The DL on PRP treatment

As an orthopedic PA and a competitive runner, I've been asked a lot of PRP as a treatment modality for tendon, muscle and ligament injuries.  Therefore, I thought I would give everyone my professional opinion.

Platelet Rich Plasma:

First, what are platelets?  Platelets are found in your blood and aide in the clotting cascade when there is injury to a vessel.  If someone has too many platelets they are at an increased risk of developing blood clots verses someone who has too little platelets.  If an individual's platelet level is low, he or she will have trouble clotting and may experience increased bruising, nose bleeds, etc.

PRP Therapy:


injection of one's platelets into an injured area has been around for a couple of decades now.  However, there is no great evidence that this is a quick fix or cure for sports related injuries.  Blood is drawn from the patient, centrifuged down and the platelets are then injected into the site of injury (usually under the guidance of ultrasound).  The thought is that the plasma contains growth factors and proteins that are needed in the repair of tendon, ligament, muscle and bone injuries.  There is however limited evidence to support PRP therapy in the treatment of soft tissue injury.  The other thing is this treatment is expensive!!!  About $600-$1,000 per injection and 2-3 injections are needed.  The other thing to think about is the injection itself is putting a needle into the site of injury, which alone will increase blood flow to that area.  This is the same concept behind dry needling, so if you haven't tried that how do you know that isn't what helped (if it does help).  

Common running injuries and PRP outcomes:

• Plantar fascitis: PRP injections have been studied against corticosteroid injections in patients with PF.  The results favored the corticosteroid injection...
• Achillies tendonitis/tear-  Like the PF, there is poor blood flow to this site.  There are some studies that suggest improvement after PRP with this injury, however once again its after months, so who knows.
• Osteoarthritis of the knee- There seems to be a lot of studies looking at OA and PRP.  One study looked at the MRI of patient's with mild OA, they then received PRP and had another MRI a year later.  The repeat MRI did not show any significant increase in the OA.  Similar studies also used pain, where patients reported less pain after PRP, however patients that received a placebo injection stated the same.  Thus, I am a fan of the imaging studies and not a patient's verbal response that could be mental, aka placebo effect. 
• Patellar tendonosis: Study in 2007 in the UK used 44 patients showed an improvement in the group that underwent PRP therapy in return to sport as well as improved tendon thickness and reduced tears.  Another study that used a single subject track athlete showed improvement after 6 months from the last injection in combination with other treatment modalities... really?!

Risks: in general the risks are minimal.  As long as you don't have any crazy hematologic issues and have exhausted everything else, it can't hurt.  I'm not saying it will help though!

Conclusion:


I feel this is a benign option for someone that has exhausted all other treatment options.  This includes time off or activity reduction, FULL therapeutic dose of NSAIDs, dry needling, physical therapy, ice, etc.  I understand what it is like to want to return to your sport and being sidelined, but just know it really is a last resort and nothing is really proven.

Spring is Blooming

Yes.  Spring is blooming.  The tulips are out.  The grass is growing (well not mine, my yard is full of weeds).  And training is doing the same.

Runcation

4/22/17-4/30/17

4/24-30: 80 miles

The morning before flying out to Arizona I had a 16 mile long run workout.  3 mile warmup, 3 miles around 6-6:05 pace, 6 miles moderate, 3 miles back at 6:05, 1 cool-down.  It went mostly well, first hard 3 were 6:06, 5:59, 5:58, moderate miles around 6:50-55, the next 3 hard ended up being 2.5- 6:02, 5:58, with 1.5 down.  Wasn't feeling that last half mile as I made a 180 turn to head back home, something about finishing hard up Western Avenue wasn't happening.  

The Brutal Sun:

On Tuesday of vacation I had a bulky 8 x mile with 60 second rest.  I thought starting at 7:15 am was early, but not in Arizona... It was already 70 degrees and the sun felt brutal.  I was on a bike path with no shade.  Ironically all these paths follow a "river or canal" but there was nothing but dried up dirt as my scenery without an ounce of water.  I made it through the first 5 repeats all faster than the given pace.  Stopped for longer than my 60 seconds and got gatorade and water at my car after the 5th.  Next thing I knew I puked during number 6.  I called it a day.  No sense of getting dehydrated or ruining my recovery.

