Runner World 08-09
August 2009 Image by Edel Rodriguez
Motivation: Runners' Stories
There are two types of injury—those runners talk about and those that matter. The athlete who joyously rattles off an encyclopedia of hurts while waiting for the starting gun will often actually win the 10-K. Nor does a Velcro splint or knee brace necessarily indicate serious disability. Often as not, you're being juked. While the runner whose Achilles tendon will force him to limp ingloriously to the sidelines after the first mile might not have mentioned it at all beforehand. I don't know why this is. Superstition? An unwillingness to display weakness? But when you're hurt, really hurt, isolation begins very quickly to compound the problem. I know because it happened to me. Having won my age category a couple of times in my late 50s, I was closing on 60 with the sort of glee that only another runner would understand. I was about to broach a new and slower age group. I was primed. I'd read dozens of books on running. I'd even written one. This was going to be my year. Then I began to limp.
And I'm the guy who, if people remember one thing about me, it's the marathons. If I bang into somebody I haven't seen in years, I get the blank look in the eyes while the stranger fumbles through cranial files, and then the question: "Still jogging?" Or if it's been snowing: "You didn't run in this?"
The answer for decades had been "Yes," and "Yes, of course!"
Suddenly I found myself pawing the ground with one foot and muttering about injuries and elliptical trainers. Which was fine, since most people—when they ask how you're doing—don't actually want an answer.
And yet I felt out of place, alone. First, I was cut off from easy access to my running friends. Hence my social life was reduced by half. Even if I had tracked down my best buddies, I would have missed the variety, the flash, and the dazzle of the big-group run. It's great to see my friends—people I've finished marathons with. But it's bliss when running with friends to fall in with somebody I hardly know and share confidences and have them shared. Because running companionships seem to exist on a plane that is almost entirely free of cant and pretense. I do see people for lunch and dinner, but a calendar of lunches and dinners couldn't fill the void. If I'm angry at somebody, I'll go for a run and talk it through. If I can't run with him, I'd just as lief not see him at all. Ever.
Nor did I care for the consolations of well-meaning acquaintances. "Now you can clean the basement, write that historical novel. . ." Every armchair doctor had a diagnosis. "All that pounding. Something's gotta give. You are getting old after all!"
The theory that the body will last longer if not used seems to have many subscribers, even though we use our bodies less and less. And also—I might add—enjoy them less and less. It's as if we're afraid of voiding the warranty.
Sure, we're staying active older—or some of us are—but the last time I checked, the body was a living organism, designed to adapt. A recent study showed that the runners were less apt to have joint trouble than the sedentary controls. Begun in 1984, the findings published in the Archives of Internal Medicine followed 538 members of a U.S. running club and 423 healthy controls, all 50 years old or older. The runners began to have the earliest forms of disability about 16 years later than did the controls, according to Dr. James Fries, a professor of medicine at Stanford University's School of Medicine. Nineteen years after the study commenced, 15 percent of the runners had died, as compared with 34 percent of the controls.
But now I was hurt. I was one of the unlucky ones. And I began for the first time in my life to feel frail. Sixty didn't look like fun anymore. I remembered "the bones" in Robert Frost's "The Witch of Coos," and began to carry myself "like a pile of dishes."
Words are magic, and the phrases tossed my way ricocheted around like advertising jingles.
The knees, the knees, oh, lord, the knees
They hurt as bad as doctor's fees.
Shins that splint, severe arthritis
Meniscus torn? The pelvis scanned,
Beware the iliotibial band.
Looking around, I couldn't help but notice an epidemic of pain out there in contemporary America. The guy who cuts my dog's hair had a disabling attack of back trouble recently, and the plumber, our best plumber, is considering an operation that would fuse several vertebrae. Neither of these men run. I number among my acquaintances a dozen men and women—some younger than myself—who have already had a hip replaced.
Recently I got on line at the local grocery store behind a slow-walking gentleman whom I heard discussing his knee replacement with the woman at the register.
My turn and I asked the cashier if she'd had a knee replacement. "I had three," she told me. "And the last one they cracked the bone. That's what hurts me now."
