Don’t Ring The Bell

This was the week that we learned Washington Wizards’ point guard and five-time All-Star John Wall will have season-ending surgery to address bone spurs in his left heel. Wall had secretly suffered through several seasons in pain before consulting with a specialist who recommended surgery. I’ve been following Wall’s condition closely since a bony heel protrusion showed up on my own right foot this past summer.

It’s called Haglund’s deformity. Mine and John Wall’s. A bony englargement on the back of the heel, or essentially a bone spur on the heel. I will only say that if you’ve got one, you’ll feel it every day forever. The last thing the doctor told me was that it would never go away. Given John Wall’s level of play, his doctor warned that the stress from the spur could eventually rupture the Achilles’ tendon. Thus the surgery, and six to eight months’ recovery.

In retrospect, I can see that I floundered a bit during the second half of 2018. Previous injuries could always be resolved with rest. Give it enough time, and whatever ailed me would get better. This time the injury turned out to be permanent, and it changed everything in life as I knew it.

Running has defined nearly half my life. Years before I even acknowledged myself to be a runner, I ran five miles every day. I didn’t take rest days because I didn’t realize you needed rest days. Memories of every place I’ve lived revolve around the running routes associated with that city. Life revolved around running, and I’ve loved every minute.

Once your mind and body have adapted to not working out, however, it’s pretty easy to convince yourself to give up on your previous level of exercise altogether. It has taken me awhile to come up with a plan.

The most common thread among athletes of all rank is injury, but it’s a short list of athletes that make a come-back from catastrophic injury. Peyton Manning had multiple neck surgeries, Serena Williams had pregnancy complications, Kobe Bryant’s shredded knees, and Ben Hogan’s serious car accident. Then there’s Tiger.

A list of Woods’ surgeries prior to his second microdiscectomy operation in Sept. 2015. 
photo courtesy: abcnews.

It’s easy to quit. It takes courage – and a plan – to stay in the game. And if you’re not moving forward, you’re losing ground.

How you plan forward momentum is dictated by your present condition, but your present condition should never prevent you from moving forward.

My husband and I have researched my injury from every direction. I’ve tried every homeopathic solution ever mentioned – he discovered a new one just yesterday that’s already on order. He also bought me a pair of minimalist shoes with the thought that they would help strengthen the muscles and tendons of my foot and ankle over time. So far so good.

I stopped running (again) in November in favor of walking. Since then I’ve focused on a strengthening routine and increased my walks to an hour, six days a week – roughly 4 miles each. By February, I hope to incorporate a few days of running, and plan my next steps from there. Surgery may still be in my future, but we’ll try every other avenue first. It’s a process.

I’m reminded of my first lessons in Kung Fu and Wing Chun. The translation of Kung Fu is time and effort. There are no short cuts. The foundation of Wing Chun is to always move forward and aim for the center.

Naval Admiral William H. McRaven, ninth commander of U.S. Special Operations Command, gave an amazing and powerful 20-minute commencement speech at the University-wide Commencement of The University of Texas at Austin in 2014. The speech was about the lessons McRaven had learned from Navy Seal training, “To me basic SEAL training was a life time of challenges crammed into six months.” A few of the key points from his speech seem to provide a nice conclusion to my thoughts. (Read the full transcript here.)

Don’t Be Afraid of the Circus. Every day during training you were challenged with multiple physical events—long runs, long swims, obstacle courses, hours of calisthenics—something designed to test your mettle. Every event had standards—times you had to meet. If you failed to meet those standards your name was posted on a list and at the end of the day those on the list were invited to—a “circus”. A circus was two hours of additional calisthenics—designed to wear you down, to break your spirit, to force you to quit. No one wanted a circus.

But an interesting thing happened to those who were constantly on the list.  Over time those students-—who did two hours of extra calisthenics—got stronger and stronger. The pain of the circuses built inner strength-built physical resiliency. Life is filled with circuses.

Get Over Being A Sugar Cookie And Keep Moving Forward. Several times a week, the instructors would line up the class and do a uniform inspection.  It was exceptionally thorough. Your hat had to be perfectly starched, your uniform immaculately pressed and your belt buckle shiny and void of any smudges. But it seemed that no matter how much effort you put into starching your hat, or pressing your uniform or polishing your belt buckle—- it just wasn’t good enough. The instructors would find “something” wrong. For failing the uniform inspection, the student had to run, fully clothed into the surf and then, wet from head to toe, roll around on the beach until every part of your body was covered with sand. The effect was known as a “sugar cookie.” You stayed in that uniform the rest of the day—cold, wet and sandy.

