Image: Denise doing step downs
Jim Seida  /  MSNBC.com
In a test of strength and balance, Denise defies the odds and actually completes a step down as physical therapist Michelle tries not to laugh.
By
msnbc.com
updated 3/17/2005 11:57:06 AM ET 2005-03-17T16:57:06

What’s black and blue and red all over? My embarrassed ego on Day 1 of physical therapy.

Oh, I have come a long way since my first lead-footed attempts at running (I would say I’m closer to regular unleaded now, with hopes of achieving premium unleaded). But for every step forward, there will be a new task, a new skill that will shout back at me: “Not so fast, sister.”

Physical therapy is one such experience. Seemingly simple tasks such as propelling myself across the room on a wheeled chair serve as illustrations of my incredible lack of strength and balance. Once again, I am humbled. And once again, the little voice starts to talk to me: “Who are you kidding? You can’t even do lunges without being out of breath? How are you going to be able to do a 140-mile race?” More on the little voice in a second.

But like much of regular training, physical therapy is about tearing you down and building you back up again. It’s about getting your injured body part back into shape, and using the other healthier body parts around it to help with that recovery.

First of all, I was incredibly lucky. My knee injury didn’t require surgery so that accelerated my rehab time considerably. But what I do have — patellar tendinitis — is an insidious injury, one that will continue to flare up again and again unless I really let it rest and heal and address the problems that led to the injury in the first place.

I have the rest part down. After the Seattle half marathon (which was Thanksgiving weekend), I stopped running. By the time I began physical therapy in late December, I had gone almost a month without running. Now it was time to work.

My PT placement exam
On my first appointment, Bonnie Mangino, my physical therapist, gave me an evaluation. She checked my flexibility, range of motion, swelling, relative leg strength and my body alignment. The good news is that I don’t have one leg that is shorter than the other, but the rest of the news was pretty grim. My flexibility was non-existent, my range of motion (largely caused by the swelling of the injury) was poor, my leg strength was feeble and my feet pronated. All right! Now we have a party!

The prescription was simple — improve the strength and flexibility in my quadriceps and hamstrings to take some of the pressure off my knee. And get inserts in my running shoes to keep my feet in better alignment and to correct the pronation.

Physical therapy always starts with massage and a warm up on the stationary bike (about 7 minutes), then the exercises begin:

  • Lunges (three laps across the room) to build strength in my quads, hammies and gluts (buns of steel!)
  • Leg press (2 sets of 20 on the weight sled) again to build strength in my quads.
  • Monster walks (this involves putting an elastic band around your knees, getting into a squat position and side stepping across the room. 3 laps.)
  • Clam shells (2 sets of 20. Lying on my side with the elastic band around my ankles, my legs bend and my feet together, I raise my upper leg to the point of resistance and lower it again). More strength building.
  • Step downs (2 sets of 20 on each leg). I stand on a box and step down with one foot and use the quads of my other leg to lift the dangling foot back up to the step. Kind of like one-legged squats.
  • One-legged hops (I stand in a taped-off cross and, on one foot, hop into each of the quadrants of the cross continually 10 times. Then I do the other leg. Then I hop back and forth diagonally to a count of 10. On each foot.) This also is a strength exercise. It also illustrates my lack of balance and makes me sweat a lot.
  • Balancing (standing on a foam mat on one leg, trying to maintain your balance to the point of fatigue. 3 times on each leg.) Don’t do it with your eyes closed. You will fall.

And then finally, my personal favorite, the stool crawl. It's very simple. I sit on the edge of a wheeled stool and, using just my heels (no upper body movement, please), pull myself across the room and back three times. Sound easy? Try it. It's all hamstrings and if your hamstrings are weak it is hard as hell. After four weeks of PT, it's getting easier, but it's far from easy.

Each therapy session ends with ice on my knee and a chance to cool down and reflect. After four weeks, I can see a marked change in my strength, balance and flexibility.

But wait, there's more
In addition to therapy, I also have been doing my regular training workouts. Mondays and Thursdays are devoted to strength training. I do a circuit on the weight machines: Biceps curls, triceps press, chest press, shoulder press, arm pulldowns, seated row, leg press, hamstring curls, calf lift, back extensions and many, many stomach crunches.

