The Wailin' Bitch Trials - The Strassburg Sock

Today, I begin a series of posts on the various treatment options I have tried to cure my plantar fasciitis.  This injury has been so annoyingly persistent, that I have "lovingly" called it "The Bitch."  (starting back with my first post entlted "The Plantar Fascia: That Fickle Bitch," and continued a couples weeks ago with "The Bitch is Back").  So, in keeping with that theme, I bring you the "Wailin' Bitch Trials" (get it?  It almost sounds like "Salem Witch Trials"... and PF is painful, so you wail in pain... shut up, I thought it was clever).

For any treatment where I tried a specific product, I will write up a review of the product.  The first product I ever tried to treat PF was the "Strassburg Sock," which is this weird looking contraption:

It feels just as weird, too

I mentioned Strassburg back in "That Fickle Bitch."  The purpose of the Sock is to keep your foot flexed while you sleep at night because both the plantar fascia and the calf (which pulls on the plantar fascia indirectly when it is tight) tighten up when you sleep.  I think it is also supposed to increase blood flow to the plantar fascia while you sleep to help heal it.

Plantar Fasciitis: The Bitch is Back

In my first incarnation of this blog, I wrote a lengthy post about plantar fasciitis, lovingly entitled The Plantar Fascia - That Fickle Bitch.  Well, as Sir Elton so colorfully sang, The Bitch is Back.  Yep, I've been struggling with one of the Five Horsemen of the Runner's Apocalypse (the others being (1) "Runner's Knee" (patellofemoral pain syndrome), (2) illiotibial band syndrome (ITBS, which I have also suffered from), (3) achilles tendinitis, and (4) shin splints)).

For anyone else who has suffered from plantar fasciitis (which I'll call "PF" because it's a pain in the ass to type out), it isn't always an incredibly painful ailment (although it certainly can be), but it is an annoyingly nagging injury that is really, really hard to get rid of (short of just not running... which isn't really an option for me, since I have the Twin Cities Marathon and the WDW Goofy Challenge coming up).  And, if you're afflicted with this asshole of an injury, you're willing to try just about anything to alleviate, and hopefully heal it.

I am no exception.

Back in the Saddle

It's been over two weeks since I ran last... but this morning, I dragged myself out of bed early and ran an easy 3.5 miles.  It went mostly fine, but my plantar fascia (PF) is still hurting me... I really hope I can kick this before I get into heavy training for the TC Marathon.


Enjoy your Tuesday!

Updates

You may have noticed a lack of posts about training since I ran the Lincoln Half Marathon earlier this month... Well, that's because I haven't run (or done anything physical) since that race.

As you may have surmised from some of my posts, I have been very busy with work all Spring, and I've been using the past couple weeks as a chance to get in a bit earlier to work and to rest up and (hopefully) get my plantar fasciitis and my ITBS mostly healed before I start training for the Twin Cities Marathon.

Here are my blogging and running plans for the next few weeks... in case you cared:

1. Start running again  - I'm going to do a couple easy runs this week, (hopefully the first tomorrow morning), and then a long-ish run this weekend (7-8 miles).
2. Injury Updates - sharp-reading fans of the blog will notice I slipped in references to plantar fasciitis (PF) and illiotibial band syndrome (ITBS) above... yep, I've been suffering from these two maladies, which are two of the most common suffered by runners (other than sprained ankles).  I've already done a pretty extensive post on PF (back when I experienced it back in 2009), but I plan on writing a follow-up on what I've been doing to try and treat this condition this spring and summer.  I'll also do a similar, semi-detailed write up on ITBS.
3. TC Marathon Training Plan - this will be a bit more in the future (mid-to-late June), but I want to write up my training plan for my first marathon (eeek!).
4. Running Goals - finally, I started the year with some running goals for 2012.  I want to see where I stand with them (hint, I've already achieved a couple of them), and I want to reevaluate and modify them as necessary.

Thanks for sticking with me so far... I hope you enjoy the "ride" (the boring, long-winded, ride)

February 2012 - A month I'd rather forget

February 2012 is finally done and it was kind of a terrible running month for me.  (It wasn't the greatest month at work either, but I'm going to keep my professional life out of this blog... because I don't want to bore you with the exciting life of a patent attorney).

I started the month injured with a soleus strain.  Technically, I got injured in January, but the rest and recovery for it basically shot the first two weeks of February.  Then, because of the injury and other issues, my endurance has taken a real hit and I've been unable to hit my target paces (by a LOT) during my training runs, particularly on my long runs.  Unless this weekends long run is better, I'm probably going to pull back my target paces again (and since it's probably only 50/50 that I'll even be able to run outside, I'm thinking I won't hit this weekend's target either).

