How to determine wether your fit to race or not? or Paula's Story.
Lawrence van Lingen
Any therapist dealing with runners will tell you that they are always asked “Am I good to go, am I ready to do this race?”. How the runner ended up in a position where he places that much trust and responsibility in the hands of another person is another subject entirely, one possibly worthy of a book.
When I was young and entirely out of my depth I was often asked this question before the running of the Comrades Marathon, a brutal 90km (56Miles) of cambered tar and inappropriately placed hills of significant length and gradient both up and down. I used to draw on my limited experience and fresh knowledge and current conceptual understanding and give them the thumbs up or down. I would assess them from head to toe, all the orthopedic tests and balance and movement screens I used to think were critical and then give them my considered opinion. I can tell you now with hindsight that probably if symptoms were improving and I saw no danger of permanent damage it was likely the thumb would point heavenward and if symptoms were deteriorating or if I was nervous of long term damage or harm the thumb would be down.
Trouble was pesky Russians kept disproving my theories. As only one example, one of the Comrades dominant Nurgalieva twins, Elena won on debut the 2003 Comrades “Down” run in 6:07:47. She injured her hamstring two days before the race. I told the manager that he was lucky there were two of them as she would certainly not go the distance. Seeing the black bruise on the back of her leg as she ran the finishing miles in the lead was a profound reality check.
Fast forward to a phone call out of the blue, late in 2015. Memory will summarize the conversation, but it went something like this. “My name is Paula Findlay, I have had surgery to my knee, the Doctor has said I will never run again, can you help me?” I asked what the diagnosis was, Paula replied “I have a 5mm hole in my knee to the bone”. What surf=gery did you have? “Removed the fragments and debris and then left it alone, can you help me?” I asked for the medical details and recent pictures or videos of Paula running and told her I would get back to her.
When I got back to Paula I remember telling her I would help her on one condition and that was that if I was helping her, she would not stop working with me until I said we were done. Her response was “can you fix my knee?” Paula does not remember this pact and I am sure Paula sees how this story goes very differently than I and that’s how it is and always will be with athlete and coach, therapist and patient, parents and children and between lovers or bosses and workers and of course between enemies or friends. All tell the story differently.
Paula went from not being able to stand pain free with full weight to walking pain free and then swimming pain free and easy cycling to harder cycling and eventually to running. During that time she had obstacles to overcome, but she was committed and brave and determined and persistent. She had swelling of the knee that caused her to go to the ER when her popliteal bursae ruptured. Twice I believe. We found that her arthroscopy scar was causing irritation and fluid build up. We worked through two previous hip injuries that had all but derailed her very promising triathlon career a few years back. For those that don’t know Paula she was winning races in 2011 and 2012 in a very dominant fashion and had medal hopes for London Olympics.
There were conference calls where her own federation was too nervous to enter her into races as she was injury prone. Paula thought she was injury prone, her own mother felt Paula was injury prone. The label’s of “you may never run again” and “you are injury prone” perhaps better replaced with “I cannot help you to run again” and “I am unable to help you with this injury”.
About 7 months later when Paula raced in Yokohama in the World Triathlon Series race, I texted her to found out if she was OK. She immediately phoned back in tears bitterly disappointed with herself for not placing better. My advice was to find champagne and friends and celebrate as she should be immensely proud of how far she had come and how much she had achieved. The conversation we had about it taking at least one year for her knee to approach normality and two years to repair not top of mind. Forward thinking. Compartmentalization.
As her mechanics improved and her body normalized it badly threw out her right foot, she had been compensating for so long. She had a forefoot varus (a twist in her foot) of about 35 to 40 degrees and had a stress reaction and swelling in her foot. A second pact was made, if I flew to her and fixed her foot and she could race in an attempt to qualify for the Rio Olympics, she would call me “Oh Great One” and owed me a training/therapy camp. The name was to make her realize she was expecting too much of me, the training camp was so that we could get ahead of the curve instead of playing catch up. She raced and was fine, her Mother, Sheila gave me strange looks when I first met her and found out I was called Oh Great One.
Paula ended up not competing in the Rio Olympics and I know that was a bitter disappointment.
Once the pressure came off, it got easier to to help Paula. I pestered her for run videos every so often and nagged her about a training camp and we shared thoughts on run form while watching the sub 2 hour attempt and while watching the odd triathlon race, I worked with Paula every few months. She was finding her feet.
The breakthrough came the first time we went for a run together. We walked, then jogged then ran and discussed cues, what she was doing, what was she thinking, what I wanted her to do, some previous ideas. Something clicked. After that Paula began describing running very differently. She started loving running, it felt easy, she went for a long run and wished it never ended. This was a breakthrough 18 months in the making. 18 months of fear, pain, doubt, frustration and disappointment. No such thing as an overnight success.
The reason I feel its ok to write this article is that recently Pula raced in Beijing, on the bike leg she fell and went down hard on her knees harder on the previously bad knee, she continued and won, her first victory in a long time. Her knees needed 17 stitches I believe. You can see the blood on her right knee, the smile too.
Just recently Paula raced a half ironman distance race, the run was 21km. I had not treated, nor seen Paula in months. I was nervous, it is a big test to bike hard for 90km and then run 21km fatigued. Had she really recovered from her fall in Beijing, I had not seen her since that fall.
Paula did a live video, race report after that race and watching the video was definitely a highlight of my career. A happy and relaxed Paula chatting about how she loved the run and felt like she could have gone faster but was nervous of blowing up, she felt good the whole way. No pain, no fear, no angst. Her run time 80 minutes. Take a bow Paula.
I think humans are remarkably gifted at anticipating effort and load and pacing. Part of our genetic success most certainly is a result of us being able to judge our effort and exertion and the cost of exertion. Can I jump that gap, can I cross that desert, can I lift that weight? Why are athletes asking therapists wether they good to race or not? I don’t have the answers.
A very accomplished athlete asked me how did it happen that Paula could damage her knee so badly. I had no good answer for why an intelligent, healthy, world class athlete and the daughter of a neurosurgeon could get to that place. If I was good at snappy comebacks it would be “she did what she was told, she did what she was sold”.
Throughout this journey I would be amiss not to mention coach Neal Henderson (Apex Coaching) that kept a steady ship and Erin Carson (ECFit Boulder) who was more than a great strength and conditioning coach. Paula has no doubt her own list and I know she has the fantastic support of her family. Go Oilers eh!
This story is written with Paula’s permission. Thank you Paula.
Lawrence van Lingen
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