Tuesday, August 17, 2010

A History of Aggravations...Part Two

Bursitis, Spring 2004

After fracturing my left femur in 1999, it would be a few years before I conquered my first marathon and managed to post a Boston qualifying time.

Entering 2004 with a qualifying time in hand, I registered for the Boston Marathon. But, a few months into 2004 I began to feel a disconcerting pain in my right hip that was not entirely dissimilar from what I felt in 1999 when I fractured my left femur.

Unnerved and still haunted by the most traumatic running related injury I had ever experienced, I demanded an xray and mri. While the xray came back negative, my orthopedist indicated it appeared there was a fracture in my right hip as per the mri.

I couldn't believe that I had sustained what sounded like the exact same injury in the opposite hip. Fortunately, my orthopedist would quickly recant this statement indicating that in actuality I had bursitis in my right hip. I'd take an inflamed bursa sac over a fractured femur any day of the week.

Sadly, Boston would not be in the cards with this diagnosis as it would take nearly a month for the pain/inflammation I was feeling to fully subside. Time and two shots of cortisone would finally take care of it, however.

The only real insight I gleaned from this one was that I likely was overtraining. Whether it was too many miles or too many INTENSE miles, this injury was clearly tied to my training approach.

Achilles Tendonitis, Summer/Fall 2004

While Boston came and went in the spring of 2004, I remained hopeful that I could still manage a solid marathon later in the fall or winter and salvage the year with a quality race.

The Chicago Marathon became my target as I ramped up my training during the summer. I had broken 3 hours for the first time at this event in 2003, so this event had a special place in my heart. Built for speed, Chicago presented a tantalizing opportunity to post yet another personal best.

But, as my training started to approach taper a nagging discomfort reared its ugly head in my left achilles. Unwilling to jettison my training given I had already been derailed earlier in the year, I stubbornly trained through this aggravation which meant I spent an inordinate amount of time icing, stretching, and massaging my left achilles and calf.

While the achilles held up, I toed the line on race day not sure if I could even complete the marathon let alone post a personal best. Fortunately, it was right around this time I came to understand I was a bit of an overstrider. Which meant I was placing more stress on my calves/achilles than I should.

With this in mind, I tried to focus on taking light/quick strides throughout the race to minimize any strain/stress on my already balky achilles. Once again, fate would smile on me as I managed to complete the race and squeeze out a modest personal best.

However, the left achilles still flares up once in awhile reminding me that virtually no running related aggravation/injury should be trained through and some never fully go away if you don't treat them properly.

Plantar Fasciitis, Summer/Fall 2006

While I have encountered a number of running related aggravations and injuries over the years of varying degrees of severity, nothing has driven me so close to the brink of insanity like plantar fasciitis. In my attempts to get rid of this albatross, I came to regard it on more than one occasion as a demon that had taken up residence in my foot. Unfortunately, even a ritual exorcism wouldn't get rid of this one.

My first encounter with this monster occurred in the summer/fall of 2006. The onset was subtle and insidious. A vague discomfort in my right heel in the morning that dissipated markedly upon walking around was the only sign of anything problematic. In short order, this vague discomfort would matriculate to near omnipresent pain that made walking to the farmer's market uncomfortable and running a veritable nightmare.

I likely spent thousands of dollars on bodywork, Active Release Technique, ice, Strausberg Socks, stretching devices, athletic tape, and everything in between to rid myself of plantar fasciitis. While all of the aforementioned helped to one degree or another, none of it rid me of this beast.

In an act of desperation, I opted for a surgical procedure that would induce trauma and serve to kickstart my body's healing process and allegedly get rid of the foot demon. The surgery would keep me away from running for a couple months and require copious amounts of physical therapy, but eventually I got back to running on a regular basis in 2007.

The real lesson I learned from my first battle with plantar fasciitis is not to take it lightly. Plantar fasciitis can set in and sideline you for MONTHS or YEARS in some cases. While it's always a good idea to be aggressive and proactive in treating any running related aggravation or injury, plantar fasciitis requires this more than any other aggravation or injury out there.

Once you've exhausted all the conventional treatment methods for plantar fasciitis, there aren't a ton of other options that don't involve surgical intervention, a lot of pain, and a LOT of money.

Plantar Fasciitis-THE REVENGE, Summer/Fall 2009

Apparently, plantar fasciitis didn't have enough fun with me in 2006, so it opted to make a return visit to my other foot in the summer/fall of 2006. Fortunately, I HAD actually learned something from our nasty encounter in 2006.