Shanon Brownlee's Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer reports that 100,000 American patients die each year from medical errors. Nobody's killing me. But for a while there I couldn't run. Which was killing me.
In a sport whose elite practitioners follow a workout with a bath in ice cubes, squeamishness is out of the question. What you don't want is that niggling tingle in the knee, that itch on the Achilles. What you don't want is to be told not to run.
A Pain in the Butt
"Pain is inevitable. Suffering is optional," writes Haruki Murakami in his running memoir, What I Talk About When I Talk About Running. I had had pain. Now I was suffering.
The timing was exquisite. I'd just published a book on running called Strides. I'd go out in the public and read from Strides about how running had changed my life. I'd read about how after my first marathon, I dreamed that I was flying. "Flying," I'd say, and then I'd gimp awkwardly out to the car.
Oddly, nobody ever confronted me in the parking lot. I hope this is because they were polite. I fear that it's because the American public is at this point profoundly cynical. In an age of licentious clerics and spendthrift financiers, why should they expect a man who wrote about running to actually run?
The pain had started in my right hamstring. This pain then migrated up to my right butt. There it settled, and on a bad day it would shoot all the way down to the Achilles. I went on the Web. I found the exact word I wanted: Piriformis.
Wikipedia defines "piriformis syndrome" as a neuromuscular disorder that occurs when the sciatic nerve is compressed or irritated by the piriformis muscle, which lies in between the pelvis and hip joint. I could imagine the piriformis choking at my nerve where it was threaded out of the hole in my hip. A nifty little condition. My piriformis didn't like it very much when I ran or—for that matter—when I spent all day sitting down and writing about running.
Although the fates seemed interested in targeting the activities I enjoyed, they took transportation as a larger theme, and so I also found it painful to move my right foot back and forth on the accelerator.
Decades ago, a chiropractor had diagnosed me as a victim of "fat wallet syndrome," and after having done what he could to slim it down, he recommended I switch my billfold to my left rear pocket. Now I moved it to my right front pocket, and put my right leg aside while driving, operating the brake and the accelerator with my left foot.
When I had been writing for three hours, I would put a plastic bin up on my desk, put my laptop on the bin and stand while I typed. I stretched. I took hot baths with Epsom salts.
I surfed the Web. There are gorgeous illustrations of the piriformis, often with the inflamed muscle looking like a piece of raw steak and the nerve in a navy blue. There are many out there in cyberspace being tortured by their piriformi. One correspondent wrote: "Massage, heat, mild stretches can help some, and if it's really serious, doctors can cut the muscle. . ."
I had a massage. Then another. I went to one chiropractor, then another. The second man said, only half joking, that if I quit my job and moved to Vermont, my symptoms would vanish.
I stretched as I had never stretched before. I iced myself. I warmed up and cooled down. But still the water was closing in above my head. In January 2008, I went on vacation to Mexico with my 22-year-old son. It was partly to show him that I could do it and partly because I so enjoyed his company, but either way, I took six days off. No running. No elliptical. Nothing. I believe this was the first time I had taken this many days off in three decades. Came home and went out for a nine-mile run. Afterward, I was limping.
Now this may sound petty to the rest of the world, but for me it was serious. Running is my anchor. It's not what I do, but it's what makes everything else I do okay.
I'm an American and know that every crisis requires a purchase. One of the top Google hits for piriformis at that time was the Sacro Wedgy. "In use almost 15 years" the ad copy informed me, "the Sacro Wedgy has helped thousands get relief from a variety of symptoms, such as sciatica, lower-back pain, hip pain, knee pain, and more. Relaxing on a regular basis helps the muscles slowly rebalance using gravity to do most of the work." I especially liked the part about gravity doing most of the work.
The Sacro Wedgy, for those of you who have never had the pleasure, is a triangular piece of plastic with another slightly larger triangle of plastic foam to put it on. You pile one on top of the other and sit on them. Costs $25.
I ordered my Sacro Wedgy in He-man blue, but it still wasn't exactly the sort of accessory you like to be seen with. Both of my sons have charming and beautiful young girlfriends, who are often in the house, so I was furtive about my Sacro Wedgy. I kept hiding it, and forgetting where it was hidden.
