Posterior Tibialis Tendonitis

In 18+ years of running, I certainly have made the rounds of all the different types of tendonitis!

Patellar Tendonitis: Spring of 2008
Peroneal Tendonitis: Fall of 2009
High Hamstring Tendonitis: Summer 2013
Achilles Tendinitis: Fall of 2017

I can now add to the list Posterior Tibialis Tendonitis. Here's how it happened.

December 8: CIM

Before CIM. No tendonitis!

Upon completion of the marathon I noticed a pain in my arch. It hurt as I walked back to the hotel, and when I took the Vaporfly Next% off of my foot- OUCH. It was a burning pain of about 6 out of 10 on the pain scale. It seemed as if the shoe had been rubbing against my foot in a certain way to cause this arch pain. It bothered me for the rest of the day and and into the following day.

December 9 - 15: Marathon recovery
The pain went away completely two days post marathon. So much so that I forgot about it.

December 16 - 20: Easing back into running
I resumed running with short, easy runs of 30-50 minutes. I didn't have any pain in my foot.

December 21: First post-marathon symptoms
I did an 11-mile long run and the arch of my foot started to hurt about halfway through. It was maybe about a 2 on the pain scale, so I wasn't concerned. As I walked around on it for the rest of the day, I noticed that it felt off, kind of like a tight muscle.

December 22 - January 9: Blissful Ignorance (or denial)
I continued to train, doing hard workouts on the track and long runs of 10-13 miles. I even ran a 5K on New Year's Day without any problems. My foot would bother me a little, but it was more of an annoyance than anything else, never getting above a 2 on the pain scale.

After my long run on January 4th, my foot hurt more than normal, which caused concern. It was mostly okay during the run, but afterwards it was about a 3.5 to 4 on the pain scale for the rest of the day. Very tender to the touch and I could feel it with each step. That's when I realized I would probably have to address it. I continued with my training plan and track workouts until I could get in to see my physical therapist on January 9.

Diagnosis!
It didn't take long for my PT to diagnose me with posterior tibialis tendonitis; I had classic symptoms. The two areas of pain were on the bottom of my foot, where the tendon connected, and on the side of the foot, about one inch forward from the ankle bone, and one inch below. He told me I would need to take some time off running to let it heal. Not the news I wanted.

Area of pain - feels like a sore ache

This issue wasn't caused by "overuse"-- it was caused by my shoe rubbing the wrong way during the race. So how does that result in tendonitis?!  My PT had a theory that it could have been because the shoe had an 8mm drop (as opposed to the 10mm I normally wear) and it was extra bouncy, causing my foot to pronate, where it normally does not pronate. Or, it could have been rubbing against my arch the wrong way, which irritated the tendon, and now it's going to take a while to calm down.

So. . . couldn't I just train through it like I trained through Achilles tendonitis? He said that this was different and I needed to ease up to give it time to heal. Of course, in addition to doing exercises. He was concerned that I took a week off post marathon and it came back. And he said that this is a nagging injury and tends to come back unless you treat it with the exercises over several months.

January 10 - 13: No running; pool workouts only
I took four full days off of running, but I went to the pool every day. I mainly did deep water running with a floatation belt, but I also added in some swimming to save myself from boredom. And I simply enjoy swimming. I would do it all the time if it were more convenient.

January 14 - now
After my four days off, I started running again, but only 3-4 miles per day. And that's where I am at now-- I just finished a 3.5 mile run in the snow. And of course, I have been religious about my exercises. Rest alone won't heal this; I need to load the tendon with weight.

I'm now at a point where I don't feel any symptoms while walking around during the day, which is a big improvement. However, after about two miles of running, I do start to feel some soreness on the bottom of my foot. Since I'm only running 3-4 mile easy runs, this pain has been about a 1.5 to 2 on the pain scale, and I am back to being symptom free five minutes after stopping.

I also bought a pair of the Mizuno Wave Inspire-- a shoe I stopped wearing over a year ago when I was told I was a neutral runner. I am a neutral runner, but the added stability will reduce the load on the tendon as I recover and the firmness of the shoe will help too. My PT told me that cushiony, bouncy shoes were bad for this injury.

