Running After a Partial Knee Replacement PKR

Besides my previous blog about running after a knee replacement, here is some additional encouraging information I came across regarding activities and running after a partial knee replacement.

http://www.arthritistoday.org/news/knee-arthroplasty-replacement-sports047.php

 Please note at the end of page two, the comments about squats. Those who know me or follow my blog already are familiar with my thoughts on squats. Do NOT do them!  See my previous blogs on training and squats, and my next blog on personal trainers.

PKR Partial Knee Replacement Conformis Knee

Hi everyone,
I am taking a break from my normal blogging on running to update you on my status of my knee replacement. My hope is that those folks who have gone bone on bone may wish to explore more than one option in living with a worn out knee part.

Not being a medical doctor, keniseoligist, orthopedic surgeon, or other medical professional, I only wish to convey my experiences from a patient centric viewpoint.

After years of sports use including basketball, skiing, riding, mountain climbing and so on, at age 46 my knee dislocated while playing hoops. Although the knee became compromised, and I was told not run, I used strength training, cross training, braces and guile to coax an additional 40 marathons out of my knee, mostly Boston qualifiers. Never the less, my knee continued to deteriorate and finally, at 58, my meniscus on my left medial (inside) knee was gone. I was bone on bone, unable to run, and at times, even walk. Prior to the loss of meniscus material, there are a variety of treatments increasing available. However, once gone, options narrow. There's plenty of articles on the net to educate and discuss amelioration.

1. The knee is mostly three parts: knee cap, and medial (inside) and lateral (outside) joints.
2. Most common is either part of the 'figure 8' like meniscus wearing out, whereby the cushioning qualities of the meniscus no longer exist; the joint goes bone on bone, no lubrication, only pain.

If you go to Midas, you're going to get a muffler!

3. Doctors usually offer the following choices to bone on bone:
    a. Bike, wear a brace and live with the pain, stop doing all the activities that put big grins on your face.
    b. Or get a full knee replacement. Basically, this is a knee amputation, and a double rodded joint replacement is added. Mobility is limited by the new appliance.

If you go to many doctors that have been doing this procedure, for advice, it's highly possible you are getting a knee replacement. I was trying to avoid a full knee replacement.

4. My attending physician, luckily, was chosen by me since he has a deep history as a record setting, and still functioning athlete. Dr. Eric Heiden treated me as an athlete, and was consultative, and did not act like a technician trying to book his calendar. Over a 9 month period, he worked diligently and personally with me to try and solve my pain, and offered alternatives. Unparalleled support by a doctor of his stature and ability in these capitated times. But none worked in helping me achieve a satisfactory result. Understanding my resolve, he offered a solution he personally did not provide, but his associate, Dr. Phil Davidson, could. Explaining the pros and cons, Dr. Heiden noted that a partial knee replacement might be worth the try, and if it failed, I could still avail myself to the full replacement as a backup.
 www.heidendavidsonortho.com
tell them Fasteddie sent you!

5. A partial knee replacement is not nearly as invasive. Rather, it is a resurfacing technique, and a smaller shelf is cut into bone to accommodate the three needed pieces.
http://www.conformis.com/Patients/About-Knee-Replacement-Surgery

6. On June 2, 2010, Dr. Phil Davidson installed a Conformis  partial knee replacement, up in Park City UT. I was walking stairs very gingerly, within a day or so.

My observations:

It is now the end of November, 2012. I successfully completed the Triple Trail Challenge in Park City (Steeplechase, Half, and Full Mid Mountain Marathon) almost within 3 months of the procedure.
(I don't think this is normal recovery protocol  :>)) I added two more since.
To date, I have now successfully completed 5 marathons, and reached my Boston Qualifier target goal at St. George this last October of 2012. 28 months.

My own experience with Physical Therapists is they have not handled many partial knee recoveries. As a result, after a few weeks of PT, I ended up with my own recovery program, rehabbing myself.

My primary issue was that the PT folks did not seem to understand that I was not recovering as fast after PKR as FKR patients. But let me explain. FKR is an amputation, then adding a new appliance. Days after surgery these FKR folks have tremendous mobility as the joint is now mechanical. Of my 3 knee parts after PKR, my left medial was new, but my left lateral knee joint was still stage 3 arthritic, and my kneecap was still stage 2. Only my medial joint had been replaced, so I was far from new.

My guess is that over time data will confirm that partial knee replacements take longer to rehabilitate.
However, the benefits may be more overall mobility and.... YOU CAN RUN! The doc is really resurfacing a small single joint.
Add to that that a full knee replacement is still then available if the partial knee fails, and I think it's worthy of consideration.

