Flexibility of a Brick

Over the past two years, I have had a never ending series of little injuries.

The injuries stated with a torn plantar fascia.  That was followed by a wicked bout of peroneal tendinitis.  Then the top of my foot started hurting.  Finally it was a sore hamstring & glute.

I was beginning to think that I couldn’t win for losing.  Seemingly, as soon as I started to recover from one injury, another would pop up.

I’ve been a pretty good patient.  Physical therapy, rolling, trigger point treatment, icing, reducing the length and effort associated with workouts.  You name it, and I’ve tried it.

While there may well be some other underlying issues around my running style and gait, shoe selection, weight (yes, that’s a biggie), and more, I’m becoming more and more convinced that the root cause of many of these injuries lies in the fact that my tendons and muscles basically have the flexibility of a piece of stone.

Some history:  I just turned 46, and have been running or cycling since I was 15.  I ran track and cross country in high school and picked up cycling in college.  In high school, we had a regimented stretching cadence that we followed both prior to and following every workout.  We’d do a warm up run, some core work, and then a bunch of basic (mostly) static stretches.  Fast forward a few years, and I essentially stopped stretching pre or post workout.  To make matters potentially worse, I sit all day long at a computer or conference room table.

Don’t get me wrong – I so some stretching, but whatever I do tends to be centralized on something that is nagging me at the moment.  For example, if my calves are sore, I’ll stretch them.  If my shoulders are sore during a swim, I’ll do some stretching.

Well, a couple of weeks ago, I was remembered a comment my teammate Ryan Heisler made earlier this year.  His statement was along the lines that everything is connected in your body, and that if you are having foot issues, the root issue may be someplace other than in your foot.

And if you think about it (and remember that Schoolhouse Rock video about the human body), it’s true.  The leg bone is connected to the hip bone, and so forth.  It only makes sense that foot pain could be the result of something jacked up in your hamstrings or hip flexors.

So, I decided to test this theory.  My going-in hypothesis was that I had at least a modicum of flexibility still.  I was going to test my flexibility through a few simple tests:  (1) crossed-foot toe touch (2) calf-stretch and (3) forward lunge.  The highly scientific benchmark was the range of motion that I remembered having back in my high school running days.  (Let’s just ignore the fact that ~30 years difference might have some impact on my level of flexibility for now).

I decided to do each of these stretches twice each leg, for :30 each leg.  The true test would be the amount of pain I had to endure and at what point I started to feel the “stretch”.

And as you might suspect, I failed miserably.  Essentially, I can’t touch my toes without feeling like my hamstrings are going to rip in half.  The forward lunge (apart from killing my quads) made my groin and hip flexors scream as if someone had forced me into a split.  I literally thought that some giant gorilla was shaking me around like an old Barbie doll or something.

So, how am I going to fix this?

For starters, I’m going to start stretching again.  I’ve read that the static stretching that is near and dear to me is no longer in vogue.  Dynamic stretching is the way to go.  And so, I”ll incorporate some of that into my routine.  I’ll stand more.  I’ll give yoga a try (begrudgingly).

I will become more flexible.

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Product Review: Athletes Treating Athletes – Solid Injury Treatment Advice Online

Since the advent of the internet, way too many of us like to self diagnose our illnesses so that we can make somewhat informed decisions about what sort of treatment we’d like to think.  The reality is, though, that there is no shortage of websites or material online.  Far too often, we find information that leads to a misdiagnosis or a perspective that we’re more (or less) injured than we might be in reality.

The problem with endurance sport injuries is that some of the “mainstream” sites only scratch the surface of the injuries that we tend to get.  Some sites, unfortunately, even give incomplete or bad advice – or at least lead us to making improper decisions.

How do I know this?  Well – over the past 16 months, I have been dealing with a variety of lower leg ailments – notably plantar fasciitis and peroneal tendonitis.  While I have absolutely sought the opinion and treatment of physicians (both a podiatrist and an orthopedic surgeon), I have done more than my fair share of research online.  Far too often, I’ve been disappointed in what I have found.  Essentially, it has been difficult for me to find a singular source for diagnosis and treatment plans.  Until now.

