Run Run Away

Question:

After starting on a positive note, I’m following up with a more sobering war stories thread. But I hope this thread will prove in some ways uplifting, and include stories not just of injury, but of triumph over injury. My rationale for posting this thread is especially to gather a body of knowledge on how people dealt with injuries, how they came out of it. Preventation has been discussed to death, but people who are injured would no doubt like to believe that they will, some day, be able to run again, and the tales of those who fought their battle and won will hopefully prove inspiring. I’m hoping for an emphasis on treatment/rehab, because prevention, training errors, etc have been discussed to death (I’ve put questions on these in anyway, but I think rehab is a more interesting topic). We already know that a beginner attempting to emulate people like Zatopek and Lindgren is likely to encounter problems. Like almost any competitive runner, I’ve had my battle wounds, and it really sucked. Getting through it was a long and demoralising process, but thankfully there was an end to it all. If you’ve sustained multiple injuries in your career, you may wish to either follow up to this post twice, or once. Whatever you like. Here are some questions to start the discussion: Basic questions: (*) What was the injury ? (*) When did you first notice the symptoms ? (*) When did you realise you actually had an injury ? Questions that are important IMO: (*) When did you begin treatment ? (*) What sort of treatment did you use ? (*) How did you approach rehab ? (*) How long was it before symptoms completely disappeared ? (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ? Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ? (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ? (*) Was footwear a contributing factor ? Cheers, — Donovan Rebbechi http://pegasus.rutgers.edu/~elflord/

Response:

Basic questions: (*) What was the injury ?

Achilles tendonitis. (*) When did you first notice the symptoms ?

First logged in about Nov 02. (*) When did you realise you actually had an injury ?

Didn’t really think of it as an "injury" until some time in January. Questions that are important IMO: (*) When did you begin treatment ?

Didn’t substantially reduce milage until March, but I was icing it using a gel pack before then, in Feb or so, I think. I don’t think I took any layoff until March. Taking a one week layoff much earlier would have probably saved me a lot of trouble. As it was, I spent a good 6 months with fairly erratic training, because I wasn’t able to train properly. It took a solid 6 week layoff to really make inroads into the injury. Achilles tendonitis does not hurt in proportion to the damage, so even though the pain is very soft and dull, the healing time for the injury can be quite long and the damage can be reasonably severe. (*) What sort of treatment did you use ?

Ice, reduced training load, and rest in that order. The two things that aggravated the injury most were long runs and speed work. A long run at a brisk pace would cause the most severe flare-ups of the injury. I also used a heel-lift when I returned to training. I cannot say with a great deal of confidence that any of the treatments I used with the exception of hard downtime had much effect. However, it is possible that a modest amount of milage with no speed work would not have been much different from rest. Given the success I had in treating another soft-tissue injury (with a short but immediate rest), I think I would have done much better if I’d got on top of it earlier. (*) How did you approach rehab ?

Periodically attempted to return to running, and took downtime if it hadn’t recovered.  Started by doing a weekly run until it felt OK. Then jumped right back into hard training, then came to my senses and set appropriate milage goals. (*) How long was it before symptoms completely disappeared ?

The injury originally came in late 2002, and the sensation of the achilles tendon being sore when I got out of bed — I still have it from time to time. But it doesn’t interfere with my training any more. In total, it took about 9 months, though it could have been much faster had I been more willing to accept downtime. (*) Given 20/20 hindsight, would you approach treatment and rehab differently ?  If so, how ?

Rest for a week. Immediately. Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ?

Not really. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

Running 5k at top speed for a week and doing intervals regularly …. probably ill-advised for a beginner. (*) Was footwear a contributing factor ?

My shoes were not a very good choice for me (NB 806), but they’re what the local FootLocker had, and I doubt they had much to do with my AT problems. Cheers, — Donovan Rebbechi http://pegasus.rutgers.edu/~elflord/

Response:

I’ve had my battle wounds, and it really sucked.

Good thread idea.  Donovan, please be sure to post a summary of your own experience with achilles troubles (I think it was), as this is surely one of the more common things which bothers runners as they increase their speed, and sure to be valuable reading.

Response:

- Hide quoted text — Show quoted text -it. Preventation has been discussed to death, but people who are injured would no doubt like to believe that they will, some day, be able to run again, and the tales of those who fought their battle and won will hopefully prove inspiring. I’m hoping for an emphasis on treatment/rehab, because prevention, training errors, etc have been discussed to death (I’ve put questions on these in anyway, but I think rehab is a more interesting topic). We already know that a beginner attempting to emulate people like Zatopek and Lindgren is likely to encounter problems. Like almost any competitive runner, I’ve had my battle wounds, and it really sucked. Getting through it was a long and demoralising process, but thankfully there was an end to it all. If you’ve sustained multiple injuries in your career, you may wish to either follow up to this post twice, or once. Whatever you like. Here are some questions to start the discussion: Basic questions: (*) What was the injury ?

