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the fertile paradox Posts

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 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 3

This was a rest day, since I try not to workout on Sundays. Did a few calf raises here and there, all without pain. I’ll say more on Monday after I have a chance to swim. 

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 bient├┤t.

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make haste slowly… plantar fasciitis recovery!

Source: The Mind Body Whisperer

This week was┬áThese past two weeks were tough and called into question whether I am even going to attempt this marathon. I’m dealing with plantar fasciitis, and now am looking at a lengthy layoff of at least 2-3 weeks one month [the Dr. said “be good”, and I figure if all I have to give up is one month for pain free running, I can do it, hard as it will be]. Because it is very early in the cycle, there is a chance I can recover early enough to start a buildup. [The good thing about writing out, by hand, a calendar through race day is that you have a tangible picture of exactly how long there is between now and race day.]

It is crucial at this point to make haste slowly. On the one hand, I had to research what the injury meant, what types of exercises rehabbed the injury, and a recovery timetable. I had to make doctor’s appointments, research and purchase footwear and inserts, do x-rays, all with 2 and 5 year-old in tow.

I wish this injury was just like a muscle strain. Rest a couple days, take it easy a couple more, in a week back good as new. Unfortunately, recovery times from plantar fasciitis seem to be all over the map. Some recover quickly and don’t miss any time, while others take quite a bit longer. Hence, one must be deliberate about the subsequent buildup to fitness, and be thoughtful about everything related to fitness, including thinking about how to develop aerobic fitness while not running.

It is tempting to give the whole race up and say this is all too hard. One might even say that running a marathon is altogether stupid. But I’m not willing to give it up just yet. I believe my foot will be healed, and that I will recover. I believe God will bring me through this.

At the same time, my body is getting used to working out 6 days per week. I have been doing more general strength and conditioning, and swimming for some moderate cardio. The pattern is helpful in establishing some initial level of acclimatization to the fatigue running training will entail. And, my weight is somewhat stable, and will probably start dropping more once I’m regularly running.

One thing I may consider doing is writing about my personal struggle with plantar fasciitis, and treat this as a narrative case study. I read quite a lot of information online, especially about shoes and the standard fasciitis/fasciosis blather, but very little from an actual runner’s perspective. [One very helpful post was The Running Man’s “How to Beat Plantar Fasciitis”, though. I was trying to avoid the long layoff, but that’s precisely what’s been prescribed.] The information about shoes was especially terrible. To make matters worse, it seems it is very individualistic, so what I say may not matter much. Nonetheless, I will try and share my experiences so that others can be helped by a real, no-ads, no-ambassador, no-fluff, amateur athlete perspective when researching their own situation. No promises on schedule or regularity of posting, but I’ll do my best.

Here’s looking to what this month will bring in terms of recovery and perseverance.

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run the race to win

What does it mean to “run in such a way as to get the prize”? (1 Corinthians 9:24-27)

Whatever it means, it is not just talking about the race. While the race is the focus and the ultimate goal of one’s training and attention, the race is simply the part of the athlete’s life that is seen by all. The race is much more about the preparation coming beforehand.

Ever since I’ve started taking up distance running as an amateur pursuit, and not just as an accessory to basketball and soccer training, I’ve been struck by how much my race times are predictable once I take a look back at my training log. There is so much truth to this that if I’d truly understood this in high school, I’d have been a much different–and much better–track and field athlete. (I would have been an excellent 300m/400m hurdler, or a decent 200m sprinter). This is because I’d have taken much more care to steward my training and my body very carefully. The goal would be the peak at the conference and regional championships (as a sophomore or junior) or regional and state championships (as a junior or senior). Every moment before then would be taken in light of the ultimate goal of winning one of these races.

In the middle distance events, I found that there is still much more variability than in distances exceeding 10k. Between 1500 to 10,000m, there is a delicate balance between tactics and talent that reveals what is in the heart of the most talented runners. If you are one who is head and shoulders above the rest of the field–and believe that is true–then you can run a fast, honest pace from the gun. This reminds me of Genzebe Dibaba and Sifan Hassan racing to break the world record at 5000m. They knew the race was among only two runners, and from the gun ran with such confident assurance. However, when the best racers equivocate, it leaves room for the less talented runners to steal a victory. As much as I love Leo Manzano, he has no business with an Olympic bronze medal at 1500m. In this case, the less talented runners race with grit and faith, while the more talented runners race with doubt and fear. At its essence, this is what makes a tactical race fun to watch–despite the often pedestrian paces.

