Tuesday, March 23, 2010

A sample size of one

These last four weeks have taught me a number of lessons, many of which have not been pleasant.  I do know that they are important nonetheless.  The biggest lesson is one that I mentioned in my last post:  we are each a sample size of one.  I have immersed myself in both scientific literature and anecdotal threads on various websites looking for a preponderance of evidence that might lead to a few key treatments for my achilles tendonopathy.  As I also mentioned in my last blog post, the recommendations are all over the board and often contradictory.  I have also been surprised (or maybe not so much) by the very few scientific studies available on the subject.  The ones that have been done (on humans rather than rats) are so over-cited that they tend to take on the form of gospel or law rather than what they really represent, which is a single study using at most a couple of dozen subjects.  I realized that I have been basically conducting a mini experiment on myself during this injurious cycle and decided to go ahead and thrust my findings into the cyber world as well.  

My decision point for things that I've tried and continued versus those that I've tried and thrown out has become simple:  does it make me feel better or worse after doing it?  While you might have just breathed a heavy sigh and rolled your eyes over that revelation, think about who you're dealing with here.  I am a runner that is used to pushing myself hard through pain and discomfort all with the goal of improving my fitness and becoming faster.  So, pain in a twisted way, is my friend and helps me improve as an athlete.  Now consider that my best friend just shat all over me, and you might get a sense of why this simple question is novel to me.

One very important point about the recovery cycle post-injury that I just realized over the weekend is that your body goes through phases in the healing process.  Maybe the rest of the world knows this, but I had never really picked up on it.  This is the primary reason that I had such trouble understanding the various recommendations regarding the use of ice.  It appears that ice is super important (as a component of P.R.I.C.E.) during the initial (acute) phase of an injury (first 3-7 days).  There seems to be general agreement on that.  However, the use of ice beyond that point is not agreed upon.  Some say that it can impede healing by decreasing blood flow to the affected area while others say it does no harm and at least keeps pain in check.  My point here is that treatment recommendations require context relative to the phase of recovery you're in, and, often times, they are not written in that context.

Another interesting recommendation that I found and actually really liked was to perform eccentric heel exercises.  I was super skeptical at first about this one because it appeared to be based on one of those one-hit wonder scientific studies and treated as gospel forevermore.  However, this was a case where the study spurred doctor's and physical therapists to try it out on patients en masse.  There now exists an impressive body of evidence from people, like myself, trying this technique out with some success.  Other studies have also been done to refine the technique.  To read all about it, go here.  What I can say about it is that my achilles and calf feel a lot better after I do these exercises even though it might hurt a little while I perform them.
So, the things that seem to be working for me are (including their recovery context):
  • not running (during the acute recovery phase)
  • icing after runs (during rehabilitation phase)
  • eccentric heel raises 3 x per day (once I could do these with only a moderate level of pain)
  • working out the adhesions in my calf muscle (for the first 2 weeks)
  • massaging my achilles using these techniques (after the acute phase, but continued during rehab.)
  • stretching my entire leg using trigger point massage, especially my hips and IT band (throughout)
  • stretching and massaging my foot (throughout)
The things that either haven't worked or I stopped because they didn't seem to help:
  • heel lifts in my running shoes (led to a change in gait and stressed my peroneal tendon)
  • stretching the calf while running (I felt relief at first, but then seemed to irritate the achilles later)
  • heating the calf prior to running (had a neutral effect at best)
I have tried to return to running three times so far typically with initial success followed by rapid decline by the third day of running.  Each time I started with a short 15 minute run and then ramped up to 4-6 miles the second day followed by an even longer run the third day.  I think testing my leg out in this way has been important, and I don't think it has set me back.  How else would I know whether or not I'm ready to run again except to go do it?  I completed an uneventful 15 minute run today and will do a hard bike ride this evening.  I'll try running again tomorrow, a bit longer, but will back off again on Thursday.  This seems to be a more sustainable pattern: short, longish, short...

The bike is currently my cross training activity of choice.  I am becoming super strong in the saddle and have found it very enjoyable to go out and hammer a hard workout on the bike trail.  I am now one of those bike jockeys that I complain about as a runner, exceeding the 15 mph speed limit and passing with reckless abandon.  I am actually quite courteous and do know how to cross over that magic yellow line in the center of the bike lane to avoid runners and other cyclists.   I have learned to use my heart rate monitor to gauge my effort level, but have to use a lower HR max on the bike to make the percent effort comparable to running.

I still haven't pulled the plug on Eugene, though each day that goes by makes the probability of making it to the starting line seem more and more bleak.  But, Eugene was a random proposition anyway and one that I am not at all married to.  So, I'm making like Bonnie Franklin, Mackenzie Phillips and Valerie Bertinelli, and taking it One Day at a Time.              


  1. Might see you on the bike trail...

  2. I hope you heal quickly. I am a heat believer, I apply the heating pad over my injury whenever I got injured! But now I do anything to get over the ache and pain. I started dip my feet in ice after ever run and pray for a better run the next day!
    Great but sad blog, again hope you heal fast for your next marathon!

  3. i am sad to hear about all this and my heart goes out to you. keep doing what you're doing and don't let it get you down or shake your resolve. i hope to see you in eugene.

  4. there is no better way to get your butt kicked in the saddle than a 10 mile time trial on the clock. you can do a free one every tues night in rancho cordova. you'll be surprised at how high your HR gets up there.


  5. Great post

    Pure gold advice that coming from those "at the coal face" and not that past off as "gospel" by the cut and pasters!

    Looking forward to reading more. Thanks!

  6. Sorry it's been hanging around. You're doing everything you can to get over the injury, and not lose fitness while doing so. Maybe cross-train the biking with the water running.

    Anyway, if not Eugene, at least you have lots of marathons over there to choose from. Once you're over the injury then calf stretching, 'heel drops' and massage could be good prevention strategies.

  7. Well, this sucks. I have no words of wisdom to offer. Only my sympathies.

  8. I know exactly how you feel, and in not being able to schedule races in the future because of the nagging injuries. You WANT to run, but you also want to heal quickly so that you can run in the near future instead of pushing your recovery back further by running through the pain. I dealt with femoral acetabular impingement that required surgery and now Plica Syndrome for which I have surgery in 2 days. Like you, I tried every bit of advice over the span of a year for each injury, including not doing any physical activity for months. Some people may frown on my decision to have surgery, but sometimes it is the only thing that works.