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).
Showing posts with label stress fracture. Show all posts
Showing posts with label stress fracture. Show all posts
PT and Biomechanics Analysis
Tuesday, May 10, 2011 barefoot running, biomechanis, injury, physical therapy, stress fracture
Ill-fated Trial Runs
Sunday, May 1, 2011 injury, stress fracture
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.
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
Wednesday, April 27, 2011 barefoot running, doctor visit, injury, minimalist running, stress fracture, vibram
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.
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
Tuesday, April 26, 2011 doctor visit, injury, stress fracture, x-rays
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!
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.
Wednesday, April 13, 2011 injury, stress fracture
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.
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
Monday, April 4, 2011 doctor visit, injury, stress fracture
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
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
X-Rays Results + Round 2
Friday, April 1, 2011 injury, stress fracture
Well, my x-ray results came back on Tuesday, but we played phonetag until Wednesday. The nurse who called me wouldn't tell me what she found, only that it was important that I come back in on Thursday to have a second round of x-rays taken to confirm the results. I headed in on Thursday assuming it would be a quick in and out, only to be called up to the doctor's office to speak with my doctor directly. As in, my physician called down and asked radiology to send me up.
When I arrived she told me that they think I have a stress fracture in the 2nd metatarsal from the first set of x-rays, but that the second round of x-rays will confirm. She wanted to proceed for now as we would for a stress fracture. At this point the bones haven't moved out of place, which is good news. She said that if I didn't hear from her by Friday with the additional x-ray results, that I should give her a call next week.
She also scolded me over the Reef sandals that I was wearing and referred to them as the Worst Possible Thing I could be wearing. She didn't seem to understand that I'm on vacation and it's like 50 degrees out! Honestly, regular walking doesn't hurt much these days. Only playing Dance Central does and specifically the Back Breaker move in Pon De Replay. In any case, she reiterated that I should wear highly cushioned running shoes from now on.
She then gave me The Ugliest Velcro Shoe On Earth (TUVSOE). The guy who fit me with the shoe explained that it simply has a stiff sole to prevent my toes from bending when I take a step. I felt that the cushioned running shoe advice was at odds with the stiff sole shoe purpose. My running shoes are highly flexible. That's the point. I'm confused. Especially since when I step in TUVSOE, my toes still bend up as I push off during a step. It is doing nothing except chafing my ankle and looking like an ugly orthpaedic shoe for someone who isn't nimble enough to tie laces. At least give me a big honking boot that actually prevents movement AND gives the impression that my foot is actually injured, as opposed to looking like an unfashionable old person sandal. I see no universe in which I will wear this thing.
I'll update next week. My received my appointment with the orthopeadic specialist - a foot/ankle guy at MGH. I won't be able to see him until April 27th. I'm on the fence about what I'm going to do about the B.A.A. 5k on Marathon Weekend. It's only 3 miles. I'm wondering if I can manage it if I wear my Landreths and take it in a jog. The alternative is to find someone who is looking for a bib. It seems a waste, especially monetarily, if someone doesn't get to the run the race with it.
When I arrived she told me that they think I have a stress fracture in the 2nd metatarsal from the first set of x-rays, but that the second round of x-rays will confirm. She wanted to proceed for now as we would for a stress fracture. At this point the bones haven't moved out of place, which is good news. She said that if I didn't hear from her by Friday with the additional x-ray results, that I should give her a call next week.
She also scolded me over the Reef sandals that I was wearing and referred to them as the Worst Possible Thing I could be wearing. She didn't seem to understand that I'm on vacation and it's like 50 degrees out! Honestly, regular walking doesn't hurt much these days. Only playing Dance Central does and specifically the Back Breaker move in Pon De Replay. In any case, she reiterated that I should wear highly cushioned running shoes from now on.
She then gave me The Ugliest Velcro Shoe On Earth (TUVSOE). The guy who fit me with the shoe explained that it simply has a stiff sole to prevent my toes from bending when I take a step. I felt that the cushioned running shoe advice was at odds with the stiff sole shoe purpose. My running shoes are highly flexible. That's the point. I'm confused. Especially since when I step in TUVSOE, my toes still bend up as I push off during a step. It is doing nothing except chafing my ankle and looking like an ugly orthpaedic shoe for someone who isn't nimble enough to tie laces. At least give me a big honking boot that actually prevents movement AND gives the impression that my foot is actually injured, as opposed to looking like an unfashionable old person sandal. I see no universe in which I will wear this thing.
