Sunday, July 31, 2011

Injury Sleuthing

One of the worst things about being an injured runner is the guilt that comes with knowing that you ignored the early warning signs and are now sidelined because of it. I refuse to let that happen to me.

Warning Signs
About a week ago, as I was laying in bed before going to sleep, I noticed something very faint in a small area of my foot. When I went to go feel for the area, I immediately recognized it as the same area that I used to massage when I had Peroneal Tendonitis back in August of 2009. That was a horrible injury. I ended up having to take five weeks off of running and I missed my fall marathon because of it. I didn't know about pool running back then so when I returned to running, my fitness had gone out the window.

I wouldn't describe what I felt last week as a pain-- more of just a sensation. Throughout the week I continued to run, but I iced the area just to be on the safe side. I didn't feel a thing while running or walking. But when I was completely at rest and trying to fall asleep, there was that nagging little feeling in my foot.

My Peroneus Longus is Irritated
After Thursday's tempo run, the area was more tender during the day, so I iced it off and on a few times while at work. On Friday morning, I actually did start to feel something while walking. Still not a pain, but it was in the exact same area of my previous peroneal tendonitis injury so I was particularly attentive. Friday was a scheduled pool running and swimming day, with no planned land running to irritate it. I also coincidentally had an appointment to get my gait professionally analyzed by a sports doctor (more on that in another blog). I told the doctor that I had a sensation in my foot that felt like the beginnings of peroneal tendonitis. He confirmed that the tender spot was the attachment of the peroneal tendon, thankfully not a 5th metatarsal stress fracture.

Emotional Roller Coaster & Denial
Friday can best be described as an emotional roller coaster. For 15 minutes, the area would be 100% silent, but then 15 minutes later, I'd feel something again. I'd walk around without any sensation in the area at all, but then a short while later I would feel something while walking. I kept going back and forth on whether or not I should do my 18-miler the next day. Eventually, I shook myself out of denial: If you are wavering this much, the answer is no long run. How much would it suck to truly injure myself on a long run when my body was giving me warning signs of a previous injury? An injury that sidelined me for five weeks!!!!

I made the sensible decision to spend 2 hours and 40 minutes pool running. Thankfully, I had the company of some of my CAR teammates. Ironically, Tara and I had planned to meet at 6:00 that day to run 18 miles, and when Saturday rolled around, we were both pool-bound. Even though my foot didn't actually hurt-- I definitely felt something in that peroneal tendon attachment area and I was taking it seriously. No denial!

Detective Work
My most important question was why I was getting this injury. My mileage increase has been extremely gradual and I even had a "cutback" week two weeks ago. I'm only running four days a week, as opposed to the six I used to run during typical marathon training cycles. So it's not overtraining. My first question in my sleuthing: what has changed in my training recently?

I can think of three things: core work, hills, no foot slapping. At first, I thought that the side bridges (core work) were the culprit. Putting weight right there on the side of my foot might have been irritating the area. Good theory, but I ultimately didn't think it was the true culprit. I didn't think it was the hills because I only do them once a week, and the hill isn't that steep. So. . . foot slapping?

When I went on my first long run with CAR, my coach told me that I was a "foot slapper" and that I needed to be lighter on my feet to prevent injury and be more efficient. Foot slapping is when the ball of the foot hits the ground and makes a slapping noise, rather than being quiet. When I asked him how to not do it, he told me to just focus on not doing it. And so I did. I found it easy to correct and since that day in late June, there was no more foot slapping.

So, foot slapping was one piece of the puzzle. Question number two: what causes peroneal tendonitis in runners? I consulted Dr. Google and found that a strained peroneus longus muscle is often the culprit. As soon I read that, I remembered back to earlier in the week when I noticed my outer lower leg was sore. This just felt like the standard muscle ache so I didn't pay any special attention to it at all. But suddenly the pieces were coming together. I massaged around the peroneous longus muscle and voila: a tight and tender area.