Hairline fracture of small bone in my right foot. (*) When did you first notice the symptoms ?

Sharp pain in upper part of foot in the middle of 8-miler.  Walked home the last 4 miles, but the pain went away. (*) When did you realise you actually had an injury ?

This was very frustrating–I wasn’t sure if there WAS an injury for weeks.  I could run without pain in the beginning, then after 1/2 mile or so, I would hurt progressively more.  Resting a few days helped. Questions that are important IMO: (*) When did you begin treatment ?

Maybe 6 weeks after resting-running-resting, I went to a podiatrist. (*) What sort of treatment did you use ?

No running for 8 weeks.   (*) How did you approach rehab ?

Cross-training on exercise bike: Intervals.  This maintained leg strength and anerobic power (400 speed) but not aerobic ability. (*) How long was it before symptoms completely disappeared ?

I ran 10 miles my first week back running.  Re-entry pace was 8:00: This sucked. (*) Given 20/20 hindsight, would you approach treatment and rehab differently ?

YES. If so, how ?

I would have gone to the podiatrist after 2 weeks of problems.  I made the withdrawal from training almost twice as bad by sitting on my ass and not getting the thing looked at.  This is an IMPORTANT less and the reason I’m writing this. Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ?

Nike training shoes (not spikes) that caused medial shinsplints.  The warning that Nike training shoes suck was not understood. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

No. (*) Was footwear a contributing factor ?

This was the cause: Nike training shoes.  Air Skylon Triax that were later recalled by Nike.  My podiatrist told me that the injury would not have happened in shoes with adequate midfoot cushioning.  This was in 1995-1996.  I have been with Adidas almost ever since and have never had another problem. Lyndon "Speed Kills…It kills those that don’t have it!"  –US Olympic Track Coach Brooks Johnson

Response:

After starting on a positive note, I’m following up with a more sobering war stories thread. But I hope this thread will prove in some ways uplifting, and include stories not just of injury, but of triumph over injury.

Another request for a war story?   Yet this one appears to seek a more reflective and sober analysis of events.   Ah well, I do tend towards the mushy when looking back on those halcyon days, so remember, you did ask… I have no visible scars to remind me of my courage and valour <splutter, guffaw during my three years of military service.   Like most happy souls who survive a war, my scars tend towards the mental. Fear not, I shan’t regale you with gory tales, or stories of tragedy, or pathos, or futility, though there are many I could tell, and many more I wish I could forget.   I’ll recall the one abiding memory of that time that’s stayed with me all these years, and it has the same meaning today as it did the moment it happened. The places and names don’t matter, so I won’t go into detail. Suffice to say we were mopping up after another unit had successfully contacted and ’sent to a better place’ many Angry Guys.   There were three wounded – not too badly – on our side and about 7 or 8 (I can’t remember) dead and one seriously wounded guy on the opposite team. An Alouette medivac helicopter had landed and the medics were discussing who was going off to casualty and who was going home on the trucks when they arrived.   The medivac helio could carry two stretcher patients, or three/four sitting casualties.   Our guys weren’t stretcher cases so they could all comfortably go into the helio, but one would have to stay and wait for the truck if we loaded the badly injured Angry Guy.   Everyone looked at the force commander for the decision. Now I’m not telling any secrets when I say that – generally – neither side bothered to take prisoners, or if they did they had a relatively short lifespan after they’d been ‘debriefed’.  I know.   It sounds bad.   But at that time and in that place it seemed eminently sensible.   It was, after all, a war.   And despite what anyone may say, attempting to apply rules to a war is almost as obscene as war itself.  So it wasn’t exactly a difficult decision for the force commander to say ‘take our guys’, especially as the Angry Guy didn’t look like he’d last ’til he got to casualty, far less provide any useful information if we managed to save his life. Half an hour later our transport had arrived and we were ready to leave.   Our remaining medic had worked hard on the Angry Guy, but it was obvious he wasn’t going to last much longer.   He was pumped so full of painkillers that I doubt he knew where he was, but he was still conscious and the question arose ‘what do we do with him?’   He clearly wouldn’t last beyond another half hour, the casualty station was a twenty minute ride away but we no longer had priority on the medivac helios, and the road journey was a good two hours long.  We had to get going, lest the other side managed to get its act together and come looking for revenge.   The force commander told me to ’sort it out’.   So, my little running chums, what was I to do? I believe that a persons death should be a private matter.   After all, even if you die in the midst of a crowd, it’s only *you* who experiences your death, no-one else.   Even if thousands die all around you, it’s still only *your* experience that matters to you. Does having a hand to hold or a kindly face to gaze into matter as you die?   I don’t know, but I’m guess I’ll find out one day.  As will you. I made my Angry Guy as comfortable as I could, half sitting against a fallen tree.  I gave him a canteen of water and asked him if he’d be ok.   He smiled and said he’d be "..fine when we fcuked off."   I picked up an AK, checked it had a full magazine, loaded the first round into the chamber, set the weapon on single shot, asked one of my troop to cover me, and placed the gun on his lap.   I stood up, took two paces back, gave him my best salute, turned and walked to the trucks.  We drove away and I never looked back. To me, my Angry Guy will always be sitting there with a half smile on his face watching some Rhodesian Army twit saluting him.   He’ll always represent a proud belief, subsequently soiled by his political masters, that he could shape the destiny of his homeland through his courage and strength.   He’s literally part of Africa now, but he was part of Africa then too.  He’s covered in dust, wearing an old t-shirt, plimsolls, and with an oil-stained cammo pair of trouser held on by an ex-Rhodesian army belt.   He’s dying, but he’s happy to be treated like a man, being given the dignity of his final moments spent in peace, and surrounded by the land he loved.   For some reason, I can’t help but envy him his manner of passing. Was this the ‘triumph over injury’ story you wanted, Donny?