There were many a student who just couldn’t accept the fact that all their effort was in vain.  That no matter how hard they tried to get the uniform right—it was unappreciated. Those students didn’t make it through training. Those students didn’t understand the purpose of the drill.  You were never going to succeed.  You were never going to have a perfect uniform. Sometimes no matter how well you prepare or how well you perform you still end up as a sugar cookie. It’s just the way life is sometimes.

If You Want To Change The World Don’t Ever, Ever Ring The Bell. Finally, in SEAL training there is a bell.  A brass bell that hangs in the center of the compound for all the students to see. All you have to do to quit—is ring the bell.  Ring the bell and you no longer have to wake up at 5 o’clock.  Ring the bell and you no longer have to do the freezing cold swims. Ring the bell and you no longer have to do the runs, the obstacle course, the PT—and you no longer have to endure the hardships of training. Just ring the bell. If you want to change the world don’t ever, ever ring the bell.

The Pump Bump and Achilles Tendinitis

She was the goddess of water in Greek mythology. Both Zeus and Poseidon loved her and did their best to win her hand in marriage until Prometheus warned them of a prophecy that her son would become greater than his father. She married a mortal king instead, and dropped their son into the river Styx to make him immortal – holding him by the heel of his foot.

I had exercised patience regarding the time required to recover from a dislodged peroneal tendon, but when the swelling subsided and I could no longer move the tendon around with my finger there was still a hard bump on the back of my heel. Even relatively easy exercise made it sore. It was time to visit the doctor.

My husband and I sat quietly while the doctor examined my heel. As he left to order the x-ray he mumbled something about a pump-bump. My husband immediately took to his phone and by the time the good doctor returned we had discovered everything there was to know about Haglund’s Heel.

Dr. Haglund was a friend of Dr. Roentgen, the inventor of the x-ray. Haglund began researching the boney anatomy of humans for his dear friend, and came up with a fairly common deviation of the heel bone, which became known as Haglund’s Heel (also Hagulund’s Syndrome or Deformity).

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This deviation is associated with decreased range of motion of the ankle and increasing age, typically hitting women in their 40s, 50s, and 60s after years of wearing high heel shoes. Jumping, running and navigating stairs can exacerbate the condition making inflammation and heel pain worse. It develops gradually, but we usually take notice when the tendon becomes inflamed. In many cases, especially with runners, Haglund’s Heel evolves into Achilles tendinitis.

Insertional Achilles Tendinitis is a common overuse injury among athletes causing stiffness in the heel especially in the morning, pain along the tendon that increases with activity and possibly swelling. A bone spur gradually develops around the tendon that can cause irritation (bone tends to generate new bone in an attempt to heal itself), and eventually the tendon may calcify and harden.

7A184A2D-7D55-4E29-9737-E6D2D4A2A7B6Note: Insertional Achilles tendinitis affects the back of the heel where the Achilles tendon inserts into the heel bone. Non-insertional Achilles Tendinitis causes pain in the lower calf, where the Achilles tendon and calf muscle meet.

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Male and female athletes alike can develop insertional Achilles tendinitis with or without the underlying Haglund’s Heel, but in many cases Haglund’s Heel will trigger or evolve into insertional Achilles tendinitis.

Why it hurts: When a healthy tendon experiences an increased load, it responds by increasing its stiffness to handle the greater demand as it also increases the production of collagen cells. Researchers propose that this non-inflammatory cell response is an attempt by the tendon to increase the cross-sectional area to better handle the load. This short-term adaptation is reversible if the load is diminished or the tendon has a chance to rest before the next stress is applied. Over time a healthy tendon adapts to the stress by growing larger and stronger. An overused or diseased tendon does not recover from the stress and the injury progressively worsens.

The Progression:

Tendinitis is inflammation of the tendon (the suffix “itis” indicates inflammation), in this case of the Achilles. The condition lasts about six weeks although most practitioners view tendinitis as the first in a continuum of tendon injuries that subsequently increase in severity (you’ll also see it spelled tendonitis). If you feel pain in your heel, this is the time to take action.

Tendinosis is a non-inflammatory degeneration of a tendon that can include changes to its structure or composition. These changes often result from repetitive micro-traumas or failure of the tissue to heal and will likely require several months of treatment.