I was EXTREMELY aggressive in dealing with plantar fasciitis this time around. I hit it with everything at my disposal immediately. Cue massage, ART, graston technique, laser treatment, taping, etc. I coupled this with a marked reduction in mileage.

Fortunately, this return visit was relatively mild in comparison to what I dealt with in 2006. But, it was still a source of discomfort and made running unpleasant most of the time.

Once again, throwing money and treatment at my plantar fasciitis would do little more than reduce pain/inflammation. Eradicating it entirely proved to be as challenging as before. But, I discovered a new treatment method with a lovely moniker, 'dry needling'.

Dry needling entailed 'perforating' the fascia and inducing fascial bleeding. The idea was to induce trauma (not unlike what my surgery did years before) in order to fully engage your body's healing process. It took me some time to find someone who had experience with this treatment method, but I finally did. Dry needling was the closest thing to a silver bullet for plantar fasciitis I could find via my research.

That being said, dry needling sounded pretty uncomfortable. My initial impression was proven correct upon subjecting myself to this treatment. The specialist did her best to numb my heel, but the first injection of lidocaine felt like a dagger of flame. Breathing deeply did little to reduce the pain. Fortunately, the lidocaine kicked in just as I felt the needling begin.

The needling was one of the most disconcerting experiences I had encountered in awhile. There was minimal pain, but I could feel odd pressure deep inside of my foot and could feel almost a cracking sensation which was apparently the specialist identifying the worst adhesions in my fascia and 'needling' them.

Not too surprisingly, I couldn't walk comfortably for a few days after this treatment as it induced a MASSIVE inflammatory response. But, this unpleasant treatment method would pay dividends as I found myself running again just a couple weeks later and would salvage the year with a solid performance at the California International Marathon in December.

I suppose the biggest learning from this was that dry needling is an effective treatment method for plantar fasciitis....at least in my case.

Femoral Stress Fracture-Summer 2010

For nearly 5 years, I had been in one way, shape, or form training with the idea that someday I would crack the 2:30's for the marathon. I posted a 2:45 in 2005, a 2:43 in 2008, and had planned on doing so in 2009 before falling prey to plantar fasciitis.

2010 started on a high note as I found myself logging 10 miles/day at around 6:30 pace...comfortably. All I would need was 6:05/mile to swing a 2:39:59. In April, I pulled the trigger and signed up for the Seattle Rock N' Roll Marathon in late June.

I kicked my training up a notch layering on some speedwork and increasing my mileage a bit which is pretty much always a bad idea. But, I was gambling a bit as I had trained this way before and had positive results.

I knocked out a number of very high quality long runs that had me convinced I was in the best running shape of my life and a time in the 2:30's was going to happen.

One of my final long runs before taper was on the horizon. I was feeling ok, but there was a nagging heaviness on the outside of my right leg. I couldn't quite place it, but it seemed minor.

I hit the road with the plan of running 22 miles with most of these miles near my target pace. Within 6 miles, the nagging heaviness had become an unnerving, amorphous pain that I felt on the outside of my leg and above my knee with no rhyme or reason.

I know I have a high tolerance to pain as evidenced by the femoral stress fracture that felled me during Bay to Breakers in 1999. This pain felt frighteningly similar. This is the only kind of pain that has ever forced me to stop running. I tried to convince myself this was not a stress fracture, but the pain I was feeling was significant and was not alleviated by rest or foam rolling.

It would take an xray, mri, and bone scan to confirm my instincts. I had sustained a femoral stress fracture in my right leg. Fortunately, this was not an injury that would require surgery, but there was no chance of running Seattle and I was looking at several weeks (if not months) of not running.

What I neglected to mention is in the midst of my training cycle for Seattle, I was moving to a new apartment and doing most of the heavy lifting myself. My old apartment required walking up two decent sized sets of stairs. In the week or so leading up to sustaining the injury, I spent an inordinate amount of time carrying a variety of large, heavy objects down both flights of stairs.

I suspect it was this additional physical labor that simply sent my body over the edge. I was not doing a good job of giving my body the rest/recovery it needed and it finally gave out. Some lessons need to be learned again.


Anne said...

Matt, I know you are a runner to your very core; but seriously I'm not sure if even my list of cycling injuries can compare to this post. I have never felt so fit as I did this year after nearly 6 months on the bike.

But all that aside, I hope that your next blog post on this topic is horribly boring.

Marathon Matt said...

Anne, bear in mind this is a comprehensive list of injuries that spans 20 years of running. Viewed through this lens, it's not that bad.

That being said, I'm hoping there won't be too many more injury related postings in my future :)