PHT rehab protocol

Went for a hilly 3 mile hike yesterday in the very cold south rim of the plateau.  Now that the injury seems to have reached a point of almost no pain, I want to put down this rehab regime for my reference starting from the least stress, 'level 1' to most 'level 4'.  I'm going to be conservative and start from the beginning.

Level 1:

Isometric hamstring load at 20-30º or less of hip flexion:

Every other day

- long lever bridge 3x5x40sec w/ 2 min rest, 3 sets spread out over the day.

Level 2: 

Isotonic hamstring load with minimal hip flexion:

Pick one or two exercises, do every other day, 4x8-15 w/ 2min rest 

Continue with level 1 on other days

- eccentric hamstring slider

- isotonic hamstring slider

- single leg bridge with or w/o weight

- Nordic ham curl

Level 3: 

Isotonic exercises with increased hip flexion 70-90º

Pick one or two exercises, do every other day, 4x6-12 w/ 2min rest

Continue with level 1 on other days

- hip thrusts off bench w or w/o weight

- weighted walking lunges

- single leg RDLs

Level 4:

Energy storage loading, sport specific

Pick 2-4 exercises every third day

- Sled pulls

- stair/hills

-split jumps

-kettlebell swings

- sprints

Integrated Weekly Plan and return to sport specific 

The PT in the video of this program says it can take 3-6 months to rehab.  I would think I'm well into it so I will progress with careful monitoring.  A couple of points made:  

- be proactive

- listen to your body and back off if pain increases

Plan

This will all be in addition to the usual biking, general fitness, upper body and core exercises.

Depending on my toleration of these exercises, I'm hoping to progress to stage 4, including full track workouts in 4-6 weeks.

bike up the mtn, track drills, bands

Beautiful day today, 60º and sunny.  Hard to believe we're under a Winter Storm Watch for tomorrow night with 3" snow predicted, high winds and bitter cold ... forecast highs 26º Saturday with a low of 14º.    

This week has been the best week of recovery I've had.  Went to the track today to warmup, do some drills, bands, etc.  Had to really stop myself from running. Afterward, I biked the mountain again.  This evening, I did a little backward running, felt fine. 

Finally think I'll be ok.  Encouraged that I'll be training by next month.  Won't run til it's painless and will start with just short hills and stairs, along with strengthening.

more biking, realization

Same as yesterday, winteresque weather, mid 40ºs and cloudy and I biked up Roarkes Cove again today.  I'm doing this about 4-5 times a week now and like last time, this was a solid effort, just under 24 minutes.  (my PR is 21:40).  Even with the cool weather, got a sweat coming up, freezing going down.

My realization is this: the less running I do now, the sooner I will be able to get back to running.  4 days with no running and good cross training, the injury has improved significantly.   If I had taken a solid 3-4 weeks off back in Dec-Jan, I probably would have been good to go for Nat'ls.  It really kills me that I won't be at the Armory.  

Tendons take a long time to heal and with any over use injury like tendonitis, continuing to stress the tendon can't be healthy.  That is why I really think PT should only be done after the pain is gone and significant healing has taken place.  Since this much improvement has happened in just 4 days of no running, I'm going to give it a few weeks I think.  

I will be starting over again when I start running.  I don't care how much one thinks you can cross train into shape, there is no way to be in '400m shape' without those track intervals.   Just not possible.  There is no substitute.   

Weight is under control.  Certainly not race weight but about 142-43 after workouts.

Bike, Stairmaster, weights

Yesterday the weather changed and it was in the upper 40ºs and wet by late afternoon.  Back to fireplace weather.  Nevertheless, I got on the bike for a 10 mile ride and some minor hill climbs in my neck of the woods.  Later last night, I went for a session at the gym that included stairmaster and one set of resistance.  

bike - 10 miles, hilly

stairmaster - 25 min

resistance - adds, abds, hip flexor, rowing

I'm thinking that racing at all this spring may be a bit ambitious, noting the slight but lingering tendon issue.  Instead of racing by early May, just being able to fully train by then would be a good goal.  It will be like starting again at that point.   From that point, I'd have 12+ weeks before Nationals.  Look like Finland probably won't happen for me, and because of the war, may not happen at all.

