Friday, 6 February 2015

Tried to Make me go to Rehab

 – and I said, nooo, nooo, oh go on then!

Here I am, sitting on the sofa, ice wrapped round my lower leg, nursing an injury and feeling a bit mardy.  And foolish. Time to reflect on how it got this bad.

Sometimes it just rights itself.
My trouble is, I take this too Literally....

When I was training for my first half marathon (Sleaford, Feb 2013), my foot was still a little weak from when I fell off my bike in May 2012.  It was only mildly niggling, barely there really and I actually felt more pain on the knee and hip on the other side. This was possibly through my gait compensating for the right-foot weakness. This was still the state of play when I ran my second half at North Lincolnshire in May the same year.  Luckily, as my ex-bad foot strengthened, any compensatory pain on the other side disappeared and I had a good 6 months of pain free running, including 2 further half marathons that year.  I think during that year, the healing continued and I also get fitter, so I kind of got away with not doing anything about the difficulties. They just righted themselves.

Ignore a Niggle at your Peril
.....and I ignore these

I next started to have problems with my ’ex-bad foot’ in 2014 when training for my first marathon (Blackpool, April 2014).  In general, the bottoms of my feet were a bit achy as the mileage increased and across the top of my foot and around the ankle hurt.  I started to have regular sports massages and the masseuse noted that my feet are very flat (not so much low arches as no arches!) and that this might be part of the cause of my problem.  I didn’t have any ankle pain in the other side so I tended to put it all down to it being niggles from the ‘ex-bad foot’.
I read the book, Running Injury Free, lent and since given to me by Sue, my running buddy.  I followed as much of the advice as I could .... except probably the most important bit: if it persists, see a physiotherapist.  Ignore a niggle at your peril, it warned.  A niggle can very quickly turn into an injury, it chided.  But I was so far through the training that I just wanted to get to race day and do it.  My foot wasn’t too bad during my last long training run, I tapered as advised and got to the start line in good shape.

From mile 19 onwards though, I was once again trying to ignore the niggle, that was turning into pain, of the ex-bad foot.  As I wrote in my blog-post about Blackpool, I had a tubi-grip support with me, but daren’t stop to put it on in case one of the marshals saw me and told me to stop.  By the end of the 26.2 miles, there was nowhere on my body that wasn’t hurting, so the foot just blended in with everything else!

I’ll just do these few halves and then I’ll get it looked at.

When I’d recovered from the general aches and pains of a marathon, I was left with a tendency to mild pain just under the inside of the ankle bone following medium length runs and it would swell if I ran far (say 10 miles plus) or following hill / speed sessions.  I started to think that I really needed to get it looked at, but I was already entered in 3 half marathon throughout the year.  I daren’t really get it looked at because I feared they would tell me that part of the recovery would be not to run for a while.  I KNOW HOW BAD THAT SOUNDS! But at the time, I just thought, OK, I’ll get these 3 halves done and then I won’t mind if I have to rest for a while.

So, when some of the CRC members were entering Chester Marathon (Nov 2014), I resisted the temptation to enter.  “No, once the Isle of Axholme half is over, I’m going to get this foot looked at,” I insisted.  For. Quite. Some. Time.  Then, after a run at Swallow we called in at the pub, I had a couple of pints and someone asked me again.  Lethal. These things always start with a conversation in the pub. That evening, I entered.

Oh – perhaps it’s just a bit ‘arthritisy’ or something.

Now, this bit, I think was a gradual thing that crept up over about 6 months – possibly beginning after Blackpool.  I started to find my ‘ex-bad foot’ was increasingly stiff in the morning, eventually getting to the point where I had to flex it about for 5 minutes before I could stand on it and even then it had to click about for quite a few paces before it loosened up.  Running was by now permanently accompanied by a dull ache, but as I was able to run without limping, I continued to press the override button - AKA ignore it. It’s only an ache, after all, not actual pain.  I even congratulated myself on having good pain threshold and saw that as a good thing because I could keep on running.  I put it down to being a bit ‘arthritisy’.

I had a couple of weeks out of training for Chester, as I hurt my back shovelling rubble, but I soon got back to it and only missed 2 long training runs.   At the end of Chester marathon, I don’t think I was aching as much as I did after Blackpool, but in the short clip of my finish, I look decidedly lop-sided. I hadn’t notice I was limping, but afterwards, the ankle was very swollen.   