That afternoon I escaped the heat a bit and ran up in Sabino Canyon for a shakeout.  

Heading up Sabino Canyon

Almost everyday consisted of running doubles, taking a hike or exploring.  My brother and I went all over--Sedona, Scottsdale, Tuscon, Mt. Lemmon.  Thursday morning I met Amy, who I crossed paths with while trying to qualify for the OT in the fall of 2015.  Thankfully she got me up and moving early for a nice 10.5 miles before it got too warm.  I attended my conference Thursday and Friday (the resort was amazing!), then Saturday night I took a redeye back to NY.  

Hiking near Scottsdale

On the property of the resort where my conference was

The Down Week and Mastodon Challenge 15k

I was told to take a day off the following week and run closer to 60-64 miles.  Wednesday I had another bulky workout-- 3 warmup, 2 miles, 3x1 mile, 2 miles, 2 cool down.  It went amazing and I hit everything faster than instructed.  I was suppose to run Broad Street 10 mile on Sunday, but given the travel and heavy mileage the week prior, I thought staying home and running a local race would be better.  I signed up for the USATF ADK 15k GP without any goals.  The course as I knew was hilly and technical.  The race started off with the first mile going downhill, however I knew this meant we would be climbing soon.  Then we went off road onto a grass stretch that led to a trail with some stone to run on.  Well it had rained earlier so it was slick.  I was forced to run along the stone in the grass and mud.  Eventually we got off and hit an uphill to get onto the bike path.  Once we got off the bike path, another uphill.  The race continued on this way with another trail section and a lot of turns.  I won and finished in 56:37, which I was extremely happy with given the course.  Maybe I would have been ready for a solid Broad Street run... oh well, there is always next year.  I still won some money and had fun with my teammates.  

Willow Street taking 1st place USATF team

Coming in for the finish

  

Later that day, Emily and me went up to a 5k in Clifton Park to support one of our local runners.  Since I already raced that day, I figured Mia would run.  She had been doing some miles with me, she ran 5 with Emily and me several weeks ago sub 8 minute pace, I thought she was ready... or not.  She bolted out the first mile in 6:40, then dropped to a 12:20 since she decided to lay down a few times.  She was done, but eventually we finished!

         Mia smiling before the race

Mia exhausted

I'm feeling good that my training and results have finally started to turn around.  Running has its ups and downs, you just have to remember that and the fact neither will last forever.

“Let it rain on some days,

Let yourself shiver on some cold nights, 

So when it's Spring you'll know why it was all worth going through.” 

Looking Up.

Finally some good training and a decent race!!!

Training April 9th-April 22nd

4/9/17- Sunday long run.  16.5 miles, normal run with the last 3 hard, closed in 6:03.  Longest run in months, to finish off a 75 mile week, my highest week in a VERY long time.  I felt awesome and we got brunch after of course.

#bRUNchrunning #bRUNtribe 

4/12/17- Workout Wednesday!  Mike prescribed 12x400m with 200m recovery jog between 76-80.  I averaged somewhere between 77-78, boom!  

4/15/17- Saturday B.A.A. 5k-  okay so 5ks are NOT my speciality so I was a little in disbelief when Mike said I should be able to run close to 17:30, that's about my PR and I'm not in that kind of shape I thought!  My personal best on the course here was 17:45 a few years ago when I was having a stellar season, right before I ran 1:18 for a 3 minute half marathon PR.  I had my traditional pasta and shrimp dinner in Newton Friday night and stayed at the Park Plaza Hotel right next to the start.

Deciding on an outfit is hard with so many @skechersperformance options!