I'm thinking about taking a different approach.  Up my cross training, more eccentric stuff, and limit my running to once a week, and only short steeps like 100s and stairs.  Some types of things really seem to make the injury feel better, like supine bridges with legs straight on a raised ledge.  I really want this injury to be gone.  Not going to race compromised.  If this injury persists, I may have to do what Duane suggested and just stop running completely for 3 months.  

Back in Dec, I never thought I'd be in this position in March, in the heart of spring track.  It completely changes the way I live and think.  During competition season, I'm super disciplined about my diet, weight, training, etc.  I'm sure not to miss taking my supplements, protein, etc... I watch the weather with an interest in the best time of day to train.  My world revolves around race dates and preparing for them.  Now, I just play guitar and enjoy hikes among the spring wildflowers.... frankly a whole lot easier, but I miss the grind and the competition.  I'm hoping to remain in shape, keep my weight under control so when it's time to start running those 800s again, it would be too brutal.  I should have taken more time off last fall. 

200m hills

Perfect weather, 71º in Sewanee this late afternoon.  Same workout as last time but 4x and a bit faster.   Still a ways from a full return to the track.  Aside from hill climbs on the bike, not too much cross training or rehab.   Want to pick that up a bit.

Hoka trainers on

stretches, drills, 2 x 100m

4 x 200m hill sprints  

My fastest one was 43.5, and I did the first 3 with less rest, about 4- 5 min.  Hard.   I do think this stresses the injury a little, but just enough to promote healing and strengthening I hope.

Expect to be back out on Tues.  A big cool down in the weather begins on Tues.  Might even be cold enough to snow by Sat morning.  

bike up the mtn

 I was going to run stairs Thurs morning, but felt an odd minor soreness in my L knee.  It went away, so I biked up the mountain today in Sewanee.  Incredible warm beautiful weather, 76º in Sewanee.  

Seriously, the ham injury feels like its about gone, but I want to be doing strengthening exercises targeting the proximal ham area with no pain during and afterward training - before running on the track.  I'm being really cautious about this.  Someone told me on an athletic site that PHT injuries are made more difficult because the injury seems to go away then comes back during training and can become chronic.  Point taken.  

I'm looking forward to a long spring of training before I jump into a race, and want to develop the confidence that I'm fully past this injury.   Pain through exertion and conditioning is OK, pain through injury and disfunction is not OK.  So, looking forward to enjoying the 400m process and this "world of 'good' pain."   

Hopefully, it won't take too long to get back.   I have colleagues that show up to championship events with minor injuries and run in a comprised state.  I won't do that.  I'm going to resist going to Indoor Nationals even though I might be able to win it with my B game in 2 weeks.  It's all or nothing.  I had my time at #1 for 18 months, and by the time I race again, I want to be able to be on or near the top again.  

There are no shortage of meets in the ATL area.  I hope to be racing by the end of April or early May.  

200m hills

 61º today in Sewanee and sunny.  I went to the track to warm up then hit the hill.  3 days with no training since Friday, feel soft and out of shape.  I went to see if I could tolerate 200m hill sprints, and I did.  

Hoka trainers on

stretches, drills, 2x100m, bands

5 x 200m hill sprints 

Can still feel the injury slightly on the flat, but could have easily run an 800m today, but I deferred to the hill.   The injury is definitely improved, but no level running until 100% gone.  I should have handled it this way from the beginning.  If I had, I wouldn't have lost Nationals, which I officially canceled today.  

These 200s hill sprints were very difficult.  I don't think I've ever done 5x in a session.  They are every bit as tough as fast 300s if not more.  I ran most of them today 44-46, same time as a 300m.  When I'm in shape, I can break 40 in a 200m hill sprint, although wasn't running nearly all out.  I did the first 3 with 4 min rest and after the third, I was almost crawling in lactic in my calves and glutes.   I rested to squeeze out 2 more. 

May do stairs on Thurs morning.   Hoping to return to the track in maybe 2 weeks or so to begin again with foundation.  I'm sure I've lost a lot of fitness.  Probably won't race til at least May.  There really is no rush at this point.  

Although I'm feeling soft and a bit flabby, still just 141.5 lbs.