Sunday 25 September 2011

The last 12 months

It's a year almost to the day when I posted about my injury and intention to get surgery to the groin injury which I had picked up during the 2010 Atacama Crossing, and prevented me running more than a few miles from March until October 2010.

I had that surgery on November 4th 2010. The procedure wasn't available on the NHS, so I paid £2k for it to be performed privately in a BUPA hospital near Cardiff. I rather unusually requested the open surgery procedure to be performed under a local nerve block, rather than under general anaesthetic. The surgery and anaesthetist agreed, though I did request some light sedation just to 'chill me out'. Apparently I was asking all sorts of babbling questions during the procedure about hospital infection rates, and all sorts, and in fact drifted off to sleep for 20 mins of the 45 min procedure, listening to my ipod.  I was very nervous before the procedure, but it was all fine in the end.

I wasn't able to go home the same day as they couldn't get the post-op pain under control once the local nerve block had worn off. I managed to stand up briefly but had to lie back down. As a result I spent the night in hospital, no extra charge and they fed me very nicely too. The hospital experience was very good, as you'd expect when paying for a private procedure.  Mastercard were even more thankful for me going private. I spent the next week at home in quite considerable discomfort, not really able to move around. The scar is just above my groin on my right side and only the length of my finger.

The surgeon had cut through all the layers and used sutures (nylon stitches) to reattach my conjoint tendon to my illioinguinal nerve. They had become separated, causing the pain, and would never have healed left alone. The surgeon had then stitched all the layers back together, and I'm left with a neat little scar that you'd have to know me very well to able to view now. Post surgery the area swells as it heals, looking fairly unpleasant. I didn't suffer from any infection, and changed the dressing, and finally removed it about 7-10 days later. It was very sore for several weeks, walking was painful. The surgeon said some people were able to run gently about a month later, but 6 weeks was a better time to try. In the next 6 weeks I took it easy, doing gentle stretching and where possible tried to avoid sneezing, which caused what I can only describe as unimaginable agony.

So, on Christmas Day 2010 I took myself out for a run, as a Christmas gift to myself. It was a cold, slow and painful run or little more than 3 miles. I didn't expect to be pain free, but it really was very sore. However, I ran about 2 miles up to a local viewpoint, stood rubbing the wound for a few minutes and ran painfully home. It wasn't a hugely inspiring run, and really just illustrated that this was no instant fix, and I could face a considerable amount of rehab.

Over the next 2 months I did a daily core strength routine, consisting of 10 exercises to strengthen my gluts, adductors, trans-abdominals and just about every other muscle in my between my knees and solar plexus. I tried to run once or twice a week two, but there was no real improvement; just pain during the run, and pain for 2 days afterwards. I did notice that sneezing no longer hurt (it always hurt pre-op). By March I was still doing all the strength work, and could run 6 miles, but it all still hurt. I read that the procedure isn't successful in all cases, and contacted the surgeon. He said he wasn't keen on going back in and performing a adductor tendon split (which can help some people). He said just to persevere with the strengthening. 

By the start of April, almost overnight, the strengthening seemed to pay-off. The pain reduced dramatically, and I could run 8-10 miles with only mild pain during and after. Getting ahead of myself I decided to take part in the Sandstone Trail Challenge on 9th April. 33 miles from Frodsham to Whitchurch. I was under no illusion that I couldn't run that far, so walked for 20 mins and ran for 5-10. I repeated this until about 25 miles at which point my groin had realised I was taking the piss and brought me back down to earth. I walked almost all of the last 8 miles, in quite considerable discomfort. Served me right to be honest. It took me 8 hours and 23 minutes.