The suffix “pathy” is derived from Greek and indicates a disease or disorder. Tendinopathy is the term also applied to a chronic condition that fails to heal. For example, a runner who has suffered a hamstring tendon rupture that does not heal properly may be diagnosed with tendinopathy.

Insertional Achilles Tendinopathy is inflammation, and later, degeneration of the tendon fibers that insert on the back of the heel bone. Since the Achilles tendon connects the calf’s gastrocnemius and soleus muscles to the calcaneus, or heel bone, by the time you’ve reached the Achilles tendinopathy stage you will likely also notice reduced strength in the calf muscles.

Treatment: The Achilles’ tendon is exposed to greater amounts of strain in the dorsiflexed or upward position where the forward section of the tendon is exposed to low loads. Researchers suggest the lack of stress on this forward aspect of the tendon may cause that section to weaken and eventually fail. The treatment goal of insertional Achilles tendinitis is to strengthen the forward-most aspect of the tendon, which is accomplished through a series of eccentric exercises.

The Alfredson Protocol: The story goes that Hakan Alfredson, an orthopedic surgeon and professor of sports medicine in Sweden, developed Achilles tendon problems in the mid-1990s. When his boss refused his request for surgery because the injury was not yet advanced enough, Dr. Alfredson attempted to deliberately aggravate the injury with a series of exercises. Instead of getting worse, however, his injury disappeared.

These exercises, now known as the “Alfredson protocol” are considered the most effective first line of treatment for Achilles tendinopathy. The eccentric movements are designed to physically stimulate the cells in the tendon as they move relative to each other, causing the cells to initiate a tissue repair process.

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Stand on your toes at the edge of a step (holding onto something for balance). Slowly lower the injured foot until the heel drops below the edge of the step. Return to the starting position (on your toes) by using the non-injured foot. The injured foot should never be used to raise onto your toes.

Perform 2 sets of 20 reps with the knee straight, which strengthens the gastrocnemius muscle, and another 2 sets of 20 with the knee bent to strengthen the soleus muscle. Repeat the exercises twice daily for 12 weeks. If the effort become too easy, add weight to increase the load.

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(The original protocol called for 3 sets of 15 reps with the knee straight and another 3 sets with the knee bent for a total of 180 reps daily.)

Note: as with everything science, there is a corresponding study that found no difference when performing the heel drop using a straight knee only, and performing the exercise from both the straight and bent knee position.

Compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy

Another study published last year involves a 3-prong approach combining the eccentric exercises mentioned above with compression band therapy, or CBT, and Lacrosse Ball Management (basically massaging the tendon using a lacrosse ball).

LBM: Once daily apply firm but comfortable pressure with the lacrosse ball while rotating the ball over the tendon.

The CBT process: Firmly wrap a floss tape around the Achilles tendon as well as the gastrocnemius and soleus muscles starting at the heel (using a 75-90% stretch) and finishing just below the knee. (In the referenced study, a black Theraband© was used.) Perform a ‘flossing motion by slightly shifting weight forward and backwards over the back foot and ankle in a standard soleus stretch position. Perform 3 sets of 10 reps daily.

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I’ve followed the exercise and massage protocol for 4 weeks (although I will admit that I have performed the flossing motion without the band). After not running one step for several months (because it hurt), I ran three times last week with no pain during or after the run. My results have been similar to the results achieved by the test subject at this same interval in the study. At the study’s nine month follow-up, the test subject was exercising up to nine hours each week with no pain. It would be premature for me to claim victory over this injury, but I am cautiously optimistic.

Read more:

Athlete’s Edge: Achilles Tendinopathy

For The Love Of Running

There would be no fartlek through the woods. No peaceful run down the mountain, and definitely none of those mind-numbing sprints around the track. In fact, there may be no substantive running at all this year. It’s shocking to the core.

If you’ve ever talked at length to a runner, chances are the discussion evolved into the topic of injuries. There’s not a single memory of an injury from the nearly 20 years of competitive tennis in my earlier years, but I can’t even put a number to all the running injuries.

You’d think it would be discouraging, but it’s not. The goal is to avoid injury, somewhat like the goal is to avoid misjudging your arrival at the airport and never miss a flight. It still happens sometimes.