Response:

Was this the ‘triumph over injury’ story you wanted, Donny?

You just can’t say a Farewell to Arms, can you, Hemingway?  Good thing I show more restraint — my entire experience with the military consists of several years on an army base in Wurzburg, Germany.

Response:

[good story snipped] Was this the ‘triumph over injury’ story you wanted, Donny?

Not exactly what I had in mind, but it was still fascinating reading. It is nice to see someone respond to my ideas as expected, but it can be even more enjoyable to watch someone pick up an idea and make it their own, spinning it off in a direction that I did not (and could not) forsee. Cheers, — Donovan Rebbechi http://pegasus.rutgers.edu/~elflord/

Response:

I have no visible scars to remind me of my courage and valour <splutter, guffaw during my three years of military service.   Like most happy souls who survive a war, my scars tend towards the mental. Fear not, I shan’t regale you with gory tales, or stories of tragedy, or pathos, or futility, though there are many I could tell, and many more I wish I could forget.   I’ll recall the one abiding memory of that time that’s stayed with me all these years, and it has the same meaning today as it did the moment it happened.

The first time you saw Tim Downie naked?

Response:

This are my perspectives as a runner who will never be anywhere than middle of the pack because of lack of inherent talent, but enjoy what I do and, after years of relative inactivity, find that being a fit 44 year old is pretty damn good. (*) What was the injury ?

Plantar fascitis, left foot.  Very sudden – said "ouch, that hurts, if it gets worse, I should turn around and walk back".  Didn’t get worse, but didn’t get much better.  And did the rest of the 8 miles. (*) When did you first notice the symptoms ?

Mile 3 of an 8 mile run. (*) When did you realise you actually had an injury ?

Several weeks later, when a friend, who had passed me on her bike while I had been running, told me how bad my gait looked at the time (she had stopped at my car to make sure I had made it back, even though I told her I was fine), and finally appreciating that the pain was not going away.  Guess endorphins and stupidity had blocked out my appreciation of the pain during the run.  That was an important lesson, and I found that I usually had worse pain the next day, rather than the running day, which made it hard to figure out when I was overdoing.  Realized it needed to be an averaged sensation – several days feeling good meant something, one day did not. Questions that are important IMO: (*) When did you begin treatment ?

After a few months of trying to get through with some rest and reduced running. (*) What sort of treatment did you use ?

Local excellent sports medicine doctor (also a runner all his life, and had dealt with bad plantar fascitis in his younger days) – foot massage to ease up fascia, calf stretchs each evening and morning for several minutes, the latter before stepping on foot.  Night splint (great attack weapon on husband – watch where you kick).  Spenco half sole also prescribed by him – been great for me and I use them still. He doesn’t usually go to orthotics at first, or didn’t with me. Stopped running at that time (I don’t think I really could run by then). (*) How did you approach rehab ?

Needed to do it badly.  Hoping for a cure, as I was symptomatic by then at all times, and very limited in foot wear (Merrel clogs with extra arch support – not very professional).  Was very diligent. (*) How long was it before symptoms completely disappeared ?

Started easing up in a month, after three (four?) months extremely minimal discomfort and started weight bearing again (elliptical trainer, which was comfortable initially without an incline)  Before that, exercise bike.  New Year’s gift to self, after 4-5 months of non-weight bearing, was running again as a complete newbie (walk 2 mins, run 1 min, for 7 minutes run, then worked up from there SLOWLY).  That was January 2003.  I’m training for the Indy mini-marathon now (terrible name for a half-marathon, but my sister lives there, and it doesn’t have Nashville’s hills) – left Galloway behind when I started back to running that January, and now only walk when I’m trying to figure out which way to go or my running partner (my dog) needs to pee.  Had done the Country Music half marathon run-walking (go ahead and laugh some more, but I felt good and finished strong.  For me.) (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ?