Please note that not only was I methodical in rehab on recovery, I was also diligent in not over stressing the knee joint and attendant muscle groups in recovery. ( I walked most of the events immediately after surgery).

At 8 months, I could barely run 8 miles, and very slowly. My plan was to go slowly for a year, and just get back to a normal gait, my second year was to develop a modicum of speed. Muscle atrophy was a long time in making. First year pain during workouts abated only very, very slowly. The first 6 months were very painful. I did not consider myself a "runner" again for about a year and a half.

I did not attain speed workout status until about 20 months! But I always kept Dr. Davidson's admonitions in mind that a PKR has small parts, and I did not want the pieces to separate from bone and resurfaced joints. So I went easy, and it paid BIG dividends from months 20-26. Just my experience, and, if you read this blog, in concert with my philosophy that slow and steady is better than fast and injured. All comes to he who waits.

So the recovery period is longer, but my knee is functioning at a very high level. Feel free to comment or ask away with any questions!
Best wishes...... Fasteddie.

Weight Training for LD Runners

Hi all,
I am sending this out FYI only. By no means the only way to weight train, it does include what I consider core workouts and, if you notice, no deadly squats or lunges. Not that you can't do them, it's just that I feel there are lower risk ways to target these areas, especially for runners who don't seem to tolerate the additional load requirements. Remember too, quad and ham injuries are notoriously difficult and long, possibly permanent, recovering injuries. So don't get injured in these areas in the first place. Squats and lunges may be very appropriate for training in some sports, say sprinting, downhill ski racing, etc., but my experience and 20 year observations are they are detrimental for long distance running considering the higher risk. That's why I state that personal trainers are usually trying to injure runners. They don't understand LD runners, and they are typically a lot younger, suffering great hubris. But please don't have your trainer call me to argue, thank you.

By no way a complete package, this workout seems to work well with runners, have a low injury rate, and tolerates speed workouts without risking higher injury rates. I cannot argue that this or that workout will make you stronger. Rather, the discussion would be can you accommodate other routines AND still be ready to do speed/tempo/long running with low injury rates. or go play tennis, cc ski, or??  Feel free to adjust the spreadsheet as you see fit, and incorporate it into an overall program. Be forewarned however, lifting regularly makes you feel better!!! ( and burns up to 13% more calories at rest).

Additionally, I believe most if not all athletes over 30 yrs. old should incorporate weight training( u r losing 1-2% muscle mass a year) and riding as core activities, because from these two, all other exercises can emanate. So I do not argue that for instance, cross country skiing is a great great alternative, just that it's harder to do 12 months a year, for example. So it's a great substitute or cross train.
 And data supports RIDING for runners overall fitness, and RIDING for recovery from marathons, and RIDING as a substitute for speedwork, and RIDING engenders heel circling for better form.
Out of saddle riding HIIT (high intensity interval training) intervals, based on studies, seems to be the single best exercise to leverage the bike for runners and other athletes requiring speed and aerobic capacity.

Feel free to ask away if any questions, or just ignore. I have been on this workout program for about 30 years with variations, using periodization and tapering, of course.

If you want this in an excel spreadsheet, just ask!  Happy Running!

 

Exercise Type	INTERVALS	REPS	WEIGHT	Notes
CORE
Bench Press	1				Comments
Leg Extensions	1
Bench Press	1
Knee Curls	1
Bench Press	1
Body Pikes	1
Seated Leg Press	3
Leg Curls	2 or 3
Leg Extensions	2 or 3
Toe Raises Straight	1
Toe Raises In	1
Toe Raises Out	1
Body Crunches	2
Body Extensions	2
Spin Warmdown	20-30 mins.
SECONDARY #1
Lat Pulldowns Front	2
Lat Pulldowns Rear	2
Lat Pulldowns Chinups	2
Dumbbell Curl/Press Taps	2
Crunch Machine	2
Tricep Pulldowns	2
Straight Arm Pulldowns	2
Deadlift to Hip	2
Rowing Full	2
Rowing Stiff	2
SECONDARY #2
DIPS	3
Spread Pullups	1
Pullups	1
Spread Chinups	1
Chinups	1
Bar Sternum Pullups	1
Bar Press Front	2
Ba rPress Rear	2
Unweighted Sits	2
Cable Work	various
At Home Any Time
Pushups	2			before every shower
Donkey Kicks	2
sit ups/crunches	2
standing sits/leg kick outs	2
Arm Extensions w/ weight	2
Standing leg swings front / rear	2
Stretching
add your personal….
Notes:
	1. Inititailly, these should be done in order. Later, mix them up, but try to do CORE category first
	2. Intersperse Bench Press with other listed bench exercises using bench as noted
	3. Try to do CORE at least 2-3 times a week, on non running days ,if possible
	4. add SECONDARY workouts AFTER completing CORE
	5. NEVER EVER do Lunges or Squats unless you like to hear me say "I told you so".
	6. When in doubt, lower weights, higher reps. You are a RUNNER, not weight lifter
	7. Thank others for their advice, then do YOUR workout.
	8. Proper form always. 6 count…Contraction 1,2, Retraction 3,4,5,6. No swinging of weights.