Question #3: Why is my peroneus longus muscle strained? To answer this one, I had to figure out which motion stresses that muscle. The answer was easy-- plantar flexation of the foot. This would explain why my foot doesn't hurt at all when I walk, but I definitely feel something while driving. My drive to and from the pool hurt my foot more than anything else because my foot was in a flexed position the entire time.

So far, I knew that plantar flexation while running caused me to strain my peroneus longus muscle, which resulted in mild tendon inflammation near the foot-- felt primarily when driving. And I knew that I changed my gait to avoid foot slapping. Well, what muscle do you use to restrain that forefoot from coming down hard? The peroneous longus!!!! I realized that I was flexing my foot ever so slightly to keep it from slapping down, and in doing so, strained the peroneous longus muscle.

I can't be 100% sure that my foot issue was caused by this, but it makes a lot of sense. Changes in gait often lead to injuries, even if they are for the better.

The Solution
I plan to do strengthening exercises for the peroneous longus muscle as well as stretching and massage. I am also wearing my CEP compression sleeve to help speed recovery. I'm icing my foot A LOT. I also scheduled two ART (Active Release Technique) sessions with the sports doctor who did my gait analysis.

My coach told me to wait until my tendon felt 100% to return to running, and I plan to take that advice. My foot already feels much better today than it did yesterday. I have no pain with walking and I only feel it while driving or when pointing and flexing my foot. And even then, I would give it a 1.5 out of 10 on the pain scale. It's very minor and had I not experienced this injury in the past, I wouldn't be reacting this way. The earliest I see myself running again is Thursday (which would be six full days off) and that's only if I am pain free. My hope is to be able to run 18 miles on Saturday, but I won't do it unless I'm completely free and clear of any foot sensations.

Some of the best running advice I ever received was "sacrifice a day of training to save a week, sacrifice a week to save a month, sacrifice a month to save a year." So I am sacrificing a week to save a month. I'll continue to do workouts in the pool (today I did 40 minutes of pool running plus 1000yd swim) and hopefully get to the starting line of my marathon both healthy and well trained.


  1. Smart process of figuring things out and coming up with a plan. I think with some strengthening and rest you will be fine. Does foam rollin' it help?

  2. Good luck. Wish there was always a clear cut reasons why injuries happen but lots of times, it's nothing we can pinpoint. Hope you get out there on Thursday feeling 100%!

  3. ""sacrifice a day of training to save a week, sacrifice a week to save a month, sacrifice a month to save a year."

    Oh so very true. And it meant I got to "run" with you on Saturday.

  4. Sorry to hear about all this, but it sounds like you are catching it before it becomes a serious issue. I'm curious as to what William is asking, does the foam roller help?

  5. I had been using the stick, but I actually think that might be too aggressive. One area of the muscle is still tender to touch so I think I will just foam roll from now on instead.

  6. I've had this injury before and it sucks. But it sounds like you caught it early enough to knock it right back out. I'm doing the same thing right now for my shin - as soon as it started nagging, I shut it all down. Sigh.

  7. I'm sorry to hear about your foot, but I'm glad you seem to have caught it early. I hope that your time off now and caution mean that you are back to regular running soon!

  8. You're being so smart! Taking it easy early is a seriously hard thing to do and I'm impressed with how you're going about it. I love the detective work too. Sending lots of good healing vibes!

  9. Sorry you are having peroneal issues!!! I'm glad you discovered it and figured out the source so quickly though. You are definitely taking the smart approach. Happy healing!

  10. Wow, you are so detailed and organized when it comes to injury, it's quite impressive.
    And WOW, 2 hours 40 minutes of pool jogging, I've never lasted more than 20 minutes doing it, you're lucky to have had someone to join you for it!
    Glad you're being smart about the potential injury, you're going to be just fine I think.

  11. Hi I have exactly same problem as yours. It took me forever like over 5 months to get better. Sometimes I still get struggle with it. How do you avoid injury during driving? I need to know this one. Please advise. Thanks

    1. Try icing and seeing a sports chiro. Physical therapists are great but sports chiropractors can actually perform techniques to help with the pain. No solution for driving, I guess just cruise control wherever possible!