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Category: injury rehab

Plantar Fasciitis Recovery Update–Good to Go! (Hopefully)

Today, I wanted to culminate my plantar fasciitis posts by letting everyone know that I think I’m good to go!

Well, I hope I’m good to go. It’s been 9 weeks since I last ran, and so I’m going to test it out tomorrow to see how it responds. This week, I have started lower body weightlifting again, and the one lift I’ve added back into my routine is the front squat. I went up to 245# today for triples, so not very heavy. My foot didn’t hurt throughout the day, and the only soreness is on the outsides of the foot where my weight has been shifting throughout the 9 weeks. So, I’m a bit nervous, but I’m excited to test it out tomorrow.

One other thing I’ve noticed is that footwear makes a big difference. I’ve been walking around almost nonstop in my Nike Zoom Pegasus 33’s, even inside, unless I get a bit skittish about wearing shoes I’ve worn pretty much everywhere else inside my house. Then I’m wearing my Adidas Sequence 9’s, which I’ve not worn outside (except to put kids in the car) yet. I can wear my Cole Haan GrandOS shoes with my SuperFeet inserts, but my Nike Pegasus 33’s with the SuperFeet Insoles are by far the most comfortable combination. So anyone with non-chronic PF may want to try certainly the SuperFeet, but also the Pegasus 33’s. Don’t wear the Pegasus without some inserts or additional support, however, since the Pegasus is not very supportive at all. Try the Asics Gel Nimbus if you want a neutral shoe that has a bit more support. I thoroughly enjoyed those shoes, and would still run in them if they weren’t completely worn down. In fact, if I were to do it from scratch today, I’d probably rotate the Gel Nimbus and the Pegasus 33’s (of course with my SuperFeet) as my training combination. I’m not serious enough for racing flats…

If you’re struggling with plantar fasciitis, and it just won’t go away, my advice to you is to rest. Before I took 9 weeks off of running, I had been dealing with PF from April 9th through July 9th or so. I would let it rest just enough to not hurt through the day, and then I’d run on it and it would hurt for two or three days. I’d go on and off like this until I tried to run a 60-minute fartlek workout in late June and it felt like something popped. I thought I’d broken something or torn a foot muscle and scheduled a doctor’s appointment, only to have a diagnosis of PF confirmed by cortisone injection. That acute injury probably saved my running career, certainly in the near-term. If I had kept on running on it, it might have turned into a chronic PF case. So, if you don’t have money for doctors, etc.., my advice to you is to bite the bullet and rest. If you can see a doctor, go get a cortisone shot and rest. Don’t run on it for at least 6 weeks. Go swim, tackle some weightlifting or calisthenics goals, catch up on reading or family/friends time, gain some weight (not too much) and let the rest of your body recover as well. Have the discipline to shut it down and alter your race plans. From what I’ve read, rest is the only thing that works for most people, and if you’ve gotten PF from running, you’ve probably got an acute case that will respond to rest. So make sure you rest. Don’t go looking for a magic cure or secret that will help you recover fast. There is no such thing, and people who recover instantly have a unique natural history with the disease.

I’m so excited to get back running, even if I have gotten into a sort of rhythm with swimming. I bless God for recovery, and I am more passionate about staying fit than I was before. This injury has taught me that your physical strength and health is not a blessing to take lightly, and that you should enjoy it while you can.

Peace and Blessings. 

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Plantar Fasciitis Recovery, Week 5, Day 6

This past week has seen very little working out, quite a lot of rest, and quite a lot of celebration and retreat. While my foot is not perfect, I’ll be a bit confused if I won’t be able to resume my running after I meet the doctor this week. 

However, I am very thankful for the experiences that have led me away from my training momentarily. First off, we bought a car–a 2014 Ford Focus–and I love every bit about how it drives. Second, our family friends–really, family to Lucine–celebrated a daughter’s wedding. It was one of the best weddings I’ve been at in a couple years. Third, I attended the InterVarsity Northeast Faculty Conference at the University of Rhode Island in Kingston, RI. This meeting was a great blessing and encouragement to my soul. So while I miss the rhythm of dropping my kids off, training, then working, I have been greatly blessed by the events that have interrupted my normal schedule.