Not sure if I would have waited so long, but I was already registered for Chicago, and didn’t want to cancel out two years in a row (first time problems with knee). Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ?

Nope.  This was very acute, and I can tell you where I was in the run.  All plantar fascitis is not chronic, and there were no preceeding signs. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

Totally stupid training on my part.  Had done a long 20 mile the week before with Gallowalk, realised later my weekly mileage did not support that (I’ll never even try for a marathon unless I really can commit serious time, which means getting divorced/getting my girls to go off to college). Next week visited my mom in beautiful Washington State and ran a lot (for me) in great weather, then came back to the humid south for the 8 mile to keep up my heat acclimation.  Moron. Too much mileage after a long run.  Not to totally fault Galloway – although the program had me on a pretty low amount of mileage, I cut even below that because of limited time for training. (*) Was footwear a contributing factor ?

No, I replace shoes a lot, as I’m rough on them, despite being short and not fat.  Still very careful with my shoe choice though.  Trying Asic GT 2080, although Saucony Omni Grids were very good as well.  I’m not the stereotypical overpronator, just a bit, but seem to be getting more neutral as I strenghten. I have shifted carefully to more of a mid-foot strike than my previous heel strike, and my knees thank me (that plus the quads strenghtening). I think that foot will never be quite perfect, as I sometimes get, well, not pain, but a little warmth.  I do 2 minutes of calf stretchs each night (using a slant board) while I brush my teeth, which does a lot of good.  I’m very careful with my running now and advance my mileage slowly and carefully, with thought.  10 mile long run last Saturday afternoon with the dog in the park – wonderful! Margaret

Response:

Not exactly what I had in mind, but it was still fascinating reading. It is nice to see someone respond to my ideas as expected, but it can be even more enjoyable to watch someone pick up an idea and make it their own, spinning it off in a direction that I did not (and could not) forsee. Cheers,

It’s simple to baffle an idiot.

Response:

Basic questions: (*) What was the injury ?

Quadraceps tear (*) When did you first notice the symptoms ?

I’d had a niggling pain after a hill run but didn’t think it was significant. (*) When did you realise you actually had an injury ?

It wasn’t until 5 days and several runs later and after I’d limped away from the end of a 5K race that I realised I had a significant problem.  After the race I simply couldn’t run at all with a lot of pain in my hip and knee. Questions that are important IMO: (*) When did you begin treatment ?

You could say that my treatment started right after my race.  I just wasn’t able to run so I  tried substituting cycling but that wasn’t any better so it was more or less complete rest for 4 weeks. (*) What sort of treatment did you use ?

Rest and a bit of swimming latterly. (*) How did you approach rehab ?

After about 3 weeks of moping around I was begining the think that I might have a stress fracture.  My hip pain seemed very localised and I was still getting pain in my knee (which I put down to refered pain).  I went to my local sports injury clinic where a very clued up doc ( a runner himself) was quickly able to demonstrate that my injury was a soft tissue one and prescribed a heat treatment session and a course of quad exercises.  I’m sure the single heat treatment did b*gg*r all but it felt nice. I was worried about running the Edinburgh marathon at the time.  The original injury occured 10 weeks before the race but I was able to resume training 4 weeks after the 5K race. (i.e. 6 weeks before the ‘thon). (*) How long was it before symptoms completely disappeared ?

About 5 weeks (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ?

If I’d known exactly what my injury was, I dare say I could have started my quad exercises sooner and possibly returned to training sooner.  I would certainly have a lower threshold for refering myself to the sports injury clinic. Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ?

Whilst I’m pretty certain that it was the hill run (the descent in particular) that initiated the damage, I can see from my running log that I still did a 5 mile club run, a 7 mile recovery run and an 18 mile LSD before the 5K so it would seem that if I had significant warning signs, I wasn’t paying them any heed. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

Apart from trying to do a bit too much too soon, nothing apart from the hill run stands out. (*) Was footwear a contributing factor ?

Don’t think so. Despite the 4 weeks lost training, I was still able to run the marathon in 3:35 which given the hilly nature of the course, I wasn’t too displeased with. Tim — Please support rheumatoid arthritis research! Visit http://www.justgiving.com/pfp/speyside or http://www.justgiving.com/speyside if you’re a UK tax payer.

Response:

I’ve had my battle wounds, and it really sucked. Good thread idea.  Donovan, please be sure to post a summary of your own experience with achilles troubles (I think it was), as this is surely one of the more common things which bothers runners as they increase their speed, and sure to be valuable reading.

Not to nitpick but Achilles problems like PF and others can be caused and or aggravated by simply too rapid an increase in miles, or hills, or speed and probably the biggest culprit, fast hill repeats, i.e. both. — Doug Freese "Caveat Lector"

Response:

Basic questions: (*) What was the injury ?

Adductor muscle pull (*) When did you first notice the symptoms ?

