The Big Picture

I haven't spent a lot of time discussing my overall fitness since the beginning of my injuries in February 2010. There is a good reason for that. It's gone downhill rapidly. I lost endurance, strength and gained a significant amount of weight. Around 20 lbs to be exact. It didn't all happen at once. I slowly and subtly saw each component develop over the course of a year. I fought it on occasion as well.

Last summer, my love of the beach and lounging in a bikini prompted me to make a considerable effort to keep my weight down, but my overall exercise levels were low. I had stopped lifting and focused on what little running I could do without aggravating the IT band.

After the half marathon last fall, I fell apart. I had pushed my body way too hard to finish that race and had to face the consequences with my IT band. I dropped off working out almost entirely. Thus in November, I took a diet-only route. Low calories, completely clean. I shed 10lbs in three weeks and looked remarkably good going into the holiday season.

The holiday season, however, took it's toll. My weight returned to about 12-15lbs above my start weight and the lack of weightlifting finally reared its head. My arms were flabby. You could see it everywhere. I was ashamed to wear sleeveless dresses. I was just plump. Weak. It's the worst feeling. It was one thing to be heavier and strong, but another kettle of fish, when you're a hot mess all around.

I reached my breaking point in February when my clothes simply weren't fitting anymore without horrific muffin top and stomach rolls. Yes, stomach rolls. I hadn't had those in four years. I even developed a back/side roll when I was standing up straight.

What the heck happened to me? I not only let down myself, but all of my friends who had looked up to me and my dedication to fitness and health. I was so ashamed. I'd gone from role model to bad example. It was really hard to look at myself in the mirror. How had I gotten to this point? It was a combination of the injuries and some personal events that I'd been struggling to overcome for the past year. I think that the internal turmoil eventually manifested itself physically. Now that I have healed internally, I'm left trying to pick up the pieces on the outside.

Thus I joined this wonderful fitness/support website that has allowed me to log my diet as well as my exercise, with daily motivation and support from a large group of friends across the world. It has helped focus me and remind me of the person I used to be, remind me what motivated me day in and day out.

Now it's May and I've shed around 7 pounds in the past two months. I have been steadily regaining my strength through four dedicated days of lifting per week, along with high intensity interval training on the upright bike. I've been dedicated to taking yoga class once a week as well and eating healthy and consistently. My goal has been to return to my former figure and fitness level by the end of June, or what will be my 30th birthday.

I've been trying to stay focused on being strong and healthy without having to run for hours each week, to show myself that there are multiple ways to do it. I still miss running and am dedicated to becoming a healthy runner again, but for now, rather than make excuses or push myself too soon, I'm trying to stay focused on the bigger picture, with or without running.

In any case, here is a snapshot from last week. I still have another 10 pounds to lose over the next two months, but my strength gains are accelerating every week and I already feel the muscle gains paying off.

PT and Biomechanics Analysis

I'm not sure if I've mentioned this before, but I work in the orthopaedics department at a major hospital. I mainly do basic research in the development of implantable devices, but the clinical half of our lab works directly with patients and is expanding to a number of gait studies. This is really exciting for me, since the majority of my work has been engineering-based, which makes sense since I'm an engineer. But I've always wanted to work on the clinical side - the point where I've debated returning to nursing school or getting a certificate in clinical research so I can shift gears.

Now I was chatting casually with one of our clinical research staff/PTs at the coffee machine last week. She was asking about how my IT band issues were coming along, and I, in turn, brought up the fact that they were great compared to the stress fracture. I dicussed my visit to Sports Medicine the week before, and how I wasn't sure if I was going to return to my traditional running shoes or the Vibrams.

Now my doctor has worked with the clinical labs in our department over the years, thus my coworker was familiar with him and his experience. She started to tell me about the new offsite gait/sports medicine facility they're currently getting set up along with a number of new biomechanics studies that I might be interested in -- and ultimately a new sports medicine PT that arrived last year. This PT apparently has extensive experience in running gait analysis. I perked right up at that. She said she would talk to him for me, see if he could help me get back running again. She also said that they'd be thrilled to have me help them out with the gait studies they'll be starting later this year.