The rest, however, has been great for my foot. It doesn’t hurt as much anymore, even though I can still “feel” it, if that makes any sense. It is a bit stiff, even if it doesn’t hurt when I wake up in the morning. I’ve also been careful to be somewhat gentle with it. When I begin training, I won’t be treating it gently–except when I’m not running.

No additional updates. I’ll check back in after I see the doc this week!

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Joining the #mondaymiles crowd, and PF Week 4, Day 1 Update

I will be joining all those who use the #mondaymiles hashtag to remind me to journal my running and training exploits. I’ll post my #mondaymiles on Monday evenings after I put my kids to sleep but before I turn in for the night. This should be between 9:30 and 11:00pm most nights.

I’m a bit late for the first one, so let me start with a plantar fasciitis (PF) update. Today I visited the podiatrist’s office for a follow-up and a consultation. It’s not technically a consultation, but my wife now has me in the habit of making sure I bring questions to my doctor’s appointments, so I had a few questions I wanted to ask about my progress.

To cut to the chase, although I haven’t run in four weeks, he wanted me to have another cortisone shot and take at least two more weeks rest. He doesn’t believe I’ll require another cortisone shot, and he believes I’m doing well on the recovery. Since I have an acute case of plantar fasciitis (thank God!), there is some inflammation involved in mine (confirmed since the prior cortisone shot relieved any pain I felt almost immediately), and he was able to feel some differences in the swelling and warmth when comparing both of my heels. And with the reading that I’ve done myself, I’m willing to go along with his judgment (not that I have a choice). So it looks like this plantar fasciitis layoff will be 6 weeks, at a minimum from running. 

There is a lot to be thankful for, though. First off, I’m thankful for all of the runners, athletes, trainers, coaches, and medical professionals who write blogs and layperson resources about this condition. I would almost certainly have done something even more stupid than waiting three months to see a doctor about this. (Something like get the cortisone shot and continue training as planned.) I’m happy that it is an acute case and not a chronic case. The treatment and recovery timelines are totally different between the two types of PF. I’m thankful for my insurance. Even though it doesn’t cover orthotics, it does cover my appointments and so I am able to see the doctor. And I’m thankful that I have a gym membership that I can use to continue training even though I can’t run. For me, physical activity is critical to maintaining my overall health, and I count it as part of my workday because otherwise I’d probably be relying on some other form of medical intervention to maintain. So I am blessed to have the gym membership to LA Fitness. And I am blessed to have health and strength. 

This week,  I’m going to try to balance a desire to push myself in the gym with the reality that I don’t have that much time to devote to training. Besides, it can be a bit redundant to do pull-ups, pushups, and swim laps day in, day out. Also, whenever you do something daily, whatever it is, it can be hard to remember that consistency is the key. Moderating the intensity can be key to being consistent. But I’m starting to get bored, and I want to see how much I can progress my pull-ups, especially. I’m not necessarily doing the Armstrong plan, but I haven’t given up on my 20 pull-ups goal.

Be blessed everyone. See you next week Monday.

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PF Recovery, Week 2, Day 5

We’re already 5 days into week 2 (or 3, depending on how you’re counting)! I stopped giving you all updates on the day-to-day because since I’m not running, it doesn’t change much. No or minimal heel pain, go to the gym, lift, swim, work, wash/rinse/repeat. So I’m not writing every day, even though every day I’m learning about PF.

That said, I did remember I’m supposed to be telling you all what I’m doing to deal with this thing. I’ve already made clear in a few of my earlier posts that PF is unique to each person–no treatment plan is 100% foolproof. I’ve told you I roll my foot on a frozen ice bottle for self myofacial release. I’ve also already told you that there is no substitute for the miracle cure. The miracle cure is the most important thing. If you are an athlete and acute PF bites you, humble yourself and shut it down for a few weeks. Err on the side of more, not less rest for the sake of your long-term sanity (I mean, running). Seriously, shut it down. If professionals can do it, us mortal amateurs can afford the time off.