The Schedule and its components 11 of 12 Use Your Brain series

As I sit here, legs up after another wonderful weekend on a Sunday night, I am reflecting on how much fun I just had running desert trails with old and new friends. Everyone should be so lucky. But now it's time to talk business.
For those of you looking for a written schedule specific to your goals and abilities, I will not provide one. But, I can help you craft your own schedule, and isn't that way mo betta? Besides, if you learn, you can help someone else someday. Never the less, I always remain available for questions and comments, so ask away.

Write your schedule:

1. Get a blank monthly calendar, and make copies if you have to. I like the 8x11 size format. 
2. Most of us work, even still, the following is the best schedule for most of us: Tuesday night speed, Thursday night tempo, Saturday morning long run
3. Other days cross train with weight lifting, biking, or even easy runs.
4. Periodization, periodization, periodization. 1st week load normal, 2nd week increase load, 3rd week increase load even more, 4th week back off to about 65% of week three, then start all over again at slightly higher levels. Forever or until recovery from your targeted race.
5. Use periodization for your cross training activities too, keep them on different schedules than the running periodization schedule.
6. Look at your goal race date. Read my blogs on taper, then work BACKWARDS from that date to today's date and write it up!
7. Remember to increase loads slowly. Load increases can be miles, intensity or both. But remember, 1,2 3 weeks then back off a bit. OC's can't do this. They can't believe that rest makes them faster. Poor OC's. they plateau then slowly deteriorate.
8. Tuesday night speed recommendations are odd weeks a mix of 400's and mile repeats, even weeks laddered 800's. So week 2, 6x800, week 4 8x800, week 6 10x800, week 8 8x800 and so on. Remember, the 800's are TOUGH workouts so don't mix 10x800 in same week as longer runs. Beginners start with 3 or 4 800's and slowly work up to the 6/8/10 schedule.
9. Thursday Tempos... start with 2x2miles, but move up to 2x5k as soon as possible. Then get faster, and negative splits.  3 minutes recovery in between. Both Tues and Thurs workouts have mile wu/mile wd.
10. Saturday long runs add 1-2 miles every other week, subtract same miles in between. 8/6/9/7/10/8/11 and so on. Also, sub in 1or 2 long run a month with a bike ride if desired. You'll feel better and be just as tough.
11. ALL workouts, speed, tempos and long runs from now on are by NEGATIVE SPLITS.
12. DON'T make up missed workouts. When really tired, just skip a workout, or immediately go into the 4th week of periodization, then start all over again.
13. HIIT High Intensity Interval Training, which this schedule employs, is the best way to get faster with less miles. But it requires CONSISTENCY!!! Back in the day, I was holding it for 48 weeks a year. It's not that bad IF you use PERIODIZATION, since every 4th week is easy recovery workouts, and weeks 1 and 2 are not THAT bad. The tough one is the 3rd week, but you'll be ready, and happy knowing the following week gets easier by a lot.

Good Luck, and feel free to ask away if needed. :>)

Body Fuel 10 of 12 Use your Brain

There's sooo much written on this subject, so I will try and be brief, and tell you what works for me. Remember, let science, not dogma, be your guide. If you have additional fact based information from neutral parties, please feel free to share it. But spare us all the quick fix magic and corporate sponsored quack wonder drugs. Like really, Red Bull, Monster???? Puhleeeze.....Try a balanced diet with fruit, protein and pasta....( and even pizza dripping with olive oil)