This latest injury happened within the first two steps of a run when I heard a loud pop. It’s curious that I heard the pop despite music blasting into my ears, which I’ve later realized is because the pop came from inside my body. The peroneal tendon of my right foot had moved out of its groove. If it moved all the way across the ankle bone and snapped back, it‘s called Peroneal Tendon Subluxation. Treatment seems to be the same nonetheless. REST.

One authority on the subject claims this injury is one of the few running injuries that’s not a consequence of overuse. They correctly observe that some athletes experience this ailment even when we’ve followed all the proper training rules. The alternative label appears to be “repetitive use with biomechanical dysfunction” because those of us with high arches that also run excessively are more prone than others to succumb to its ill fate.

Initially it hurt to do everything. The back of my heel was swollen, the tendon was tender to the touch, and would move around slightly. It was during these early weeks that it hurt to walk, run, or even ride my bike. Some weeks I did nothing at all. It was depressing, frustrating, and every other aggravating ‘-ing’ word imaginable.

My husband told me one day that I needed to get out there and do something to exhaustion. We found a new bike route and I went for a long ride. There were the steepest hills I’ve ever climbed, nail-biting descents, and the hairiest of all hair-pin turns. I used every gear in my arsenal that day. It was exhausting.

I’ve learned something. I love running so much.

I love the long runs, and the total exhaustion that comes from a grueling race. I simply adore the daily routine of charging up my watch and following a training plan. I miss all those things that runners learn to endure over years of practice.

The advice I’d want to give to every new runner is to stick with it. It gets better. It doesn’t always hurt. Focus on training your mind, and some day you’ll be pleasantly surprised that you’ve actually enjoyed yourself.

Exactly the conversation I’ve finally had with myself about doing every other exercise besides running.

 

For more information about a peroneal tendon injury or the dreaded subluxation, click on one of the articles below.

http://www.footeducation.com/page/subluxing-peroneal-tendons

https://www.epainassist.com/sports-injuries/ankle-injuries/peroneal-tendon-subluxation-or-dislocation-causes-symptoms-treatment

 

 

A-Kills-Me Tendon and a Peroneal Mess

The best laid plans often go awry, and I still don’t understand why it needs to be that way. My husband always advised that we should prepare a good plan, and work the plan. If you have a good plan and stick with it, according to his playbook, success is inevitable. My training plans could surely challenge that theory, or perhaps I’ve yet to establish a good plan?

Twenty-eighteen appeared to be the first year we would not be remodeling a house, and I was going to put the extra stress-free time to good use. I spent several weeks researching the most effective way to design a full-year training program, and documented my plan on this blog. Enter the awry part.

It was late February when I noticed my calves were tight. I even mentioned it to my husband. But life gets busy. We forget to stretch. Muscles get tighter, and they take other major body parts down with them.

My Achilles’ tendon got all out of sorts, and finally I started stretching. Except this irritable tendon became inflamed by the sudden attention and swole in disgust.

Not one to give in to a rant from Achilles, I ran through the pain until it settled down and left me alone. It’s a known fact we will almost always lose a battle with overuse injuries. ”Overuse” is not the true source of our ailments anyway. Training error accounts for most of our problems, which makes the question from the first paragraph all the more apt.

Of course, I continued to train through the pain. If I could just survive a minute or two of being uncomfortable, I could run for as long as I wanted pain free.  But the damage was still being done, and it should come as no surprise that eventually things went from bad to worse.


Achilles’ tendon issues will usually diminish when tight calves are resolved. Even if the tendon settles down, it will flare up again if running is resumed when the calf muscles remain tight. The key is to stretch the calves without over-stretching the Achilles.

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Courtesy: Epainassist.com (includes Achilles’ tendon stretches for recovery)

In my case, the peroneal muscles also became tight. This caused pain in the peroneal tendons that run behind the outer ankle bone. Injury of these tendons include tendonitis, tears and subluxation – the latter of which is not pretty in the least.

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DocPod.com

Peroneal injuries are caused by injury/trauma to the ankle, such as a sprain, or from overuse of the tendon (training that does not include sufficient periods of rest). Having high arches also puts you at greater risk for peroneal injury, and could lead to developing a degenerative tear.

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My full-year training plan has been re-worked. Running has been replaced with long walks, and the strengthening phase began last week instead of next month. I have succumbed to a massage that helped relax the calves and the peroneal muscles – something my husband had suggested in early March. The swelling is slowly subsiding, but the tendons remain tender to the touch. This has clearly been a peroneal mess of my own making.

