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Showing posts with label Injury. Show all posts
Showing posts with label Injury. Show all posts

Plantar Plate Injury and Capsulitis: Cured!

For nearly six months, I struggled with a plantar plate injury, capsulitis, metatarsalgia - there are many names for it, and plenty to read on the internet about what can be done. 

After I exhausted the internet's articles, discussion boards and forums, taped the toe down, rested, and put in metatarsal inserts, what to do next?

This mild but persistent injury had dogged me since mid-October, coming and going but never fully resolving, despite the efforts of two different podiatrists and my regular acupuncturist and a month of no running whatsoever.

At the insistence of my good friend Katie, I went to see her Sports Acupuncturist. Where would I be without you, my friend?

Yes, there was a little tightness around my second toe. But the real issue wasn't in my foot, it was in my lower leg. A tight flexor digitorum longus was the culprit. As a runner, I really need to learn my anatomy.

Oh, all that punishing climbing I'd been doing on the treadmill last fall? Yep, that's where it burned, how about that?

Plink, plink, plink, plink - a few needles in key spots and after I got past the slight soreness the next day, I could feel the difference. For the first time in months it just felt RIGHT.

One sports acupuncture session with Larry the Legend solved my issue. 

If you too have this not-so-common injury, I highly recommend a sports acupuncturist.

Since then I have carefully been building my time and mileage, and I'm pretty excited about the possibilities. 

Vermont 100, here I come!

  


Tenderfoot

I've had a bit of a tender foot since mid-October.

It kept going away, but it cropped up again as soon as I had forgotten it. Despite taking 2 weeks off from running over the holidays, it flared up after some hiking.

I finally got myself to the podiatrist, expecting him to clear me and confirm that it was really nothing.

Instead I got a diagnosis of a Plantar Plate injury. In other words, Turf Toe. It's quite mild, most days I don't feel anything.



I rigged up a little homemade orthotic using Superfeet and some thick moleskin.





Though I don't appear to have any signs of hammertoe, I taped my second toe like this.

I took another 10 days off running which coincided perfectly with a nasty chest cold and cough.

I got rid of some nice winter boots I'd been wearing (not high-heeled, I don't wear those anymore) which seemed to aggravate my foot.

I am now wearing shoes at all times, rather than walking around sock-footed at home.

My mile and a half test run yesterday appears to have gone well; no tenderfoot today.

Fingers crossed that I am on the road to recovery!

It's the Ligament, Stupid

Red = damage. Image from http://en.wikipedia.org/wiki/File:Gray355.png

My podiatrist, Dr. Pribut, is a trip. He's also extremely knowledgeable, understands runners and he's Metro accessible. It didn't take long for him to diagnose my problem as a ligament that had gotten overstretched (so much for my tendon theory).

Apparently, I turned my right ankle at some point during Bull Run Run 50 Miler (maybe it happened when I face-planted, twice). The strange thing is that it didn't hurt at the time or even during any of my recovery runs until nearly a week later. It doesn't hurt to walk, and I don't have any noticeable swelling. I always get odd injuries that seem to come out of nowhere. 

He did say the forces that caused my injury could have resulted in a fracture, so I consider myself lucky. I'm also frankly ecstatic that I am not in a boot or on crutches.

He prescribed rest, for 7 days. No running, biking, hiking, swimming or pool running (what!? I thought you could pool run with any injury!) or anything that stresses the ankle for a week. That means about half of the 26 Bikram yoga postures are out since they require serious plantarflexion or dorsiflexion of the ankle. 

Image from http://twofeetstuckoutside.blogspot.com/2010/07/to-plantarflex-to-dorsiflex.html

He also ordered me to begin rehabilitation exercises, twice a day on the Wobble Board

My new best friend

This week, I am only allowed to do Front to Back.

Front to Back on the Wobble Board

Next week, if things go well I can add Side to Side.


Side to Side on the Wobble Board

And finally, in Week 3 I will graduate to Round and Round!

The Pinnacle of Ankle Rehab, rotational Wobbling!
Starting Friday, I can run again: 2 miles every other day, as long as that is well below my pain threshold.

This means my beloved Capon Valley 50K is off the race schedule. Bummer. All my friends will be running it, and I'll be the only one not getting my feet wet.

I haven't made a final decision on Laurel Highlands 70 Miler, but I'm leaning strongly toward dropping down to the 50K race. I'd rather not run 70 miles under-trained and with the increased risk of tweaking my ligament again, or worse. It seems like the smart decision.

After all, my ultimate goal is to keep on running for a long time.





