Saturday, March 21, 2015

PRP - Platelet Rich Plasma Will Help Your HHT - High Hamstring Tendinopathy

A very unoriginal title but I do that purposely in the hopes that someone searching on google for more information will come across this blog.

I won't bore you with all of the details because if you really want to know everything, I have about four or five blog posts that detail my experience with this dreaded running affliction.  So here's the long and short of it.

For the past two years my running performance and corresponding pain was spiraling downward.  I had a dull ached and tightness that just did not allow me to run fast.  Over time, my race performances got worse and worse.  I had numerous poor performances in road marathons like Houston in 2012, Boston 2013 and Little Rock 2013 and equally poor performances in trail ultras.  The final nail in the coffin came last May at the Jemez 50 Miler when I limped in the 50K and could barely walk, much less run.  I was not long after that, that I could no longer run at all.

I searched high and low to find out what type of injury I had.  For years I thought I had sciatica or piriformis syndrome.  One doctor (unfamiliar with running injuries) was sure it was my back and this was just referral pain so he gave me a steroid injection.  As if.  After another doctor who listened very well did a piriformis injection and that ultimately failed as well, I then began to look at what else it could be.  After some more research on the internet, I came across HHT - High Hamstring Tendinopathy - my symptoms fit it exactly.

The only options for HHT is rest in the hopes that the tendon will recover, or PRP which costs $1500 for the bilateral injection.  I chose to wait for three or four months to see if there would be any improvement.  So from July through November I did not run hardly at all.  I played tennis to maintain my sanity but otherwise grew pudgy and for the first time in 16 years, I started to get ''out of shape".

In late November and early December, I thought enough time might have passed that I could run again and so I slowly tried to run but to no avail.  Nothing had really changed.  Maybe slight improvement, but there was still no way I could ever compete again.

So on December 12th, I finally had the PRP injection done and coughed up the $1500.  I was already out of pocket well over a thousand dollars for various costs like MRI and doctors visits and injections and the insurance is just a joke.  They only partially covered the things that did not work, and they did not cover at all the PRP which did work!!

So after the injection I had about 7 weeks where I did absolutely nothing except Rubik's Cube and Netflix.  What a sad hard time.  Luckily I also had to organize my 50K trail race, the Ouachita Switchbacks and that helped entertain me during this trying time.

Finally in early February, I slowly began to run again.  I could tell there was some change but not a lot.  I did do the White Rock 25K at a very slow pace and although this was encouraging, I still struggled considerably and for a time, I did not think the PRP worked.

But slowly over the following weeks, I began to run 15, 20 and then 30 mile weeks.  And each week, the HHT got a little better.  I really noticed it in my daily life.  I could bend over and pick something up without pain, I could drive in the car for long periods without pain, I had much greater flexibility and just felt so much better.  So even if the running did not get better, this in and of itself was worth the money.

BUT THE RUNNING DID GET BETTER!  I started to feel well enough to run fast.  At first it was limited effort like a single 7 minute mile.  Then I ran a 5K a couple of weeks ago.  I ran 20:35 which is about 3 minutes off my best, but more importantly, I did not really have any pain or discomfort.

Then this past week was just a major breakthrough!  I've been on Spring Break and since we returned from a skiing trip, I've run 7 miles twice a day and I've run it at a good solid training pace without any discomfort.  Today I did a ten mile hard and hilly forest road run and it was just like old times!

I have a half marathon next week that will really test things but I expect I should be able to run without much trouble - or at least I hope!  Naturally I am much slower and I will not be running any where near as fast as I used to but I am beginning to think that with careful training, stretching, rest and monitoring of the formal injury, that I might just yet have a second act in competitive running.

So if you are like I was and searching for some cure, some hope, some answer to your HHT, I sympathize with you.  I did the same thing.  There is a lot of conflicting information out there and that makes it even more difficult.  But my advice would be to have the PRP done.  It really worked for me.  Don't expect an instant cure.  It will take months and months to get better.  It's been four months since the injection and only now do I feel like I am a runner again - able to run without pain and carefree and  really enjoying it for the first time in two or three years.  So for me, that is a cure even if I am never really competitive again.

Wednesday, December 31, 2014

Good Riddance to 2014 and Optimism for 2015

So for my ultra trail running and backpacking, 2014 was pretty much a bust.  The worst year I have had since beginning in 1999.  This was because of an injury which had deteriorated in throughout 2013 and led to many painful races in the early part of 2014 until Jemez 50 in May that was so painful, it convinced me that I needed to seek more medical help and eventually to stop running altogether at the end of June.

The good news is that by the end of July I had a firm diagnosis confirmed by MRI of Proximal Hamstring Tendinopathy after years of thinking I had either sciatic pain or piriformis syndrome.  I had several months of relative rest hoping the problem would go away and finally on December 12th, I laid out some big bucks to have bilateral Plasma Rich Platelet injections done.  The healing was either non existent or so incremental to the point that I thought that I might never get better.  It was really a no brainer to have the PRP because even though I stood to lose a lot of money if it did not work, I could not go on without being able to run wondering that if only I had the injection, I might be back to where I was.