Over the weekend, I stumbled across a really awesome site – which I have since fallen in love with.  It’s called Athletes Treating Athletes, and can be found at http://athletestreatingathletes.com/.

The site was founded in 2010 by Leigh Boyle – a doctor of Physical Therapy and certified strength and conditioning specialist.

The site is geared towards endurance athletes, and is really slick.  The goal of the site is to help athletes like you and me not only treat injuries but also strengthen our bodies so that we don’t end up with injuries in the first place.  The website is easy to use and navigate.  There’s a blog (that contains posts called “injury of the week”) and a really intuitive body map that will help you pinpoint the specific area of your body where you are injured.  You can also search the site for a particular injury if you already have an idea of what you have going on.

The site carries a five-part approach towards self treatment:  (1) self massage (2) mobilization techniques (used to break up soft tissue and adhesions), (3) stretching, (4) KT taping, and (5) strengthening.  Basically, it seems that the treatment approach is exactly what you’d experience by going to a local physical therapist…just without the office visit and insurance co-payment.

Finding your injury is pretty darn easy.  As I noted above, if you know what your injury is, you can search for it.  You can also leverage the “Body Map” page to find and link to the specific area of your body that is hurting.

BodyMap

 

When you click on a body part, you go to a webpage that is detailed for that section of your body.  There’s usually a nifty graphic that shows the interior anatomy of that body part.  Since I’ve been dealing with peroneal tendonitis, I looked for it by clicking both the “foot” link and the “shin + outer leg” link.  Alas, peroneal tendonitis is found under “Shin + Outer Leg”.  Once you land on the page for the specific body part, you’ll find a ton of information, including a diagram of the body part and a listing of injury treatment plans available.  The example (of the Shin + Outer Leg page) below shows both the bones and muscles of the anterior portion of your lower leg.  You can see that there are two specific injuries listed on the Shin + Outer Leg page:  Peroneal tendonitis and Shin Splints.

ATXA leg

 

Since I’ve been dealing with Peroneal Tendonitis, I clicked that link:

ATXA peroneal

All you have to do to gain the information you need to treat your injury is to click the hyperlink for it.  I clicked the link for “Peroneal Tendonitis”.  Once you land on the page for the specific injury, the site gives a good description of the anatomy of that area, the potential causes of the injury, and then a detailed treatment plan.

ATXZ peroneal tx plan

As you can tell, each treatment plan contains some pretty easy to follow (and non-scientific) language about how to treat the injury.  There are typically a plethora of hyperlinks to videos.  For example, in the post above, you will find links to videos about how to correctly apply KT tape to help provide stability.

Even cooler – You can download an injury-specific treatment plan that includes hyperlinks, exercise descriptions, sets and examples, and a full suite of treatment steps that you should take to heal an injury.

In short – this is a self-treater’s Mecca!

Even better, the information is generally free!

Hope you enjoy the site.  As I noted above, you can subscribe to a weekly newsletter that the site sends out.  They also have a Twitter (@A_Tx_A) and like most other companies these days have their own Facebook, YouTube channel and Pinterest page.

Run! Run! Run!

This sticker has been a great description of the amount of run training I’ve been doing this year:

runsticker

I’ve had a fairly nasty bout of plantar fasciitis since January.  In fact, I not only had just inflammation and pain, I actually TORE the dang thing.  A while back I had a cortisone shot in my heel – which felt awesome, by the way – that seemed to help with some of the pain and discomfort.  The cortisone didn’t heal my foot, though, and so I’ve been dealing with ongoing pain, tightness, discomfort.  About six weeks ago, I got clearance from my podiatrist to start running very low mileage and at a very slow pace.

I’ve been a good patient.  I’ve run some – never more than a couple of miles, an never faster than about a ten-minute mile pace.  Low and slow…that’s been my motto.  I’ve also been super diligent about rolling and stretching.  I’ve iced.  I’ve used electrical stimulation (via my Compex unit….an amazing tool).  I’ve used my NormaTec boots hoping that they’d help flush out any residual swelling in my foot.  Slowly and surely, my foot has become less angry. 

But this improvement hasn’t come all that easy.  You see, there have been days where my foot really didn’t like me.  I’d go for a run, ice it down, etc…and still I’d be hobbled.  I would be in such pain that it’d be difficult to walk without a limp and I’d be popping Motrin like it was SweetTarts.  Other days, I’d have literally no pain at all in my foot.