Tendon Trouble

During Bull Run Run 50 Miler, my calves and anterior tibialis were cramping and quivering late in the race -- most noticeably on the downhill sections. This is pretty common in my experience (and completely expected given my low training volume). I had no pain during or after the race. In fact I was pleasantly surprised at how little soreness I had afterward. 

I didn't notice any issues until a leisurely hike/run with friends last weekend, cruising on a long downhill section. Suddenly, the front of my ankle felt sore, as if I'd bruised the front of my ankle area. At first I thought I'd tied my shoes too tightly, but it soon became obvious something else was going on.  

Where it hurts. Image from http://home.comcast.net/~wnor/ankle.htm

My first guess was anterior tibialis tendonitis, but that pain tends to diminish as it warms up on a run, whereas mine definitely hurts more the longer I run. Now, I'm leaning toward Lower Extremity Tenosynovitis.
Lower extremity tenosynovitis is a condition affecting the tendons of a lower limb. It also affects the lining of the sheath around the tendon. Tendons are cords of tissue that connect muscles to the bones. With lower extremity tenosynovitis, the sheath and the synovium of the flexor muscles become inflamed. The tendons may become thickened and have a hard time moving through the swollen covering. This can cause pain and tenderness when moving the affected foot, especially the ankle and heel areas. Lower extremity tenosynovitis usually affects athletes, ballet dancers, and people of middle age or older.
Symptoms include redness, swelling, or pain in the affected leg or foot. The pain or tenderness usually occurs when you move or bend the affected part, such as while running or walking. Over time, the pain may become worse and may be present even at rest. You may also have:
  •     Clicking, locking, or snapping of ankles. YEP. But my left ankle clicks too. Hmm.
  •     Develop a flatfoot. Not yet.
  •     Grating sound or feeling when the leg or foot is touched or rubbed. Mmm-Hmm.
  •     Nodule may be present or toes may look like sausages. Nope, thank goodness!
  •     Stiffening of the leg, ankle, or foot. No noticeable stiffness.
  •     Weakness and limited movement of the affected part. So far, none of that.

Since I only have a couple of symptoms, it's in the very early stages, or I'm an incompetent doctor (obviously). The treatment is to minimize movement of the affected area. That means no running, biking or even much walking. I'm hoping I won't need an air cast or other immobilizing contraption, but that's probably overly optimistic, considering that I have to walk some in my job (and also to get there).

I'm hopeful that I'll only have to rest it a week or two. Right now it doesn't hurt at all unless I'm running.

What I'll be doing a lot of. image from http://www.eatrunread.com/2010/04/mollie-rant-pools.html
I really don't want to run my next two races under-trained, and the steep and plentiful climbs and descents on both courses will cause problems if this isn't completely healed. Everything I've read about this condition indicates that training through the pain will aggravate the area and may cause it to become chronic.

Looks like it's rest, Bikram yoga and pool running for me!

And if you've had tendon issue before and have any advice, I'd love to hear it.


P.S. I just got an appointment with my podiatrist for this afternoon -- check back next week to guffaw at my misdiagnosis.

My Running Partner

I feel I've been neglecting my blog. I haven't had much motivation to write.
 

Oddly enough, I'm running - a lot. More than usual, in fact. But I haven't felt I've had much to say about my training.

Oh, I've had all the typical runs: the I-love-running runs, scenic runs, it's-way-too-hot runs, the fast runs that felt pretty easy, the breakthrough run (fast, with hills!) and yes, a couple of demoralizing, no energy, slow, anybody-wanna-buy-a-registration? runs. 
 
It's good having a goal, a plan, and a daily workout to accomplish. It's fun to log those miles.

So what gives?

Normally, I'm running trails and ridiculous distances but not training all that much. I'm surrounded with friends and the whole run is like a big party, even the suffering. Then, there's a party at the end. Fun!

Lately, training runs have been like Solitary Confinement for this girl. I've skipped most of the ultras this summer, as they aren't what I need to prepare for this marathon.
I haven't planned to run with friends, or a running group, and lo and behold, I've ended up training alone.


Hubz had joined me on some days. Before this summer, we rarely ran together because he runs a faster pace than I do. But as a result of the amazing improvements in my body since I began practicing Bikram yoga, as well as doing speedwork, hill repeats, and running more miles, I'm running faster. Hubz and I are more evenly matched.

We were both really enjoying these shared training runs. As two people who tend to prefer doing their own thing (athletically, anyway), I think it surprised us both.

He showed me some new routes in our neighborhood, I shared my knowledge from my four previous marathon training seasons. We commiserated about the quirks and pains of road running. 
Then, he got injured.  