I'll update next week. My received my appointment with the orthopeadic specialist - a foot/ankle guy at MGH. I won't be able to see him until April 27th. I'm on the fence about what I'm going to do about the B.A.A. 5k on Marathon Weekend. It's only 3 miles. I'm wondering if I can manage it if I wear my Landreths and take it in a jog. The alternative is to find someone who is looking for a bib. It seems a waste, especially monetarily, if someone doesn't get to the run the race with it.
The Doctor's Appointment
Monday, March 28, 2011 doctor visit, injury, stress fracture
Well, I went in for my yearly physical this morning with my new physician. She's a bit older, but very sweet. I asked if she could look at my foot while I was there, providing a brief history of my running injuries over the past year. I suppose I'm rather long-winded when I describe my running history, but I felt that it was necessary in order to provide proper background to diagnose the issue. Apparently she didn't feel that way.
She rushed me and didn't ask too many questions. Instead, she scolded me for wearing Vibram Five Fingers and made a bold, baffling statement: "Your feet aren't meant to run without lots of cushioning." Something along those lines. She actually referred to the Vibrams as "Extremely dangerous." Seriously. Someone hasn't brushed up on their recent running biomechanics. However, I nodded and smiled because she was referring me to an orthopaedic specialist and wanted me to go to PT once we took some x-rays. Basically, it doesn't matter what her opinion on natural running and Vibrams are once I'm placed into the hands of the specialist. I requested someone from MGH, if possible due to both convenience and the fact that it took over an hour past my appointment start time to see my doctor. I don't think my new health center runs efficiently.
So tomorrow I'm going back for x-rays of the left foot and we'll see if its tendinitis or something more serious.
She rushed me and didn't ask too many questions. Instead, she scolded me for wearing Vibram Five Fingers and made a bold, baffling statement: "Your feet aren't meant to run without lots of cushioning." Something along those lines. She actually referred to the Vibrams as "Extremely dangerous." Seriously. Someone hasn't brushed up on their recent running biomechanics. However, I nodded and smiled because she was referring me to an orthopaedic specialist and wanted me to go to PT once we took some x-rays. Basically, it doesn't matter what her opinion on natural running and Vibrams are once I'm placed into the hands of the specialist. I requested someone from MGH, if possible due to both convenience and the fact that it took over an hour past my appointment start time to see my doctor. I don't think my new health center runs efficiently.
So tomorrow I'm going back for x-rays of the left foot and we'll see if its tendinitis or something more serious.
Three days to recover
Thursday, March 10, 2011 injury, running, stress fracture, top of foot pain
Well, I'm three days away from the Ras na hEirran and the diagnosis doesn't look good. I can walk without a limp now and at a moderate pace. I still have to ice at night, morning and take Aleve, but I'm otherwise in relatively little pain.
That is, until I try doing something strictly load bearing on my foot - such as forefoot running, calf raises, lunges, etc. Even the plank/push-up plans for last evening fell short because I had to do them one-legged, which provides additional difficulty to the exercises and disheartened me, ultimately my downfall.
Ab Ripper X is getting easier. I excel at Crossovers, Roll Ups + V-Ups, and Leg Climbers. They are very similar to pilates moves that I used to love. I suspect there is some muscle memory at work here. The Mason Twist is a struggle to complete and my oblique v-ups simply aren't up to his speed.
Did I mention that I miss lifting at the gym? Nothing has changed, except me. I think it'll take a couple of months, but I'm hoping to match my previous lifting numbers by mid-May. Anything I accomplish over the summer should be a big bonus.
Not running is bringing me down, but it's beginning to be a sad old story. I'm wondering about the wisdom in pushing it the way I do. But about 5 minutes into upright bike intervals, I remember why running outside is nirvana-inducing.
On a fun note, we've decided on our Warrior Dash team theme: Ke$ha Warriors! There will be neon, glittering facepaint and crazy hair.
...glitter on our eyes
Stockings ripped all up the side
Looking sick and sexy-fied...
That is, until I try doing something strictly load bearing on my foot - such as forefoot running, calf raises, lunges, etc. Even the plank/push-up plans for last evening fell short because I had to do them one-legged, which provides additional difficulty to the exercises and disheartened me, ultimately my downfall.
Ab Ripper X is getting easier. I excel at Crossovers, Roll Ups + V-Ups, and Leg Climbers. They are very similar to pilates moves that I used to love. I suspect there is some muscle memory at work here. The Mason Twist is a struggle to complete and my oblique v-ups simply aren't up to his speed.