1. Basically, the physiologists tell us we have about 2200 calories of stored glycogen calories at full taper. Runners burn 80 to 120 calories per mile running. A marathon is 26.2 miles. DO THE MATH......Glycogen stores alone are not enough, no matter how mentally tough you are. You will need upwards of 3-4000 calories just to RUN, adjusted for effort, weather conditions, and myriad other variables.
2. The higher the intensity, the more straight glycogen is burned. The lower the intensity, the more fat is mixed with glycogen for fuel. So learn to pace properly whereby you burn glycogen AND fat simultaneously. This "pushes out" the limits of the 2200 calories of stored glycogen, thereby extending the "wall" or "bonk" that inevitably stalks all endurance athletes running maximal efforts at around the 2-3 hour marks.
3. When you run out of glycogen, your body is unable to burn fat. With no glycogen, your body can't burn fat. Your body bonks, and you switch to eating protein; and you are miserable. Basically, when you go out too fast, don't run a negative split, and don't fuel properly, you eat muscle. Not good. Not good racing, not good in training. Older runners who follow outdated running programs, lose, instead of gain, muscle mass. Bad news.     Most folks run and train this incorrect way. Stop it!
4. Not only do you eat muscle mass if you run out of glycogen, you prolong greatly the recovery period after endurance efforts like marathons or long runs. Another reason to FUEL UP on the backside of training runs, regardless of how you "feel".
5. Basically, if you are out over 1 1/2 hours on a training run, or 2 hours in a race, you need to address glycogen stores for either current and/or recovery conditions.
6. Experienced runners can ingest upwards or beyond 1000 calories under race conditions, between goos, blocks, sharks, gatorade, fav natural food, etc.( I love my dried sugared mangos in a plastic ziplocked baggie stowed away in my shorts) thereby allowing a faster pace, as they can delay the glycogen bonk that occurs around 20 miles. (get a calculator out at re read #1 above). See previous blogs on what when and how to ingest, otherwise ask questions in comment section. Remember, if you run a negative split, you can start eating VERY early, while your stomach can handle it, and thereby delay the glycogen bonk until very late or even to the finish line. If you run a positive split, not only do you shut your stomach down earlier, you exceed lactate thresholds earlier, you run out of glycogen earlier, and the back half of the race is a miserable lactic acid induced, muscle eating disaster.
7. Consider eating better in training, constantly testing race fuel strategies. and also thinking ahead to tomorrow's fuel needs, while on the back side of today's longer workouts. Preserve more glycogen right now, feel better now, and recover faster for tomorrow.
8. I will cover pre race loading and general diets in other blogs, so stay posted!

TAPER Taper taper Use Your Brain 9 of 12

If you read my blogs, you know how I feel about excessive miles down the stretch and especially LONGER runs than you need in the taper. Never the less, let's review a few key points:

1. Most running schedules are archaic dogmatic old school unscientific programs that will ensure you finish the race slower than you should, and you will probably finish IN SPITE of the particular author's advice. (yikes, here comes the emails from the GGGS's!)
2. Most runners will execute the dreaded"pretest", a longer than need run in the last 6 weeks, to mentally assuage their weak minds that they can "do" the distance, instead of steadfastly believing the taper works, and instead of a maximum effort on race day, ensuring a mediocre race, or worse, the dreaded "bonk" that they, except for us small cadre of counter intuitive, scientific, critically thinking but genetic losers, will think it "came out of nowhere" even though they trained really, really hard, and chalk it up to bad luck, bad shoes, or the elliptical moon being in a shortened synodic month.
3. Complete your longest runs 8 weeks out, or pick another race.
4. Almost, almost (hehe) ALL runners are overtrained at the start. (it's just that they follow schedules mentioned in #1 above)
5. Almost, almost all runners will go out too fast and FAIL to run negative splits (and many pace groups run positive splits, in my experience)
6. If you use periodization schedules backwards from race day, for both lifting, cross training, and running, you'll be happier in the death zone. (the last 10k when the bear jumps on your back)

7. Ok.... get a blank piece of paper. Draw a big X on it. Lets get ZEN like and stare at it a few minutes. Uhh, not THAT long, unless you pass it over to me. Tell me grasshopper... what do you see? 
(If you say a big X, you actually may run a great race, because you need a brain to feel pain!)
So down on the lower left, that's the line for intensity on this axis laden example. In Western culture, we would say it goes UP. That's intensity. Now, guess where we go next. No, not to the refer for Haagen Dazs (how did I know you were a woman?)
So up on the upper left, in Western culture, we'd say the line goes DOWN. That's LOAD or mileage. 
Write INTENSITY on the line going UP, and MILES on the one going down. Wha lah!
At the far left bottom, write "6 weeks left".
Near, but not quite all the way to the END of lower right bottom of the page, write "1 week left, STOP RUNNING almost". 