Follow-up: when the swelling was gone and the peroneal tendon had fully healed, it became obvious there was another underlying issue with my heel: a ‘pump bump.’

The Pump Bump and Achilles Tendinitis

The Anatomy of a Runner

Some athletes have left an indelible mark – they are so spectacularly talented it simply boggles the mind.

Michael Jordan comes to mind. I was lucky enough to have watched him play at the United Center in Chicago some years ago. He was mesmerizing. And I’m just old enough to remember Walter Payton running across the field for a touchdown, like art in motion. . . the same as watching Michael Phelps swim, or Shalane Flanagan’s stride. The examples are endless, but what is it that makes these athletes successful? The magic question.

It would be easy enough to blame it on genetics, but I would offer up Misty Copeland – the first African American woman to be named principal dancer with the legendary American Ballet Theatre. Whatever your ballet stereotypes, Copeland probably doesn’t fit them. She’s been told she shouldn’t wear a tutu – she doesn’t have the right legs, her muscles are too big.

IMG_2882Emil Zátopek was the first runner to break the 29-minute barrier in the 10,000 meters, and the instigator of interval training. Even as he trained to become an Olympian, he wore work boots instead of running shoes, and moved his torso in a way that many criticized as inefficient. His tortured facial expressions prompted one sports columnist to remark that he “ran like a man with a noose around his neck.”

He is the only athlete to win the 5,000 and 10,000 meter races, as well as the marathon (a race he had never run) in one Olympic Games.

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What many of our favorite athletes have in common is that they were unlikely candidates for their sport. They move funny, have unorthodox body types, suffered devastating setbacks, started their sport late in life. . . or didn’t burn out despite starting too early. We all have more in common than we thought.

I hold my elbows too far out when I run. It probably makes me slower. Maybe you kick one leg out at the back of your stride, over-pronate, or carry your hips off-center. Does it matter? If we review the most unorthodox athletes of all time and consider their accomplishments, I would have to suggest the answer is no, it doesn’t matter.

Does it cause injuries? Maybe.

IMG_2885.JPGMy first real issue was that my toes went numb when I ran. My husband and I tried everything – larger shoes, different socks, orthopedic inserts. Once we figured out the problem was Morton’s Neuroma, I was on a mission to discover a fix, which turned out to be as simple as taking one vitamin B-12 each day – for ten years and counting.

Whatever the injury/pain/issue, the anatomy behind the issue became as fascinating to me as the running itself.

Runners have hundreds of issues in common. We have a propensity for pulling the same muscles: the quad, hamstring and/or calf muscles. Then there are those dreaded black toenails (cut them short!).

Muscles that are the most prone to cramps are those that cross two joints. A weakened Tensor Fascia Latae can tug on the knee and vice versa. Gentle stretching may help the sore Achilles’ tendon and an out of sorts Plantar Fasciitis, but does very little to loosen a tightened ITB. If you have knee problems, it might be wise to strengthen the hip. A sore back? Strengthen the abs.

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Every athlete is different. Our execution varies from one to the other. What works for me may not work for you, and vice versa. One thing is certain, however, the anatomy behind our running that can (and eventually will) affect our running is shared by us all, and it spans from our brains to our little toe.

A better understanding of our anatomy may be the secret sauce in the never-ending quest to remain injury free – something else we all have in common, whether you’re a runner, walker, dancer, gardener, or mom lifting baby.

(Reader Alert: consider this the prologue of another Fartlek series of posts: The Anatomy of a Runner.)

Next up:  The Anatomy of a Runner:  it’s all about that bass.

New Remedies for Plantar Fasciitis

scenarioPatients were scattered in the cool, wet grassy area just outside the classroom. Half the students pretend to be wounded, complete with fake blood and bruising, while the other students exercise their newly learned wilderness first aid skills. I was casually roaming between medical catastrophes answering questions and asking in return, “Are you going to touch that patient without your gloves?”

This was the day I felt the short-lived, but unmistakable, sharp pain on top of my right foot – it had stress fracture written all over it.

If I know how to react to anything in life, I know how to react to that sharp, little pain on the top of my foot. Action, or reaction, is swift and aggressive: a continuous dose of herbs, the offending area is taped, and extra days of rest added to the schedule. Preventative measures escalate every few days until the issue is resolved; my focus so intense on this little pain that I totally ignored the soreness in the arch of the same foot.

After several weeks of denial, I announced to my husband, “Its plantar fasciitis.” Swift and aggressive reaction finally began.