 I warmed up with Mollie and Lopez while Lopez's husband was our bag man.  Unlike the last time I ran this race, we couldn't just jump in our corral at the start like I thought.  We were directed to the other side of the park where we had to fight our way through thousands of people 10 minutes before the gun went off... stressful!!!!   My first mile was fast, but I felt relaxed and smooth- 5:31.  The second mile I lost Mollie during the "uphill" of the underpass.  We made the turn around, came back down the underpass and back up again.  Mile 2 was right before turning on Boylston.  It was so packed as we came back towards the park, I never saw the mile 3 sign.  We turned the corner and the finish line was already there.  I was slightly bummed because I had a lot left and should had known to kick earlier.  My final mile was 5:43, but the final .12 was sub 5 minute pace.  I ran 17:35, and felt good finishing, which I can't complain about.  We met up with Joe Benny for our cool-down, showered, got drinks and an amazing brunch!

Brunch with Lopez and Dave (Ame for it coaching), never a dull moment!!!  Thanks for picking Brownstone, so yummy!!!

4/18/17- Track Tuesday-   The workout- 10x800 at 5:50-55 pace with 200m recovery jog, followed by 10x200 at 3k-1 mile pace.  

Actual-10x800m with 200 recovery all between 2:47-2:49 (5:36-5:39) 200m were all sub 5 minute pace, except the first.  Warm up and cool-down--> 14 mile day!  That was a long one!

4/22/17- Saturday long run before jumping on a plane!  16 miles with some hard miles in there at 6:00 pace, mile 14- 5:58 before a 2 mile cool down!

In addition, I've added a more structured strength training program.  Doing it in my basement solo wasn't really cutting it, so twice a week I've been meeting up with some other runners at Powerhouse Athletics to do some fun, crazy strength stuff!  

This week I'll be in vacation in Arizona (Phoenix, Sedona and Tucson).  If you have any suggestions where I should run, hit me up! 

Happy Running! 😎

Life in a nutshell.

It's been a long time since I've updated my blog.  And there's good reason for that.  My running has sucked.  My grandmother who I lived with all my life passed, work has been crazy and I'm just trying to make it from one place to the next without being too late in life.  I told them to stop during my massage last week because I was late for a work dinner, then quickly changed into 1 of 3 outfits I brought to my appointment and did my makeup while driving (unsafe, I know).

Last November, I completely changed my training to try something different.  I started doing less mileage, higher intensity and more workouts.  I thought I would be in great shape for the Houston half in January... then on Wednesday before the race I got a call at work.  My grandmother had a heart attack.  She was stable but not looking great.  I got out of work late and rushed to the hospital.  As soon as I got there, my grandmother perked up.  She had been out of it all day, but I got to see her up and alert.  We knew that night wasn't certain.  I arrived at the hospital the next morning to wait for the doctors as I'm the medical one of the family and need to be present for these things.

This was the first day of running I missed in months...

My grandmother hadn't  eaten and was refusing to until AFTER the doctors got there because "the last thing I want to do is eat, get sick and be unable to talk to them."  Sure enough rounds took forever and I was able to get nan to eat some toast.  The doctor walked in, and as she called it, she puked.  We went outside to talk where we ultimately made the decision of hospice, we were going to withdraw the drip she was currently on, along with other medications.  Nan was upset.  "I don't want hospice, those people take care of you, just let me go home by myself."  As crystal clear as she was, she didn't get it.  No one said anything, so I had to tell her, you aren't going home, this hospice is here in the hospital...

The look on her face as I told her I will never forget.  To know your body has totally failed you, despite being healthy-- riding her bike, doing her abs everyday still and lifting her soup cans as weights, and that this was it.  I told her we weren't going to be sad and instead do something fun.  I went and got nail polish to paint her nails, and we reminisced and I laid in bed with her.

I left to go take care of myself, I still had a flight to Houston the next day.   I came back that night and everything changed.  Nan was no longer coherent.  We played Frank  Sinatra for hours, then I finally left, knowing this would be the final goodbye.