Looking ahead
I'm trying not to look ahead and take this one day at a time. I have no idea how bad this is going to be. Once I start increasing my mileage (next week) will the pain come back while walking around during the day? Will it become more painful so that I can't run? My PT said that I can let it get to a "3" on the pain scale. But anything above that and I need to stop running and go back to a reduced load. Thankfully, I haven't felt a 3 or above since the day of my long run two weekends ago, and I want to keep it that way.

If this had happened a month out from Boston, I probably would have continued to train through it at full intensity and waited until after the race to rehab it. But since Boston is still over 12 weeks away, I feel like I can get away with easing up on the mileage now and still run a strong race.

How I feel
Of course, this sucks. I'm generally optimistic because as I said above, it wasn't like I was overtraining or anything. It was caused by the Vaporfly during a marathon, so once it calms down it shouldn't come back. I'd be discouraged if my normal running routine caused this.

I basically have some loathing of CIM, though. I tried to be positive about my experience there, but now I just look back on that race with regret. I had a perfect training cycle and I was in the best shape of my life. I went into that race healthy and with no issues. I ended up having a difficult race, missing my goal time, not getting a PR, and ending up with an injury.

My primary positive takeaway from that race was that I had such a great training cycle and it would set me up well for my Boston cycle. But now just the opposite is true. The race set me up to start my training cycle off with an injury. If CIM had been the race I had hoped to run, I wouldn't be as peeved about this. I would have been "worth it." I'm glad CIM is behind me, and I'm never going back there and I'm on the fence about ever putting my foot in a Vaporfly Next% ever again.

Phew! Glad to get that off my chest. I am sour, but I have been distracting myself with my pool workouts and focusing on the healing process. So generally, I am in a good spot mentally. I still think I will be able to run well in Boston, and at least participate (if not run fast) in the races I have signed up for this spring.

Insertional Achilles Tendonitis Recovery

If you've been following this blog you'll know that I have been struggling with insertional Achilles Tendonitis for the past few months. I'm delighted to say (and I hope I am not speaking too soon) that I have made a near-full recovery, or at the least have experienced a dramatic improvement. I'm writing this blog primarily for my own records, and also in the hopes that it helps someone else out there. I am not a medical professional, but I thought I would share my experience and what helped me recover.

Onset
This all started in mid-July when I noticed stiffness on the backs of my heels when waking up in the morning and taking those first few steps. I didn't think it was a big deal at the time because it wasn't painful (stiffness is the best term for it) and I really only felt it when I first got out of bed. After a few weeks, the issue became more noticeable while on the Great Alaskan Running Cruise. It still wasn't painful, but I felt the stiffness more frequently, like after running.

At this point, I consulted with Dr. Google and diagnosed myself with Achilles tendonitis in both feet. What I didn't realize, though, is that there are two types of Achilles tendonitis: insertional and midpoint. The treatment for each of these is different. However, without knowing this fact (and that's the danger of Dr. Google) I started doing the exercises that had proven to heal midpoint tendonitis.

Progression
I did these exercises every day throughout the month of August. The exercise was standing on the edge of a step, and doing heel drops so that my heel fell below the step. This was slightly painful to do, but the article I read said that these exercises should feel painful. I also stretched my calves thoroughly each day.

The pain gradually worsened in that I would feel it after almost every run. My runs were completely pain-free (with maybe a hint of stiffness at the beginning), but then I would spend 40 minutes driving to work, which resulted in them stiffening up substantially. I would get out of my car and the first few steps would be really painful. The pain would last for the first hour of the day and then subside. This pattern continued for a month before I finally decided to see my sports chiropractor.

Rehab Exercises
My sports chiropractor told me that by stretching and doing those exercises, I was treating midpoint Achilles tendonitis, not insertional tendonitis. He told me that stretching my calves and sinking my heel below the step was putting additional strain on the tendon and making things worse! Oops! He told me that I should do eccentric heel drops on each foot, but on a flat surface. He told me that I should use as much weight as tolerated because the added weight would stimulate healing.

Ideally I would back off of the training, but given that I had a marathon approaching, he told me I could continue running, as long as I did the exercises every day. And once the marathon was over, he advised that I take a few weeks off to let the tendons completely recover.