For the longer distances, however, it is very much like the sprints. Everyone knows the one or two individuals who will have a real shot at winning. This is because there is very, very little room for error. While these races are given somewhat to tactics, they are principally determined by the condition of the physiological systems of the racers. Therefore, the training is an accurate indicator of the fitness and race capability of the racers. For sprints and distance events exceeding 10 miles, there is very little left to chance barring injury or other accident.

This is where we return to the statement above: “run in such a way as to get the prize.” You cannot run to get the price starting with the gun. The racing begins in the training so that the athlete is transformed into one who is able to get the prize. Your physiological systems must be different when the gun goes off than they were when you started training towards the event. World class athletes know this, and approach their training with the same methodical precision as a world class researcher. While the effort is not the same in each session, every session has a purpose. Each moment has a place in the athlete’s teleological transformation. This is how our lives with God should be viewed. Each moment is not the same. However, we must approach each of our days with God intending to be transformed into one who thinks His thoughts and knows His ways. We do not run the race once we enter His presence, because that is the end, the peak, not the race itself. The race is to be transformed into Christ’s likeness by having our minds renewed daily through interaction with Him, His Word, and His people.

We must run the race so as to win the prize. How will you run your race for the glory of God today?

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What’s behind the door?

Imagine that you were standing in front of a door that had everything you have ever desired or wanted behind it. If you were told you could have everything behind the door, would you be able to open it?

This is one of the illustrations James K.A. Smith uses when he tries to convince us that we are fundamentally lovers, not thinkers. In his lecture “You Are What You Love,” he makes a compelling case that we are creatures of desire. The narratives that arouse the most desire in us are the ones that direct our thoughts and actions. These desires are so deep that we are not always aware of them. So, while we know what we should say when someone asks us what we should desire, chances are that we love something altogether different. For most people, this should be a harrowing idea.

I’m not sure I would have the courage to open the door. 

I know what I should say when someone asks me what I love. I love the Lord Jesus Christ and want to see Him glorified. I love my wife and my kids and want to give selflessly to them. I love other people and want to see their lives improved. But when I actually reflect on what my actions say about who I love, I love myself. I want to be king over my life, unconditionally. I want my kids to do what I say as soon as I say it. I want my wife to do what I want. I want to be served and not to serve anyone else.

In light of Christ’s commands, I don’t want to open that door. Especially not in front of Him.

I know that my inner life needs to be renovated and re-created. I want my desires to truly be re-made before I come to see Him. If I can be honest, the thought of divine judgment is terrifying because I know that I would hesitate to open that door.

It’s a good thing that God knows we would hesitate. James K.A. Smith paraphrases an important Biblical command by saying “The beginning of all wisdom is to know we don’t desire God.” At this point, it is clear to us that we cannot do this on our own–we need the Holy Sprit’s intervention. We need Him to help us imitate the desires of Christ. Ultimately, this is the goal of Christian discipleship, that our desires would be the same as those of the Lord Jesus Christ. The loves that drive us would be the same as His loves. Our deepest unconscious desires would glorify Him by second-nature.

While I would be absolutely terrified to open the door today, the song “Just Want You” by Travis Greene is my prayer today. Would you make it yours?

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mind matters

Physical training consumes the body but principally reveals what is in your mind. It doesn’t matter what type of physical training, all of them teach you about what is in your mind.

In fact, the lessons are all the same, but only the medium or emphasis is different. Have you learned how to listen to what your body is saying? Can you be consistently committed? Can you effectively envision the accomplishment of a challenging goal well before it happens? Can you plan for that vision? Can you keep the big picture in mind? Can you keep from being distracted from the vision when things are not going well?

This week, dealing with plantar fasciitis has challenged me to revisit all of this. Not because it is so bad that I have to stop training. No, but I was feeling down towards the end of this week because I realized that I have to lose some weight to accomplish my goals and help to address the plantar fasciitis. Why does losing weight challenge what is in your mind? Because you have enough to make substantial life changes over a long period of time to be successful.

In the short term, I think about how hard this will be. How hungry you always get when training. How inconvenient it is to manage what goes into your mouth when you just want to stop being hungry. But the next day, I was reminded of the challenges and opportunities. First, if I am able to make the weight loss goal I want, I will be able to be much more confident in setting and achieving my goal time. Second, I got a body fat reading at the gym, and it was much higher than I expected. So if I can meet my goal, I can get closer to my target body fat measurement as well. Third, I’m not sure it’s good to have a high BMI, even if one is muscular or functionally fit. Your heart can’t tell the difference, and it would still be stressed. So, if I meet my goal I’d be lowering a long term health risk factor for several chronic diseases.

Training and managing my diet will test me. But, at least I’ve got an even bigger picture in mind. Thoughts or suggestions, anyone?

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