Finally, I switched to a lacrosse ball, which seemed to work almost as well. If somebody should spot it on the front seat of my car, I hoped they'd conclude, "Oh, he still plays lacrosse," instead of "The old man's got something disgusting wrong with his behind."
A friend in California e-mailed me that when his back hurt him, he'd wear his sacroiliac belt. And his back pain would clear up. Back to the Web. Maybe my problem wasn't my piriformis. Maybe it was my SI joints. I ogled many brilliantly colored pictures of my skeletal system. People who had been in excruciating pain had put on one of these belts and, miraculously, they were cured. This was because their sacroiliac joints had been injured and needed to be stabilized so that they could heal. Sounded right to me. I ordered a sacroiliac belt, and wore it everywhere. Then I wore it for a run. Afterward I was limping.
Ultimately, I decided that instead of the relatively inexpensive chiropractors and massage therapists I had to pay for myself, I'd see a much more expensive doctor for whom—because of my wife's health insurance—I'd have to pay almost nothing. The doctor I saw was a charming young woman, recommended by another runner who had been injured and successfully rehabbed. She was in her 30s. She had been a runner. I liked that. She was limping from her recent knee replacement. I didn't like that. She had X-rays taken, which showed nothing, except odd little bits of calcium floating around. She asked if I'd been taking a lot of calcium. I had.
The doctor bills—although insurance made my actual costs insignificant—were so sobering that I stopped running. I worked out almost daily on an elliptical trainer, but I DID NOT RUN.
The doctor sent me to physical therapy. I'd go in two times a week. First I'd lie down in a darkened room with a Transcutaneous Electric Nerve Stimulator (TENS) attached to my butt and calf. I lay still for 15 minutes. I often napped, which, incidentally, is good for most conditions and has not yet been patented. Refreshed, I'd move out into the big room where, with others, I stretched and lifted ankle weights and was yanked on by one of two physical therapists. The physical therapists were talented, thoughtful men, but there were only two of them with as many as a half dozen patients. So we never figured out for certain which stretches and exercises worked, and which did not.
Don't misunderstand me here. I thoroughly enjoyed my afternoons. But I was spending three hours a week now dealing with my injury. I was becoming a professional invalid.
It's a Mystery
After several weeks in physical therapy, I went back to the doctor. She asked if I was all better. I said that I was not all better. She sent me in for an MRI. I'm frightened of MRIs. There was an accident at one of the local hospitals not many years ago, during which a rogue metal tank got so excited by the magnets that it banged into somebody and killed him. And I have a friend whose aged mother went into a coma. They put her into the machine, which was then a completely darkened tunnel, and she woke up inside and died of fright. Or that's how it looked to him afterward.
I passed my MRI without incident, then went back to see my young doctor. She came into the waiting room with three manila envelopes in her hand and called three patients into three examining rooms. When she came into my room, she said the MRI didn't show anything substantive. When I said, "Maybe this is all in my head," she said she thought not, which made me like her. She said there was some slight bulging in my disks, but nothing determinative. She'd be happy to refer me to a back doctor, who would probably recommend that I have cortisone shots in my back. "Wouldn't it be better if I just swam instead?" I said, even though I hate swimming.
She said sure, swimming would be good, but that she figured I really wanted to run. I did want to run, but I don't like to have strangers thrusting long, sharp needles into my back. So she signed me up for more physical therapy. My doctor managed to make the minutes she spent with me seem relaxed, still, they were just that—minutes. I was reminded of something I'd read in Malcolm Gladwell's book Blink.
"Believe it or not, the risk of being sued for malpractice has very little to do with how many mistakes a doctor makes," he writes. "Analyses of malpractice lawsuits show that there are highly skilled doctors who get sued a lot and doctors who make lots of mistakes and never get sued."
Gladwell reported that in one study roughly half the doctors had never been sued, while the others had been sued at least twice. The doctors never sued spent 18.3 minutes with a patient, while those sued had spent 15 minutes.
While I liked the doctor I saw, I also felt overlooked. Yes, if I'd known exactly what was wrong, I would have had time to blurt it out. And in fact I did get the chance to blurt out the word "piriformis," but I didn't feel that she was losing sleep at night tossing and turning with my name in her head. "Ben Cheever, what to do about his piriformis?"
