Pabebe Jog: Baby Steps Post-ITB Rehab

After 11 weeks of ITB (iliotibial band) rehabilitation, it feels good to be jogging again.  

To be able to run again, I have to take things easy. Easy is the operative word.  No long distance running, and no speed work for a couple of weeks.  Effort and pace should be kept at low intensity for minimal impact. This is the period for 'baby steps', which coincides with the latest social media term 'pabebe' (Tagalog slang:  feeling like a baby, if you can get away with it).  For me, it's either pabebe jog, or rehab again. Pabebe jog should be okay for now.  

In photo:   'pabebe' jog from my pre-wedding photos.

I played badminton 2x and ran a 6km tempo on the 4th week of rehab, without seeking advice from Dr. Wolf.  It almost nullified our first 3 weeks of effort, and rehab was extended for several weeks more. I thought badminton might help strengthen my hips because of the horizontal movements required for this sport, but I did not consider the agile shift in movement.  Dr. Wolf advised me to stop playing badminton for a while.  He said, unlike in the States, most of them play badminton and can still hold a glass of iced tea at the same time.  Here in PH, when we play badminton, it is like we are out to kill someone. Well, true.  

My rehab program is a combination of several modalities, and a break from badminton and running:

1. Lumbar and cervical vertebrae alignment by a Chiropractor  - my tendons were cracking way ahead of New Year's eve celebration.  What pain?  I love it.  I could imagine my skeletal muscles like a highway choked in traffic.  After removing the bottleneck, the traffic flowed.  Much like my muscles, the alignment addresses the stiffness, so that energy/oxygen flows through the muscle more efficiently. 

Grabbed from www.intercare-centers.com

2. Myofascial release (MFR, Myotherapy) - a soft tissue therapy for the treatment of skeletal muscle immobility and pain.  It is a deep tissue massage, enough to make any muscle man cry.  I would always ask my therapist why don't we call it fraternity hazing, instead. Every time after the treatment, I feel like a 'new person' or a computer post-reboot.  

Grabbed from www.barefootdaves.com

3. Therapeutic ultrasound - non-greasy gel is applied, and 1-3Mhz of ultrasound is rolling on my back.  I feel like an ironing board being poked once in a while, and my muscles are like clothes.  The ultrasound feels warm to the skin. It is actually relaxing.

Grabbed from www.sportsclinical.co.uk

4. ICSS (conditioning strengthening stretch) - this really helped my muscles to become flexible again. The first session was tough, but the succeeding ones made me wish they stretch me enough to add even just an inch to my height.  

Frequency of therapy:  For the first 3 weeks, I went to Intercare 3x a week. It became 2x a week from the 4th week until 9th. Then, 1x a week on the 10th and 11th weeks.

Cost:  The monetary cost was significant, but reasonable.  The total depends on the combination of modalities and length of treatment.  

Learning - continue with consistency:

1.  Stretch. Stretch. Stretch.  Warm muscles are easier to stretch.  

2.  Warm up is equally important.  It helps prepare the muscles for a strenuous task.

3.  Muscle conditioning must be part of my sports activities.  Weekend warriors or recreational athletes are not exempted from muscle conditioning.  

Learning - stop:

1.  Any strenuous activities (in my case, running and badminton) when pain persists - do not train while injured.  It is bad training and will take a toll on other muscle groups, which compensate for the effort.  

Learning - start:

1.  Taping my knees and thighs before playing badminton.  

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Want to know more about Intercare?  Please visit their website.  

Related post:  ITBS: The band that never rocks

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Disclaimer:  This is a personal write-up, not a paid advertisement.

ITBS: The band that never rocks

April 2015 - I felt like running and I were back together again. It's true love, indeed. After two failed artificial inseminations, a surgical operation, and unwanted pounds, I started brisk walking several times for about three weeks.  