Running the Fancy Pants 5K together in April
I miss his company out there. While he's always happy to hear about my running, there's less joy in sharing my running stories knowing he can't do what he loves.

I've been dragging him to Bikram yoga recently. He's excited to have a new challenge. I'm hoping he gets as much out of it as I have, and that he'll heal quickly. 

I'm really looking forward to running with him again.

Five Days of Bikram Yoga (in.a.row.)

Why?  I bought a 10-class pass. It expires in 10 days, with 6 classes remaining. I’m not willing to forfeit that money. Yes, I had three months to use it so I am teaching myself a lesson in the process.
So?  I feel like I’m a good beginner case study, because up until this week, I’d done exactly six Bikram classes, over a four month period.
Day 1
I was slightly worried about my five-in-a-row plan. Would I hurt myself? Would I be able to get through them all? How likely was I to be hospitalized with heat exhaustion or dehydration?
But I felt good in the heat, and strong.  I had some real breakthroughs this session. Something clicks and my body is one step closer in several poses I've not been able to do at all thus far.
Asana #8. Dandayamana-Bibhaktapada-Paschimotthanasana (Standing Separate Leg Stretching Pose). I finally grabbed my heels!
Asana #14. Pavanamuktasana (Wind Removing Pose). HUGE! ACTUALLY GRABBED BOTH ELBOWS. For the record, no wind has been removed from me so far.
Asana #20. Supta Vajrasana (Fixed Firm Pose). Got legs flat and butt on floor, leaned back further than ever.
Asana #21. Ardha-Kurmasana (Half Tortoise Pose). I was able to get much more flat on the floor.
Asana #22. Ustrasana (Camel Pose). This one always makes me feel faint. Got further back than ever before.
Asana #23. Sanangasana (Rabbit Pose). Figured out that hips stay down on feet, mostly stayed in pose.
Asana #24b. Paschimotthanasana (Head to Knee Pose). Got my head and knee to touch with leg almost on floor!
Every day after class there is a fresh, cut up pineapple or other fruit. It’s insanely good and refreshing. I desperately need it after climbing the two flights of stairs from the yoga room to the changing room.
Day 2
I was one of the last to arrive at class this evening. I slunk to the only space left, near the back windows where there are no mirrors. The towel I brought was too small, making it nearly impossible to perform the poses where my legs are four feet apart. Also, I‘m well hydrated and positively pouring sweat, so the towel is sopping wet halfway through class.
It was so hot & humid in Bikram tonight, halfway through the instructor OPENED A WINDOW. This is unheard of! And guess who was right next to the window? Honestly, I thought I was having a heat-induced hallucination.
Also, I nearly drowned in this class when we did a pose where we bent over and all the sweat ran right into my nostrils. Note to self: find headband!
My back is sore, but in a good way. And I'm not nearly as exhausted as I feared I'd be at this point. However, I’d recommend you not get between me and food after I come out of class. Hubz almost got his head bitten off.

Day 3
It was a little tough getting out of bed, having left class just 10 hours before.
But I love Wednesday morning Bikram class because Lukas teaches. He's so helpful, explaining every little thing you need to do with each body part and focus on for each pose. It really makes me work harder. And, he sings. What a voice!
I sing the body electric
I celebrate the me yet to come
I toast to my own reunion
When I become one with the sun

And I'll look back on Venus
I'll look back on Mars
And I'll burn with the fire of ten million stars
And in time
And in time
We will all be stars
As class ended, I was momentarily sad that this week seems to be going so quickly.
I almost forgot to get coffee when I got to work. What is happening to me?

Day 4
I’ve gotten my first Bikram injury. I have serious towel burn on my right elbow.
I did the next step in Vrksasana (Toe Stand pose) today. And my Dandayamana-Dhanurasana (Standing Bow pose) was pretty good. Padangustasana (Camel pose) still makes me nearly faint, even when I’m only doing the first part of it, and I can’t get my hand on my knee in Ardha-Matsyendrasana (Spinal Twist). My favorite pose, I think, is Garurasana (Eagle Pose).
There was no fresh fruit cut up for us today. That’s a first.
Also, I’ve drunk so much coconut water I’m gonna start sprouting palm leaves out of my arms. My solid, concrete, one piece, lamppost, unbroken arms. Wait, that’s dialogue about the leg. Whatever.
I got up from my desk, headed for the kitchen at least twice, but I got sidetracked and never got coffee.  I’m not looking to quit caffeine; it just seems superfluous these last couple of days.
My back is no longer sore. In fact, it’s noticeably stronger. When I open massive doors, shovel mulch into a wheelbarrow and hop astride my bicycle, I no longer sense that weakness. Also, the ever-present slight tightness in my right glute/piriformis – that’s right my constant troublesome spot, injury waiting to happen, Gone!
Dare I put it in words? Bikram yoga is beginning to seem miraculous.