Did I mention that I miss lifting at the gym? Nothing has changed, except me. I think it'll take a couple of months, but I'm hoping to match my previous lifting numbers by mid-May. Anything I accomplish over the summer should be a big bonus.
Not running is bringing me down, but it's beginning to be a sad old story. I'm wondering about the wisdom in pushing it the way I do. But about 5 minutes into upright bike intervals, I remember why running outside is nirvana-inducing.
On a fun note, we've decided on our Warrior Dash team theme: Ke$ha Warriors! There will be neon, glittering facepaint and crazy hair.
...glitter on our eyes
Stockings ripped all up the side
Looking sick and sexy-fied...
Wednesday, March 2, 2011
barefoot running,
extensor tendinitis,
stress fracture,
top of foot pain
0
I had a sad realization today that perhaps it wasn't my ballet flats, but the forefoot running had led to what feels like a broken foot (<-- melodramatic, not broken). I was reading several barefoot running blogs that discuss how top of the foot pain is fairly common due to overuse, tight calves, etc.
From Go Barefooting:
I had diagnosed it correctly, it seems. I feel reassured, however, that this is both common and I can address it through stretching my calves more. Which apparently IS, in fact, possible. Even last fall when I did the TRX training with Janet, she told me my calves were impossibly tight. I can't imagine how much worse it has gotten since I began forefoot running, even with my careful stretching.
I had recently noticed that while I could run anywhere from 3-5 miles in the vibrams, that my calves ached considerable just after 1 1/2-2 miles still. That I could still physically run, but my calves were definitely maintaining a dull ache for the run. I also noticed some uncomfortable sharp pain through my left foot at times. I always slowed or stopped when it happened, and it immediately went away, but there could be some cumulative effect.
I'm still icing 2-3 times per day, taking ibuprofin and trying to be as gentle as possible. My plan is to not leave my couch this weekend. It sounds insanely boring, but its all I can do. Okay, I might leave to do laundry but that's it! Besides I ant to do that at 7am on Saturday morning. For workouts I'll do non-foot-loading strength training and P90X. I can do the pushups and stuff as long as I balance on my right foot or do them on my knees.
I have a plan. That always makes me feel better.
On a side note, I signed up for the B.A.A. 5k this morning. I'm excited to celebrate Marathon Weekend with a race, even if it's not 26 miles. And I talked my best friend into doing the Warrior Dash in June. It will be my last hurrah - as in, I turn 30 on Sunday. Saturday, however, we will be Warriors! Woohoo!
This is a shot of my swollen left foot today:
From Go Barefooting:
The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet. These pains are usually coming from two muscles and/or three tendons that run the length of the top of the foot, one of which actually starts along the tibia.
....
All of you who started out with calf pain transitioned to top-of-the-foot pain for that very reason. Your calves got extremely tight and sore. A lack of proper stretching and relaxing caused a counter balance problem, which manifested itself in the connective tissues in the top of the foot. Remember that every joint in the body is a balancing act between muscles, and the pain you feel is rarely coming from the spot you are feeling where you feel it.
With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.
I had diagnosed it correctly, it seems. I feel reassured, however, that this is both common and I can address it through stretching my calves more. Which apparently IS, in fact, possible. Even last fall when I did the TRX training with Janet, she told me my calves were impossibly tight. I can't imagine how much worse it has gotten since I began forefoot running, even with my careful stretching.
I had recently noticed that while I could run anywhere from 3-5 miles in the vibrams, that my calves ached considerable just after 1 1/2-2 miles still. That I could still physically run, but my calves were definitely maintaining a dull ache for the run. I also noticed some uncomfortable sharp pain through my left foot at times. I always slowed or stopped when it happened, and it immediately went away, but there could be some cumulative effect.
I'm still icing 2-3 times per day, taking ibuprofin and trying to be as gentle as possible. My plan is to not leave my couch this weekend. It sounds insanely boring, but its all I can do. Okay, I might leave to do laundry but that's it! Besides I ant to do that at 7am on Saturday morning. For workouts I'll do non-foot-loading strength training and P90X. I can do the pushups and stuff as long as I balance on my right foot or do them on my knees.
I have a plan. That always makes me feel better.
On a side note, I signed up for the B.A.A. 5k this morning. I'm excited to celebrate Marathon Weekend with a race, even if it's not 26 miles. And I talked my best friend into doing the Warrior Dash in June. It will be my last hurrah - as in, I turn 30 on Sunday. Saturday, however, we will be Warriors! Woohoo!
