Monday, March 24, 2014

Running injuries: part of the game?

Although we hate them, injuries have a few benefits. First, they are a vocal expression of our body talking to us. It is so hard to follow the adage "listen to your body" and know when to stop, just before pushing the envelope an inch too far. Minor injuries, although they interfere with our passion and balance or, for some and depending on your perspective, imbalance, are a reminders to put things into context and appreciate even more the marvels of what's still working fine in our complex body and much bigger challenges that others may be going through. Another benefit of some physical injuries is the reminder for more stretching, especially to loosen up muscles opposite to the harmed area, or strengthen a particular muscle in order to protect and ease the efforts on a particular joint and, certainly a reminder to work our on core muscles. I'm sure they are many more pluses to the bad news but the last one I'll mention here is the opportunity to learn more about anatomy in particular and sport medicine in general. This is such a vast field, I certainly don't feel the need nor the courage to go back to school to become a specialist. Hopefully, our IBM Watson cognitive system will do that for me! ;-)

Talking about injury is still quite an uncomfortable topic for me as I had always thought and hoped I had found the miracle recipe to keep them at arm's or more specifically at leg's length... A neutral foot, variety in training intensity, length and grounds and rotating different models of shoes, from minimalist flats to more cushioning. Oh maybe I broke the rules in January, too excited I was to still gain speed and working hard to get a few fast races in my new age group. The pain in the tibialis anterior came 2 days after Jed Smith. A small one which looked like the tear of a small muscle fiber. I took two days off, ran/train again for 2 days, stopped for a week, trained 4 days through the injury, tapered another week before the Nationals, tapered for 6 days between the two 50K races, Caumsett and Way Too Cool, and the pain traveled down along the tendon, now a burning pain which looked like an inflammation except that it resisted anti-inflammatory.

I must say that I shouldn't complain too much because, although it persisted through these short breaks and prevented me from training these past 7 weeks, the pain is disappearing after a few days off running and pounding, so I can still cross-train and walk without limping. I know many have gone through much serious injuries. For instance, Sarah had months to ruminate or fulminate and, as a result, she produced a superb piece on the topic, illustrating the patience and wisdom required for coming back to a top form. Her friend Olga is still facing a mysterious abdominal issue, but also shares a touching story about rebuilding her life despite and around the uncertainty. And you can find hundreds of injury-related stories in the blogophere... Even the new goddess of ultra running, Ellie Greenwood, was forced to quit running for 11.5 months for a fibula stress fracture. So glad for her that she came back with another win at Chuckanut this month! And I could talk about friends who are battling cancer, my injury is so insignificant in comparison, time to be grateful for life!

Some people think that, based on the level of competition we are going through in ultra running, we must have access to very good medical expertise and advice, like some champions. Well, that's quite not the case, unless you make it to Team USA and are invited to represent our country at world championships. Like the docs who fixed Jon Olsen before he won the world 24-hour championships last year, but that's only at the event, not through the year and even champions like Jon have to deal with injuries on their own, guess what they are and how to heal. I'm so glad my sister is an MD in France and she strives to keep learning, admits when she doesn't know instead of jumping to pre-conceived and quick conclusions that she might have been taught during her many years of training, and reaches out to her medical network, including a few ultra runners.

So, what is this grain of sand which is derailing my training plans? According to both the sport medicine orthopedics and podiatrists who examined me two weeks ago, it is indeed an issue with my tibialis anterior. They didn't ruled out a somehow simple tendinitis but they prescribed an MRI to determine if the tendon might have been damaged by a tendinosis. Quite close words to me but a big difference in Wikipedia's definition of tendinosis (which isn't even a word in Google's Blogger spell checker by the way), and a sentence which I don't particularly like:

"Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community."

That reminds me how we say that ultra running is a big experiment. And I'm one of the guinea pigs which was happily running in the spinning wheel so far, it is time to learn more about running mechanics and the moving boundaries of my envelope, from this new episode. Time to be patient, wiser, cross-train, do some strength training, more stretching, that's all part of the game too, and I had easily forgotten when everything was going so well and smooth last year. When I say that injury is a n opportunity to learn, I'm discovering new soreness in muscles I had no idea existed in my legs thanks to the cross training. And I also learned about a new physical therapy technique which may hopefully be more than what I actually need to get back to running (look at this pretty impressive and drastic video of the ASTYM (Augmented Soft Tissue Mobilization) technique to remove scar tissues, ouch!).
In the meantime, the radiologist hasn't spotted anything on the tibia and fibula (phew!), no edema in the muscles (re-phew!), but some potential tenosynovitis along three tendons (tibialis posterior, flexor digitorum longus and flexor hallux longus, thank you Wikipedia again...) but no mention of the tibialis anterior which was the initial culprit. Ah, which trick is my body playing now? I can't differentiate from sure fat from tendon in the image, so better let the experts do their job... I'm now waiting to hear from the reading and interpretation of the MRI by the orthopedic before deciding what to do next...And while I wait, I'm indeed wondering if injuries are not a normal part of running to our best, of this game of determining and finding what are these limits... To the point that injuries would be an integral part of sustainable running... What do you think, should we go that far?


MJ said...

My chiropractor, who treats a fair number of runners and other athletes, says injuries and pain to some degree are part of the "game". "If you're using the machine, something's probably going to hurt." He does differentiate between niggles or things you just have to live with (tendons that never completely stop talking at you because you're still on your feet) or temporary situations with real overuse injuries. But his acceptance of his own issues and pain and the way he's treated me in my comeback from extensor tendon sheath inflammation has given me a different perspective, especially as a Masters runner. You strengthen, train smart, mitigate with chiro, massage, other therapies, rest and XT and you manage the best you can. But it doesn't always mean you have to stop.

Jean Pommier said...

Thanks for the encouraging note, MJ. I did stop this time because the orthopedic talked about tendinosis and Wikipedia describes this as "chronic degeneration" of the tendon so I wanted to make sure I was really not going to tear the tendon apart. The doc called tonight and isn't sure about anything now apart from the generic "it may take time." So it seems that I can resume some running, however it won't be wise to push as much as I did in January. Thanks again for the feedback.

Unknown said...

Jean, do you know of a south bay provider that does ASTYM?

Jean Pommier said...

Hi Tina! No, I haven't experienced ASTYM myself, but they have a nice provider locator on their website, with a few names in our area: . Hope this helps. Incidentally, I also have a friend in Los Altos, licensed for Rapid Release Therapy: .