Last June, Dr. Thomas Michaud wrote an article, New Techniques for Treating Plantar Fasciitis, and updated it this month, as if on cue for me to discover it on running.competitor.com this week – just in time research.

Predicting Plantar Fasciitis

running.competitor.com
running.competitor.com

The plantar fascia, connective tissue that runs from the heel to the base of the toes, stabilizes the inner forefoot as forces peak during pushoff (runners expose the plantar fascia to up to 7x their body weight during the pushoff phase). The plantar fascia passively stores and returns energy, while another lesser known, small muscle that goes to the toes (the flexor digitorum brevis muscle – FDB) plays a more dynamic role in variable load sharing.

When tension in the plantar fascia gets too high, the FDB muscle tenses to distribute pressure away from the overworked plantar fascia. Latest research confirms the best predictor of the development of plantar fasciitis is not actually the height of the arch (specialists have commonly believed most plantar fasciitis cases are due to excessive lowering of the arch), but rather the speed in which the toes move upward during the propulsive period (which occurs when the FDB is weak).

Treatment….

There are several tests that can be performed to confirm you have plantar fasciitis (and not heel spurs), but the most common indicator is a sharp stab or deep ache in the middle of the heel or along the arch – worst during the first few steps of the morning or after sitting for awhile.

Injuries in general will almost always respond well to stretching, massage, or both. For example, it is my experience that IT Band Syndrome (ITBS) responds best to massage, especially the jiggling motion favored by a good massage therapist. Stretching does little, if anything, to resolve ITBS.

pt3Plantar Fasciitis responds well to stretching. Pull your big toe back for 10 seconds, repeated 30 times per day. It has proven effective in relieving the pain in my heel after only a few days of consistent stretching –  no heel lifts, no night brace, not even massage.

Aside from the fact that athletes often do really stupid things when it comes to training and recovery, there are lessons we can all take away.

When I finally owned up to my injury, my husband reminded me I have been on the verge of plantar fasciitis many times. For years I maintained a stash of tennis and golf balls to massage the arch when I felt that tinge of tightness. At one point, he went so far as to buy the night brace for me, which I hated.

Every athlete’s body has certain weaknesses. Mine happens to be my feet – possibly because of my Morton’s Toe, which makes me susceptible to stress fractures, tight calves and apparently plantar fasciitis. Your issues may be with your knees, hips or lower back. We should pay attention when our body speaks, and become well versed on how to resolve the issues specific to our body. Better yet, be diligent with injury prevention that is especially specific to your issues.

Resolve issues with a swift and aggressive reaction. Think of the days of pain I could have avoided had I not remained in denial.

Recovery, after all, can only begin when we acknowledge the problem.

Do’s and Don’ts for Plantar Fasciitis

  • Avoid a mid- or forefoot strike pattern in favor of a heel-first strike, and don’t run hills until the injury is resolved..
  • Reduce stride length and increase cadence.
  • Build up gradually to minimalist shoes, especially for runners with tight calves.
  • Avoid corticosteroid injections; surgical intervention should be a last resort.
  • Use trigger point massage.
  • Consider taping the arch for support (visit kttape.com for one method)
  • Pick things up with your toes / strengthen the FDB muscle (see article below)
  • Maintain calf flexibility
  • Pull your big toe back for 10 seconds 30x/day

Read Dr. Michaud’s article: New Techniques For Treating Plantar Fasciitis

Running Rule No. 2: Avoid Injuries

There’s no need to be an athlete to appreciate the aggravation of an injury. Why and when our bodies break down is the question that may never have an answer, but maybe there’s a way to beat the system.

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Injuries are generally defined as cumulative (overuse) or acute (traumatic). Football and soccer players most often suffer from acute injuries, having sustained the injury during a game. On the other hand, runners most often suffer from overuse injuries – caused by the constant repetition of the same movement.

Runner’s injuries have been attributed to a multitude of different causes, such as weight (over- being the operative missing word), minimalist shoes, over-cushioned shoes, rear foot-strike versus fore-strike, sedentariness (running 45 minutes a day and sitting on your bum the rest of the day), training errors, hard surfaces, anatomic abnormalities, not stretching, over-stretching….

However, the association between running injuries and factors such as warm-up and stretching, body height, mal-alignment, muscular imbalance, restricted range of motion, running frequency, level of performance, shoes and in-shoe orthoses, and running on one side of the road remains unclear or is backed by contradicting research findings.