I slipped happily back into physical therapy, and after some sessions, the pain was greatly reduced, while after others it was not. I was encouraged to run on a treadmill, but only for a mile. I asked the physical therapists if I could run more. They said I could. I went out one afternoon and met a pleasant young woman. We had friends in common. She was going long, and oops, I ran for an hour and a half.
The next day I made the mistake of telling one of the physical therapists what I had done. "Get out of here," he told me chuckling. "You're cured."
"But I'm limping," I said.
Later, an old friend—a doctor—told me she'd seen a clinical massage therapist who had impressed her.
"I mentioned you to him," she said, "and he knows about the piriformis."
So I went to see John Lia. He's a clinical massage therapist who has worked in hospitals. He located my piriformis. It was tight. He pushed hard on it until it stopped hurting. The pain radiated down my right leg, but my left SI joint was closed.
Could he open my left SI joint? He could and did. He worked my legs, but he also worked up and down my back. I think now that the tightness I experienced from my piriformis all the way down to my right Achilles had its origin much higher in my back. It was as if a thread tied high in my left shoulder, right where an epaulette might go, ran down my back, through my right calf and Achilles, and out the bottom of my foot. The pain was all below the waist, but I responded best to stretching and massage that started much higher. For months I'd channeled my need to run onto an elliptical trainer, which allowed me to use my arms as well as my legs. Now it seemed that my cross-training had actually locked in my injury.
After a couple of sessions with John, though, I could run again. And afterward I wouldn't limp. At about this time another friend, Mike Barnow, founder of the Westchester Road Runner's Club, recommended I try a foam roller. He'd known lots of people who had trouble with their piriformis and with their iliotibial band. They'd had luck with the foam roller. I ordered a foam roller that came with an instructional CD. The advantage to the roller is that you sit on it, so you can put your full body weight into every massage. You can release the piriformis.
I stretched, and while my wife and I watched the news on television at night, I'd roll out my calves and piriformis on my foam roller. I also worked out with ankle weights.
Now I was running, but I was still worried. John Lia could fix me, but I needed to be fixed at least once a week. This didn't seem like a cure. The next runner I complained to—an airline pilot I met at an audio books event—told me that I should wear Masai Barefoot Trainers. "I got hurt and then I wore these, and now I can run as much as I want," she told me.
Lickety-split I ordered myself a pair of Masai Barefoot Trainers. They cost more than ordinary shoes, and they look much, much worse, but I'd been told to try them by an actual live person, and one who flew jet planes for a living. Quite aside from being almost twice as big as regular shoes, my MBTs had red laces and bright red flashing on the side. "Oh," said one friend, "are those those shoes designed to tighten your bum?"
Shortly after the beginning of my MBT era, I was scheduled to be on a panel to celebrate the centennial of William Maxwell, the fabled New Yorker editor and writer. I was one of many young men who had been mentored by Bill. I stopped at the Manhattan apartment of my sister, Susan, on the way to the event. I was wearing my MBTs. My sister is a much bigger literary noise than I am, so I asked her if I could wear my MBTs up on the stage.
"Change your shoes," she told me. "You look like a clown. You look like one of those blow-up dummies that you knock down, and it has a base full of sand, so it pops right up."
On the elevator down from Susan's apartment I met a young woman with her 2-year-old son. "Are those MBTs?" she asked. She'd been given hers at her baby shower, and had used them to lose her pregnancy weight.
"My sister says I look like a clown," I said. "And that I can't wear them in public."
"I think they look sharp," she said. "I didn't know they made them for men."
I wore them anyway. I was tired of limping. I'd rather look absurd for the rest of my life than limp.
The Road to Wellville
My sister, who is not a runner, had been having trouble for a couple of years with her hip. She'd had physical therapy. Then she had an MRI. And her MRI was terrible.
"It looked like a plate of spaghetti," she told me. She was in terrific pain. Surgery was recommended.
Then she'd heard of John Sarno. Sarno, an M.D. in New York, has written three bestselling books on back and joint pain. She read two of his books, saw him, and he pronounced her well.
