Monday, October 7, 2013

P.F. Injury Postmortem Part 2-3

P.F. Injury Postmortem Part 2: Low Point

Immediately after racing Ironhorse, I drew the following chart in my running log:


The idea was to figure out what was making my foot hurt, and how it responded to the various treatments I devised. In point of fact it was more of a psychological ploy--making a graph made me feel like I was controlling the situation. Unfortunately it didn't work, which is why I stopped--foot pain would increase unpredictably, and not in ways I could easily correlate to what I was doing.

Runners may know what I mean when I say there are two kinds of pain: the pain that "settles out", and the pain that "settles in". The former is usually nothing to worry about: you start a run, something creaks a bit, then it goes away. The latter is a different matter. It's the kind of pain that sneaks up on you, getting worse after every mile. That's the hurt that makes you stop.

The way my PF manifested, there was both: an intense hot-poker style stabbing pain, which was of no account, and a dull pain that would get worse and worse the more I was on my feet.

The dull pain was infuriating. It kept my running mileage close to zero, and it didn't seem to get the least bit better; not even going cold turkey on running, not even while avoiding walking. I couldn't even get any real hiking in over the summer, and I felt pretty damn low about it, to tell the truth. One thing injury reminds me of is how much of a mood-manager running is for me; when I couldn't do it anymore I felt like somebody had taken the happy pills away, leaving me in a deep blue funk.

I wasn't logging anything in my notebook at this time, so I don't have any daily records of my state. I was continuing to ice the base of my foot, and I was keeping an empty peanut-butter jar under my desk at work to help me keep my plantar fascia loose. The pain persisted, however. Until...


P.F. Injury Postmortem Part 3: Recovery

On July 24th I got this:



It's a "Bird & Cronin" Night Splint, aka "boot". You wear it overnight and it keeps your foot dorsiflexed (pulled up toward your shin), so that the plantar fascia is extended. This avoids a period in the morning where the injured tendon tightens up and complains terribly with every footstep. If you run in the morning like I do, this makes a HUGE difference. The night splint didn't miraculously fix my injury, but I do think it made it possible for me to start rehabbing my injury in earnest. Prior to this point, all attempts at resuming running invariably re-aggravated the PF pain (unsurprising, perhaps, since I run in the mornings).

After I started wearing the boot every night, things started to turn around. I was able to begin gradually adding mileage, and my mood improved. I kept icing and stretching, and it finally seemed to pay dividends.

Some log excerpts:

8-4: "Some twinges by E.o.W, but still slightly better over course of week. Trying for 30 miles next week" (after 26 miles the preceding week).

8-11: "I degraded this week. Too much mileage or because I slacked off on boot? So Frustrating!" (In retrospect, I think missing a couple nights wearing the boot was most of the problem)

8-13: "5 miles, cool day into Town Forest, no pain--felt happy"

8-18: "10 in Blue Hills, foot felt great for first 8, then small twinges. Never any major pain; pretty much the best I could hope for. Feeling optimism again."

8-26: "4 miles; some foot pain still"

8-29: "8 (cool, overcast, humid) feel very tired & out of shape. A little foot pain persists, but seems just a faint remnant."

9-2: "Walpole 10K in 45:20. Ugh--super muggy. Basically everything needs tons of work (strength, speed, endurance) Foot was basically OK though--OOS [out of shape] or not, excited to be back in it.

Improvement continued steadily. On September 8th I did 13 miles on trail. on 9/14 I did 14 on roads, which would have been inconceivable two months prior. On 9/17 I did a track workout, and it actually went OK. I was starting to feel like my old self.

And now, am I completely recovered? Well, sort of. Functionally, I'm all the way back. My foot "works"; it can hold up to high intensity workouts, hill sprints, and long runs on pavement. When I get up out of a chair after an hour or two, I might feel some mild soreness, but nothing like the hobbling pain I used to feel. On the other hand, I am still wearing the boot, and missing a night still seems to matter (though less than it did). My left foot feels "different", like it has some permanent mild soreness. With some more time, I am optimistic I can kick these remaining symptoms too.


Final Thoughts on Getting Over a Bout of Plantar Fasciitis

  1. Get a boot. 
  2. Ice the pain. At first I was using a bucket filled with ice water, but for simplicity I just started standing on an ice-pack while making and eating breakfast.
  3. Stretch. Wall stretches and toe touches helped me. In particular, there's a stretch where you put your foot over your knee and pull back the toes toward your shin that directly stretches the fascia--that was quite useful, and when I was in the middle my injury I did it a lot.
  4. RUN. This is tricky, because running injudiciously will make the injury worse. On the other hand, you have to get your foot strong again, and that will never happen if you don't use it. The trick is to stress it just right, so that you're building it up and not reinjuring it. I think any run where you don't hurt after you finish is probably helping. I did very slow jogs on a dead-flat trail, no more than 3 miles total, as my main medicinal exercise.
  5. Be optimistic and don't give up. 




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