So where does that leave me now.  Well, after nearly 3 weeks, I am very encouraged.  Initially I had a period of regression immediately after the injection, but that is to be expected because of the injection itself and the healing is expected to begin two to three weeks later and can continue to improve for six months.  I really feel like I am now at the beginning of that period.  I can drive without discomfort, I can sit in hard seats, I can stretch with very minimal discomfort in the HHT area and am almost at the point now where I have almost no discomfort 24 hours a day.  That will be the first time that has happened in years!  So that is indeed encouraging.

What then can I expect from 2015?  I am not foolish enough to think I will be doing a 2:44 marathon again and I may not even be able to compete in ultras in the top ten, but I now have some expectations that I can again complete ultras.  And that means the world to me at this point!

So 2015 is now looking to include Jemez 50 Miler in Jemez Mountains New Mexico in May, San Juan Solstice 50 Miler in Lake City, Colorado in June, Beaverhead 100k which is on the Continental Divide Trail between Idaho and Montana in July, Multi-day hike on the Colorado Trail also in July and then the Run Rabbit Run 100 in Steamboat Springs, Colorado in September for which I had to postpone my entry last year due to injury.  That's just the summer schedule and I haven't yet decided about next fall.

January will be continued total rest and rehabilitation.  February and March I will slowly begin training again.  April I will work in a 50K or two to build endurance.

It's an ambitious schedule but I am full of hope and optimism and have only in mind to complete these events and not compete in them.  I think too that if I can get fully recovered, then I can better manage the tendinopathy and then hopefully never again get in the condition that I was in this past year.  I think the biggest reason for this injury was weekly mileage in the 70 to 100 mile range without ever a break and so I just ran this injury into the ground until it finally forced me to stop.

So that's my hope.  I will check back next year hopefully with the full satisfaction that I had some great races!

Friday, December 12, 2014

Ultrarunning and High Hamstring Tendinopathy - Part V - PRP Baby!

After finally exhausting all other options, today I finally went ahead and got a bilateral plasma rich platelet (prp) injection at the ischial bursitis insertional point of the proximal hamstring tendinopathy.  Say that five times fast.  It took me four months to memorize that diagnosis.

A little update on my progress since my last blog.  I have returned to running two to three times a week.  The really good news is that my gait and stride have returned to normal after nearly five months of relative rest (I still played tennis and had one or two runs per week of 3 or 4 miles and they were very slow).  The fact that my gait has returned to normal and my right foot has stopped flaying out I take to be a good sign that the rest is helping albeit very slowly.

In the past two weeks leading up to the injection today things really improved.  I had two runs of about five miles each where I felt only a little discomfort and during the first run I through in a seven minute mile and then during the second run a couple of days later, I was able to somewhat comfortably run a 6:35 mile.  That is the first time that I have been able to do that in 8 months!

Then yesterday I went for a six mile run hoping to maybe even throw in a 5k speed work.  If I could successfully do that, then I was going to forego the PRP.  But as it would turn out, I really struggled.  It was humid that day and humidity definitely seems to make my condition worse.  The good thing about that run was it sealed the deal for me as I knew I needed the PRP because quite frankly I could tell that this was nothing near normal in spite of a few good miles.

As for the injection.  I had read a few blogs and reports that the injections were painful.  Not so, it was surprisingly easy with just a few needle injections.  Actually four for me.  Two to get blood out, and two to put blood in.  Dr. Stanley did mention that the needle is not long enough because the company doesn't make a 2 1/2 inch needle and that makes it more difficult to get to the place that the prp needs to go.  I asked what effect that might have and now that I think about it, didn't really get an answer.  As I understand it, the prp will still be where it needs to be in the tendon and the ischial tuberosity or at least that's what I hope.

One caveat for other sufferers who are going to get PRP, a few hours after the injection, you will become very sore.  I have trouble just bending over and picking things up because I am so sore.  This is suppose to only last for a couple of days.

So now the wait begins.  Dr. Stanley ordered four weeks of no running and I will certainly oblige because prp ain't cheap and I do not want to do it again.  After that, I am hoping to start trying it out and hopefully it will be even more improved than it was right before the injection.

At times I have hope that I will be 100% again and can be a competitive marathon and ultra runner again.  But sometimes I feel that the reality might be that I am limited to slow running and hiking in which case, 50 miles would probably be the furthest distance I would be capable of.  Only time will tell. I will certainly continue to up date my blog.  I will let you know how the first run post prp goes one month from now.

But with my gait and stride returning to normal and continued and steady improvement, I may yet be running as I used to.

As always, if you are a fellow runner and sufferer of HHT, share your experiences.  Together we may be able to beat this thing.