By July I had to decide if I would pay the balance for the RacingThePlanet Nepal race in November. I had entered a year previous before I knew the severity of the groin injury. I had the option of just losing a deposit. So, I continued to train. I had good days and bad days. One day I'd run 15 miles and not suffer too much discomfort, other days I would get some discomort still, just part of the healing process I guess. I did the Baslow Boot Bash in June in a reasonable steady time. In July I set myself a test; 3 long distance events on successive weekends. If I got through with no or low levels of pain, I'd pay for Nepal. So I entered the Peakers Stroll, a very hilly LDWA event of around 22 miles, then 6 days later the Harden Hard'un, another notoriously hilly moorland run of 27 miles, then the 20 mile John Knox Challenge a week after that. I managed all with a either no pain or just a minor twinge, and figured there was enough to try and build on with 3 months left.

I went back to see Jarrod, the physio at Pure Sports Med in Kensington. I thought I had built up good strength, but an hour long session showed that whilst I had made huge improvements in some areas, I had not properly addressed all. He gave me a fairly punishing routingeof just half a dozen exercises to do 4 times a week which take around an hour. I did them diligently and a month later at my next appointment I was considerably stronger, and was getting less pain. Jarrod said he didn't need to see me again, but I would need to continue the exercises to keep the areas strong. I'm still doing them now.

In August on successive weekends I entered the 15 Mile Gritstone Tryal, a navigation run, then the 26 mile Mile Dovedale Dipper, then the Salisbury 54321, a 30 mile race. I completed all successfully. Still, I'm sore the day afterwards, but it's not too bad. 11th September I did the 22 mile hills and dales, and suffered some discomort in the last 2 miles. I'm not sure if it was the rough and slippy terrain, but the follwing day I was fine again. A week later (last weekend) I completed the High Peak 40, albeit quite slowly in 9hrs 40 mins. I didn't get any serious groin pain though. So, I think the groin still continues to improve.  The pain I get is really very low level now, and I expect coming up to 12 months post-op I'll almost forget I had it.

The course notes for Nepal are out and they are quite scary. 9,000 meters of elevation across the course of 250km. A marathon for the first 4 stages with at around 1 mile of vertical ascent each day. One stage has 1200m of ascent over just 6 miles. Stage 5 is almost 50 miles in length. The terrain includes narrow hand carved stone steps, and 10 narrow suspension bridges, sometime only 1 person can pass at a time. The organisers warned that serious hill training would be required.

I changed the rest of my schedule, to ensure I take on much tougher races. Next weekend it's the Black Mountains 30 in Wales, with around 2200M of ascent. A week later the Talybont Trial 20 in Brecon with around 1500M of ascent. Two weeks after that I fly to Spain to do the Ultima Frontera 80km race, with has 2700M of ascent. The following week I plan to train for the whole weekend in Snowdonia. Two weeks after that the 26 miles Six Dales race, which is relatively flat, but it's 3 days before I fly to Nepal, so I need an easier week.

I haven't trained with any weight really, 2 or 3 kg's. I will probably walk to work with 10kg packs from next week, but I won't run with any weight; too much risk of injury. I'm getting in an least 2 gym sessions every week to maintain my core strength, and doing some speed work mid week too. I genuinely don't know how Nepal will go. I'm not the runner I was in the Atacama 2010, but I hope I'm patched up enough to have a good go. I may make the first couple of days and do ok, and nut we'll have to see as the week goes on. I hope I can finish the race. I'm in good company at least; Ryan Sandes and Marshall Ulrich are taking part in the race, amongst others.

Most of my travel to Nepal is booked. I was about to book the last internal flight when news of yet another tourist plan crash in Nepal, with 19 deaths, broke today. Nepal has an awful record of aviation disasters. The road's are not much safer either. I may well take a 6 hour bus ride instead of the plane, but I'm not sure either is a better bet.

So, that's the last year. It's not a fairy tale, but 12 months ago I didn't think I'd be able to run more than 10 miles again in my life. The surgery works, but a lot of hard work has to follow, to strengthen and address the core weaknesses. I don't think it will ever be quite the same again, but it's an improvement, and I'll take that. Nepal is 2 months away, so I'm continuing to train and hope for the best.