May 2015 - I was training 3x a week already, and maintaining a 5.5km for 40 minutes per run, as what work schedule typically allowed. I gradually introduced a once-a-week long slow distance (LSD) run.  I was running 40 min 2x a week, and 1.5 hours 1x a week.  

What began as an abrupt, sharp pain in my hip and lower back became a mainstay for three weeks. I had nagging thoughts that it could be due to my current fitness level - muscle weakness, weight gain, and postural issue while driving in heavy traffic and office work.  It is not yet enough for a conservative training to half mary. I also threw some muscle strengthening routine to my training, and a recovery drink.  The pain won't go away.  It could be the start of the iliotibial band syndrome (ITBS), and I was worried about its impact to my knees.  I have a history of bursitis (fluid in the knee), which I got from overtraining in badminton.  My right knee was then treated by a chiropractor.
  

10km is my new long slow distance (LSD) run.  Smile, though my hip and lower back were aching.
At the RU2 event with BFD, photo by Letsky Runner.

After the Run United event last week, I decided to consult a chiropractor, Dr Wolf.  He is one of the resident chiropractors at Intercare Clinic in Makati.  

Cozy reception area of Intercare Makati

Diagnosis:  ITBS (Yes, I was in denial for so long). 

Grabbed from http://www.mendmyhip.com/

Diagnostic approach and initial therapy:

1. Patient fills up form, chief complaint (CC), pain intensity/frequency/duration.

2. Patient is assisted to a therapy room, requested to wear a hospital gown.  Chiropractor interviews the patient, completes patient's posture/spine profile, and details about CC.  (Dr. Wolf also took note of my activities as a recreational runner and badminton player).

3. In my case - a physical therapist wrapped me in a warm blanket for 15 minutes, and then she massaged my back and hips to get rid of nodules (stuck lactic acid in the muscles; lamig in Tagalog).  There was a difference in response between the left and right regions of my back.  Dr. Wolf began to do alignment by applying pressure on certain muscle groups. My tendons were cracking like firecrackers (tendons are what hold muscles and bones together).  

Cause:  Weak abductor muscles (pelvic region); there is a misalignment in the pelvic-thigh region, and the right hip and leg are starting to exert more effort to compensate for the pain in the left side. 

To me, it means LACK OF BADMINTON.  I used to play badminton as part of my cross training for full marathons. I never had an ITBS issue back in the day.  The side-to-side (lateral) movement is a good exercise to strengthen the hip abductors (gluteus maximus and minimus, tensor fascia - muscles that hold the hips together).  

My first corporate badminton championship game.  Even bursitis cannot stop me.
I used to play like there was no tomorrow.  

Rehabilitation: Weeks of chiropractic + physical therapy + myotherapy sessions; at least, two sessions in a week.

Good things:

1. ITBS is highly curable.  Therapy is almost always effective. 

2. My ITBS has not yet affected my left knee. 

3. I can still do brisk walking with minimal discomfort, bike, and swim.

4. Chiropractic session (Chiropractor aligns bones, muscles, tendons - imagine all the cracking!  I'm a crack addict)

5.  Myotherapy and physical therapy to rehabilitate my muscles and tendons (tendons hold our muscle together)  

6. I have an 'almost balanced posture'.  My shoulders and back require minimal alignment.
7. I do not have to take any pain reliever or anti-inflammatory drug. 

Bad things: 

1.  No running in the meantime. 
2.  I cannot run long distance yet - wait, wait, wait some more.

3.  Forget about the half marathon race (21km) at the Manila Milo Marathon (July 26, 2015). 

4.  Canyon or Revel full marathon (42km) in California, Nov 2015 seems far fetched.

I will continue to rehabilitate my sore and inflamed muscles. I am looking forward to the day when I can chronicle my first serious training for a half mary and full marathon in three years.  

Enter soundtrack by Coldplay (music video grabbed from Coldplay Official Channel YouTube).  ITBS does not rock, Coldplay does!  \m/