One of my favorite things about my current PT is his positive outlook. At my first visit I didn't mention the fact that I was hoping to run a marathon in less than four weeks, because I didn't need to hear any doomsaying about it when I was already well aware that it might not happen. On the second visit he asked me when my next event was, so I told him & braced myself for the doubtful looks & pessimistic prognosis.
But his only response was "Well, we better get you fixed up, then."
Given that this last visit was only 10 days before the marathon and my TFL had been getting better, he said he wanted to assume that I would be able to run and treat aggressively today to give me the best shot possible at a solid, pain-free race. I could have hugged him just for saying it.
Apparently 'aggressive' meant a gauntlet of stretching, adjusting, aligning, ART, and yes, more suction cups. This time several of the bruises swelled up like sponges when they took the cups off, which was I guess impressive enough that he kept calling over other therapists & being like, "Here, come touch this. This is how you know you got the right spot." (Not the first time I've been used as a teaching tool in a medical setting, and probably not the last.)
From what he told me, I *think* the puffing up means that the muscle was so tight & locked up that metabolic byproducts & other fluids had gotten trapped inside it & couldn't get out. When the adhesions were released by the suction, the fluid causes the muscle & other tissue to swell up as they began flushing out. (Any PT/bio/medical nerds, feel free to correct me if any of that sounds completely wrong.) I skipped the pictures this time because how many giant hickey photos do you really need to see in life, but if you've forgotten, it pretty much looks exactly the same as last week, just with an extra layer of lighter, half-healed bruises underneath the fresh ones.
Finally, he used a technique called iontophoresis (or "ionto" as the cool kids call it) to inject a corticosteroid called dexamethasone ("dex") into my TFL, which I thought was just the coolest shit ever. Basically iontophoresis uses electric current to push an ionized medicine through the skin and into deep tissue via a disposable adhesive patch.
Battery-powered ionto patch
After swabbing my skin & pressing the patch into place, he charged the tiny batteries on top of the patch. The charging process is very slightly uncomfortable, sort of like being bitten by an ant or mosquito for 2-3 minutes, but I got used to it pretty quickly. After that I had to wear the patch for 2 hours while the medicine sank in. Wearing the patch was completely comfortable; if anything, all I felt was a little warmth from the battery.
I did a little reading on the technique when I got home, and it sounds like iontophoresis with dex is becoming a popular treatment for inflamed tissue because it has all the benefits of a cortisone injection (immediate, potent, targeted) without the drawbacks (discomfort, irritation, risk of infection or tissue damage). My therapist's view seemed to be that the worst was over and the muscle was healing, and the steroid would keep the inflammation that's part of the natural healing process from getting out of hand & causing tightness & stiffness over the next week.
I told him that my plan was to gradually increase the lengths of my runs this week, & if I could do 10-12 over the weekend with little or no pain (and most importantly, pain that didn't get progressively worse), I would feel comfortable at least attempting the marathon.
"Keep it to 10," he advised me. "The extra two won't help you at this point, and there's no reason to risk aggravating it again. 10 will tell you what you need to know."
"My prediction is, you'll be able to do it," he told me before I left. "You may have some discomfort towards the end & not be able to run as hard as you want to, but if you can get through 10, you can get through 26."
Again, I could have hugged him.
Today (Saturday) I'd planned to run 8, and if that went well, try for 10 on Sunday. But when I got to four miles and still felt good, I decided not to turn around & instead just try to get the ten done. It was a warm one out in GG Park today & I definitely stopped at every water fountain & took advantage of all the shade I could find, but I finished my ten with just the tiniest noticeable twinge, and even that went away within half an hour or so.
Bay to Breakers prep under way in the Panhandle. One of these years I won't have other race plans on that day or the weekends before or after & will finally get to run it. For living in San Francisco, I don't see nearly enough naked / bizarrely costumed people.
It's been a close thing, but I feel like I can say with 99% certainty that one week from tomorrow, I'm running a marathon. (Assuming I haven't just jinxed myself....)