Now, back to what I’m doing/using for PF besides the miracle cure. Today, I’ll talk about my inserts. I have been wearing the Superfeet Green insoles.

I bought mine here in Baltimore from Charm City Run Timonium, but you can do the online thing if you’d like. When I’m not in a pool or a shower, these things are under my feet. I have a pair of new sneakers (more on those later) that I wear only in the house with these in, but I take out the factory inserts in every other pair of shoes I wear and put these things in. They are exceptional. If you use a cheap pair of penny loafers (when I first bought these 5 years ago, that’s what I had) or dress slide-in shoes, these will not feel good. But this time around, these feel very supportive, and firm, while still allowing the cushioning system of the shoe itself to work. It took some time to get used to, and I don’t wear some of my shoes because the insert-shoe combination causes some knee pain in my “good” leg. As Flossy Carter would say, this is a real review. I paid for this with my own money, and I use it in my own life. These insoles are the real deal, and this has remained true even after the cortisone has worn off. I haven’t run in them yet, but they are my daily drivers in the gym and nothing else about my routine has changed (except no deadlifts/squats/burpees).

Another thing that’s hit me while researching and reading about this insanely irritating condition. So many people are trying to make money off this thing. Consider this: every single video or blog I’ve watched or read has substantial spam about “natural cures” for PF or “cure your PF in 3 days!” or something of that sort. So many people have this thing, and it is so irritating because nobody knows how to cure it, lol. That said, I have found some resources that seem truthful, including Dr. Julia Overstreet. Her video is the best resource I’ve seen on PF that you can consume in under 20 minutes, hands-down, when you take into account the quality of the information with respect to the science, and the honesty of the information. In it, she describes how she directs her patients to use over-the-counter inserts first to see if symptoms subside, and of c0urse, Superfeet Green makes an appearance. This is because when OTC are compared in clinical trials to prescription orthotics, there is no statistical difference.

Happy running! God bless.

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PF Recovery, Week 1 Recap

So what have I learned after taking two weeks of rest with plantar fasciitis? I’ve learned that no one knows much of anything about this condition, and I’ve learned that swimming is a lot of fun. I’ve also learned that exercise can be immensely pleasurable.

I’ve felt, at least for the past 8 years or so, that whenever I was exercising, I was stealing time from someone or something that was more worthy of it–family, work, church, or some combination of those three. I justified it to myself by saying that I needed to stay fit because of health, knowing that I want to avoid any number of Western diseases. While that justification might work if I were an extreme workaholic and never paid my diet or lifestyle, it is very difficult to use that justification for anything remotely performance oriented.

What plantar fasciitis has done for me is made me reject feelings of guilt that may crop up when I’m enjoying a workout or planning a race goal. Plantar fasciitis, for me, has made me realize that these things don’t last forever. More than that, your body and soul are made for pleasure and not just obligation. If one is built for strength and power, or if one likes endurance sports, these are legitimate pleasures to be enjoyed while they can be.

I have nothing much to say PF-specific because, of course, there is nothing much specific to say. Except that for most cases the miracle cure is something no one tries: rest. Of course there are a few additional components to your recovery protocol, including strengthening exercises, calf stretches, and OTC orthotics, but for most cases-especially in athletes-it’s just time to shut it down for a while. Unfortunately, PF and other repetitive strain injuries don’t come at the most convenient times, and most people are not willing to take the time off. So every day that I am forced to take a day off of running makes me all the more grateful for the miles that I have, and will, run.

I’m not sure I’ll write daily about PF, but I’ll be sure to provide a weekly update. Hope you are enjoying your favorite workout!

Peace and Blessings.

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PF Recovery, Day 5

Another day pain free in the heel, but now have to figure out how to strengthen and loosen my calves. Those feel a bit tight from the calf raises I’ve been doing–specifically the seated calf raises–and so I’ll be taking it slow there. My calves have always given me problems, especially as I increase the running volume whenever I start a training block. What I’ve noticed after doing a lot more one-legged bridges in my general conditioning program is that when my left leg is on the ground, my lower back muscles on the right hand side are much weaker compared with when my right leg is on the ground and my left side lower back muscles are stabilizing. Almost certainly this has an effect on my calves, it’s just that I have no way of predicting the effects with any precision. It is mostly an issue when I’m doing hill sprints or anything less than 200m.

