Overtraining

Overtraining is a common issue in endurance sports, but paresthesia changes the game on overtraining for those of us facing into something like TM. Without being able to trust what my body is telling me, I needed to rethink my approach to acute training load.

Learning the Hard Way

I personally have significant perceptive loss in my legs and abs, which means I don’t get the same feedback while training. Initially when I was first starting PT and starting to build duration into my workouts I couldn’t understand the spikes in function loss and nerve pain that were happening. I explained it away as ‘no pain, no gain’ and (in typical fashion) tried to push through the pain barrier. I thought I was only trying to work through the function and signal loss from my lesions, but it turns out I was only (very) partially right.

In hindsight, what actually happened is I vastly underestimated the muscle loss from the high doses of corticosteroids I had been on. I suffered from corticosteroid induced myopathy and my muscles atrophied extremely quickly. I did not manage my recovery well and it set me back months. I ran into a lot of problems by initially trying to measure my effort and create a structure based on ‘feel’. By not accepting that ‘feel’ didn’t mean the same thing, I kept overdoing it and not prioritizing structure and rest. Eventually, I realized my body was lying to me and I needed to change.

The first key I learned seems simple, but it took a lot of mistakes for me to figure out. I had to stop trying to train to failure, if I trained until I couldn’t go anymore I was pushing way beyond my total threshold. Because of the mixed signals my body gives my brain, I was going too hard and too long. After I had a pseudo-relapse (which needs a post of its’ own), I started working seriously towards putting a better amount of structure together.

Finding Balance

One of my biggest struggles with overtraining was getting sidelined from normal family life when I went too hard. There were days where I was too tired to walk up the stairs or even be on my feet for any amount of time and I was stuck, leaving my wife to pick up the burden. This all fed into a really difficult mental state and created a very bad feedback loop.

I had to start small and be consistent. 10min on the trainer with very mild body weight stretching. Combined with daily life and getting out walking in my neighborhood, I was able to ‘train’ while still being able to manage the rigor of daily family life. I set hard limits for myself and I had to break the habit of pushing through the pain barrier, knowing that if I did I wouldn’t be able to keep up with my young son who wanted nothing more than to play with his dad.

Learning to Stop

It’s going to sound very counter-intuitive, especially for people who are into endurance sports, but the hardest workouts were the ones where I felt the best. I’d have a workout that fit into my structure and if felt really good, I wanted to push it. I wanted to ride longer, ski more, keep going. Learning how to stop felt impossible at first. I had always felt like I could do that one more lap, one more run, a few more miles and that it was the right thing to do. Why not get a little more training under my belt?

It was not an easy lesson to learn, I continually tried to up the effort which ultimately resulted in setback. I was stuck on a plateau of my own making and I kept feeling like if I worked harder I could break through. It was a terrible cycle and it was affecting every aspect of my life.

I committed myself to going easy. I bought a power meter, put more focus on HR load, and went slower that I thought I should. This was in early 2024. Over the course of that year I went from struggling through 10-15mi rides to getting back to 40+mi training rides and still being able to keep up with work and family obligations.

Nuts and Bolts

What did my training actually look like?

If you look through 2024, my weekly training load was all over the place for the first half of the year. I kept falling into the same overtraining trap I had fallen into the year before. My intensity levels were too high and it was coming at the cost of consistency and progress. I started training to HR and then started using a power meter to better manage effort.

That strategy carried me through the winter and into 2025 where I was able to continue to build my overall base. I was careful to include rest into my schedule, I tended to keep my hourly load similar and slowly increase my overall intensity while not burning myself out.

Where historically I would have worked to find my FTP by doing a straight up ramp test, I didn’t have the aerobic base or enough understanding of my body ‘feel’ to do that. I started by keeping my output intentionally low and then slowly increasing effort.

