Monday, October 10, 2016

A Long, Sad Summer - Part 2: The Injury

The last time I was here in April (geesh...) I was triumphant. I had redeemed my terrible Monument Avenue 10k with a PR at the Carytown 10k. I felt pretty invincible and fantastic.

5 months later, this is my situation.

And this is really just the tip of the injury iceberg.

What happened you ask?

Two simple words: Plantar Fasciitis.

Actually, let's make that three words: Acute plantar fasciitis.

My last good run happened on Wednesday, May 4. Kit and I ran a north side route flat and fast - 8 miles at a 7:29 pace. I specifically remember being very happy with it because I had felt kind of sluggish for a few days and this was the first time I had enjoyed a fast pace that felt comfortable and giddy. I thought, "Finally, I'm back to my old self."

If only I knew what was in store for me.

The following Friday night, at 3:30 am, I startled awake thanks to the most excruciating calf cramp I have ever experienced. It was the kind of pain that makes you feel like you're going to throw up or pass out; the kind that makes your mind go blank and takes over everything. I was writhing and literally crying out in pain, which woke up Husband who tried to massage my rock hard left calf into submission but it just wasn't having it. Finally, after what seemed like an eternity, the muscle relaxed. The episode probably lasted 2 or 3 minutes. I was absolutely covered with sweat and gasping for breath.

What caused this cramp is a mystery to me. I had not been doing anything out of the ordinary in the days leading up to it. I have had this calf cramp up on me at night before, but only two times that I can remember and never to this level.

My calf was sore for a solid two weeks after that, but being a runner, I continued to run through the discomfort. I did go see BFF Steve and had him do some massage on the calf.

In mid-May, Husband and I went to Chicago. Admittedly, I did not take very good shoes with me (by good, I mean supportive). In fact, a few hours after we arrived we hit a Sketchers store and both of us ended up buying new shoes that would be better for touristing. It just so happened that there was a half marathon going on while we were there - entirely coincidental, I swear! - so I had signed up for it. I ran the race on Sunday the 22nd.

At first I wanted to run it all out but I ended up slowing up quite a bit because it turned out to be a very warm day, the lake front offered nothing in the form of shade, and because my calf started bothering me around mile 8. So at the turnaround, I decided to just chill and be a tourist runner. I stopped a few times and took some pictures of the Chicago skyline and then at mile 12.5, I was coming up behind a male runner who was obviously in distress. He was weaving, barely staying upright. I immediately pulled up next to him and slowed to a walk, putting my hand on his arm to steady him and asking if he was ok. His arm was freezing cold - never a good sign on a 70 degree day. I ended up doubling back to the nearest aid station and then staying with him until medics showed up.

Despite all that, I finished in 1:46. And the medal was totally cool.

The Ferris Wheel spins!

Our agenda for the rest of the day included a walking food tour, which covered about 3 miles. By the end, I was trailing behind my husband and our friends because my foot and calf were hurting, but I chalked it up to trying to be all crazy during the first half of the race. Besides, my feet had been hurting since pretty much day one - again, I had written it off to being out of practice when it comes to playing tourist.

That night, I woke up in the middle of the night to go to the bathroom. When I tried to get out of the bed, I almost fell on the floor thanks to an intense, shooting pain stemming from my left heel. It felt like a knife was in my heel. I hobbled to the bathroom and prayed that by morning it would be better. It wasn't, really, but we still had two more days of sight seeing to do so I hobbled through the Art Museum, Wrigley Field, and the Willis Tower.

Back at home in Richmond, I foolishly continued to run. I thought that it would work itself out. Then, during a run with Kit and Lauren on Wednesday, June 1, I was in so much pain by the end of the run that I was literally in tears. It was mostly my calf, which felt rock hard, and by extension, my foot.

At this point, I knew that I needed to stop running and give this thing a chance to calm down. Even though it killed me to do it, I did not run on the first day of MTT (the first Saturday of June). I rode my bike to the stadium for orientation and to meet my new team - I had been assigned to Orange - the second fastest team in the program, and I was really excited about it. Besides, the first day of MTT is like the first day of school and I was eager to at least say hi to all of my running friends. I was ok during the pep talk but once the teams started to run from the stadium and I was left behind, it felt like my heart being yanked from my chest. I sadly rode my bike home and hoped beyond hope that with some rest I'd be joining in on the next weekend's run.