This is a shot of my swollen left foot today:
Extensor Tendinitis
Tuesday, March 1, 2011 extensor tendinitis, foot pain, injury, stress fracture, tendinitis
So last June I came down with extensor tendinitis. It started like this. I went for a starter jog, like 2-3 miles, nothing remotely rough. After the jog, I settled down in the park for some leg work and stretching. Squats and lunges in the grass.
During one of my lunges, I stepped back on a divot in the ground, twisting my foot a little funny, but nothing traumatizing. I continued to lunges, stretch and headed home. A couple of days later, I got this aching pain in the top of my foot. A pain that grew and grew. You could see the swelling on the top of my foot. It couldn't bear much weight and I certainly couldn't run.
I swapped to flip flops which only made it worse. Thus I thought that perhaps it wasn't the mis-step in the grass, but instead the build up of flip-flop induced foot pain. You know how you have to curl your toes when you step to hold the flip flop in place? I assume that was the issue. I wore regular shoes for a couple of weeks and it all got better. I resumed wearing flip flops, but it never bothered me again.
Until last week. I've been running in the vibrams inconsistently. Or rather, I've running inconsistently, but wearing the vibrams only. Only 2-3 jogs per week, for short distances. I've had no problem except the achy calves after about 2 miles.
Then on the weekend of the 19th, I wore these completely unsupported, flat footed thin ballet flats. These were my flat shoes of choice last summer also. I power walked around many miles in these shoes on Sunday and then again on Tuesday. And by Tuesday my left foot was in massive pain. The whole top of the foot is swollen. I can't land on the foot. I have sharp pain in my three middle does when I bend them in any fashion. It's straight up awful. I'm limping around awkwardly.
I've also been icing my foot for a week. I briefly wrapped it, but that didn't seem to help. I take ibuprofin morning and night. I've rubbed it down with icy hot. And I haven't run since the 19th. I've even taken to hopping on the bus to get to the train station rather than walking the short half mile. Cumulatively my commute walks me 2 miles per day. That's just day to day wear and tear. But I'm wondering if even that won't help. I've self-diagnosed with the extensor tendinitis again, but with all of these injuries there is just no good or fast treatment.
Last night I kept waking up in pain as I turn in bed or my foot lay in an awkward position. It's getting miserable. Then I tripped on this hose at work today, forcing me to land hard on the ball of the left foot, sending shooting pain in all directions.
This is lame. St. Patrick's Day 5k is in 1 1/2 weeks. Must fix this problem now, so I can run my first race in vibrams.
During one of my lunges, I stepped back on a divot in the ground, twisting my foot a little funny, but nothing traumatizing. I continued to lunges, stretch and headed home. A couple of days later, I got this aching pain in the top of my foot. A pain that grew and grew. You could see the swelling on the top of my foot. It couldn't bear much weight and I certainly couldn't run.
I swapped to flip flops which only made it worse. Thus I thought that perhaps it wasn't the mis-step in the grass, but instead the build up of flip-flop induced foot pain. You know how you have to curl your toes when you step to hold the flip flop in place? I assume that was the issue. I wore regular shoes for a couple of weeks and it all got better. I resumed wearing flip flops, but it never bothered me again.
Until last week. I've been running in the vibrams inconsistently. Or rather, I've running inconsistently, but wearing the vibrams only. Only 2-3 jogs per week, for short distances. I've had no problem except the achy calves after about 2 miles.
Then on the weekend of the 19th, I wore these completely unsupported, flat footed thin ballet flats. These were my flat shoes of choice last summer also. I power walked around many miles in these shoes on Sunday and then again on Tuesday. And by Tuesday my left foot was in massive pain. The whole top of the foot is swollen. I can't land on the foot. I have sharp pain in my three middle does when I bend them in any fashion. It's straight up awful. I'm limping around awkwardly.
I've also been icing my foot for a week. I briefly wrapped it, but that didn't seem to help. I take ibuprofin morning and night. I've rubbed it down with icy hot. And I haven't run since the 19th. I've even taken to hopping on the bus to get to the train station rather than walking the short half mile. Cumulatively my commute walks me 2 miles per day. That's just day to day wear and tear. But I'm wondering if even that won't help. I've self-diagnosed with the extensor tendinitis again, but with all of these injuries there is just no good or fast treatment.
Last night I kept waking up in pain as I turn in bed or my foot lay in an awkward position. It's getting miserable. Then I tripped on this hose at work today, forcing me to land hard on the ball of the left foot, sending shooting pain in all directions.
This is lame. St. Patrick's Day 5k is in 1 1/2 weeks. Must fix this problem now, so I can run my first race in vibrams.
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