The TM Difference

Everything I’ve written above probably seems like a no-brainer to anyone who has done consistent training in the past. The difference for us lucky few that contend with partial SCI issues is the importance of having an outside measure to monitor our effort. With my nerve signals all garbled up in my spine, I can’t always trust what I ‘feel’. It goes both ways, somedays I feel terrible but my power numbers and HR are both looking strong and I know I can push through. Other days, I’m feeling alright but my heart rate is spiking and I can’t maintain the power I need for a workout. By using these tools I’m able to have a much more productive training schedule and avoid injury and burnout.

Thanks for reading!

Getting back on my Feet

After I made it through the lumbar punctures, MRI’s, steroids, and all of the other normal things that people like to do… I was demanding to stand up. I know this is not a surprise to anyone who has had an experience like this, but I was angry. Angry and frustrated and very very scared.

I forced myself to focus on the next thing: I could wiggle a toe, can I move my foot? My foot can wiggle, how about lifting my leg? I sat in my hospital bed and did whatever I could. Once I got to the point where I could (very weakly) wiggle my legs I started trying to stand. Every time my PT or OT came in and asked what I wanted to do, “Let’s try getting up again”

I had a lot of false starts, my PT would throw on the gait belt and basically lift me up. It was good exercise and good practice, but as soon he’d let go I flop right back down. Eventually I was able to hold it for a few seconds, than a few more, than it was a couple minutes. But it all started with the first time I was able to lift myself out of the chair and into my walker.

Needless to say, I immediately started on the next goal, I needed to take some steps.

I was really fortunate to end up with the inpatient physical therapist that I had. He was always down for whatever I wanted to try and would swing through whenever he had a gap in his schedule to hang out and see what we could do next. Normally patients only get an hour or so of dedicated PT time per day, I was lucky that I was definitely getting more than that, even if it was in bite-sized chunks. The consistency and the challenge got me through the early stages of TM.

Once I was able to stand in my walker and hold myself up, we immediately went to the gym. We tried to take steps, but it just wasn’t happening. Dynamic movement resulted in a near-fall every time. I just hadn’t regained the control.

So we worked on those simple dynamic movements. First with stretch bands while standing in my walker and my PT holding on to me and progressed from being able to work in the parallel bars and try the balance board. My PT and I got very well acquainted, I was determined to try anything and he was determined to help. Simple acts like getting on the balance board or even into the bars required him to give me a big ol’ hug and support me in. I’ll be forever grateful to that guy and he was one of the few people from my care team I send occasional updates to.

He didn’t have to do all this for me, he could have been like other caregivers I experienced on my journey and counsel me to ‘learn to accept what I had’. Instead he wanted to see what I could do. A piece of my thinks he was just entertained by this maniac he had as a patient. Jimmy, I’ll never forget you.

All of this culminated in finally taking some clumsy steps with a gang of PT’s holding me up like a stinky marionette:

One thing that complicated every part of my PT was the fact that, like most TM friends, had lost all bowel and bladder function. The care team was very determined to get me to have a BM so in addition to my normal meds I was getting loaded up with laxatives. Needless to say they didn’t work for a while so I was just uncomfortable all day every day. If you’ve ever had a serious case of gut rebellion on a long ride or run, you have an idea what I was feeling while trying to get things sorted. Coupled with the challenges of having a foley catheter in 24hrs/day and I was always having to juggle multiple issues while trying to exercise.

Lastly, something not mentioned enough is how the lack of privacy, lack of sleep, hospital food, and the overall lack of dignity of inpatient life really impact recovery. It was a motivator, for sure, but it was definitely not “healthy” motivation. Having people around that could just act as a support to listen was absolutely critical.

Pretty soon after I started walking with a walker, I was transferred to an acute rehab center, my next stop on my eventual return home.

Thanks for reading!

The Start of my Journey

I work in manufacturing and have for my entire adult life, which means I travel to a lot of factories and spend my days on my feet. On that normal Monday I was scheduled to go on a business trip like I’ve done hundreds of times. Bring my son to daycare, run some errands, take my dog for a hike, catch a flight, go into the office. Simple. Routine.