Many years back when I was pushing doing multiple ultras in a year without understanding my recover rate. I knew how to train but not recover. Questions that are important IMO: (*) When did you begin treatment ?

Immediately cuz it hurt like hell to run. (*) What sort of treatment did you use ?

It ran the gamut and took almost a year to finally discover the best treatment. Shaggy dog story to follow. (*) How did you approach rehab ?

Typically. Stopped running for some days, then for some weeks but it did not help. Went to the Vet and repeated rest with 2 weeks of industrial strength Anti inflammatory. Did not work, Finally an MRI which showed no obvious muscle problems. Suspected a nerve issue and off to a neurologist. The nerve guy tested me for the slightest nerve damage and found none. (*) How long was it before symptoms completely disappeared ?

The nerve guy in probing my history after finding no nerve problem said, you know, many people need more than traditional two weeks of anti inflammatories to aid and abet healing. He wrote me a prescription for a 30 day AI and walla, on day 31 I went for 1/2 mile run with no problem. In the past, after a two weeks supply, it hurt after a few hundred yards.  I very slowly went back to running being thrilled to again run a mile, then two….. (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ?

I think the answer is obvious, for harsher, more stubborn injuries longer rest and AI’s are at times necessary. i would still recommend the two week supply as a first pass but keep in mind, it that does not work, ask your doctor about a longer AI cycle. Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ? No suddenly. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

Running a fast 5 mile race a week or so after a 100 mile race because I felt good. Feeling recovered and actually being recovered are two different animals!!!!!! Hindsight – to this day I follow a long race with 2-3 weeks of recovery to include zero the week after and delightfully slow and low junk for another two weeks.  Since I run 20-25 miles each weekend for 3-4 weeks, back down for a week, and repeat during my training,  a long race is 50 miles and above.  I’m very in tune with my recovery rate so I can do a 50k and 50 miles race three weeks apart. (*) Was footwear a contributing factor ?

Nope. — Doug Freese "Caveat Lector"

Response:

Nice post. I been in his group for many years. and did a marathon. not knowing what a marathon was when I started. reason I stay and talk B.S.  main is for my own health and well being. I am and older and well not meant to be completive. I just want to be in the race for the fun. Evan if I am in the back of the pack. I have taken lots of trolls and local bad stiff you were it hurts remarks, and like a rubber ball it bounce. and evan did the breaks a leg.  did not know it could really happen.  it can.  after news and t.v. radio local persons new of me. it can get really.  Break a leg.  well I got breaker too. after a long Aug 2002 since I have evensong. I went to the doctor over a back injurious and am now ready to train for and iron man.  I know  you and abuse troll. and no way.  well I found a way. I am still sticking my toe in the cold water and looking like a white crane with one foot up. well you know. I amp to get mad at self and mean no harm to others evan if I can get right rude at time to breaker a leg or evan heart attacks.    I am my self  Not you. Butt I take some trolls for my other reasons. as she wartime not to mention for she is above RR. so I won’t. evan or odds. if it ever happens or not. I am a 48 year old man who just wants to do the thanks to look back one day and live with self and look in the mirror.  and die. Hope full in nature.  I like nature, I am a nature person. now.  No Gym,  No tights. No bra hrm or pieds or gps. just nature. And all the other science sorceries  gizmo moes these rr use and most abuse. I miss tea blond babe who die of cancer.  I didn’t do it. and irac constitute London base Iamin. chill, let the soldiers do there job there. maybe rip some mor banks to pay for it. They sure don’t/  O righttttttttttt see some get the right to work 24 7 and lose a dollor and them There righttttttttt and get 500 million a day to lend so they can get 499 million a day interest and work 24 7.         I know it is money.  Get real  You a  hole. I know 2 plus 2 means I get 1 dollor for a day work and owe you 10 dollor. for you to make 100 dollor and get to make it for all others to give you more.   I well never under stand money. Evan nash live in a room by his aunt and wore the same red tennie shoe and rode a bike in a circle. and for what he got and die, a paper.  butt you guys can come up with more reasons. I am 48 and  well  chill  all. I don’t have money all. stop talking like I do.   Gee they are so smart butt are so dumb. 2 plus 2  is 4.  got  it.     shit.   god speed  rr. Lowtuc.p.s  I get mad and change name all  the time.     shit. I got to ride.

Response:

Basic questions: (*) What was the injury ? Adductor muscle pull

Every time I see the word "adductor" all I can think of is my noticing that around 90% of the time people discuss problems with that muscle here on the NG over the years, they spell it "abductor"… which always makes me smile. It’s right up there with "loosing" weight. cheers, — David (in Hamilton, ON) www.allfalldown.org "The most insecure people are the ones you see, putting other people down constantly."

Response:

Nice thread, Donovan. My reply: (*) What was the injury ?

Morton’s Neuroma. (*) When did you first notice the symptoms ?