The next morning on my way to the airport my grandmother shockingly called me.  I couldn't believe it.  She called my brother in Arizona as well who was desperately trying to get on a flight.  Mentally she was hanging on to say goodbyes.  Saturday morning I walked into the expo to pick up my bib and got the phone call, she had passed.

You may wonder why I still went to Houston knowing what was going to happen.  I had the best last memories with her and wanted those to be it.  She got bad.  I know what happens. I see people die in the hospital a lot.  I wanted me painting her nails, laying in bed, talking about the old days with her to be my last memories.

The next week was hard.  I  read her eulogy at the funeral.  I heard from friends I was shocked to hear from and didn't from others I would have thought I would have.  I learned a lot about family and true friendships during this period.

So anyway, this is about running, right?

My running still hasn't been great... in March I went to Gate River.   I ran the worst race of my life.  I did all the work (the abs, but not soup cans), yet my body failed me.  My plane had an emergency landing on the way in, delayed my arrival into JAX and altered my ride picking me up from the airport.  Thankfully for this disaster, I was able to stay an extra night and partake in the after parties.  So I still had a good time and met new people, one of who suggested to get my cortisol tested.  Several days later I did and it was through the roof.  Who knows if that was it or mentally I just wasn't there (racing is 90% mental), but I  recently decided to go back to what worked.

Anytime I meet a non-runner and tell them how much I run, they always say "wow, you must really love running".   Well this is first time I'm admitting this out loud....  No.  I feel like I am missing out on parts of life because I have a long run the next day or I am tired from running 75 miles that week, but I am stubborn and I have a plan.  I always have a plan, I am a planner.  And that plan is Berlin.

The Back Story

Running came into my life at a very important time.  Sure, I ran through HS and college and was decent, I was a soccer player, but the competitive aspect kind of saved me.  After undergrad, I did a masters program at BU medical, which essentially was first year medical school.  I hated it and was beyond stressed and depressed about what I was going to do with my life.  As I had in the past, I used food (rather the lack of) to have control.  Unfortunately this led to rock bottom where I collapsed on the green line in Boston.  The paramedics came down to the lowest level of the train station and took me out on a stretcher to the hospital.  The facility where I had been receiving outpatient treatment was contacted.  The next day I was admitted.

After several weeks, I signed out AMA (against medical advice) and moved home.  I then ran my first marathon the next month (without medical permission or knowledge of course).  I lived, in more way than just not having a heart attack.  I joined a running group and started to see real runners normalizing running and food.  Fast forward 4-5 years and I was now 100% normal in regards to food.  Some people say you can't be cured of an eating disorder, but screw that.   I'm living proof.  Zero negative thoughts enter my mind when I eat chocolate cake.

So I got healthy because I loved running and wanted to run fast.  And guess what, I ran so much faster!!!!   My marathons went from 3:57, 3:27, 3:19, 3:13, 3:12, 3:08, 3:07, 2:59, 2:50, 2:45.

I love competing and I love winning.  But at the end of the day, there is so much more to life than just running.  Sure, I have my best friends I get to run with and travel to races with, but it's nearly impossible to date outside of this world.  No normal person will understand that I NEED to get up early to run, and yes, then run again after work because I'm too stubborn to give up when there are 45 seconds between me and making the OTQ.  That taste in my mouth after missing the trials, of failing. After all that's happened I will be there in 2020.

So full circle here.  My plan is to make the OTQ this September in Berlin.  Then I'm done for a bit.  Life is too short to not live it to the fullest in all aspects of life.  I haven't had a period in 5, maybe 6 years?  To get my body rested and recovered and live a life that more normal people my age are doing!

I'm pretty excited!

November Training

Well, the year had been rather disappointing and instead of doing the same thing over and over again expecting different results (insanity) I decided I needed a change.  It was an extremely tough decision, but I decided to change up my training with a new coach as of November 1st.  I LOVED my last coach, I had been with him for almost 4 years and I have all the confidence in the world in him.  However, I felt like I needed to try to impress someone new.  Mike was great and always found the silver lining, however I somehow knew if it didn't go well he'd make it okay, which is great and he did.  But it was almost like I lost that drive to try to impress him (or my team for that matter) because I was old news or they/he wouldn't think of me any less.  Twisted I know, but I needed a change that was going to light a fire underneath my butt again.