But by the second Saturday of June, it wasn't better. At all. I was starting to wonder if maybe my foot was broken again - this time the heel. I ended up seeing Dr. Cutter on the 14th, where I promptly failed the "squeeze test" on my heel and the Good Doctor ordered up an MRI suspecting a heel fracture. The next day I was in the MRI machine and completely convinced at this point I was looking at a stress fracture and 6-8 weeks of a boot and no running. I was hoping beyond hope that it was not fractured and merely a case of plantar fasciitis. At that time, my naïve self thought that a soft tissue injury would be easier to get over and I'd be able to continue running through it. It seemed the lesser of two evils.

When I went that Friday to my diagnosis appointment, I didn't wear mascara because I was certain I was going to be told I had a fracture and therefore, I was going to be crying. When Dr. Cutter said it looked like a case of PF, I was overjoyed.

"The face of a runner who was just told she DOES NOT have a stress fracture."
Initially, the prognosis was to take 2 weeks off from running to give it time to calm down. As it turned out, it just so happened that my sports doc was considering purchasing a pulse ultrasound device and was in the midst of a mini clinical trial on selected patients to see if it did indeed have a positive affect on plantar fasciitis. He wanted me to get the treatments, which for most patients, resulted in a drastic reduction of plantar fasciitis pain. Better yet, I was going to get the treatments for free.

My first session was on June 29th. I was nervous but not terrified - it didn't involve needles, so in my book it couldn't be THAT bad. A very nice sales rep named Conner did the treatments, which were about 10-15 minutes long and involved me trying not to jump off the table while he used this ultrasound gun to pummel my foot.

The first level would be a "warm up" for about 3-5 minutes, followed by the intense stuff for 3-5 more minutes, and then the finish with a massager that was supposed to feel good (it never felt good to me). He used the thing on my entire foot but concentrated the most on the spots that were sore. The idea is that these very deep ultra sound waves would penetrate deep into the inflamed tissue to encourage blood flow and stimulate healing.

It hurt - a lot. I would have to brace myself to not involuntarily scooch backwards away from him and/or jump off the table. It always hurt the most when he was concentrating on the tender area, but when he went nearer to my toes it made my foot bones feel like they were going to shatter. I was pretty convinced it was going to break my foot again. It brought tears to my eyes more than once. Conner did his best to distract me and told me that it would all be worth it; that it helped so many people and it was going to make me better. He found it really hard to believe that it hurt more than a tattoo (it did - a lot more!) and also more than running a marathon (A LOT MORE).  He would tell me that some of the other patients he would treating felt nearly pain free when they got down from the table and took their first steps after a treatment.

That never happened for me. It would hurt the same (or worse). After the standard three treatments (once a week), I told Conner I didn't think it was doing a damn thing and he said he would treat me two more times to prove that it worked.

It never worked.

Meanwhile, I was attacking the thing with everything I could: regular old PT with BFF Steve, stretching, night splint, icing, shoe inserts, a new rolling stick, and fancy calf stretching device. Oh, and of course no running. The whole no running for 2 weeks prognosis stretched on in to July as none of the treatments worked. Steve encouraged me to try out running to see what would happen, so I did the beginning of July. About a mile into the very slow run, my foot didn't seem to hurt so much. But I ended up paying for that little 3 mile run with excruciating pain later that day and being barely able to walk. That earned me two more weeks on the bench.

At the end of July, I made the decision to defer my entry into Marine Corps Marathon and transferred my MTT registration to the Half Training Team, thinking that if I could get back by the second week of August, I could probably run the half.

During all of this time, I was an emotional wreck. I wasn't getting my usual endorphins, I wasn't hanging out with my friends, I didn't have anything to look forward to. None of the treatments were working and just walking caused me serious pain. Something as simple as driving on Riverside Drive made me misty-eyed. Seeing runners created instant tears. Every time someone sent me an encouraging text or checked in on me, I would weep. The worst was at night when I would lay in bed, my foot in a splint and my foot throbbing, knowing I wasn't waking up to run and wondering if I ever would again. At least once a week throughout July and August, I would have at least one ugly crying jag - the kind where you get a giant headache, go through 50 tissues, and then can't breathe through your nose for hours.