I had been doing fairly high mileage, and one day I came back from a long-ish run and was standing at the sink washing a glass to make my recovery drink when I suddenly got a sharp pain in a localized spot on the top/middle of my right foot, in between two metatarsal bones, about a centimetre (around half an inch) from where the toes start. I looked down and there was a perfect puffy, slightly raised circle, a tad smaller than quarter, in the descibed location. It was a little red and very tender.  It was like I wanted to spread my toes apart to relieve the pressure. If you wanted to torture me right then, you could grab my foot and squeeze it. (*) When did you realise you actually had an injury ?

Right then and there. It was obvious something was wrong and this was not a muscle pull or tendon/ligament problem. I immediately assumed it was a stress fracture, because of the suddenness and the highly localized nature. If you read Lyndon’s  post in this thread, you can see some our experiences were similar, although we had completely different problems. There are differences, of course. (*) When did you begin treatment ?

I tried to take a bit of time off and then slowly run though it, hoping it would somehow go away. After some time and some miserable races in which I either dropped out or finished badly, I sought some treatment. I knew I had to when I noticed I was grimacing in painful anticipation every time I was about to turn. That was the worst. (*) What sort of treatment did you use ?

I made the HUGE error of going to a regular doctor at the emergency section of the hospital to get a local cortisone injection one day when it was so bad I could not walk. My reasoning that because this procedure helps a lot when I throw my back out once-or-twice yearly. I go from being unable to walk upright to totally fine in one day, so I thought it was a good idea… besides, I’ve read various case studies on the net that suggested this works for many neuroma patients. Certainly it is not unusual treatment. Instead of that effect, I ended up being completely crippled and in agonizing pain for over a month. I knew from about 10 minutes after I got the injections that I had seriously screwed up in my choice. I tried a few over-the-counter inserts designed for MN, and in doing so I discovered that it’s primarily a female’s injury due to wearing high heels all the time that squish the toebox and create the pressure that eventually causes the nerve(s) in between the metatarsals to get inflamed. I eventually visited a very good pedorthist, the one who made the orthotics Donovan Bailey was wearing when he made his WR 100m run. He made me a custom pair, designed to fit in flats, which is all I wear. Once I had them in, the pain started going away and gently subsided over several weeks. (*) How did you approach rehab ?

I avoided turning corners while running, and no fast stuff, as the added push-off power needed was very painful. (*) How long was it before symptoms completely disappeared ?

They never have, completely. I can tell it’s still there but it does not bother me at all. It’s like a healed broken bone – it never feels quite the same, but it doesn’t affect you. Perhaps it’s scar tissue from the cortisone injection, and I can "feel" it. (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ?

No cortisone. No injections. (*) Was it preceeded by any warning signs ?

None whatsoever. (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

I had just made the transition from a heel striker to a midfoot/forefoot stiker. This, coupled with the fact that I wear racing flats only, probably brought it on. Not to mention that I had increased my mileage a lot… steadily and properly,but neverthess it could have contributed. (*) Was footwear a contributing factor ?

As noted above, possibly. However, I believe wearing flats all the time prevents many potential injuries as well as improves form. The positives outweigh the negatives. I try on a pair of trainers now and they feel like high-heeled moon boots. It’s like the ground is not there. cheers, — David (in Hamilton, ON) www.allfalldown.org "The most insecure people are the ones you see, putting other people down constantly."

Response:

Basic questions: (*) What was the injury ? Plantar Fasciitis (*) When did you first notice the symptoms ?

My foot started hurting intermittantly after I took a bad step on a hilly run. Going fast downhill. (*) When did you realise you actually had an injury ?

I gave it a couple of days’ rest, then when I started running again it would occaisionally hurt at the beginnings of a run. Then it began to become more frequent. It took about 3 weeks before I realized I had something chronic starting to form. Questions that are important IMO: (*) When did you begin treatment ?

I iced it the first few days, then again after I realized I had a problem (several weeks later). At that point also started taking an ibuprofen before the run. And tried gel heel lifts, which didn’t help much. It helped some, but didn’t entirely go away. So saw a podiatrist a couple of months later, and he put me into a night brace. Helped some, but still not a complete recovery. So he sent me to the PTs. They got to the root of the problem- very tight high arches- and started me on stretching and massage therapy. This made it go away (took about 2-3 months). To this day, when my foot feels tight, I do the stretches for a few days or the foot can start getting painful. (*) Given 20/20 hindsight, would you approach treatment and rehab differently ? If so, how ?

I would have kept icing and ibuprofen, and gotten to the PTs sooner. Moderately interesting questions (but less important because causes of injury have already been discussed to death here): (*) Was it preceeded by any warning signs ?

No, not really. I had tight, high arches, but I didn’t know that they needed to be "watched". (*) Was it preceeded by ill-advised training ? Or any training that was " ill-advised" given 20/20 hindsight ?