I was very good about doing the exercises and I saw a notable improvement within just a few days. What a relief! I wore a backpack with 20 lbs worth of weights inside while I did the heel drops. I did 3 sets of 15 on each side, as prescribed, twice a day. As prescribed, I did these very slowly (lasting 3 seconds for the full drop) starting from half the height of full tippy-toes.

I continued training, running 60-70 miles a week, and sure enough, the pain worsened again a month later. Even though my actual runs were pain free, my heels really hurt afterwards. After a 22-miler, they hurt all day long, so I ended up taking 3 full days off from running. The most worrisome part about this was that my heels hurt when I was at rest, whereas typically they would only hurt when walking. The time off worked, with the pain diminishing significantly, and I was able to resume training, with just three weeks left to go.

The Smith Machine

I lower the bar and hold it in a relaxed position

The marathon came and went. My heels were mostly pain-free during the race, but they were extremely painful afterwards. With every step I took I could feel a burning sensation! I took two weeks off from running and spent this time focusing on recovery. After doing more research on insertional Achilles Tendonitis, I realized that my backpack-with-weights approach was not allowing me to add enough weight to stimulate tendon recovery. These exercises didn't hurt at all, and apparently they were supposed to hurt a little bit.

So, I discovered the Smith Machine at gym in my office building. This machine allows me to do the heel drops with a lot more weight, as it is easier to use the bar than wear a backpack. I simply hold the bar with my arms in a relaxed position down at my thighs. I started off with 25 lbs + the weight of the bar and after about a week, upped it to 30 lbs + the weight of the bar. I started doing the exercises twice a day, 15 reps on each side. And I am still doing them at this level.

Doing the heel drops with this machine has helped me more than anything. As soon as I discovered it, my Achilles felt dramatically better within just two days. I've now been using this machine for three weeks, and I am close to 100% recovered. By that I mean that most days are completely pain free, and on the days I do feel it, it's only for a minute at a time, like once or twice during the day. This injury developed gradually so I imagine it will take awhile to become 100% pain free 100% of the time. But I am very close to being there.

FAQ
Here are some questions I had about this injury, and the answers I discovered. Once again, I am not a medical professional so take this as one runner's experience and opinion!

Shoes I wear to avoid additional tendon strain

Q: What type of shoes should I wear when not running?
A: My sports chiropractor advised me to wear a backless shoe with a chunky 1-2 inch heel, and that the heel height would relieve the strain on the tendon. While high heels are not a good long-term solution, they did allow me to be pain-free while walking around, and in order to recover fully, it's necessary to reduce strain on the tendon as much as possible.

Q: How do I know how much weight to use for the heel drops?
A: I started with a low weight (15 lbs in the backpack) and worked my way up. I think it's supposed to slightly hurt in the area of pain, but not horribly so. All of the articles I've read say "once you can do this without pain, then up the weight." So I assume there should be a little bit of pain or you aren't using a heavy enough weight. I saw the most improvement when I discovered the Smith machine and used 25 lbs plus the weight of the bar.

Q: How do I know if I should run?
A: This is a tough question, especially if you are pain-free while running. I think it really depends on how bad the situation is, and you should consult a medical professional. When my Achilles started to ache all the time (even when not walking) I knew it was time to stop running altogether until they calmed down. Recovery is not linear-- some days are better and some days are worse. It's important to look for a trend towards improvement and if you aren't seeing that, then it means you should reduce your mileage or stop running.

Q: What causes insertional Achilles tendonitis?
A: In my case, I think it was a change in footwear. I had been using a 10mm drop firm shoe for my speed work for the past decade, and then I changed to an 8mm drop cushy shoe in June. Even though this is only 2mm difference, my heel was getting even closer to the ground because of the cushiness of the shoe. My sports chiropractor cautioned me that those heel drop numbers can be deceiving because you have to take into account how stiff/firm the shoe is. I have limited ankle mobility, so I am not a candidate for a low heel drop shoe. Generally speaking, a high heel-to-toe ratio is best for preventing Achilles tendonitis.

Q: Should I ice or heat the tendon?
A: I've gotten conflicting guidance on this from multiple trusted sources. I tried icing my heels once after a run and 5 minutes in, they started burning really badly. So I nixed ice. Tendonitis means that the tendon is inflamed, so heat isn't a great idea either. However, heating the lower calf to get blood flow to the area is a good idea before runs.