This yucky cycle prompted me to tweet this comment:

tweet

Well, finally, I have what seems to be some good news to report.  I ran PAIN FREE last night!  It wasn’t a really long mile (just 2 miles) and it certainly wasn’t fast (9:38/mi pace)…but I had NO PAIN!

And to make things even better….

My foot isn’t hurting at all today!

Of course, all this makes me happy and optimistic that I’m close to getting over this crazy injury.  We shall see.

Have you ever had an injury that seemed to take forever to heal?  How did you deal with it?

Thera-Band & Biofreeze To The Rescue!

Here I am in the midst of my “recovery” from a partially torn Plantar Fascia.  Which, by the way, pretty much sucks.  The cortisone shot I got last week has finally started to kick in, and the sharp pains that I had in my heel are gone for the most part.  I’m wearing my night split religiously. Cortisone and wearing a night split won’t cure my PF on their own.  A large part of my rehab includes stretching and exercise.  To accomplish this, I’ve become one with my Thera-Band tools. 

About half a year ago, Thera-Band sent me a huge box of goodies to try out and use.  Included in the enormous box from Thera-Band were the following:  a new foam roller and Wrap+ wraps, a Foot Roller, a Stretch Strap, a Flex Bar, a very cool portable Roller Massager, and a green Exercise Band.  I also got a bunch of BioFreeze – which I absolutely LOVE.  I’ve been using these products since I received them, but mostly for what I’d call “maintenance”.  For example, if I’d done some really intensive running sessions or hill repeats on my bike, I’d use the foam roller for a while to help work out the kinks and aid in my normal recovery. 

Well, since I’m now on the physically unable to run list, I’m using these Thera-Band products for a more purposeful use:  Rehabilitation of my injury.

I finally feel like I’ve used these products sufficiently well to actually write about them.  Thera-Band products are professional grade medical devices.  In fact, if you go to an orthopaedist, podiatrist, chiropractor, or physical therapist, you will likely find Thera-Band products there.  They are, as you’d expect, constructed really well.  For example, none of the foam on any of the rolling devices that I have received has experienced any noticeable compression (whereas a foam roller I bought years ago to fight IT band syndrome has developed a “groove” in it that perfectly fits my legs….and don’t say that’s happened because I’m fat!).

Thera-Band's Foam Roller and Wrap+

Thera-Band’s Foam Roller and Wrap+

 

Thera-Band Foam Roller and Wrap +

Most of us have seen or used a foam roller before.  I personally have a love/hate relationship with my foam roller that grew a few years ago when  I had a particularly bad bout of IT Band Syndrome.  But this is not your ordinary foam roller.  When you combine the foam roller with the Wrap+ wraps, you can achieve a totally new level of massage.  These very cool, ridged-surface wraps come in four progressive levels of density – allowing you to really customize the level of tissue massage you give yourself.  And I’m here to tell you…if you think plain, normal foam rolling can be an episode of S&M, then you need to try one of these Wrap+’s.  The bottom line, though, is that with these very cool innovations, you can really massage deeply and free knots and muscle adherences.  That, my friends, is what foam roller massage is really all about.

footroller_box_bar_logo%20visible01_1

Thera-Band Foot Roller

The Thera-Band Foot Roller has become my real go-to appliance recently.  I’ve been using this roller as one aspect of a three-part strategy to roll my feet since I’ve been diagnosed with plantar fasciitis  (the other two parts include a lacrosse ball and a golf ball).  This molded foam roller is made of fairly dense material, but it’s not as hard as, say, PVC pipe.  The ridges are helpful, and feel great.  The added bonus – and one that I only recently realized, is that you can put the Foot Roller in the freezer!  It doesn’t get quite as cold as a bag of ice or an ice cup would, but it does cool down considerably.  Plus – if you lather your foot up with BioFreeze then use the Foot Roller you get twice the benefit!