"He's a real doctor," she told me, "in a suit and wearing a white jacket. He told me I was fine. He said, 'Susan, there's nothing wrong with you.'"
"And are you fine?" I asked.
"Yes," she said. "I think so."
I kept checking on her. She kept being fine. She'd been having trouble walking upstairs. Now she was playing tennis.
I downloaded Sarno's Healing Back Pain: The Mind-Body Connection, and while running I listened to it on my iPod. Then I downloaded his most recent, The Divided Mind. Listening to that got me very excited.
Condensing Sarno's theory this dramatically is the rough equivalent of reducing Christianity to a love affair between a woman and a dove, but here goes: In order to distract ourselves from the rage and sorrow of life, the brain will cut down on the oxygen supply to a targeted section of the body, creating a socially acceptable physical problem such as back pain, or a tight piriformis. Sarno calls this tension myositis syndrome (TMS), although the diagnosis is not recognized by mainstream medical science. Painful conditions attributed to structural problems are often not structural at all, he believes. He points to the relatively low rate of success for back surgery, and to the fact that X-rays or MRIs of people who are pain-free often show the same irregularities that can be used to justify surgery in others. To me the theory was compelling, even if it was controversial.
The pain is real, according to Sarno, and can be disabling. "Clearly the brain considers unconscious feelings to be infinitely more dangerous or painful than pain, or why would it practice so sedulously to deceive?" he writes.
Sarno wrote of a 1996 study that found an epidemic of whiplash in Norway and none in Lithuania. Why? No insurance in Lithuania. In order for a condition to spread and prosper, it must have a name and a treatment. Funding also helps.
I don't remember hearing about iliotibial-band syndrome 30 years ago, but now it's common. The piriformis is the new hot disability to have. "Pain in the buttock," Sarno calls it, "attributed to compression of the sciatic nerve by the piriformis muscle—a rather frivolous concept with no evidence of validity."
It turned out I knew quite a few people who had been helped by Sarno. As a young man, one friend, now almost as old as I am, had had disabling back pain. He had surgery, which temporarily alleviated the problem, then the pain came back. He flew in from California to see Sarno. "And you've been cured?" I asked. He had been pain-free for 20 years.
I could easily discern the psychological origin for my injury. Writing the book about running, I had the best case ever for running every day, sometimes twice a day. "I'm not doing this for fun," I could say flying out of the house on Saturday morning. "This is work!"
I'm guessing that I ran too much, and I certainly thought too much about running. I let the connections to publications not about running wither and die. When the book was done, I was genuinely out of work. And being out of work is a trauma. Just ask anyone who has lost a job. My trauma located itself in my piriformis. My most acute attacks were precisely timed to match psychological insults. My oldest son went off to Europe for a semester and we took a last run together. Afterward I could barely walk.
I made an appointment to see Dr. Sarno. I was wild with anxiety about it. I had taken notes about the time and the location of his office. I transferred Sarno's information to my computer, but also kept the crumpled piece of paper on which it was written. And still I called once on the day before the appointment and once the day of to make sure I had the time and place right. What if he found that there was something the matter with me? Then I'd certainly have to have needles stuck into my spine. Or worse yet, I might have to stop running.
John Sarno's office is one of many on the ground floor of the Howard A. Rusk Institute of Rehabilitation Medicine at 400 East 34th Street. I figured going to see a miracle worker like Sarno would be like going to see the Pope, or at least like going to Lourdes. There would be signs, votive candles, a wall with discarded crutches and canes hanging from it.
There is nothing about the Rusk Rehabilitation Center at New York University that trumpets the existence of John Sarno. When I asked the man at the front desk where Dr. Sarno was, he had to look him up in the directory.
I found the office. I had to write out a check for $1,300. Sarno is not covered by most insurance plans. My appointment was for 1 p.m. At 12:56 a door opened and John Sarno popped out. At 86 he's handsome and has all his hair, but he's tiny. I'd guess he's under five feet tall.
He picked up my chart. "Cheever," he said. "Now that's an interesting name."
"Miniver Cheevy," he said. "Isn't there a poem?"