Q: What's the best form of cross training?

Getting ready to go deep water running!

A: I was reluctant to use the elliptical machine or the bike because those machines can place strain on the tendon by forcing the foot to flex upwards. Swimming and pool running were a good option for me because I don't move my feet much when I do those activities. A more skilled swimmer might potentially move his/her feet more and thus irritate the tendon. I am not all that skilled!

Q: What about a night splint?
A: My podiatrist gave me a night boot/splint thing to wear while sleeping, but my sports chiropractor thought this was a bad idea. What to do? Since the boot didn't fit me anyway, I never used it, but I know some people have had relief with it. It basically keeps your foot in a neutral position overnight (not allowing the tendon to shorten/relax) so that when you get up and start walking around, your tendon has adjusted to being lengthened.

Q: Can the tendon rupture?
A: My sports chiro and my podiatrist both told me that this would not happen from long distance running. A rupture occurs from sudden force, which is more likely to happen in soccer or basketball. I ran a marathon with insertional Achilles tendonitis and it didn't rupture.

My best advice to anyone struggling with insertional Achilles tendonitis is to see a doctor, PT, or sports chiropractor. It's important to have a correct diagnosis and to pinpoint what caused the issue. It's also important to have a medical professional watch you do the exercises so that you know you are doing them correctly.

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.

Three Things

Bad things happen in threes. Like my three stress fractures. To combat this, I have decided to make good things happen in threes too. In fact, here are three sets of three:

1. Three Types of Cross Training

My cross training has consisted of using the elliptical, pool running and swimming.

I typically use the elliptical twice a week, with one of these times being at tempo effort. I monitor my heart rate closely and usually I am at the top of my tempo zone, if not above it (the gym is really hot, so I think that account for an elevated HR). During easy elliptical workouts, I amuse myself by listening to podcasts from How Stuff Works. I've chosen a variety of topics including the the origin of Christmas, the economic bailout, FDA regulation of supplements, contagious laughter, blood pressure, the sun, memory, population studies, the lottery and many others. I am interested in a lot of different things! During tempo workouts, I have to listen to very pumped up music to keep me going.

I'm also a huge fan of pool running, and I have mentioned this in the past. I usually do pool running 3 times a week, with one of those days being a "long run" of at least two hours and another day being an interval day. The third day is easy pool running combined with swimming. For those of you who don't know much about deep water running, here is a video of me:

The third type of cross training is swimming-- always freestyle. I don't do any other stroke or any type of drill. I just swim back and forth freestyle because it's what I'm comfortable with and I think it provides a challenging workout. I typically swim about 2-3 times a week. I almost always accompany my long run with a swim so that I am in the pool for well over two hours. On my easy pool running days, I am also sure to swim so that I can get my heart rate up. 

Swimming is tough for me during the first 5-10 laps but gets remarkably easier as the workout goes on. I think it's because I find that "sweet spot" of speed and form that works for me. My longest swim with this injury has been 1500 yards (30 laps). Usually I do around 20-25. Swimming comes naturally because I grew up as a dancer, so the bilateral breathing thing that a lot of people struggle with is just like a dance movement to me. I was never on a swim team, but I was a lifeguard and taught swimming to small children. The only thing I dislike about swimming is that sharing a lane is tough for me. I have to watch out for that other person so I can't focus on my form, my breathing, or remembering what lap I'm on. I would hate to be taking a gasp of air right at the moment when that person is splashing and swallow a huge mouthful of water. 

2. Three Fun Challenges/Distractions

I'm a very goal-oriented person, and since I don't have my weekly mileage goals to fulfill that need, I have other hobbies and associated goals. Playing chess, singing Glee Karoake, and tiling the kitchen floor. 

Kitchen Tile

Tiling the kitchen floor isn't something that I am going to do myself, but picking out the tile, finding a good contractor and deciding on a pattern is quite a task. We are also re-doing our powder room which involves picking out a new toilet, sink, and lighting fixture. Shopping for a toilet with my new husband isn't the most romantic thing we have done together, but it's been fun. We finally made all of our decisions, now we just have to purchase the materials and wait for the work to start in early April. We ended up going with large 19" by 19" tiles in a slate color. Like a blackish grey, and with a lot of texture. We have light cabinets and light hardwoods in the neighboring rooms, so we though the black would be a good contrast.