Roller-Massager-Portable-500pxW

Thera-Band Portable Roller Massager

Until recently (meaning until I got PF and started using the Foot Roller daily) the Portable Roller Massager was by far my most favorite device from Thera-Band.  This massager has a fairly familiar look and feel.  It’s essentially your mother’s rolling pin, but instead of being made out of wood, it’s made out of high density foam.  The foam on the Roller Massager, like the Foot Roller and Wrap+ devices, is ridged.  This helps increase the massage sensation and bring more bloodflow to the area to help with healing.  The very cool thing about this device is that the handles are spring-loaded, and can be retracted into the device.  This makes the entire unit much smaller (and hence portable).  I’ve taken this on numerous trips during the past six months; it fits nicely in my luggage – but would also fit nicely into a carry-on or briefcase.  I use the Roller Massager everywhere…calves, quads, hammies, glutes, back.  Basically everywhere I can reach.  I even used the end of the handle to dig in really deep to accomplish trigger point release.

StretchStrapProductShot

Thera-Band Stretch Strap

I don’t know about you, but I’m not as bendy as I once was.  Stretching has become….shall we say….painful.  I’ve often found myself using the same-old stretches that I did when I was a high-school runner back in the 1980’s.  Here’s the problem with doing the same old thing.  I have found that I am unable to properly stretch certain muscle groups due to age-induced loss of flexibility.  Here’s where the stretch strap comes into play.  You can use this to really get the right range of motion needed to properly stretch.  The strap can be used in conjunction with dynamic or static stretching (once properly warmed up).  I’ve probably used this device second most of all the tools that I received from Thera-Band.

Flexbar2_2

Flex Bar

The Flex Bar is designed to work your hands and forearms.  Quite frankly, I’ve hardly used this device, as I haven’t had any real issues with my arms at all.  My wife, on the other hand, uses this thing religiously.  She has been dealing with tennis elbow for years – which is odd, because she doesn’t play tennis.  Regardless, this device is used to strengthen your forearms and help alleviate tennis elbow.  I believe you can also use it for carpal tunnel syndrome.

hand01web

Biofreeze

Chances are high that you’ve seen or used Biofreeze before.  This menthol-based product is a topical pain reliever that can be applied directly to the area where you are sensing pain and discomfort.  The “cold therapy” that results from using this product inhibits the sensory production of pain and helps deliver relief.  Biofreeze comes in many variations – gel, spray, and new, single-use packets.  I really like these because the product is clear (and liquid based), doesn’t stain, and actually carries a lighter scent than the original, green gel does.

Where Can You Purchase Thera-Band and Biofreeze products?

Well, like most products these days, you can purchse practically anything online.  Both Thera-Band and Biofreeze are sold through one central website – complete with lots of details and online ordering.  You can also purchase any of these products from your health-care professional…especially if they are in the sports-related field (think Chiropractor, Physical Therapist, Orthopaedists, Podiatrists).  I’m not sure that an OB-GYN sells Biofreeze, but you never know 😉  The pricing is really fair.  For example, a 10-pack box of Biofreeze Singles is about $15.00. 

 

And the Diagnosis Is….

If you follow me on Twitter (if you don’t, shame on you.  Go do so here), you know that for the past two months I’ve complained intermittently about my left foot hurting.

You see, way back on January 15th, I was out for a super-easy run.  Nothing big.  Just around 3 miles at a leisurely pace.  Well, about two miles in, I felt a painful twinge in my left heel.  Almost as if I stepped on a rock.  I sort of ran through it, although I had to stop and walk a couple of times.  By the time I got home that night, I could hardly walk without limping.  Having dealt with all sorts of nagging injuries over the years, I suspected that I either (1) stepped on something and really bruised my heel, or (2) I had plantar fasciitis.  So that night, I iced my foot, rolled my calves with a foam roller and slept in my foot split.  The pain ebbed and flowed for a couple of days, but by the first of February I was almost pain-free.

Until I ran again. 

This time, I didn’t really have any pain while I ran, but by the time I was done running, my foot was done being pain-free.  And so I took off a couple more weeks.  All the while, I was icing some, rolling a lot, and my lacrosse ball and I became friendly.

Again, the pain started to subside.  So I ran again.  (You’re seeing a pattern develop here, right?)  Just as you would guess….no pain during the run, but crazy painful afterwards.