So November 1st, I started a new, intense, training program.  The biggest difference was the emphasis on my recovery days.... run SLOW.  I'm not talking crazy slow, but 8 minute pace.  Yes, this was very hard at first.  The day after a race or workout it wasn't abnormal for Emily and me to push the pace, running some sub 7 minute miles, totally unnecessary.  In addition, we've added a lot of strength routines (ugg these are so time consuming!), and hard efforts for all my long runs on top of 2 workouts plus a turnover workout.  So really, those 8 minute recovery days are so needed as they only occur 3 days a week!

Despite all the workouts I wanted to keep my promise to my team that I would run both Stockade-athon and Troy Turkey Trot.  Stockade-athon didn't go so well, however I do believe a lot of it was mental.  For some reason I told Mollie to go and take off just after mile 4 when another female came up on us.  I should have went.  This was technically an easier mile on the course and I let them go.  At this point in the race I was thinking I should just shut it down and finish as a workout, damn it I have to finish because we only had 3 people on our A team to score, me being the third.  Surprisingly (or not so much) this was my slowest mile of the race.  Given the course, this should not have been the case!!!

2 days later I had a workout.   I got stuck operating late at work for almost 12 hours.  When I got home it was dark, cold and raining--so miserable.  But I had to do the work.  I headed to SUNY for a 3 mile warm up, then got on the track.  Hit the workout (okay the first rep was a little slow, but its so hard to judge your pace in the dark, you always think you're running faster!), got home had a protein shake before passing out.  I continued the week with a good 10k tempo at a small race in Hudson Falls on my way up to Lake George for my cousin's bachelorette party.  After a fun afternoon/evening with the ladies I passed out in my bed at the house they rented to catch some sleep before a hard long run the next morning.  I woke up to nasty freezing rain/sleet/snow the next morning, I was about to throw the hard long run out the door.  Thankfully, some of the Willow Street gang agreed to meet me at Zim Smith and Brittany was still up for doing the workout. 14 miles total, with the first 2 being an easy warm-up.  We averaged 6:26 for the next 12 miles, making it a good day.

60 degrees one day, then snow the next!  Glad I
got to wear my new Skechers crop top before bra season is over!

Then came Thanksgiving, the Troy Turkey Trot.  I didn't have much confidence going into the race and already told everyone that asked if I was going to win again this year "No".  I said my teammate had been running great and I wasn't so I was hoping for second place.  I had a race strategy going into the race in attempt to get me just under 37 minutes.  The first mile was a little slick!  We go over a bridge that we then make a 180 degree turn around a cone to come back on.  A guy in front of me fell.  I literally stopped dead in my tracks to make that turn.  Brittany was ahead of me, but I kept telling myself not to get too far back, stay within distance.  By mile 1 I pulled up along the side of her and continued to go.  I was pleasantly surprised when I came through mile 3 pretty much right where I wanted to be.  Then came mile 4--wow I didn't die, then 5--really?!, mile 6 and the finish.  I ran 36:26, 8 seconds slower than my PR for the distance a year ago.  I was excited.  I didn't think I was in shape for that, or my legs would respond after the heavy past week and a half of training...wait that means I am in shape?!  It's amazing how running can be so mental....

Willow Street took the 1-2-3 sweep and clearly won the team division.  A great day for running and to eat lots of food after!

I don't like 2016.

So where to begin?

This has been the worst running year for quite some time... Assuming I don't have some massive improvement in the next couple months this will be the first time in 8 years I didn't run a PR.  And it's not that I'm not only not running a PR but I'm getting slower and slower (cry).