The next challenge/hobby is Glee Karaoke for the iPad. This app is extremely addictive and can be very good or bad for the ego. I've downloaded about 10 songs that I can sing and be rated on. My two best songs are "No Air" originally by Jordan Sparks and "Hello" originally by Lionel Ritchie. My main goal was to be ranked in the top 100 of all time for No Air, out of over thousands of performances. I started out in the 900's and now I have worked my way up to 116. That top 100 is so close. There are also daily rankings, and my performance of No Air was ranked #1 for the day at the time I sang it. There had only been 81 other recordings at that point, but I think 1 out of 81 is pretty good! My "Hello" ranking once reached #4 for the day out of hundreds and I would like to see that one do as well as No Air.  Songs I suck at are "Take A Bow" and "Total Eclipse of the Heart". But they're still fun to sing.

Perhaps the biggest focus for me has been playing chess. Greg got me a really nice set for Christmas, like I have always wanted, and we have been playing all the time. On the weekends it's not uncommon for us to play 5-6 games. Sometimes more. I've also joined some tournaments on chess.com and playing people from all over the world. Another major opponent is Greg's dad, who we both play online at chess.com.

Chess is another hobby that involves rankings (I am so competitive) and my ranking is slightly above average.  I've been playing since I was six years old but I've never really studied it, and there have been long periods (years) when I have gone without playing it.  Usually because I lacked an opponent. But now I am discovering new ways of thinking about the game and I'm a much stronger player than I was before this recent obsession.

3. Three Consolation Gifts
I'm very upset about this injury ruining my spring racing season, so I bought myself a few presents-- jewelry, clothing and a car stereo w/iPod.

New Earrings

I went to a jewelry party a few weeks ago where they have jewelry on display and in a catalog and you buy stuff. Like the tupperware parties, but with jewelry. I splurged and bought myself two new necklaces and two pairs of earrings. And then a few days later, I went to White House Black Market and bought myself three more necklaces and another pair of earrings. I usually wear the same three necklaces that I've had for about 10 years, so it was time for a change.

During my White House Black Market trip, I also bought myself two new outfits. New, stylish clothing always makes me feel so refreshed and puts me in a good mood. I wore one of my outfits this week and it just felt fun.

The major gift to myself was the new car stereo and a Nano to go with it. I've always wanted the ability to listen to my iPod from my car, so I bought a stereo that has both an auxiliary input and a USB input. Since my iPod Nano "lives" in its waterproof casing and isn't synced with my iTunes library because of a computer virus that wiped out a lot of the songs that are now exclusively on the Nano, I treated myself to the new Nano. The new Nano has a touch screen and can clip on to your clothing. Of course, none of these features matter when controlling it through the car stereo, but they are cool anyway. Considering I have three shuffles, an iPad and an older Nano, this purchase was a bit irrational, but I wanted it as a consolation gift.

So those are my coping strategies and they've worked decently well. I'm now to the point where I am running every other day, about four miles at a time. Not enough to keep my fitness where I want to be, so I am still cross training almost as much as when I couldn't run at all. 

The Simple Joy of Running

I have just returned from my first real run since my injury. It felt SO amazing to run! I forgot how much I simply enjoy running. Especially on a day like today when it's in the low 60's and I'm just going out for something very easy.

Wednesday, Feb. 23 marked the 4-week point of no running. The time actually went by pretty quickly. I had been mainly pain free walking around for two weeks, so I decided to give it a shot. I had been to two separate doctors and a physical therapist, and none of them gave me a concrete answer on when to start running again. But everyone agreed that my bone stimulator machine would reduce healing time. Both doctors told me I just needed to really monitor my symptoms and back off if I was feeling pain. But one doctor said it wouldn't be pain free, and some pains during/after were normal. But anything that was more than a minor twinge and I should back off.

I was feeling very frustrated with all the ambiguity. I was very anxious to get back into running, but I didn't want my four weeks off to have gone to waste by my foolishness. So on Wednesday I attempted my first run. I used a treadmill, which was dumb, because that's how I think I got the stress fracture to begin with. But I wanted to do the run-walk prior to my pool run and there are treadmills at the facility where my pool is, so it was the most convenient option. I set the treadmill to a conservative 5.4. I did feel a bit of something. I did two sets of 5 mins walking, 5 mins running and then stopped. Later that day I was having more pain in my shin than normal so I was discouraged.