I was hoping that I didn’t have something majorly wrong with my foot. 

source: Tt.tennis-warehouse.com

source: Tt.tennis-warehouse.com

The red circle represents where my foot hurt the most.  In reality, if you slid the red circle down towards the bottom of my heel just a little, that’s actually where it hurt the most.  And my foot also hurt along the edges of my heel on both the lateral and medial side (that means on the inside and outside).  This didn’t feel like plantar fasciitis. 

As all self-respecting triathletes who think they are injured should do, I tried to self-diagnose myself.  I went to Google.  I read hundreds of articles, posts, and blogs about heel pain.  Achilles tendonitis?  Maybe.  Stress fractures?  Could be.  Plantar Fasciitis?  No way.  Almost everything I read said the pain was where the blue and green areas are on the graphic above.  In fact, the last time I had PF, it was where the blue area was.  Based on where my foot hurt, surely this was something serious!

Here we are, 60 days out from my initial feeling of pain, and I’ve only run 3 times in 2013!  How the heck am I supposed to be a triathlete if I can’t run?  How will I ever race in Knoxville in early May? 

I finally caved and called a podiatrist yesterday.  Based upon the experience of my teammate, Joshua, I decided to call Dr. Vimal Reddy at Jacksonville’s First Coast Foot & Ankle Clinic.  Surprisingly, they could see me this morning. 

I just wanted to make sure that I didn’t have a stress fracture or alien in my heel or something.

So this morning, I arrived at Dr. Reddy’s office and shared my story with the nurse.  I got a couple of x-rays done (I guess to rule out stress fracture) and then sat and waited for the good old doctor.  Dr. Reddy finally made his grand entrance, and I recapped again what has been ailing my foot.  He proceeded to do an ultrasound of both my feet and then announced…

“You’ve partially torn your plantar fascia.”

“WHAT!?!?!?!?!?!?!?!?!  But my arch doesn’t hurt!” I said.

Well, it turns out that many folks who have plantar fasciitis don’t actually feel the pain in their arch….they feel it exactly where I do.  And, it’s a good thing that I’ve been rolling, icing, and becoming BFF’s with my lax ball and golf ball, as those efforts have likely been keeping my PF from getting worse.  Dr. Reddy showed me on the ultrasound where I’ve got some really magnificent scar tissue built up, and then he proceeded to PUSH ON IT!  Which of course, hurt like crazy.

We talked about stretching, icing, and such….and about how I can’t run for at least two more weeks.  Then we talked about getting a cortisone shot to help with the swelling.

Oh.  Boy.

I’ve heard about those.  My wife has had a couple in her shoulder and says that they rank right up with childbirth in the pain department.  Now, I’m a big sissy when it comes to pain, so I’m not going to lie.  I was not looking forward to this.

Dr. Reddy sprayed some chemical stuff on my foot to numb it.  It sort of looked like the stuff that comes out of those cans of air that folks use to clean out their keyboards at work…you know the stuff that has warning about not exposing the liquid to skin because you could get frostbite!  And then, injection time, baby!

This is not my actual foot, but a good example of a doctor using Ultrasound to place a cortisone injection.  Source: bmj.com

This is not my actual foot, but a good example of a doctor using Ultrasound to place a cortisone injection. Source: bmj.com

Dr. Reddy used the ultrasound to pinpoint the needle (Ha – see that….PINpoint the NEEDLE) to the correct spot.  Holy COW!  IT HURT!!!!  I don’t know if it felt like child birthing pain or not, but it’s not a feeling I’d like to have on a regular basis.  As I was leaving I mentioned how painful the shot was to the receptionist.  She said that because he used the ultrasound he could pinpoint the exact spot to do the injection and there was no guesswork involved…but that approach did tend to hurt folks more.  Yay.  Lucky me.

Well, now we know.  The diagnosis is…Plantar Fasciitis.  No running for at least two more weeks.  Just more icing, rolling and making friends with my balls.  Um….that sounded bad.  My lacrosse and golf balls.  Hopefully that stuff, combined with a pretty rigorous stretching approach, will lead to some improvement.  I have read about some of the risks associated with having cortisone injections (like ruptured tendons), so I most likely will not have any more injections…hopefully one makes the swelling and pain abate some and then the more “natural” remedies I’ll follow will do the trick.

Have you ever had PF?  What did you do to overcome it?