A bad step on a steep downhill at fast speed started it all. Maybe it wouldn’t have happened if I hadn’t had that step, but it’s made me aware of my feet’s shortcomings and what I need to watch to keep them healthy and happy. (*) Was footwear a contributing factor ?

Don’t think so. But now I do put Sof Sole Arch Plus inserts into my shoes and I think that helps. Teresa in AZ

Response:

  I don’t think I can quite call it an injury, but it certainly interfered with my regular running.  Since the general situation isn’t that unusual, I’ll go through the story.   That is, I followed Marine Corps with flu for a week or two, and annoyed lungs for another week or three after that.  I actually did rest during that period.  The rest period ended with me running an 8k race off zero training and struggling to finish in a round time I’d ordinarily have jogged pretty easily.  After that, I ran more normal mileage for the rest of the year (about 5 weeks).  The temperatures dropped in early January, my lungs got more annoyed, and I started running less.  On the other hand, I shifted some to indoor machines (mostly bike as my shoulder was acting up again).  Toss in another one or two minor under-the-weather spells in here.   Concurrent with the above, I decided I was tired of having an extra 10-15 lbs and started some calorie reduction.  Nothing drastic, but it was there.   That joint situation of feeling like my lungs were annoyed, reduced calories, and trying to push back to more ‘normal’ levels, lasted until I was flattened by the speed stomach flu that has been going around.  After losing 8 lbs in a night (wrong way!) I went so far as to speak to a doctor.     Finally I concluded that I had gotten incredibly run down (duh!), checked out my protein intake and saw that I was well under even the sedentary levels of .6-.8 g/kg, and decided that I should get myself some rest, adequate protein, and more rest.   Last week was my first week of something like normal running, which meant 2 days — Tuesday, where I went for a 1 mile warmup and then 6×100m with about 1 min recovery, and Saturday, where I went what I’d previously have considered a leisurely and short 2.8 miles. Unlike the December/January/February bouts, I actually felt good after these runs and _not_ drained.  Last night was 1200 m warmup, 2×2000m at a brisk pace, and a 1600m cool down.  Legs now feel very good.   Good thing I’m rd for the April race rather than running in it. 8k of rolling road is not something I can race a month from today. Hindsight:   Don’t run a knowingly underprepared marathon.   Especially don’t do it on a dew point temperature of 65 F and over.   If you get sick, recover from it.   While recovering from a marathon or illness is a bad time to reduce     calories.   Dead legs don’t run well. — Robert Grumbine http://www.radix.net/~bobg/ Science faqs and amateur activities notes and links. Sagredo (Galileo Galilei) "You present these recondite matters with too much evidence and ease; this great facility makes them less appreciated than they would be had they been presented in a more abstruse manner." Two New Sciences

Response:

I’m hoping for an emphasis on treatment/rehab, because prevention, training errors, etc have been discussed to death (I’ve put questions on these in anyway, but I think rehab is a more interesting topic).

Oh, rats. I was expecting a best-blood thread Other than a couple minor ankle twists last winter (missing edge of mat I was jumping over, stepping on round rock in the dark behind me as I was turning around to avoid going in to the path of a landslide chute which had a few actively falling rocks, and over stretching in xt class last winter), most of my aches / pains (don’t have names for most) have been attributable to muscle imbalances or foot/ankle structural / functional issues that my PT had identified and I just hadn’t gotten them strengthened enough before I did too many hills (or had a negative interaction of running and field work). Rehab from one set of injuries is the prevention, hopefully, for the next set. For these types of things, I don’t think they can be separated. I’ve got one lingering pain that I almost went to GP or PT about, but 1-2 hr snowshoe walking and running has been the best rehab for that so far, and as long as snow doesn’t melt from underneath me, I think that pain may be completely gone in a few weeks, maybe less (much better this week than last). Not everything is strengthened yet, but it’s getting there and will continue through progressions. Other rehab / prevention is the usual strengthening drills – lunges, squats (1-legged), heel / toe raises with the heel raises progressing to slopes simulating hills, both 1- and 2-legged, and eventually with weights (not that far yet), assortment of things on stability ball, some hand weights, barefoot running, foot exercises, xt warmup drills (forward, backward, sideways, twisting, cross-overs, etc), proprioception, etc. Core is one of the big things I really need to work on more. Dot — "Success is different things to different people" -Bernd Heinrich in Racing the Antelope

Response:

I’m hoping for an emphasis on treatment/rehab, because prevention, training errors, etc have been discussed to death (I’ve put questions on these in anyway, but I think rehab is a more interesting topic).

