What injuries should you ice and what injuries should you apply heat to?
The rule of thumb is to apply ice an acute injury and heat a chronic injury. Ice constricts blood flow to muscles. As the muscle cools, the amount of blood in the muscle diminishes as the constriction process pushes it out. This is great to help reduce bruising, swelling and discomfort. As the muscle warms and the blood vessels expand, new blood comes rushing in and cleans the debris left behind from the injury and stimulates the healing process. It is recommended that ice is only applied for 10 minutes every hour. The more often the cycle is allowed to transition, the faster one’s body can recover from an acute muscle injury (injury having severe onset and a short course).
Moist heat is a great treatment tool for chronic muscle injuries (injuries persisting for a long time). Moist heat applied to the injury site opens up the blood vessels allowing blood to flow more freely. So next time you are dealing with an injury...make sure you are treating in a way that will get you back on the road!

TODAY'S WORKOUT:
2h15m on the bike. Nothing fancy, just a good, long aerobic ride in zone 2.
Avg HR = 127 bpm
Max Hr = 145 bpm

Running Intervals

TODAY'S WORKOUT:
Run- Did some pyramid intervals at the track in the gym. I call this workout "Twin Peaks"...for obvious reasons. Lap count was 2,4,6,8,6,4,2,4,6,8,6,4,2 with a minute rest between each interval. Here's a chart of my distance and pace.

While I try to maintain the same pace whether I'm going 2 laps or 8, you can see from the graph that I slow down on the longer intervals. Total time including warm-up and cool down was 1:04; total distance was 5.85 miles.

Swim- Did 50:08 without resting. Most of the workout was done at an easy pace. I worked on sighting and technique during most of the swim. I also counted strokes per lap (this helps pass the time). I was right at 22-23 strokes per pool length (24yd). A typical age-group triathlete may have a stroke length that allows them to complete 50yd in about 38 - 52 strokes (I'm at 46 strokes per 50yd), and a stroke rate of 54 - 64spm (strokes per minute). Compare this to an elite swimmer, i.e. Ian Thorpe - who would typically swim with a stroke count of 27 - 32 strokes per 50yd and a stroke rate of 72 to 76spm, and its easy to see how a swimmer like this moves faster through the water than I do.
Total distance for today's workout was around 2,328 yards (1.32 miles) - pace was 37:54 min/mile.

More on Sports Drinks

So yesterday I narrowed down my sports drink selection to the four that had what I was looking for in both sodium content and carbohydrates. I took a few quick minutes to do a price check on those four.
Prices are per Amazon.com, but I priced them elsewhere and there wasn't much difference.

Gatorade Powder - Makes 1 gal of gatorade per package, 40 packages per case = 200, 24 oz. servings: $58.94 ($0.29 per serving)

Gatorade Endurance Drink Mix - Makes 29, 24 oz. servings: $21.20 ($0.73 per serving)

PowerBar Endurance Drink Mix - Makes 17, 24 oz. servings: $21.95 ($1.29 per serving)

PowerAde ION4 - ??? I can't find pricing on this anywhere online. Maybe I'll check and see next time I'm at Walmart.

So clearly, buying "standard" Gatorade powder and mixing up my own drinks is the cheapest way to go. All I need is a 1 gallon container to keep in the fridge to fill my 24 oz. bottle from each morning. Any suggestions on flavor?

TODAY'S WORKOUT:
Run - 10.10 miles in 1:21:15 (8:02 min/mile pace)
Still trying to get these workouts in zone 2, but I'm having trouble keeping my heart rate high enough. I've sent an email to Joe Friel about this problem...we'll see what he says.
Avg HR = 151 bpm
Max HR = 161 bpm

Swim - 5 minute warm-up followed by 15 minutes of drills. I did some typical drills (catch-ups, fist swimming, one arms, etc.), but I also practiced some sighting. This will be crucial to a good swim time in open water. Good thing I practiced! I took in some water the first few times, but got in a good rhythm of sighting every 3-4 strokes. I'll continue to incorporate these sighting drills into my workouts. Finished off with 3 x 50 sprints.
1) 41.34 sec.
2) 40.21
3) 38.97