"Miniver Cheevy, child of scorn," I said.
"Cursed the day that he was born." Sarno smiled.
I followed the doctor back into his lair, which was tidy, but a little faded, with his diplomas on one wall, and a porcelain bowl filled with paper clips. Dr. Sarno wanted the chronology of my ailment. Where had the pain first manifested itself? Then he asked about my childhood.
"Sometimes I think it was heaven," I said. "Sometimes I'm sure it was hell."
Then Dr. Sarno brought me back into his examining room. He told me to strip down to my jockey shorts. He had me stand on my toes and walk around. Asked if that hurt. Nope. Then he had me stand on my heels and walk around and he asked if that hurt. Then he had me sit. Dr. Sarno tested my reflexes with a rubber hammer.
He had me lie on my back and lift up my right leg. Then my left leg. Had me lie on my stomach, and pushed against the sides of my butt. He asked where it hurt. I told him.
"You're a classic case, " Dr. Sarno told me. The weak link was in my lower back. He showed me a picture of the back, and two places that the nerves came out of the spine. And he said that my brain restricted oxygen to those two areas. We returned to the front office, and Dr. Sarno drew a line on a sheet of paper. The line separated the conscious and the unconscious mind. Rage collects in the unconscious, he told me, and then the brain helps take your mind off of this by giving you a hurt.
Dr. Sarno said that when my piriformis began acting up, I should try to think about what was really bothering me. "Take it from the physical ball park and into the psychological," he said to me.
He said that I should also sit quietly with my hands on my stomach and breathe and remember how I looked at age six or seven. And then my adult intellectual self should talk to the child I had been and tell him, "I know you had to put up with a lot of garbage. But I'm here for you now. Now I'm gonna help you."
"You?" I asked, imagining that I would be in daily contact with this odd doctor.
"Not me," Dr. Sarno said, "but you. Your grown intellectual half."
"But I'm okay?" I asked.
"There's absolutely nothing wrong with you," he said.
"I can run?" I asked.
"Oh sure, run as much as you want," he said. "I used to run all the time. I ran until I was 80." I walked out of his office in my MBTs, excited but apprehensive. Would the cure take? Of course, I'll never know for sure. Or I won't know until I die and stop running. But for right now, it has worked. I still stretch some and I see John Lia whenever I can, but I still run every day. Saturday and Sunday mornings are joyous again. I'm 61 and not widely considered to be a creep, but I still feel anxious coming over that last hill to the parking lot where we form up. Rick's off-white Lexus is almost always there and a knot of people to whom I feel free to say anything at all. I can do the regular seven-mile loop, or if there's time and somebody else is so inclined, I can go a long distance.
As a child I was afraid of everything. I was afraid of the werewolf. I was afraid of Aurie Henry—who used to knock me down, put his knees on my shoulders and punch me in the face. But I wasn't afraid of a plane crash, because if you died in a plane crash, you didn't die alone. When they parted the black velvet curtains—if there are black velvet curtains—you'd be part of the group.
Now I'm back in the group.
Will it last? Will I wear my body out? I don't think so, although the naysayers are everywhere. After a recent 20-mile run, I went out for coffee, and when I boasted to the proprietor of the Dragonfly Caf?hat I had just run for three hours, another customer said, and without malice, "Doesn't that beat up your body?"
The odds of running for a lifetime without injury are bad. But the odds of staying well are even worse if you don't run. Although I have learned now to take a couple of days off in a row once in a while. At 61 this seems appropriate. I also suspect that I would have been a better runner all along if I had known how to take time off. Taking a day off from running—sometimes two—is a good idea. It's an agony, but an agony that pays off.
I ran a 3:55:22 at the Philadelphia Marathon in November 2008. Not lightning fast, but quick enough for an old man like me to qualify for Boston. And it was 16 minutes faster than the last marathon I'd run, faster than the last two marathons I'd run, and these were both before my injury.
The French General Ferdinand Foch is credited with sending this message back to headquarters during the 1914 battle of the Marne: "My center is giving way, my right is in retreat; situation excellent. I shall attack." That's the attitude. You can rest. Rest is good. But don't surrender. Don't ever give up. Attack! Attack!