On the journey home the next day my foot had a definite tendency to turn inwards at the ankle and was painful when I tried to straighten it.
With no more races apart from the 2 mile Santa Run is December, I eased off quickly on the mileage and the foot went back to just its regular stiffness in the morning and click, clicking and loosening throughout the day.

It’s feeling a bit better – let’s mess it up again!
It's about time I started learning those lessons!

You’d have thought by now, I would have learned my lesson and had it looked at whilst there were no races to think about.  But no.  I focused on ‘managing  it’.  Loosening it up every morning,  icing it if it swelled up after running. 
I’d had my rejection letter from London Marathon 2015 and the club place had gone to little Kath (well deserved too – seeing as she ran Chester Marathon only 3 weeks after getting her foot out of pot).  I was drawn as the reserve, but I know that Kath does not need a reserve – nothing will stop her from running that race.  So, what did I do?  Got carried away and entered ManchesterMarathon – April 19th

I downloaded an intermediate training plan and got started the week after Christmas.  I was very excited.  I immediately went from running 3 or 4 times a week to 5 times every week.  The first long run was actually quite short (6 miles) so I popped a couple of extra miles on and did 8.  The next week I did 10 and I kept up all the weekly sessions by combining my training plan with the CRC plan and incorporating Cleethorpes parkrun on Saturday.
On the day that it fell apart a bit, I’d had a great morning.  I’d run parkrun with  Michelle Jones, who was just back running following illness and is working toward 10k ready for the Lincoln 10k in March.  We had a great run and chat, and as usual had breakfast at Cleethorpes Wetherspoons Old Coliseum with the CRC regular parkrunners.

In the afternoon, I set off for what would have been a 12 mile run.  I’d planned a route and was looking forward to it.  As I set off, I could tell I was a little bit limpy on the ‘ex-bad foot’ and had a twinge under the inside ankle bone.  I genuinely thought I would run it off in a couple of miles, so pressed on.  After the first mile, it was a very slight incline and I started to notice I was a bit more limpy and that the niggle under the ankle bone was now pain.  There was also a twinge above the ankle.  By a mile and a half, this was turning to pain, and gradually creeping up the inside of my lower calf.  I was thinking, “WTF?!  This is not good – I think I might just do 6 miles today instead of 12.”  I knew exactly the point I could loop back to cut the run in half.  However, about a minute later, the pain was really severe and I was dropping badly on the right foot / leg. I had to stop and turned round to start walking back.  Three paces later I was on the phone to Chris getting him to pick me up.  I NEVER DO THIS! By the time he arrived, I could hardly walk.  There followed ice, pain relief and a strong resolve to see a physiotherapist.  Amazing how strong the resolve is when it’s a case of ‘can’t run’ rather than just, ‘running hurts a bit’.

A Visit to the Physio

This was much better than I expected.  I know I’ve been foolish to ignore the injury and dismiss it as the ‘ex-bad foot’ or a touch of arthritis, so I was sort of expecting the same humiliation I felt as a child when the dentist informed me I hadn’t been brushing my teeth well enough!  It wasn’t like that at all.  The physio came highly recommended by several CRC members and is a runner herself, so she knows what we’re like.  When I told her I’ve been trying to ignore it, she just said, “we’ve all done it!”.
I described what has been going on and she very quickly mooted what she thought the problem was, and showed me the offending part on a diagram on the wall.  She confirmed this with a physical examination.  Tibialis Posterior Tendinitis.

Green Arrows show the site of pain and the Tibialis posterior tendon.


She explained that it’s something that runners are prone to – especially runners with flat feet!  That’ll be me then!  It’s an ‘over-use’ injury, generally caused or exacerbated by sudden increases in mileage and / or frequency of running.  Yep – two big ticks in those boxes too.

NOTE TO SELF – AND LET’S PUT THIS IN BIG LETTERS!

IN FUTURE, INCREASE MILEAGE MORE GRADUALLY.  DO NOT GET SMUG AND ADD EXTRA MILES TO YOUR LONG RUN WHEN YOU’RE ALREADY INCREASING FREQUENCY OF RUNNING. IF IN PAIN – BACK OFF. STICKING TO THE TRAINING PLAN RIDGIDLY (OR INCREASING IT EVEN MORE THAN THE PLAN SUGGESTS) CAN RESULT IN BEING OUT OF RUNNING FOR LONGER.