Day 5
The office closed early, so I went to the 4:00 class. The yoga room is definitely hotter, humid as a jungle, and more crowded.
I picked a spot by the west-facing window. I became aware of my mistake when we relaxed, face down after cobra pose and I found that the sun had made the floor quite hot!
What a great session. My body seems to be better at this yoga business later in the day.
I got my hands almost on the floor in Toe Stand. Improved at Cobra and Locust, and my arms are finally getting used to doing this and not feeling like they have been run over by a truck afterward.
I went deeper in many poses. But the grandest accomplishment of all was that I TOUCHED MY HEAD TO MY KNEE in the second to last pose while my leg was flat on the floor. ME! The inflexible girl!
I hit the showers, proud of myself. Wait, why are the tops of my feet stinging? Ah, they have chafing in Bikram yoga, too. That or I burned them on the sun-baked floor.

Conclusions
Bikram is sweaty, uncomfortable, challenging, arduous and laundry-producing. Carrying my yoga mat and towels is a chore. Ninety minutes of class plus changing and showering takes up a lot of time.
I’m not in love with Bikram yoga. But you better believe I’ll be in class on a regular basis. After only eleven sessions, there have been tangible benefits. That’s a pretty impressive return on investment.

Trying New Things

When was the last time you tried something you haven't tried before? I tend to get in a rut with my exercise, cooking, and habits. But I tried three new things recently, and I'm glad I did.

Acupuncture. Three months of Physical Therapy and back strengthening exercises hasn't fixed me. So, I'm trying a new approach.

On my first visit, my acupuncturist stuck many tiny needles in my back. "Drink lots of water. And don't apply lotion for twenty-four hours, your Qi might still be leaving your body."

Yesterday, she focused on a treatment to balance the two sides of my body. This time I got a few tiny needles in my feet and wrist. She lit sandalwood sticks and waved them over each finger and toe and I had to tell her when my Qi got hot.

So far, I'm seeing positive results. I feel better overall, in subtle ways. The tingling, while not completely gone, has diminished. I can sit and sleep more comfortably. I don't feel the overwhelming urge to stretch my piriformis constantly.

Roasted Broccoli. How have I never tried this before? Toss broccoli with canola or olive oil and a little coarse kosher salt. Roast in oven at 425 or 450 until the broccoli begins to brown, turning after about 5 minutes. The timing will depend on how large you cut them. I chopped each floret in half so they could lay flat on one side, but left them in fairly large chunks. Oh the flavor! Even if you're not usually a broccoli fan, I implore you to make this. It's an entirely different kind of flavor.

Burgers with Bulgur. I admit, I was dubious about adding soaked bulgur to high quality ground beef. But this was a winner. Not only was it wonderfully moist, the seasoning was spot on. Now, I've never had trouble tucking away a burger. But the icing on the cake, so to speak, was that this one was a bit less heavy. In a very good way. Click here for the recipe.

Here's to trying new things. Happy running and good eating!

What's The Deal?

After seven weeks of physical therapy, it turns out my injury was not my IT Band, nor even my Quad. It is a Bulging Disc.

Thus the strange tingling, itchy, random numbness episodes I'd been experiencing while doing my test runs.

Determined to kick this injury to the curb!
I'm continuing physical therapy and doing some new back strengthening exercises.
No running or biking (say WHAT!?) allowed. I can walk on the Dreadmill and use the elliptical trainer, but that tends to bring the tightness to my IT band that first sent me to the Egyptian Magician (my Physical Therapist).

I feel so out of shape but somehow (admittedly, after I threw myself a few pity parties) I also feel positive. I can tell I'm getting stronger.

I'm hanging in there and I will be back!

On Not Running

Only when we are no longer afraid do we begin to live. - Dorothy Thompson

Not long ago @runnrgrl asked the question of me: What is your greatest fear?

Without hesitation, I replied: Not being able to run.

Running is who I am.
It's my joy, my hobby, my freedom.
It's my identity - quite literally, on Twitter and Blogger.
It's my sanity. My discipline. A big chunk of my social life.
It's what makes me feel like I'm "good enough" despite my many shortcomings.
It's how I met Tom, and no small factor in our marriage.

It has been six weeks since I've run.

I'm much more serene than I thought I'd be about this.