So wait, let me parse this down for you, since I'm ramling:

(1) I get to work with an accomplished PT to determine weaknesses in my biomechanics and ultimately how to fix them to run healthy.
(2) I have been invited to participate in running gait analysis research, which will ultimately be cutting edge research in the sports medicine/orthopaedic field and help answer all of the questions that have arisen in the wake of the minimalist running fad (it's now my word too).

Ill-fated Trial Runs

Test Run #1: Wednesday, April 27th

After the go ahead on Wednesday, I immediately decided to leap into action and go for a run. He said treadmill, but it was the most beautiful day ever and I couldn't resist the call of the wild (or in this case, the call of the urban park). Going home directly after work, I thought I'd do a nice 1 mile loop down and around Bremen Street Park. Children and families were everywhere. Busier than your average summer weekend even. I guess that's the call of the first spring-like day.

I took it easy, settling into what was about a 9:30 min/mile pace, lightly bouncing off my forefoot in the Bikilas. I decided to stick with the VFFs because ultimately I feel more efficient and comfortable with the new gait. I think this is a viable option as long as I strength the weakness in my feet, ankles and calves. Take it slower. Avoid cement.

When I met up with the park, I jogged solely on the grass. It's very squishy, lush grass, but with some mild risk of turning an ankle in a divet. I didn't do so. I made it about 1 mile without pain, when I paused for a stretch. It felt good. I did some push-ups, then took off again. I made it another 0.25 of a mile before I called it a day. I wasn't about to push my luck. I felt a mild ache in the top of the foot as if perhaps it would turn to pain if I'd kept it up.

I left the run optimistic!

Test Run #2: Friday, April 29th

Given the nearly positive results of my Wednesday run, I thought I'd do a quick out and back along the esplanade two days later. Another gorgeous day - the grass green, the sky clear and sunny, the weather warm with a breeze off the river. Everyone was out taking advantage of the weather from joggers, like myself, to cyclists and families.

In order to avoid the harsh impact on cement, I casually walked through the intersection by Science Park until I could hope onto the grass/trail near the tennis courts. Passing the Charlesbank playground, I turned off through the parking lot to join the running trail along the river. All was going well up until I hit the overpass by the Long Fellow. Approximately 0.5 miles into the run. Mild, ignorable pain in my foot. Pain that eased up when I used a midfoot landing and forward shuffle instead of a bouncing forefoot strike. I stopped by the bridge to stretch the calves, rest the foot a few minutes.

When I started up again, I stuck the dirt beside the paved path, but never made it much further than the boathouse. I stretched some more and turned myself around. The very pain had hit me that I was warned not to run on. I was also feeling it in the left side of my ankle. As if perhaps I'd been compensating somehow in my landing and put extra strain on the ankle. Defeated, I returned to the gym with my head hung low.

Conclusions:

I've since decided to give myself another two weeks of rest before I attempt another run. The foot had clearly not healed entirely and I likely set back my progress with the trial runs. This isn't boding well for the Warrior Dash in June - but at least my aerobic capacity is being held in shape with my regular bike intervals.

What happened with the podiatrist

I had my visit with the orthopaedic podiatrist this morning. It was uneventful and confusing. Now I really liked the doctor. He was friendly, had a sense of humor and amicable to asking all of my questions. He even said I had good questions - score!

Perhaps it was the excellent conversation that left me pleased with the visit in spite of the lack of answers.

When I explain how I went about injuring my foot, I could already see the rueful shake of his head. I later learned that give the "fad" (his word, not mine) of minimalist running, that people were arriving at his doorstep in epic numbers with injuries such as mine. I was, in fact, a statistic. He and some collaborators at Harvard are currently writing a paper on this very observation, to be submitted in the near future to JBJS or JSM.