But the more I thought about it, I remembered what the doctor saying about it not being pain-free, and my 5.4 miles per hour was unnaturally slow for me, which could have contributed to the awkwardness. So I decided to give it another go today (four days after the first attempt) and run outside. It was so beautiful out and I had my husband to accompany me, which was awesome. I was afraid that the run would hurt and that I would become discouraged, so having my husband for moral support was a huge help. I even wore my brand new Pacers Ambassadors shirt in honor of the occasion!

I did three sets of (5 mins walking, 5 mins running). We covered 2.52 miles total, and the run portion was just over 1.5 miles at an average pace of 9:41.

The first run section was a 10:04 pace and it felt rather easy. The next run portion was a 9:38 pace and that also felt really easy. The last run portion was a 9:22, and it still felt easy and pain-free. Yay! I was overcome with joy at the simple act of running outdoors without pain. I was also pretty excited about how easy those paces felt. When I was returning to running after my foot injury in October of 2009, a 10:00 pace felt like an 8:30 pace. But today, all of my paces felt exactly as they had felt prior to the injury. Now, I only ran for five minutes at a time, which is no indicator of where I am truly at fitness wise. But it was encouraging that it felt exactly as it did before the injury.

As for keeping my fitness up, I have been spending a lot of time water running, swimming and using the elliptical. I've actually spent more hours doing these activities then I would have normally spent running. For example, yesterday I did water running for 2.5 hours. This morning, I did water running again for 1.5 hours, and then finished it off with a 20-minute swim. And then later in the afternoon I did the run I just described. As for the elliptical, I have been using that about twice a week and doing it at a tempo effort. Usually I break the tempo effort into two sets, because it's just so unbearably hot in my gym and I need a break. But I think it's been effective. If I take my hands off the machine and use them as if I was running, it almost feels like running when going at the fast speed.

It's going to be a few more weeks until my running is intense enough to have any fitness benefits. And it will probably be another 2-3 months before my mileage can be where it was pre-injury. But I am going to my best to be patient. I want to be one of those success stories of an injured runner who came back stronger and faster! I'll be back in the pool tomorrow and Tuesday, and make another running attempt on Wednesday, so long as the shin behaves between now and then.

Special thanks to Cristina, Cheryl, Kathy and all of the others who have supported me and given me guidance throughout this injury! It's far from over, but I think I am heading in the right direction.

Bad Things Happen in Three's

Many of my readers already know the punchline from last week's ballad- I do have a stress fracture. Multiple ones, according to the results of my bone scan. Even though it's only my right shin that hurts, the scan apparently detected two stress fractures in the left leg (one on the tibia, one on the fibula) in addition to the one on my right tibia. The nurse called me to deliver the results, so I wasn't able to ask the doctor about the oddity of three simultaneous stress fractures, especially considering that there is no pain in the left leg. I did leave him a message, but he hasn't gotten back to me yet. I always feel like doctors just want to rush you in and out and be done with you, and don't want to really talk you through things. 

I've never been someone to do anything half-way. I've always maintained an "all or nothing" attitude, which often works in my favor, but has sometimes worked against me. So it when it comes to injuries, naturally I can't just have one stress fracture, I have to have three.

My guesses on what's going on:

• It's only a stress fracture on the right, everything on the left is a stress reaction, or something else going on.
• They are all three stress fractures, but only the right one is bad enough to where it actually causes pain.
• It was caused by the introduction of the treadmill after a long period of no treadmill. And they say treadmill running alters your gait.
• Having lower than normal bone density (I was told I was osteopenic in 2003) was a contributing factor.

The good news is that I am getting them all out of the way at once, and now I know I need to be religious about taking calcium supplements. And the treadmill is a definite no-no. 

Doctor's orders were simple (and once again, I didn't have the ability to ask questions). Make a follow-up appointment for 4 weeks. No running until then, but elliptical and swimming are ok. From my knowlege of stress fractures, it's typically 6 weeks of no running, followed by a very gradual build-up. And after 90 days, it should be healed completely. My last day of running was Tuesday, Jan. 25, which means I should be able to re-introduce running on March 9. I don't expect full recovery until the end of April. Thankfully, I hadn't registered for many spring races, just the Shamrock marathon. I'm hoping that by that time I can run the last 1-2 miles with my husband. 