The year started with a training run 2 weeks before Houston (1:22:30 half, perfect pacing), followed by a 2:46 at Houston, followed by a 1:22:06 the following weekend.  Time for a break.  However I never came back with speed.  I ran a 1:21:00 half in May, a couple decent 5ks (17:31 and 17:43) a 23:20 on a hot 4th of July 4 miler, but that was it.  I don't know what happened.  I was running 78 and 77 half marathons, 36 minute 10ks on the verge of going sub 36, low 29 and sub 29 5 milers... what happened?

In August I got periostitis of my second metatarsal which halted my training as soon as I was finally ramping up.  I went from finally getting to 2-70 mile weeks to 16..30...40 miles/week until I could finally get back into the 50's.. still no workouts to ensure it healed.  And then it did when I finally hit a 72 mile week.  Then the following week as I continued to increased my mileage, boom.. runner's knee... down to 30 miles the next 2 weeks (including this week).  I decided to still run the local half marathon today... 1:23:23.  Are you kidding me?  I haven't ran a half that slow in years.. my marathon half split is faster than that!  That being said, I guess you can subtract 30-45 seconds for the extra distance we ran in the first mile... a group of us went the wrong way, got yelled to come back and had to turn around.  So not fun.... BUT STILL??!?!  Partially I was being smart with my knee, I didn't know what would happen and it had been 2 weeks since I could run over 7 miles without pain and having to stop, so yes, I was not mentally or physically prepared to really attack and race.  However, I thought I should be able to run a tad bit faster without "attacking a race" and just being comfortable.

It's hard for me to decide what to do next.  Was part of it the sudden drop in mileage the last 2 weeks?   All the glute, quad and hamstring exercises I compulsively did multiple times a day the past 2 weeks? The back to back injuries that mentally made me scared to race?  Or have I adapted to a training program that needs some drastic change, or do I just need a long break and start from scratch?  I really wanted to wait until mid-January to take a break, but we will see.

I CANNOT wait until 2017....

All About that Base.

July 10th, 2016

Well after a few days off and a month of casual running I am feeling pretty good.  Aside from 2 races I jumped into because I was already committed, I haven't done a workout in over a month.  I ran the Adirondack 10 miler at the end of June and surprisingly ran pretty even splits despite my lack of distance/long run strength recently.  It was warm per usual and I was still able to run 30 seconds faster than last year.  On the 4th of July I ran the Firecracker 4 miler--I knew I should be faster than last year, but the conditions were nothing like 2015.  Last year was overcast and cool for July 4th, whereas this year was sunny and 70 at the start.  I managed to run 9 seconds faster this year which I am sure could have been more had it been cooler.  The other positives from this year was I was able to out kick the girl in front of me for 2nd place overall and I went through the 5k in 17:51, right where I was at OK5k almost a month earlier on what was a flat course on a perfect overcast day unlike FC4.  I finished in 23:20, definitely slowing uphill around the 3.25-5 mark, but not terrible overall.  Our open team and 50+ team won our categories and took home some cash for that as well.

Beginning of the ADK 10 miler

2nd Overall Female @ FC4

The other good thing that has happened during this rebuilding period is I signed on with Skechers!  I'm super excited and pumped to be part of a community that is supportive, understanding and overall has some awesome people.  I started wearing the Go Run Ride 5, which I really like.  Dave (our local rep) sent me the go meb speed for FC4 which were great.  I must say this is the first time my bunion hasn't bothered me in YEARS!

My sweet Skechers' race kit!

What's next?!
So another 2 weeks or so of base training, then we will start to work in the workouts.  I have decided to run a 10k in less than 2 weeks with some of the Skechers women, but I'm not expecting anything spectacular.  If anything, it will be a chance to meet some new people and get in a workout.  I bumped my mileage up from 55 the last 2 weeks (last week was impossible to hit 60 with work) to 64 this week.  Likely 70 next week and 75 the following before really adding long aerobic workouts.

I have some big goals for this fall and am trying to remember to be patient.

"Patience is key to success. Good things come to those who wait. Success doesn't come overnight for most people. It requires a lot of learning, hard work and experience to reach a certain life goal."