As I think about it, this is possibly the reason I’m dealing with PF in the first place. Not only are my calves weaker than they used to be, but since my hips and core are not balanced, my left calf and foot had to transfer a greater proportion of force to the ground than my right calf and foot. It probably also didn’t help that my right calf had been strained, and I probably didn’t wait long enough for it to recover. As if injuries weren’t complex enough, trying to sort out the ultimate cause can be an intractable puzzle in itself.

Well, my body is feeling great, calves aside, and I’ve never been as strong above my hips as I am now. In the last six months, I’ve set personal bests in every lift that I do {pullups, bench, incline bench, deadlift, barbell row} except for pushup, and that’s only because I find doing high volumes of pushups (or anything else besides running, for that matter) tedious. Swimming has helped keep the feeling you get from a good cardiovascular workout, at least for me. When I’m only lifting, not only do I gain weight quickly, but I just feel heavy and my mind is not as sharp. When I’m doing aerobic-heavy workouts, I’m always tired. So the circuit-based training I’m doing based on pushups, pullups (and squats/deadlifts when my foot recovers) has preserved enough time for the aerobic workouts I need to feel healthy.

Before I close, let me share two great posts on PF from Strength +Running. The first is an overview of PF rehab, and the second is a summary of the process. Again, evidence-based, extremely helpful stuff that fits into an overall wellness philosophy.

And before I go to work, let me take a moment to share a brief reflection on 2 Corinthians 4:16 [NIV]-“Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.” As an amateur athlete who believes fitness is a critical component of your whole health, it is nonetheless true that we *will* decline. Our strength will not remain, and we will not be able to keep what we have gained in our bodies. We as athletes reject this truth, but unfortunately truth cannot be rejected. However, we can learn to be renewed daily in Christ. This renewal takes a trajectory from the periphery of spiritual experience into the core of life in God as we transition from this life. While it is of considerable value to develop our bodies, we must take care that we are not neglecting the soul. The natural course is for both your soul and your bodies to be wasting away. We have the choice to avoid the decay of only one of these. Please be sure you are spending your life wisely in this regard.

Peace and Blessings.

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PF Recovery, Day 4

4 days pain free! Even on first step out of bed…

I never thought I’d be saying that so soon, but it’s true. Hopefully it’s not just the cortisone, but that there is some healing going on as a result of wearing the inserts and avoiding running. It’s been two weeks tomorrow since I’ve run on the foot, and I’m getting antsy, but am just glad I can continue to stay fit by going to the gym and swimming. I’m very thankful for that.

I’ve also been thinking a lot about this, and I’m definitely modifying my goal for this fall. I’m certainly not doing the marathon, and I think I’ll defer Richmond until next year because I really want to run Richmond. I will pick a 13.1-miler or 10K, and use the training to establish a base that will help me reach my goals of a 6 minute mile and a 75 minute 10-miler.

Revising my goal will allow me to be flexible about really listening to my body and my foot, rebuilding some of the lower body coordination and strength I may have lost due to not lifting heavy squats/deadlifts and not doing hill sprints, and changing the way I work in faster intervals.

PF is a really remarkable thing. As I said, there were a couple very interesting posts here and here on PF I found informative on runresearchjunkie.com. These posts (aside from a YouTube video I have to find the link for you for) are hands-down the most informative and credible pieces on PF written for the general audience. Virtually everything else I’ve read is either solely anecdotal accounts or polemical position-focused writing. 

Both articles deal with the science of PF’s etiology, natural history, and effectiveness of treatment strategies. You should read runresearchjunkie’s write-ups, for sure, but the rundown is as follows. First, there seem to be relatively few effective treatments when compared with the natural history (i.e., course of PF without any intervention or treatment). These effective treatments are basically limited to *rest*(!!, which I guess to some folks is the same as natural history), low-dye taping, orthotics, and cortisone shots. Almost everything else you see advocated as effective courses of treatment have not been demonstrated in randomized, controlled clinical trials (RCTs).