My friend Cristina used a bone stimulator machine to shorten the healing time of the fracture in her foot. These machines have been shown to reduce healing time, so I purchased one for myself off of eBay. (They retail for $4000 and my insurance won't cover it unless it's a full break). So the way to go, recommended by Cristina, it to get one that has been gently used from eBay. The machine is supposed to arrive tomorrow. My appointment with my doctor is on Feb. 25, at which point an X-ray should reveal the progress of the healing. If the machine works as well for me as it did Cristinia, then maybe I could shorten the whole thing by a few weeks. Which is totally worth the investment to me. The only problem I might run into is that I don't know the exact location of the fractures. I have requested copies of the bone scan so that I can see for myself. Apparently the stimulating device needs to be placed exactly at the site of the stress fracture.

Pool Running

As for cross-training, I am going to be conservative and lay off of the elliptical for another week, even though the doctor said it was okay. To maintain my fitness, my main focus has been deep-water pool running (with a flotation belt) with some swimming thrown in here and there. I've read quite a few articles and blogs on pool running, and there is a great deal of evidence out there that when done at the proper intensity, pool running can help you maintain most, if not all of your fitness over a six-week period. Even with all the evidence, I am a bit skeptical because I just don't feel like I am working as hard on my "easy" pool runs. But we shall see.

Thankfully, there is a pool about two miles from my house. This means I can spend up to an hour and a half in the pool before having to leave for work. On the weekends, I have been going to a pool about 30 minutes away to meet up with some friends. Yesterday, I spent three hours in the pool, 2:30 running and half an hour swimming. Afterwards, I was as tired as if I had done an 18-20 miler. And my legs certainly felt it.

So far, this injury has not gotten me down as much as previous injuries. Mainly because I really think the pool running will preserve my fitness and there is nothing more disheartening than the belief that everything you've been working so hard for has gone to waste. Also, I just came off of a fantastic year of running, setting PRs at nearly every distance. I was fortunate to be injury free for 15 months, so I guess I was due. During that time I really maximized it and I can only hope for another long stretch of no injuries again once this is done with. Of course I am upset about this, but I am trying to focus on recovery, and not think about all the races I'm missing out on this season. The outpouring of support of my running friends has been incredible. Without them, I would know nothing of pool running and bone stimulators!

I'm very determined to keep my spirits high and to preserve my fitness. I also need to be prepared to lose some of it. It will be such a letdown if the pool running doesn't work as good as expected, so I need to be cautiously optimistic.

Woe is me!

Woe is me.
I have an injury.
Few things are worse for a runner to face
I have to accept this will slow down my pace.
I am hopeful that it's just a shin splint
But it hurts when I walk, much more than a hint.
If this is a stress fracture I'm going to be mad
For the PRs I hoped for will not be had.

The only good thing I can think of to say,
I'd rather be injured now than in the month of May.
There's snow everywhere, so I'd be stuck on the 'mill
Just one long flat surface, not one single hill.
I think that's the culprit of my shin pain anyway,
To much treadmill running, and now I'm having to pay.
Now it's pool running for me, and elliptical too
I cannot land run until the pain has subdued.

I've been stretching and strengthening and treating with ice
Despite all these measures, my shin feels not nice.
Even at rest, I can feel a dull ache
I certainly hope my shin bone didn't break!
All of this makes me extremely frustrated,
I don't want my spring season to be so ill-fated.

A bone scan this week will determine my fate,
Will I run a spring marathon, or do I have to wait?
I was doing so well with my training, you know
I averaged 7:26 on my 5-mile tempo.
With my heart rate staying in that LT zone.
And I thought I was no longer injury prone!

My fitness had reached an exciting new peak,
Can I preserve it without 50+ per week?
I did a 3-hour pool workout of running and swimming
And that seemed to be effective, and not at all skimping.

Woe is me.
I have an injury.
And what is the damage?  That's left to be seen.

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Thanks to everyone who commented on my previous blog and the Cool Pool Runners who helped me get started with that!