The Treatment

The physio did quite a lot of manipulation along the length of the offending tendon, then treated the main site of the pain with a long-wave ultra-sound machine. She then massaged the lower leg muscles that are around the tendon - but not too deep.  Before the ultra-sound, she pressed around the painful area to establish where the worst of it was.  When she pressed hard it was very painful.  After the ultra-sound treatment, she pressed it again quite hard, and all there was was mild discomfort! Bloody hell - miracle machine!  When I walked after that, it was much better.

The Rehabilitation Plan

I was advised to -
·         get a sports massage for both legs – the whole of both legs.  No problem, I already had one booked for 10 days later.
·         Take ibuprofen regularly, even if not in pain, for the anti-inflammatory benefits
·          Ice it regularly throughout the day for 10 to 15 minutes, whether it’s swollen or not.
·         Stretch regularly (with muscles warm – so not after icing, obviously) and she gave me some adaptations to my usual calf stretch in order to stretch a different part of the calf.
·         Use silicon heel cups not just in my running shoes, but day-to-day shoes too.
·         Keep some comfortable shoes on in the house rather than going barefoot.

It was Thursday when I saw her and she recommended the following plan for getting back running.

·         Stretch after every run and then ice the offending parts.
·         My first run to be on Sunday, on flat grass, no more than 10 to 15 minutes.
·         No running on consecutive days.
·         Run again on Tuesday, on flat grass, 10 – 15 mins.
·         If that goes OK, run again on Thursday, up to 20 minutes.
·         No road running at all until after I’ve seen her again

Next appointment – booked for fortnight later.  And in the longer term, she’s advised I see a podiatrist to get some inserts made to help with my flat-footedness. Ha! To think one of my reasons for taking up running was that it’s a cheap hobby!

How is it going?

Luckily, I was off work for 4 days after the physio appointment, so doing all the stretching and icing was easy to fit in.
The first run on our local playing field was a little scary. I was DESPERATE TO RUN but I hadn't run for a fortnight (since the day I had to be picked up on a run) and seeing as walking had been painful in that time, I didn't know what to expect. After about 4 minutes, I was conscious of it being quite uncomfortable and was thinking, “it will be nearer 10 minutes than 15.” But it settled down after a few more minutes and I managed to get to 15 minutes.  I stretched and iced afterwards as though my life depended on it!
The next day, the injury was sore. I was limpy.  But by Tuesday it was settled again and I was ready for run 2. I headed for the playing field again.  Unfortunately we’ve been having some snow and the ground was frozen.  I felt a bit limpy throughout, but pressed on to 15 minutes.  Stretch. Ice.  Sore the next day. But ready to go again on Thursday – yesterday.
For a change, I drove up to Caistor to run on the playing field there.  It’s CRC run night so I planned to meet up with the others after their run.  As it goes, it was to icy for them to run on the roads, so they ran around the field with me.  When I say, “with me”, I mean I was running with a different person every few minutes as they gradually all passed me and I ended up running half a lap behind the pack.  Jayne ran back to meet me and ran the rest of my run with me.  I planned to do 20 minutes, but at 17 minutes, I was feeling quite a bad twinge above my ankle. I felt like I could have possibly pushed through it and got to 20 minutes, but I’m now so fearful of going backwards that I decided to stop.  I can’t believe how my confidence has taken such a knock!

Today, my lower calf on the inside, and around my ankle aches as though I had run 10+ miles yesterday.  If I hadn’t had that run that I had to abandon, I wouldn’t think anything of it to ache badly after a long run. I’d just know it would go off and I’d look forward to the next run.  But this wasn’t a long run – it was 1.2 miles. 

What now?

I believe it’s 10 weeks on Sunday to Manchester Marathon.  I don’t know how I’m going to get from running 15 minutes to running for over 4 hours in that time.  I’ll see how it goes over the next few weeks.  Perhaps after a massage and another treatment from the physio I’ll improve more rapidly.  We’ll see. If I don’t think I can run to the finish line, I won’t even go to the start line. I’d rather give someone else my place and just go along to support my fellow CRC runners.  But there’s a big part of me that believes I’ll pull round and run it. I really need to not get hooked up on PBs though!

Whether I run Manchester or not, I’ve learned my lesson:

DON’T IGNORE

PERSISTENT NIGGLES!





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