8. Take this paper, and put in under your pillow, next to your last tooth. Eventually, over less than one 4 week periodization schedule, the paper will stop crinkling, and your spouse or dog, or both, will start to come back to bed.
9. Go to bed every night from now on until race day and repeat over and over again the following until asleep:
"I will not overtrain, I will not go out too fast, I will not overtrain, I will not go out too fast..."
Naahnaah naah umm umm ummm neewah neewah  zzzzzzzzzzzzzzzzzzzzzzzz............
COME TO THE LIGHT....... COME TO THE LIGHT..... you CAN run less miles and get FASTER....

Himself

Using your Brain 8 of 12 .....Gear

Gear Choices

1. SHOES Ok let's start right at the most important item of your gear. Shoes. There are a myriad of choices nowadays, well beyond the scope of this blog topic. So let me lay down a few major ideas here for shoe selection. 

Proper last construction....every runner runs, strides, and hits the ground differently. Toe tappers and heel strikers are on different end of the spectrum, so if you mix the wrong shoe with style, you will be miserable and slow. Generally, the more you move towards motion control, the slower you will be. The more you move towards lightweight racers, the more perfect your stride should be, and the more injuries you may end up suffering as distance is increased.
But wait, this isn't monolithic; you can mix them for the desired workout. Just never go completely against the desired useage, like use a racing shoe on at 20 miler... you'll injure out.
And as always, execute moderation between useage. Morph between running shoes, don't just retire a shoe or run all miles in a new shoe. Studies indicate our feet will accomodate a variety of strides and cushioning, just use moderation in change. This is REALLY BIG.
Finally, manufacturers constantly take really great shoes and progressively move them to "the middle" as the line model ages, to encourage more sales.
Nike is the worst at this. Pegasus was my favorite. One year the model is a great trainer, the very next year the same model becomes a motion control shoe, the next year it's a bigger toebox. Go figure. My recommendation: Once you find your fav shoe, buy large quantities of the EXACT same year, and stockpile them. Then rotate in new shoes, date them with indelible ink, and that way you'll know when to retire older worn shoes. X out the worn ones for gardening, painting or donating. It's 2012, and I still run in new 2005 Pegasus for my primo events.
     2. CLOTHING.... cotton kills as we say in mountain climbing. So only wear cotton in the desert on hot days. the rest of the time there is a panoply of smart fiber products, just be aware of chafing.
     3. PACKS..... there's now a few choices but here's my take. Fanny packs are great for slower longer runs, but no bueno if racing. Hydration packs are wonderful for hauling gear, fluids and phones. They are GREAT for trail running, longer runs in training, and in bad weather. But for real road racing, I like to clip or pocket my goos/blocks /sharks, and just use a fluted 16 oz. water bottle stuffed in my pants on my back hip, held in place by my pant string. Undiluted, I cut my fluid to 50% concentration by mixing water in my mouth at aid stations, ie. take a swig of gatorade full strength just before aid, then swig a cup of water to cut. that gets me to my 7% solution.  :>)
    4. SOCKS....I like to train a bit in cotton or acrylic to build callous, and use smart wool blends for longer distance. If it's going to be wet, wool blend or straight poly pro/ acrylic types that don't hold water. For instance, dry marathons, wear smart wool blends, if it's raining, acrylic. Just keep in mind acrylic can cause blisters faster. I also like to take plain old vaseline and LIGHTLY coat my feet and toes before long distances to keep abrasions/blisters to a minimum.
    5. BANDANAS....these darn things serve so many purposes, they are my most often used piece of gear. I like to wear around my neck for heating/cooling and keeping sun off my neck. They can be used as a doo rag on your head or to keep in heat if cold. They can be used to wash and hydrate your hands, skin, face. Desert runners should always wear for a light tourniquet in case of a bite. They can be worn under a hat fluttering legion style to protect the head and neck of skin if sunny. A versatile piece of equipment, wash them alot and make them super soft, then wear them in all seasons.
    6. HATS.... I prefer visors in concert with bandanas, rather than a hat. I have a good head of hair, and I just plain overheat, so I like more versatility. Personal preference. I also like the UNDERSIDE of my visor/hat to be black, to knock down sunlight diffusion for my light sensitive eyes.
    7. SUNGLASSES.....I like the light PINK tints, to better see trails, cheaper $30 wraparounds to knock down wind, and if I sit on them, scratch them or lose them, no biggy rather than expensive $100 jobs. I buy 3 pairs at a crack for about $25 price, and vary style and color. If you get headaches, it could be the way they sit on your nose, so play with different styles.
    8. NEVER... never test new equipment/food/shoes/gear if the event is important to you.  :>)

Ok, there you have some gear ideas. Please add your own comments/ ideas and go enjoy a run.

Fasteddie