Now, if you read the running blogs or do a quick Google search of “plantar fasciitis treatment running” or some combination of plantar fasciitis and athletics, you will believe that the treatments I’ve described are wholly ineffective. First off, many writers seem to believe that cortisone therapies are actually harmful, when in fact, they are demonstrated in RCTs to be effective. I believe much of the controversy centers on the risk of PF rupture. As I wrote previously, PF rupture seems to be associated with cortisone shots when the drug is administered wrongly, or the athlete decides to return to normal activities too soon. Orthotics are another controversial treatment, if you were to believe the anecdotes on running blogs, etc. Some people swear they are worthless. However, one must be careful to define what is meant by “orthotic.” First off, if orthotic includes custom and generic, then it is clear that orthotics are effective. The question seems to be, “Should I sink $100s into custom orthotics or buy a good off-the-shelf orthotic?” The answer to this question is, in fact, more equivocal, with some podiatrists instructing their patients to purchase OTC orthotics before they try prescription orthotics. Nonetheless, orthotics are clearly effective, and demonstrated so in  RCTs.

I think that the problem seems to be in the tension between the expectations of the athletes and the reality of PF. First off, just because a treatment is demonstrated effective, doesn’t mean that it is foolproof. For example, suppose the natural history (course without treatment) of PF is that 50% of patients are returned to normal activity after 4 weeks of rest (I’m just throwing these numbers out there as examples). Well, if cortisone returns 55% of patients to normal activity after 4 weeks of rest in an RCT, then cortisone would be demonstrated an effective treatment. But, what this says is that there is a relatively small effect size (true for almost all PF treatments, regardless of the actual numbers) meaning that there is relatively small improvement in treatment efficacy over the natural history. When athlete sees a doctor or a physical therapist, what they want is fool-proof, not something slightly better than their current inability to perform. Yet, that’s what you get with most PF treatments, and hence why there’s so much controversy and passionate debate about this topic based in anecdotes and personal experiences. PF takes time, rest, and seems to resolve itself over time. The control of this recovery, unlike the recovery from many other types of injuries an athlete can suffer, is simply out of their–or their care provider’s–control.

If you have PF, you know that it tests your ability to trust the process and be patient. Have you had PF? Are you able to let go and listen to your body while letting the process work?

Peace and blessings.

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PF Recovery, Day 2

The cortisone is still working, although I feel like it may be starting to wear off and that I’ll be able to rely on cues from my foot if I do something I’m not supposed to. All that to say, still no pain. 

Now about that cross training. I basically do a circuit weight training workout for about 20-40 minutes and then swim anywhere from 10-25 minutes depending on how much time I have. I am planning to build the swim up to 40 minutes 2x per week, and about 20 3-4x per week. For weights, I emphasize pullups, weighted push-ups, and planks. I always superset the pullups and push-ups with one of the following: stability ball hamstring curls, lunges, cossack squats, and single leg squats. No heavy squats or deadlifts right now, but I’ll add those back in once I’m clear to run a bit more. 

This is comfortable for me because I am trying to be a well rounded athlete, not necessarily the best “runner” I can be. I want to run, but I also want to look and feel strong and powerful. So my workout hasn’t changed much from what I usually do, just no heavy squats, deadlifts, or burpees. 

As the month wears on, I may need to experiment with cycling. I don’t want to since I don’t think stationary cycling simulates road cycling, and I’m enjoying swimming, but I want to avoid overuse injuries in my shoulders since those are the most important joints for weightlifting. If I hurt my shoulders, I’m not sure what, if any, strength exercises one can do, so I don’t want to overdo swimming even though I like it quite a lot. 

Maybe one of these days, I’ll type up some of my log and post it for you. What do you do for cross training? 

Tomorrow, adding back in calf raises and stretching exercises. Hope there are no surprises after cortisone. And, here’s a link to a very interesting post here and here on PF I found informative. Maybe some thoughts on those links tomorrow. 

