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. 

P.F Injury Postmortem: Part 1, Descent

My running year in 2013 has been heavily impacted by a foot injury that settled in in March and persisted as a major limiting factor until at least the end of August. I was more or less completely exiled from running from June 4th to July 20th, in which time I probably ran no more than 50 miles (and those probably unwisely). This is a summary of how I got myself into trouble, and then how I eventually climbed back out again.

Log Excerpts, March--June (Descent)
3-10: "12 into Hale, muddy mess, w/ 1.5 mile progression."  No pain mentioned, but I remember this run, in all its sloppy, early spring glory, with the trails muddy streams and the north face of Noanet Hill still covered in snow. The soles of both my feet hurt by the end of it. Nothing unusual about that following a long run coming out of a winter slump. I ignored it.

3-23/24: "14 w/2 mile progression, 7.5 feet hurt/tired". I ramped up my weekly mileage to 52, continuing to ignore pain following long runs.

3-29: "14 w/ stops @ 4 and 6 to rest feet (soles very sore)". An obvious pattern should have materialized to me at this point--needless to say the fact that my feet hurt intensely after long runs, particularly my left foot, did not seem to register.

4-13: "15 into Hale. Started Progression @ mile 13, but PF pain intense after 3/4 mile. Iced carefully on return, but worried foot isn't steady-state". I remember that moment well...my feet had been hurting moderately, nothing unusual for a long run with a heavy pavement component. I went to accelerate into the progression, and...twang! ow, ow, ow! That was probably the moment I went from mild inflammation and weakness to full-on injury.

I had by this time self-identified the problem in my left foot as plantar fasciitis. All the classic symptoms were there, the pain right under the heel, the sharp, screwdriver-stab when stepping on the foot for the first time each morning. At this point I was about 7 weeks out from my goal Half Marathon in early June. I did not have time to be injured, damn it!

5-4/5: "16 in Blue Hills, all the way into Quincy. Does not get any prettier. Left foot hurt a lot by end, but totally worth it. 8.5 foot surprisingly improved!"  Denial is not just a river in Egypt.

5-11/12: "16, rest. PF is spoiling the pleasure of running, particularly long. I'm going to see if rest fixes it. 6 days mandatory off." This close to my half marathon, this was a miserable decision to make, but I had a desperate hope that I could 'reset' my foot by giving it some time to heal and then come back with minimal loss of conditioning.

5-18: After making it through five days of rest, I wrote: "PF feels better, but not cured. Only minor dull pain in morning w/ rare sharp stabs. Out of patience, back to running." sigh. Rest really did seem to help. It was easy to pretend that I had ameliorated things.

5-21/22/23/24: "7.5 (10x400 in ....) foot hurts again., rest, rest, rest."  No escaping reality now.

on June 2nd I ran the Iron Horse Half Marathon in Simsbury. I had lost a lot of training time due to the PF, and my confidence in having a good day was basically zero. I seriously considered a DNS, but I had DNS'd the same race last year. Come on! I was determined to run, hurt foot or not, and then worry about rehabbing it afterwards. This might not have been the smartest thing, but I'm not sorry I did it--I actually finally had a hot-weather race where I felt reasonably in-control of my own thermoregulation. If I had been totally healthy, I think I probably would have plunged out at suicide pace and blown up in spectacular fashion. Silver linings.

I had by now also made the difficult decision to DNS on what I hoped would be my second appearance at the Highland Sky Ultra. I was majorly bummed about that, but the thought of starting a 40 with a hurt foot (a hurt that gets worse the longer you run on it), was too scary. My only priority after Ironhorse was to rehab my foot.


Part 2: Getting Through the Injury, and Part 3: Recovery, coming soon!

ladder workout, 400-1200

Ladder workout, 400-1200 and back down again:

400:     73
600:   2:02
800:   2:43
1000: 3:30
1200: 4:12
1200: 4:14
1000: 3:30
800:   2:46
600:   1:58 (!)
400:    75

Gorgeous day to be on the track; slight breeze increasing during second half of workout, but I can't really blame slowing intervals on that. Happy about that 2nd 600--that's the kind of interval that makes me think I could break 16:30 in the 5K under the right conditions.

women's world championship 1500m final

Anyone else out there following the world championships in Moscow? Watching Mo Farah pull out another flawless double was epic. It astounds me, because no matter how good you are, there are so many little positional things that can go wrong in a track race that can cost you the win--yet somehow Mo always seems to know exactly where he should be, and exactly when he should move. It's like he's already won the race in his head and he's just playing forward the inexorable sequence of events that will bring him over the line first. If you haven't already done so, you should watch the men's 800m final--no Rudisha,but still a hell of a race.

One of the more interesting storylines from a US perspective, though, was the women's 1500m. Two Americans made it to the final, the 2011 World Champion Jenny Simpson, and 17 year old high school prodigy Mary Cain. Despite being the 2011 champion, Simpson wasn't exactly the favorite, as the championship she had won was considered by some to have been somewhat uncompetitive (and featuring a fall by the favorite, Morgan Uceny). Meanwhile there was a fair amount of hype about Cain following her surprise advancement to the Final.

How'd it play out? Well, here's the race. (Sorry, can't embed--it would spoil the results)

dodging cyclones while naked

A little while back, while it was very hot in the waking world, I had a vivid dream. It seemed to me that I had just run through a the center of a little town, and had moved out onto a lonely highway surrounded by golden fields and the red-gold colors of autumn forest in the distance. I was only wearing my underwear; no clothes, no shoes, and the pavement was warm against the soles of my feet.

As I made my way down a long hill, however, I noticed the clouds beginning to move in a funny way. It was as if whole patches of sky had suddenly decided to start rotating clock-wise. As I drew closer, still running easily in the margin of the road, funnels stretched down from the centers of those rotating clouds and slammed into the ground, blowing up huge plumes of debris as they stalked across the fields toward the highway.

I felt a sudden prick of fear and turned around, running hard back up to the top of the hill, where I re-entered the little town. It was now deserted, which struck me as eerie. I felt that I had probably escaped the cyclones, but I still had a hunted feeling, and so I ran down another side-street.

I hadn't gone far when I realized the road had taken me into a notch between two mountains. Huge flanks of stone rose up to either side of me, decorated patchily by scrubby alpine firs. As the road dropped slightly, I saw that it led to an unlit tunnel, burrowed through the base of another mountain.

I was just about to enter the tunnel when I woke up.

The main thing that stayed with me after the dream ended was how good running felt. This is what my subconscious does while I'm in a recovery period from an injury, apparently.

As an update on that injury, by the way--I'm coming along fairly well. I've been doing this plantar fascia stretch regularly and it seems to be helping (along with a lot of wall stretching, and habitually dorsiflexing my foot whenever possible). I ran a whole six miles today! (I know, right?)  I think that I've rounded the corner on it, but I'm not quite ready to do the victory dance yet. The main danger now is picking up some compensatory injury while my left foot is still weak.

I hope to put myself back on a schedule next week, but it will probably still be a few weeks before I do any speed-work, sadly.