Now he specifically stated that he neither supports nor discourages minimalist running. However, he did spend quite a bit of time pointing out some rather glaring holes in the few papers published on barefoot running - notably the sample population in the Nature article (all Kenyans who had never worn shoes and grew up running on grass compared to shod American runners who ran on urban surfaces). Or that fact that they measured impact force on the ground as opposed between the heel and shoe. And the obvious lingering question - even if you can steadily show that barefoot runners land with 20% of the force of a shod runner, does this actually lead to lower rates of injury? Even Dr. Lieberman wasn't able to conclusively say that barefoot running resulted in lower risk of injury. The research simply hasn't been done at this stage. Adequate controls and sample populations weren't in place in the published studies.

Beyond the few studies themselves, becomes the most relevant question - one that I asked him: As a heel-striking, shod runner, how can I safely transition to a minimalist, forefoot-landing running style? There is no proven or certified method of doing so at this stage. Current research compares lifetime barefoot runners and lifetime shod runners. As someone who spent the first 30 years of their life wearing shoes, running in shoes with an elevated heel, will I not only be able to transition to a healthy, safe barefoot stride that equals the same efficiency? My body has adapted and is "efficient at running inefficiently" - to quote Danny Abshire. The bottom line: Will this transition reduce my risk of injury? The answer is that no one knows right now. The research hasn't been done.

So after spending 30 minutes talking intently to the orthopaedist about this, we did come to several conclusions.

I have a fairly uncommon foot type where my heels are set inward when I stand with my feet facing straight forward. So if you look at my feet head-on, you can see the insides of my heels. This results in a mild supination of my foot, where my foot settles off to the sides and I land harder on the outside of my foot. This is something that could be corrected with a couple millimeter heel wedge. He said that if I continue to have ITBS problems, to give him a call and we'll look into the heel wedge.

If I stick to a minimalist stride, the ITBS may not be a problem, since it is primarily an overuse injury that is a result of the heel-striking gait and compensations associated with it. Therefore, if I continue to land on my forefoot, I will likely curtail the ITBS.

This sounded great to me. My entire reason to swap to the VFFs and natural running stride was to get rid of the ITBS that was plaguing me with mileage above 6-8 miles. So upon having this route confirmed, I asked, "So how do I safely return to the forefoot striking gait without reinjuring myself?"

That's the million dollar question.

For one thing, the stress fracture repairs itself stronger and healthier than it was originally - so the likelihood of refracturing that exact spot is unlikely. That doesn't mean I won't just fracture at another location. I asked if there was a set program or recommended transition. He laughs in a good natured way "You mean, is there running school or programs that safely transitions runners from shod to barefoot running safely? No. That would be handy. I'm sure you can find some guy claiming to be able to do just that, but its not routed in research or proven safe practices. There is no certified program to transition you. Our PTs wouldn't be able to help with that, and I don't know of any place off hand that offers such a program."

So pretty much, I'm on my own. He did confirm that weak calves were the primary problem. I suggested calf strengthening exercises - something I already do - and slowly easing into running. On grass - not pavement. He didn't really confirm or deny. But I can certainly continue my non-impact weightlifting and cardio.

He did tell me that I can go onto the treadmill tonight for a trial run. I am to run 1/2 to 1 mile. If I feel any pain, I should stop. Pain indicates that the fracture isn't healed. I can "only run when there is no pain." This can take any numbers of days or weeks, depending on my day to day activity levels. Every time I feel pain though, I should consider the fact that I'm taking a little away from the healing process.

I asked if I should wear the VFFs or my Landreths for the treadmill trial. He said that was up to me. But suggested if I was going to go the minimalist route in the future, that I should consider alternating in the beginning. That is a wise idea.

So...that's that. You're probably as confused as I am. But I'm not more confused than I was going in. I've just had the confusion over this transition to minimalist running confirmed by one of the leading doctors in the nation. Sweet.