I tried to do other things to stay in shape and recapture some endorphins. First, I bought a class pass to SwimRVA and started going to aqua jogging - which, as my friend Sarah says, sounds really lame so I should really call it "deep water running" - but I can never remember to call it that. Anyway, aqua jogging is a fantastic workout but it is also immensely boring and maddening. There is nothing more frustrating than pumping your arms and legs are hard as you can and going essentially nowhere. But I have kept to it faithfully, going at least once a week to the 6 am class. One morning, I watched a beautiful sunrise while standing in the parking lot of the aquatics center. I texted Kit, "You'd better be outside running this morning, watching this sunrise." A woman - another injured runner - who was in class with me often saw me standing out there and when I came inside she said, "You were wishing you were running, weren't you?"


Second, I started cycling long on the weekends. I had inherited a road bike from my friend Barbara, so I hauled it out and hit the Capital Trail with Kit on Sundays or did a route I felt relatively safe on in the mornings before work. I started buying cycling stuff - padded shorts being the first investment, followed by gloves and then clip in pedals. One Thursday night, I spent almost 45 minutes in my driveway trying to teach myself how to clip in. Eventually my friend Mark met me at a local cycling hot spot known as West Creek, where he helped me get the hang of clipping in and took me on my first successful clipped in ride. I was extremely proud of myself for not tipping over and smashing my face in.

Then, Mark let me borrow his wife's bike one weekend. Her bike was a carbon fiber road bike and after riding that beauty, I simply had to have one. On my way home that morning I stopped by a local bike shop to see how much an upgrade would cost me and was surprised at how relatively affordable it could be. I went home and talked to my husband about buying the bike and that afternoon, I went back and bought an aluminum road bike with carbon fiber fork. I named her Astrid then called Mark and told him he owed me $800.

I started doing longer and more challenging rides, hitting 40 miles on the weekends. But I refused to be called a cyclist or even entertain the thought of taking up triathlon. (There will be an entry on that one of these days). And I declare that I still strongly dislike it. It's just so much of a hassle. When I'm going cycling, I have to make sure that my bike rack is on the car, find my helmet and my gloves, my bike shoes, check my tires, wrestle the bike onto the car (which isn't so awful since Astrid is pretty light). When I get to where we're cycling, it takes me at least 10 minutes to get the bike off the car, change my shoes, get my gloves and helmet on, etc.

Running is so simple. You put you shoes and clothes on. You get in the car and 30 seconds later, you're running.

It's also not a very social activity. When you get going, the wind is too loud in your ears to really be able to talk to the person you are with and unless you're on an empty trail you can't ride next to each other either. I also find it terrifying. If you fall off a bike, you are really going to get screwed up. Yes, I've hurt myself falling while running but the amount of damage that can be done when taking a tumble off a bike is much worse. It didn't help that Mark told me tales of his epic bike crashes - one including being taken out by a deer! - or that I am already a nervous cyclist to begin with.

Anyway, cycling didn't help me with endorphins much, but I am grateful that I had it so that at least I was getting some kind of outdoor exercise. I got to know Mark much better as a result and also got to reconnect with Ed, who I used to run with on the Edge of Midnight during my first year of MTT. I always loved Ed's company and had missed him, so it was nice to ride with him (or more accurately, chase him because he's one super fast cyclist!).

I admit it was fun to reach new distance PRs and to cover so much ground in one morning. Saying I rode to Charles City Courthouse was a big achievement for me and one time Ed took Kit and I with him on a route from West Creek that took us far into the country. I had no idea where I was and it was kind of awesome. I still don't know, for the record.

And I do love Astrid.

Third, I did yoga faithfully on Tuesday nights and strength training with Kit on Mondays. By the end of the summer I could do 10-12 push ups, had mastered side planks and wild thing, and even my warrior three pose was much better (I hate warrior three). One day, I challenged Kit to a plank-off and beat him. My proudest moment, to be sure.

Despite all of this, I was still miserable.  I felt like I was falling further and further behind and losing all of running fitness. I desperately missed my friends. By early August, I was reaching the end of my rope. Nothing was working and I was ready to try the next level of treatment, so I started researching my options and narrowed them down to: 1) cortisone shot; 2) platelet rich plasma injections; 3) dry needling; or 4) a new outpatient surgical procedure called image guided tended treatment - otherwise known as Tenex.

Here is where I'll end part 2. I think it is worthwhile to tell you all about my researching and decision making process.

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