Oh, rats. I was expecting a best-blood thread Other than a couple minor ankle twists last winter (missing edge of mat I was jumping over, stepping on round rock in the dark behind me as I was turning around to avoid going in to the path of a landslide chute which had a few actively falling rocks) and over stretching in xt class last winter (I was smarter this winter and didn’t do those), most of my aches / pains (don’t have names for most) have been attributable to muscle imbalances or foot/ankle functional issues that my PT had identified and I just hadn’t gotten them strengthened enough before I did too many hills (or had a negative interaction of running and field work). Rehab from one set of injuries is the prevention, hopefully, for the next set. For these types of things, I don’t think they can be separated. I’ve got one lingering pain that I almost went to GP or PT about, but 1-2 hr snowshoe walking and running has been the best rehab, and as long as snow doesn’t melt from underneath me, I think that may be completely gone in a few weeks or sooner (much better this week than last – noticeably better after long snowshoe on Sun). Other rehab / prevention is the usual strengthening drills – lunges, squats (1-legged), heel / toe raises with the heel raises progressing to slopes, both 1- and 2-legged, and eventually with weights (not that far yet), assortment of things on stability ball, some hand weights, barefoot running, foot exercises, xt warmup drills (forward, backward, sideways, twisting, etc) etc. Core is one of the big things I really need to work on more. The more serious ones actually were non-running before I started structured running, but they resulted from same causes – just weren’t diagnosed or given long-term rehab earlier. Dot — "Success is different things to different people" -Bernd Heinrich in Racing the Antelope

Response:

For some years, was plagued with stress fractures: mostly in the posterior tibial area, but also in the neck of the femur. Started as most of us know as dull pain, usually following a ramp-up in mileage, that drifts into constant nagging pain that actually becomes sharper when in a prone position or holding the affected limb in a particular attitude. The worst part of these things is that the diagnosis isn’t clear until 2-3 weeks after inception, when a bone scan can pick them up. From there, it can be 3-6 more weeks for complete healing, which is made worse by the uncertainty as to whether the fracture is still green or if you’re past the point of re-injury and are just dealing with pain. Tried aircasts to stabilize the fracture, which helped a bit (this was some years ago, and the treatment and technology may have changed in the interim). But no course of muscle strengthening, stretching, etc. seemed to eliminate the problem. I’m a moderate pronater, and had been wearing orthotics for many years. One day my podiatrist called, said ‘come over and bring the orthotics with you’. When I arrived, he was in a state of high excitement, said ‘I’ve figured out your problem. He grabbed the orthotics, and began grinding down the posterior portion – as originally designed, the posterior portion extended the length of the foot. When I asked what he was doing, he told me he had finally figured out that counter-intuitively a pronater’s big toe had to be allowed full flexibility at the joint in order to act as an efficient lever. Over-stabilitzing it distorted the stride mechanism and generated unnatural torque up the shaft of the leg. Sounded like black arts to me, but nothing else had worked, so I figured little to lose. That was 25 years ago; since then, I’ve never had another stress fracture, and the worst injury was a strain in my iliotibial band (but that’s another story). So, no specific rehab, because the problem was entirely different, but I’ve become convinced that an experienced podiatrist who understands biomechanics can be a great resource. HTH

Response:

You need to run through stress fractures. When it hurts do a 20 miler, it’ll fix you right up. – Hide quoted text — Show quoted text – For some years, was plagued with stress fractures: mostly in the posterior tibial area, but also in the neck of the femur. Started as most of us know as dull pain, usually following a ramp-up in mileage, that drifts into constant nagging pain that actually becomes sharper when in a prone position or holding the affected limb in a particular attitude. The worst part of these things is that the diagnosis isn’t clear until 2-3 weeks after inception, when a bone scan can pick them up. From there, it can be 3-6 more weeks for complete healing, which is made worse by the uncertainty as to whether the fracture is still green or if you’re past the point of re-injury and are just dealing with pain. Tried aircasts to stabilize the fracture, which helped a bit (this was some years ago, and the treatment and technology may have changed in the interim). But no course of muscle strengthening, stretching, etc. seemed to eliminate the problem. I’m a moderate pronater, and had been wearing orthotics for many years. One day my podiatrist called, said ‘come over and bring the orthotics with you’. When I arrived, he was in a state of high excitement, said ‘I’ve figured out your problem. He grabbed the orthotics, and began grinding down the posterior portion – as originally designed, the posterior portion extended the length of the foot. When I asked what he was doing, he told me he had finally figured out that counter-intuitively a pronater’s big toe had to be allowed full flexibility at the joint in order to act as an efficient lever. Over-stabilitzing it distorted the stride mechanism and generated unnatural torque up the shaft of the leg. Sounded like black arts to me, but nothing else had worked, so I figured little to lose. That was 25 years ago; since then, I’ve never had another stress fracture, and the worst injury was a strain in my iliotibial band (but that’s another story). So, no specific rehab, because the problem was entirely different, but I’ve become convinced that an experienced podiatrist who understands biomechanics can be a great resource. HTH

Response:

You need to run through stress fractures. When it hurts do a 20 miler, it’ll fix you right up.

Hey, why not? Works about as well as anything else. HTH

Response: