resistance - pullup PR, forward - MRI impressions

Doing my usual pullups and core work, hanging about 143-144 lbs, did 25 consecutive pullups today, a lifetime PR.  

The key findings in my MRI was that the posterior root repair as stated "remains intact."   Curiously, no mention of stitching on the medial complex tear although a mention of a "Prior repair of vertical tear in the posterior horn which remains intact."   This is relatively good news because a re-tear of the root would be unrepairable.  

Basically, all of these stresses were likely due to overly ambitious and premature training after the repair in an effort to get back to competition last winter/ early spring indoor season.   

All AI programs I've consulted on this say that I need a significant break from running 6-12 weeks and a slow cautious return.  That means even limiting my cycling and any leg-centered stuff, probably including rowing.  Swimming and water running seem the safest in the short term.   I will probably take a 10 day break from all cycling until I meet with the ortho a week from Tues. 

It seems that my natural knee health may be only barely salvageable, and this may very well be my last chance to get healed.  Certainly any further trauma will only shorten the time toward a TKR, however, my pain has truly been minimal, probably due to strengthening.  I have zero pain walking up and down stairs even when carrying significant weight.  Although, I do sometimes feel soreness or stiffness after a long hike.  There are also treatment options like subchondroplasty and injections which could be utilized as last option.  

I have been pushing very hard on the bike, HR into at least the 170s at least 3x a week.   I worry that a sudden cessation of hard cardio work will have deleterious effects on my CV wellness.   Same day I meet with my Dr., I'm getting a barrage of tests I purchased from this new test broker:  Goodlabs.  Incredibly inexpensive.  Should be a good CV risk assessment.    Also, have a colonoscopy on Wed.  

Fellow track mate Andrea asked me if I thought I might be ready to compete at worlds in March, I said I don't know.  It becomes a game of attrition at this point.  One guy I raced with in '21 just had a TKR and he's trying to run on it.  Very slow progress.  Another fellow world medalist in my age group had a heart ablation due to afib that caused his HR to spike to 250.  That would be scary.   He recently returned to race for the first time.  If I am to compete in March, I would need to start my first conservative running by Oct.  I have time.  

Looking back, if I had just done one short turf workout every 2-3 weeks all summer, that would have been probably OK.  But 2 track workouts with just 2 - 3x 90% effort sprints 5 days apart, I wasn't ready for that.  Should have stayed on turf and kept intensity to 80%. 

Again, I have time.   Now, knowing what to do with it.   Half jokingly (and half not) thought, maybe I should go non weight bearing, brace and crutches for a month?  Nah, probably overkill.  Then again, it couldn't hurt? Or could it... with the atrophy?  Motion and flexibility are good.  Should stimulate healing I would think.  I think they still try and stimulate healing with micro fracture technique... not that I'm going to do that.  But the body does respond to stimulus and to tasks.  

bike sprint, MRI

Did my first training involving legs since last Saturday's running.  Just a neighborhood bike sprint.   Got the knee MRI.  Definitely a mess.  

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 10:01

Avg speed - 13.6 mph

Max HR - 173

HR over 156 - 5:05

HR over 170 - 5:18 

Avg HR - 166 (inc 1 min recovery at end)

Slower and higher avg HR but lower Max HR from last time.

Knee continues to feel better and will allow recovery til I do make any running attempts.  

As expected, MRI showed a lot of problems.  It seems that the game should be to expect trauma and to allow recovery.  

On the plus side:

"Intact root attachment.... prior repair of vertical tear in the posterior horn which remains intact. Intact anterior root"

On the minus side:

"recurrent macerated tearing along the free edge of the posterior horn/root junction creating a small free edge flap with intact posterior root. Degenerative undersurface tearing of the meniscus at the posterior junction and partially extruded body segment without flap displacement ...  Prior repair of vertical tear in the posterior horn which remains intact. Intact anterior root with reactive edema or root sprain. Diffuse chondral loss throughout the central and posterior weightbearing femoral condyle at least 75% chondral thickness with stress related marrow changes diffusely throughout the femoral condyle associated within

evolving subchondral fracture in the posterior weightbearing aspect measuring 0.7 cm transversely with evidence of remotely healed subchondral fracture in the more anterior weightbearing femoral condyle. Partial chondral loss in the tibial plateau centrally at least 50% chondral thickness with mild stress response peripherally and posteriorly... Full thickness chondral loss in the central, with highgrade partial chondral loss in the inferior medial trochlea with chronic stress response and preserved cartilage in the lateral trochlear facet."

Summary impression:

1. Prior medial meniscal repair posteriorly with recurrent free edge tearing of the posterior horn/root junction, undersurface tearing of the peripheral posterior horn extending to the body segment with intact root attachments demonstrating degeneration/sprain and progressive arthrosis in the compartment at least moderate severity with increased stress response throughout the femoral condyle associated with a evolving subchondral stress or insufficiency fracture of the posterior weightbearing aspect, likely a pain generator.

2. Intact lateral meniscus with degenerative fraying along the free edge and relatively superficial focal chondral loss without significant compartment arthrosis.

3. Intact cruciate, collateral ligaments without acute injury or tear, early mucinous degeneration of the ACL.

4. Patellofemoral arthrosis, moderate severity with chronic stress response related to highgrade chondral loss in the trochlea.

5. Moderate size joint effusion with chronic synovitis more pronounced suprapatellar fossa, medial compartment. Small loose osseous bodies in the posterior superior medial femoral recess measuring up to 0.5 cm.

Seems that the worst cartilage loss is not on the tibial or condyle surfaces, but behind the kneecap on the medial trochlea.   Anyway, it sucks.   

Weight pulls, sprints

Saturday workout was cut short by a storm.  I went out to do some weight pulls and felt good enough after warmups to do a few sprints.  But did one too many.  Ran a 50m, then a fast 100m, then did 2x50 yd 90lb weight pulls.  Storm then came.  Was bummed I couldn't do more due to the rain and lightning, so I ran a hard 50m in the rain. Shouldn't have, knee hurt after.  Should have just quit while I was ahead.  But I ran a 13.8 100m in trainers, not bad for not having sprinted twice in 2 months.

Stretches, drills, bands

2 x 50m high knees

50m - 7.10

100m - 13.85

2 x 50m weight pulls on turf with 90lbs

50m - 7.40

Went swimming afterward.   Won't try running again for a while.  

MRI on R knee today, should get the report this week.  Not optimistic.  

Was 142.5 today before dinner.  12.6% body fat.  Going to continue with the weights and stuff.  The campus weight room was just renovated with many new machines.  They finally got a glute machine you can load up with plates.  That'll be good.  Should open this week.  

Lovely this morning, 6:00 am...

hot bike climb

Went out in the heat today for a bike climb, 92º and exceptionally humid, dewpoint 78º, heat index 107º.  Hottest part of the day.   I got Dr. Scott an endurance runner a few yrs younger than me to motivate me.  We finished together.  

This was the hardest I've ever pushed my HR.  The overall time was not exceptional, but the effort was due to the conditions.   Faster than last time.  I did very little sprinting off the seat.  Scott did more than I did.  

Roark's Cove bike climb

Total time - 23:11

Avg speed - 6.1 mph

Max HR - 190

HR over 170 - 14:59

HR over 180 - 4:15

Avg HR - 166

Had a nice swim afterward.  Scott lives right at the top of the hill and on a lake.  Got to hang with friends for a few hrs.  Roya joined us.

It was supposed to rain today, even possible severe storms, but nothing came.  Nice lightning and thunder in the distance. 

Roya's day off tomorrow so we'll go swimming.  I want to hit the track during the heat and do some weight pulls.  Could be hotter tomorrow, and certainly will on the reflective turf field in full sun.  

bike sprint, weights, water running, swim

Not keeping track of all my workouts but spent Sunday doing weights all day, several sets of upper body and core.  Finished with a brief swim.  

Tuesday did a bike sprint.  2nd fastest.

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 9:31

Avg speed - 14.3 mph

Max HR - 184

HR over 156 - 8:10

HR over 170 - 1:10

HR over 180 -  0:26 

Avg HR - 160 (inc 1 min recovery at end)

Today, water running, lake swim, weights, backward walking uphill.  I really felt the fatigue in my quads at first.  Any new activity gets new areas.  

water running:

6 x 60 strides w/ 1 min rest

Max HR - 160

Avg HR - 124

Lake swim:

345 yds

Max HR - 139

Avg HR - 124

Lake water temperature 90º according to my watch.
 

Interestingly, more confirmation there is no activity like sprinting... with just a few short sprints on Sat, my hamstrings were a little sore for 3 days.  Don't get that from slow running, drill, stairs, etc...  

Even though I haven't lost much weight, hanging around 142 -144, my body fat % is down 1% from when I first started measuring it, from 13.5% to 12.5%, according to the Hume pod.  Have added some hard fought muscle mass I think.

Hottest day of the year today, low 90's and super humid, dewpoint hit 80º today and heat index over 100ºF.  Early evening before we went to the gym, we walked up the Roark's cove rd. steep and that lush micro climate on the north side of the mountain was noticeably cooler (84ºF) than the area around my house, a south facing bluff which was over 90ºF.  I walked up the steeps backward.  Really felt it in my quads.  

Roya likes to walk with ankle weights while pumping light dumbells.  Looks kinda funny. 

Medical:

My MRI results showed very little.  Very scant detail, nothing concerning, pancreas cyst no change, perhaps even a mm smaller (7mm).  The radiologist has good creds (Harvard, J. Hopkins, BU) but is relatively young.  

Monday, I'm going for an MRI of my knee to assess the issues.  

Roya just had an Ezra full body scan.  No results yet.  

Tomorrow, we'll have heat indexes close to 100º.  I'm going to revel in it.  Going to the track and taking my weight harness, going to pull the 90 lbs weights across the field in the hottest part of the day.  Will be fun.  

Drinking tea again.  Flowers are loving this weather.

Resistance, first track sprints in 2 mo

I got to the gym today, did mostly upper body but went to the track afterward.  Felt ok, not 100%.

Stretches, drills, bands

2 x 50m - high knees

50m - 7.10

100m - 14.17 (6.90, 7.27)

Not terrible considering my first sprints in 2 mo and in trainers with a 3 step rolling start.  Got to be careful and not do this much.  I originally said I was going to wait til Sept to run, but a lot of time on my hands and I miss it.  The knee is not pain free but isn't bad.  The lateral stability has improved but the week has been tough.  2 bike workouts and a stair session since Tues. 

Heat wave starts tomorrow, but it won't be unbearable here like in the cities.  Highs pushing 90º here on the mtn for the next several days.  100º down below for the cities. 

141.1 lbs after workout.  

bike sprint - PR

This was a hard effort.   Massive PR by 17 sec.   This one will be hard to top.

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 9:21

Avg speed - 14.3 mph

Max HR - 177

HR over 156 - 9:51 (inc 1 min recovery at end)

HR over 170 - 3:53

Avg HR - 166 

I hit the turnaround at 9:56 about 4 sec faster than last PR.

Have been eating more meat (chicken breast) lately.  Weight holding steady in the 142s.  Doing daily strength so seeing a little difference.  

For whatever reason, my MRCP / MRI read may take another week.  I've never known a report to take this long.  I really think this Vanderbilt medical center isn't what it used to be.  When it was a single centralized teaching hospital back in the day, it was top notch.  Now it has taken over numerous other smaller hospitals and facilities, it's losing quality for quantity.  I may look elsewhere in the future.  The Vanderbilt medical name was always very well respected.  Notsomuch now, judging by online reviews.  

The weather has been awesome so far, cool for this time of year but a heat wave hits on Sunday and continues without rain for about 4 days, temperatures in the lower 90ºs... which means near 100º in the cities.  

I expect I'll be swimming and water running everyday beginning Monday.  

Yesterday before my bike climb, I did an 80yd sprint on the track.  It felt ok. Kind of chompin to get back to some limited running.  Maybe do some drills and high knee runs in the heat next week