The sets are the same for all machines. Start with 12 reps at the heaviest weight I can stand and still complete 12 reps, then drop the weight by 10 percent and immediately do 20 more reps. If I can't complete 20 at that weight, I drop the weight further and start again. After just a month, my strength and definition are improving.

  1. Don't miss these Health stories
    1. Splash News
      More women opting for preventive mastectomy - but should they be?

      Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

    2. Larry Page's damaged vocal cords: Treatment comes with trade-offs
    3. Report questioning salt guidelines riles heart experts
    4. CDC: 2012 was deadliest year for West Nile in US
    5. What stresses moms most? Themselves, survey says

Tuesdays are brick day. For those of you unfamiliar with triathlon parlance, a brick is a combination of events done one right after the other (like you would do in a triathlon). For now, I'm doing a bike-run brick. I ride the stationary bike for 30 minutes, then immediately get on the treadmill and run for 30 minutes. The goal is to stay within my heart-rate zone, or close to it, for the duration of each segment.

Wednesday, in addition to physical therapy, I swim and attend a speed workout at the track. For now, I'm focusing on drills in the pool (more about that next time).

At the track, however, the emphasis is on speed.  We always start with a warm up mile in the warmer weather. In the chilly Januarys of Seattle, we do two miles to warm up (eight laps).

After that, it's a series of drills designed to work on leg turnover and form. Jeff, my personal trainer and leader of our scrappy band of overachievers, gives us a series of intervals. For example, we might do mile repeaters, during which we are supposed to run each lap of the four-lap mile at the same pace. The idea is that you can run faster and push yourself for a shorter distance, and gradually, your leg turnover gets faster when you do your longer runs, thus cutting your times. The Wednesday track workout has been the single greatest reason for my improvement as a runner and a triathlete.

Woohoo! It's play day!
Friday is my off day. If I go right home after work, there's a better than 70 percent chance I will fall asleep on the couch. But if I plan accordingly, I can laugh, drink, eat, go to a movie or simply play with friends. Rest and recovery are as important to training as reps and bricks. They're also good for the soul.

Saturday is another swim day, coupled with a 30-minute bike ride. A relative rest day compared to Sunday, which is long run day.

While I continue to rehab my knee, I have been building my stamina and strength back up during these Sunday runs. I complete the set time goal (this week it was 80 minutes), but at a slower than normal pace. I also run on a 9-1 system, meaning that I run for 9 minutes, then take a 1 minute walk break, then repeat.

During the past few weeks, Jeff has been running with me while the rest of the gazelles in our group gallop ahead. Jeff has graciously offered to be my running partner during my first test of the season — the Vancouver marathon. During our Sunday runs, he paces me. And we talk a lot. About the voice.

I mentioned the voice earlier. It comes in many forms. It can be that inner demon that has been telling you from birth that you aren't good enough. It can come in the form of your mother or your friend's voice, questioning your sanity or wondering if you aren't really just avoiding other "deficiencies" in your life with all this training nonsense. It can come in the form of others who wonder if you aren't showing proper respect for Ironman by trying such an endeavor with little previous experience.

Sometimes, it can be a whisper and other times it roars. It pops up during training sessions and physical therapy and I can be sure it will bellow like a soprano doing "La Boheme" during the Vancouver marathon and Ironman itself. We talk a lot about how to answer the voice, in all its forms.

It's natural and normal to have doubts, especially when it involves something that is so big, so demanding. But the chase for Ironman, or any other meaningful endeavor, isn't something you do to avoid getting a real job or finding a mate. It's not a mission of madness or impetuosity. There's too much time alone on the road and in the pool to ponder your actions. It's about testing your body, your heart, your mind. And knowing that no matter the outcome, whether you finish Ironman or not, you are up to the test. In all things.

Next installment: I love the smell of chlorine in the morning. It smells like work.

© 2013 msnbc.com Reprints

Discuss:

Discussion comments

,

Most active discussions

  1. votes comments
  2. votes comments
  3. votes comments
  4. votes comments