I try to stay sunny, keeping in mind that injury is temporary. I lift weights and cross-train. I feel glad for the opportunity to change things up and get stronger.

I don't watch what I eat. In fact, I'm a bit more indulgent. My philosophy is to enjoy my food, not obsess about my body. I'll use it as extra motivation to get back to my happy running weight when I'm healed. So far I've gained about five pounds. Truthfully, I'm kind of enjoying being a little curvier.

I'm using this time to enjoy the things that running often forces to the sidelines: leisurely meals with friends, long-plotted visits to the numerous wineries we pass by en route to our mountain runs, happy hour, exploring the city on bike rides, puttering in my garden, paddling kayaks.

Along with my coping mechanisms, I've observed some wholly unexpected changes.

I don't sleep as well. There's something so good about how hard I sleep after a good run. I think I'd run for that benefit alone. While I am waking more often, and sleeping less soundly, I also seem to need slightly less sleep.

I'm wearing glasses. Normally, I do this only between shower and bedtime, or when the pollen overwhelms my peepers. I can't wear them when I run (sweat makes them slide down my nose), but biking with them offers the extra benefit of keeping my eyes bug-free. And I feel much like I look in glasses: Nerdy. Contemplative. I'm another version of myself.

Oddly, I'm less obsessive about cooking away my CSA. I don't seem to fret as much about using every odd vegetable and herb in our share.

I'm enjoying time alone more, or perhaps I'm more mindful and relaxed. Before my injury, I was always trying to squeeze in one more thing.

Perhaps living the maxim "accept the things I cannot change" has permeated my perspective.

Could it be that I'm peeling away the layers of what I thought made me, and seeing more than I expected underneath?

In living my fear, I've stumbled upon this: I exist without running. And quite well, thank you.


Time in the Saddle

What does an ultrarunner do when she can't run?

The answer isn't pretty. Rather than learning a practical skill (like how to work my new camera) or do something productive (hello, weedy garden), I've channeled my energy into the consumption of beer and ice cream. And some good old-fashioned moping.

What about biking? I'm forever espousing my love for my two-wheeled commute. I adore jaunts around the city. It's amazing cross-training!

Ironically, biking is known to irritate IT bands, which is (at least part of) my injury. I'm very wary of overdoing it, and haven't felt comfortable pedalling for more than a few minutes at a time.

Furthermore, riding in suburbia is simply not the same. No one lives there. At least, no one is ever seen outside of their car. No worthy people-watching opportunities, just endless blocks of houses. And hills. It seems there is no actual flat road in our neighborhood. It's a little much for my weak quads right now.

How about walking? I love to walk! One of the things I miss most about living in the city full time is strolling around the city, taking in the sights and people-watching. It's even moderately enjoyable ambling around suburbia.

Sigh. A girl can only do so much walking without losing her mind and breaking into a run.

I finally gave in and succumbed to the dreaded Elliptical. I had myself all excited about the great cardio I was getting, and then, twenty minutes in, there was an unpleasant twinge. Uh-oh.

That brings us back to the bike as my only practical option. (Yes, I know I swore I was going to get to the pool. I haven't. But my Twitter friend @donna_de is mailing me a Twitter swim cap so when that arrives I'll have no more excuses. Really.)

Thanks largely to Katie, I'm getting in some good morning rides, and they haven't been causing pain.

On a bike ride with Katie earlier this summer
They're neither long nor hilly, but they give me the physical exertion I've been sorely missing. They lift my spirits, and make me feel a little more like . . . well, me!

So, here's to more time in the saddle, and wind in your hair. I hope to see you out there!

Physical Therapy: A Very Short Story

I am seeing a very good Physical Therapist. He's an ultrarunner!

He is also a complete sadist.

This better fix me.

I have gained two pounds.

I miss running.

Injured

My marathon training has ground to a sudden halt. I am injured.

Though my weekly mileage did not increase, the intensity and frequency jumped a bit. Apparently, my Iliotibial Band took offense.


The bad news: ITBS can take a long time to overcome. If the athlete continues running while it is inflamed, it can become chronic.

The good news: I have not progressed to the stage where pain has halted my running (it starts feeling tight and hurting a few hours after I run). So I'm doing the smart thing: laying off running entirely. On Monday I'll be on the Physical Therapist's table. I am confident that I caught it early, and that he'll be able to get me back in the game quickly.

Thank you to all my Twitter and running friends who have given me advice, exercises, referrals and support! I am grateful.

In the meantime, I'll try to stay optimistic, hope that I'll be allowed to bike and swim in the interim, and keep my ultimate goal in mind when I get impatient.

Stay tuned.