Peace and blessings. 

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PF Recovery, Day 1

Plantar fasciitis makes you grateful and very thankful that you have the physical ability to run, lift (somewhat) heavy things, and move through almost any natural pattern without pain. Because plantar fasciitis seemingly comes from nowhere, and apparently goes away of its own accord.

However, on my first day of what I’m calling “plantar fasciitis (PF) recovery” I am just thankful. I am thankful that I learned to swim well enough to get a decent workout in the pool and develop some cardiovascular fitness. I am thankful that I can still do enough lifting to keep my weight stable and still look strong. I am also thankful I have good insurance and can see the doctor.

You see, the most important thing for PF, I’m realizing, is rest. A lot of it. Preferably no running. So every time I complain to myself I can’t run, I remember how thankful I am for the fact that running is still in my future. 

But yes, the most important thing for PF, at least for me, is rest. A lot of it. I haven’t run pain-free (afterwards) for nearly 3 months now. This is probably because I never gave my foot the rest it needed to recover. Each time I would feel my PF getting better (after 2 or 3 days of no running and swimming/weights as my cross-training–sometimes as much as a week), I would go run. The run would feel awesome, but the rest of the workday and when I wake up my foot would be incredibly painful. I would always be tempted to run after it feels even a bit better, but after calling the doctor’s office, two visits, and a referral to the podiatrist, I am now accepting the fact I need to submit to extended rest. At least 4 weeks of it.

This is because the podiatrist made me (can I say that?) take a cortisone shot. Let me tell you, that thing is amazing. Instantly pain free, for me (especially since my PF was feeling better after taking a week off before the podiatrist). When I say instant, I mean once he took the needle out, it was as if my PF was normal again. 

However, if you have PF and you get a cortisone shot, by no means or under no circumstances run on your foot–not even if you’re going to miss your train to work!

This was what was going through my mind yesterday and this morning while I was thinking about all this. A quick Google search will reveal how controversial the cortisone shot is in the running community. Some say absolutely not unless you are seriously considering surgery. Others say there’s nothing at all to worry about. The main two side effects that other runners have reported experiencing are complete rupture of the PF and/or fat pat atrophy. However, reading some of the critical reviews you can find on PubMed, you come away with the impression that a good portion of this is due to two things: poor administration of the cortisone and continuing to exercise during the healing period. I have read that the most critical time after the cortisone shot is 2-3 days after administration. It is during this time that the short-term cortisone makes the tendons the weakest, and so if you run while the foot feels amazing after the cortisone (and it feels truly amazing!), you are at the very least risking long-term chronic PF injury, and complete PF rupture at the worst.

Therein lies the rub. To most athletes, let alone running, the cortisone shot would make a return to full activity so tempting. In my reading it seems a lot of us have gotten into this trouble because we are pushing the envelope in the first place and trying to prepare for a goal race or competition. Once PF hits, whatever goals one may have had must certainly be revised. But who wants to lose fitness during a training cycle? Once you have the cortisone, it can be incredibly difficult to resist a workout. Especially if your foot feels amazing like mine does. Don’t risk it. You won’t feel the damage, but damage will certainly be done. When the cortisone wears off, oh boy…

That’s the weirdest part of all this. My foot feels amazing, but I know it’s not healthy. I’ve read enough to know not to mess with this so early on. So it feels like my mind is playing tricks on me because I still act as if it is delicate, but there is absolutely no pain. My worst nightmare is if something I do now makes it much worse since I’ll have no immediate feedback until much later after the damage.

Anyways, I guess the short of it all for day 1 is: cortisone is an absolutely beautiful thing. I believe there will be no horror stories on the other side. And, yes, I will take the 4 weeks off. The horror stories of runners who’ve pushed through on the cortisone are very persuasive! I won’t be adding to the list. 

For day 2, I’ll describe my cross-training and some of the exercises I believe were making a big difference over the first week before the shot. I’m taking a break from them until after the third day post-shot, but my foot was feeling a great deal better and so I think they were doing something for me. 

A bientôt.

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