The day was going exactly to plan, got some stuff done, went for a nice trail run, played with my dog, and went home to pack and leave. When i jumped in the shower I noticed my left hand was numb. I chalked it up to an old rugby injury acting up. I probably tweaked something horsing around, wasn’t the first time.

After the shower, my arm was now numb to the shoulder. I ignored it, I had to get on the move. While I got dressed and packed my suitcase I felt unsteady, my feet and legs felt like rubber and feet were getting numb.

At that point I couldn’t ignore it anymore. I managed to go downstairs, scooting on my butt to make it down safely. I called my wife and told her that I wasn’t going on this trip and I needed to go to the hospital. I didn’t know what was going on, but I was scared and knew I needed help.

My wife came immediately home. By this point my hands were so weak I needed her to put my shoes on me, I couldn’t even grip the laces. She helped me to the car and drove to the ER. I managed to slowly, carefully, walk in. Once I reached the registration desk, all I could tell them was that I couldn’t feel my legs and was about to fall down. They grabbed me a wheelchair and immediately brought me back. I didn’t realize at the time it would be a few weeks before I attempted to stand up again.

By this point a little over two hours had passed since I first noticed the numbness. I was in a hospital bed, I couldn’t move or feel anything from below my waist, and the paralysis was still ascending. I got rushed into an MRI that was inconclusive, in hindsight they were using a lower power MRI in a mobile trailer while their normal facility was upgraded. It wasn’t until later, at a different facility, that my lesions were clearly seen.

While the team worked to determine what was going on and simultaneously worked to find me a bed at a hospital with a dedicated neurology team, the paralysis continued to ascend. The doctors brought in a respiratory therapist to monitor my breathing to make sure I didn’t need to be intubated. Thankfully the paralysis stopped at my chest and I remained able to breathe under my own power.

At this point I was getting MRI’s every hour or so while the team tried to get a bead on what was going on. The running theory became Guillain-Barre, but my symptoms didn’t add up.

By that evening, the team was narrowing down options for a transfer. Simultaneously I was now begging for a catheter, I had lost the ability to urinate but not the desire. I had never expected in my life to beg for something like that, but here we are.

Around 3am, I secured a bed in the emergency department at Albany Medical Center in Albany, NY. The helicopter couldn’t fly due to weather, so I got loaded into an ambulance.

After arriving in Albany, I was admitted, seen by their neurology service, and immediately started on high-dose IV steroids. They correctly guessed I had TM and that was confirmed by a follow-up MRI.

My overall experience from here will be familiar to people that have had any sort of spinal cord injury. Steroids, more MRI’s, poked by pins, hit with hammers, and lumbar punctures. My tests at that point weren’t to determine what I had, but WHY I had it. Everything came back normal or negative. No sign of multiple sclerosis, no sign of MOG antibody disease, etc. I was told I had idiopathic transverse myelitis. It could have been caused by a virus I picked up, but at that point it was impossible to tell.

My first morning after being admitted I had a meeting with the neurology team and the fellow and the consulting doctor stuck around to answer questions about my condition. At this point I was confused, scared, hurt, and very very angry. About 24 hours ago I could run, I could pick up my son. I traveled the world for work! I had a family, a career, a life! So I asked the obvious question, when do I get better? When do I go home?

The doctor told me that I needed to start coming to terms with the fact I would never walk again. I felt like I had just been hit with a sledgehammer, I had never had to wrestle with the fact that so much of my sense of self was tied to movement. I raced bikes, I played rugby, I skied! In an afternoon, all of that was gone with no explanation.

I ended up being in Albany Medical Center for a few weeks, at the end of which I could walk very short distances with a walker and was otherwise in a wheelchair. I’ll share my next stop on my journey next, acute inpatient rehab!