Statements such as these make it abundantly clear we are anything but clear on what causes injuries.

My own pattern of training and injuries are interestingly odd as well. At times I have run 25 miles per week in constant pain and on the verge of injury, while other times I may run 70-mile weeks with absolutely no aches or pains.

During the last marathon training session, my calendar included two 20-mile runs. Unfortunately the weekend of the second such run also included a 24-mile backpacking trip with my classmates. To avoid dropping what I considered an integral portion of my training program, the 2nd 20-mile run was squeezed into the same 7-day period as the first 20-mile run, rendering myself a week of 90+ miles. It’s this kind of training decision we look back on and say “How stupid was that?”

Luckily, I survived that stupid decision…but why?

To build my case, let’s look at the list of several elite athletes’ injuries:

Nicolas Batum
Nicolas Batum

In 2009, Nicolas Batum of the Portland Trail Blazers suffered a shoulder injury, re-injured it during the summer, and tore it again when the season began – this time requiring surgery. Martell Webster (same team) had a stress fracture in his foot in 2008 and re-broke the same foot a year later.

tiger
Tiger Woods

Between 2002 and 2012, Tiger Woods sustained injuries to his left leg 9 times with a combination of ACL, MCL, tibia and Achilles’ tendon issues. It all began in earnest December 1994 when he had surgery on his left knee to remove two benign tumors and scar tissue.

Ryan Hall’s trouble began with plantar fascia problems, and then a hamstring injury forced him to drop out of the Olympic Marathon. That same hamstring injury also caused him to withdraw from the 2012 NYC Marathon. It was quad pain that caused him to ultimately withdraw from the Boston Marathon, and this past fall it was a hip injury – all on the same leg.

Paula Radcliffe
Paula Radcliffe

Paula Radcliffe’s running achievements appear larger than life now that we understand most of them came with what was effectively a broken left foot, courtesy of a stress fracture that never healed back in 1994.

Aches, pains and the highest risk of injury occur when coming back from a layoff….. what I call ‘re-entry’.

Over the years I have learned exactly where my aches and pains will show up: 1) on the top of the feet near the toes; 2) a small spot on the top of the right foot near the ankle; 3) sore shins;

Over the years I have also figured out exactly why these aches and pains show up: 1) Morton’s Toe, which makes the  metatarsals more prone to stress fractures; 2) possibly the car accident in 1985 that nearly crushed my right foot, or simply the way I’m made; 3) tight calf muscles.

None of these issues are an excuse not to exercise – they are simply the characteristics that make me who I am.  Left unchecked they will get worse. Left unhealed properly they will return even worse.

In case you haven’t heard, one of America’s premier talents in the marathon, Ryan Hall, has withdrawn from the 2013 ING New York City Marathon. Unfortunately for Hall, this is the third consecutive major marathon he’s pulled out of, and prior to that, he dropped out of the London Olympics due to a hamstring. Oct 28, 2013

Let’s Beat the System.

The body is a connected chain and will always compensate (often times unknowingly) when we have pain or weakness in a specific area, resulting in a never-ending cycle of injuries. If the injury is in the soft tissue such as when a muscle is torn, the tear, or rupture, is repaired with scar tissue. Untreated scar tissue is the major cause of re-injury, long after after you thought the injury had fully healed. There are ways to reduce the build-up of scar tissue at the time of the injury, and a deep sports massage will help reduce scar tissue that has already formed.

Understand your weaknesses and focus on them early.

I have learned my re-entry schedule must ramp up slowly or the weak body parts will be over-stressed. On the other hand, when I am in peak shape I can push the envelope a little. A slow ramp-up allows the metatarsals to become strong, massage helps the spot on the top of my right foot, and stretching the calves prevents the shins from becoming so sore that they are debilitating.

Your issues will be individual to you (remember N=1) making the fix equally individual.

If you’ve been diligent about a new exercise routine over the past few weeks, you are no doubt feeling a few aches and pains. You are not alone.

Acute injuries may be tough to avoid depending on your chosen sport, and sometimes our bodies will throw us a curve ball. For the every day aches, pains and looming danger, it is entirely possible to beat the system if you take the time to develop a real partnership with your body… and pay attention when it speaks.

 

Related:

Collateral and Re-Injury Prevention

Pulled Muscles, Scar Tissue, and Re-Inujury

This elite runner suffered from severe low blood sugar…..weaknesses are not always injuries.