On a side note, I gave myself a mini-pedicure in anticipation of the visit today. My toes are sparkling with fluorescent pink polish. I get giddy just looking at them.

Pre-Appointment Update

Tomorrow is my appointment with the orthopaedist. Last week (April 18th), I had another set of x-rays taken on my foot. I received a note from my doctor stating that it was continuing to heal well and that I should bring along my x-rays to the appointment. Therefore this morning I swung by radiology to grab copies of the x-rays. I will now share them for your viewing pleasure!

As you can see from the periosteal reaction, the stress fracture is located near the head of my second metatarsal of my left foot. These images are at 4 weeks and 7 weeks post-fracture, once healing had begun.





I don't necessarily see dramatic healing in last week's x-rays, but my day to day pain has subsided. I can perform lunges and last week I participated in yoga without much difficulty. I feel comfortable performing knee-dropping dance moves on Dance Central. I get minor pain (3/10) when I walk up a steep incline or hill, but daily activities are unaffected. I'm feeling confident that I'll have permission to start running ASAP.

I will report back after tomorrow's visit!

A lot of nothing.

I haven't updated in the past week because nothing has happened.

My appointment with specialist isn't until April 28th. My foot feels generally unchanged. I haven't been wearing the shoe, but I haven't been jogging or walking around in heels either. The most pressure I've put on the foot is to do seated calf raises, and while this will eventually lead to an imbalance, my right foot tends to carry most of the load.

Outside the sphere of running, I've been making strides in with my lifting. Yes, I'm graphing my weight gains on Excel. I think that my muscles are beginning to pick up steam now that I'm back into the routine and I'm seeing faster gains in strength. I'm back to Fall 2009 levels with my upper body, but I'm taking it easy with the legs. The last thing I need is to vault myself into further injury by non-running related means.

I think that mentally I've nearly had it with this injury business. In some ways, I feel like I've lost my identity as a runner. It's been over a year now, since I ran injury-free. Last summer and early autumn seemed like a fluke. It doesn't seem real that I actually ran that half marathon. My vibram/natural running transition of December-Feburary was so low mileage that that didn't even seem to qualify. I have no idea what kind of standard I'm setting to call myself a runner again, but at the moment, since I'm not running, I'm definitely not meeting it.

The weight gain and general loss of cardio-vascular strength is frustrating as well. I feel unmotivated to perform any type of exercise if running isn't somehow involved. Yes, the lifting is fun - but I always did it in conjunction with running. I was doing it to be a better runner. There has never been anything independent about my other exercise. It has all been for the purpose of improving myself as a runner. While continuing to workout while injured, I am certainly trying to maintain some level of fitness so that my return to running won't be hampered by sloth - but I really just don't love the rest of it as much.

I'm also getting bitter when I hear friends talk about their running and achievements. I am completely thrilled for them and motivated by their efforts - but feeling motivated while you're injured is like gunning the engine while you're in park. It's very frustrating after a while. That's where I now stand. Or sit. Or have parked my car.

Confirmation

Nothing has really changed. I got confirmation from the second set of x-rays today that it's a "healing" stress fracture. Which I suppose explains why hurts less now than it did a couple of weeks ago. On a positive note, in my mind at least, this means that I can totally run the 5k in a couple of weeks. If its already healing, then it should be fine by the time of the race. I lightly jogged to the train this morning (mainly because it was arriving and I wasn't at the station) and my foot didn't feel so bad in my Landreths. I guess cushioning and heel-striking tends to lessen the damage on my toe. I'm debating if this means I can run three miles like that. I think that this week I will go for a 1 mile trial run down the park and back. I'll ice it up and if it feels good, then I'll be on for race. Or more like a slow jog, which I know shames people actually racing it. But what can you do? I just love the exhilaration of marathon weekend.

I'm going to try to score the x-rays when I talk to my doctor next time. I really want to see my the bones in my foot.

Anyway, this is what happened:

Image from AAOS website: Here