I know these "problems" are pretty minor compared to a lot of people's lives... Heck, I know these "problems" are minor compared to some people's running problems (my injury was relatively minor, nothing like a stress fracture or some lingering, 6-month long knee injury), and really all this means is I probably won't PR in the Half Marathon in May.  Oh well.  But, this Half in May was really my only chance to PR in the Half for awhile, since I'll be focusing on a Full Marathon for this fall, then (hopefully) on gearing up for the Goofy Challenge next January.

After that, I'm going to have to scale back training immensely because my wife and I plan on adding a 3rd little runner sometime in 2013, and the long training for Halfs and full marathons is not really conducive to taking care of two toddlers and a pregnant wife, and then taking care of two toddlers and a newborn.  I may be able to do a more toned-down training program and run a Half here and there, but I won't be able to put in the time for a "serious" training program.  Instead, I'll probably focus on 5Ks and 10Ks.

OK, I'm thinking about this way too much, and I just need to calm down and focus on my next run (a 2x2 mi. tempo run).  Enjoy March, because February is finally over (thank God).

Uh oh... I may have a Soleus Strain

On Wednesday, during a speed interval workout on the treadmill, I had some pain in my right calf toward the end of the workout.  I tried to stretch it out well and I iced it later that morning, but otherwise I just thought maybe that leg got worked harder for some reason (no reason why that would have happened), and that after a full day off (yesterday was a swimming workout, so no weight on the calf) I would be good to go.

Well, this morning, I was supposed to run a 5 mile tempo run.  I started out with a slow warm up jog, but only about 6 minutes into that warmup, I felt a sharper pain in the same spot in my calf.  Rather than risk really screwing this up worse, I stopped running and walked home.

After a short bit of research online (dubious, I know), I think I have a minor soleus strain (it could be a gastrocnemius strain as well, but based on where the pain is, I'm guessing soleus).  Unfortunately, that kind of injury appears to require at least a full week to 10 days off from running (and if it is a more severe strain, this could require a few weeks off).  I'm hoping that it is still just a tweak, and that since I basically took today off, and tomorrow is a full off day (no exercise at all), I will be fine by Sunday (when I supposed to do a 9 mile long run).  But, if it still hurts on Sunday, I guess I'll have to resign myself to a week or two of swimming (which will be great for my general fitness, but will throw a big wrench in my Lincoln Half Marathon training plan).

More on this story as it develops.

The Plantar Fascia: That Fickle Bitch

One of the most common injuries experienced by runners is plantar fasciitis (often incorrectly referred to as a heel spur, which is technically a different, but often related, injury). And like the hundreds and thousands of runners before me who have experienced the pain of PF, I too am afflicted with this condition. In fact, I had a mild case of PF for over a year (even when I wasn't running) and didn't really know what it was.

What is Plantar Fasciitis?
According to one of the best websites on the subject, heelspurs.com, "plantar fasciitis (pronounced PLAN-ter fa-shee-EYE-tiss) is an inflamation of the plantar fascia in your foot. The plantar fascia is a large band of connective tissue between your heel and the ball of your foot, and it acts to support your arch when you walk. The plantar fascia experiences tension as you lift your back heel off the ground when you walk or run. The tension is greatly increased (leading to PF) when the calf muscle is tight and inflexible. The following two pictures (again, from the wonderful site heelspurs.com) show the plantar fascia and the most common point of pain for PF.





The "Pain Often here" spot on the second picture is exactly where I felt a sharp stabbing pain when I walked, particularly after I started ramping up my running to about 15 miles per week back in April. The weird thing about PF is it hurts the worst right when you get up in the morning, and it gets progessively less painful throughout the day. For me, the pain usually went away completely when I ran, so I never equated it with running until I looked into it more. The reason PF hurts the worst in the morning is when you sleep, your feet generally flatten out, releasing the tension in your calves and causing them to tighten so that when you get up and start to walk, your plantar fascia starts screaming because the tension on the plantar fascia increases as the calf gets tighter and more inflexible. Similarly, PF pain tends to go away as you walk or run around because your calves warm up and become less tight, relieve the tension on your plantar fascia.

Unfortunately, there is no quick treatment for PF. Also, while resting (i.e. laying of on exercise) helps, it often isn't enough to cure PF (unless you are able to remain in bed 24/7 for an extended period of time). You pretty much have to stick with some common sense remedies for a long period of time to reduce or eliminate the extra stress on your plantar fascia while the inflammation heals. Here are the treatments I have used that have helped reduce, and on some days eliminate, my PF pain.
1. Stretching - Regular calf stretches help a lot. I do a couple pushing up against a wall (the "Gastroc" and "Soleus" stretches demonstrated here). Another that helps me a lot (although you have to be careful not to overstretch) is to stand on the edge of a stair step on the balls or toes of my feet (either both feet, or you can isolate your left or right calves) while slowly lowering my heels below the level of the step. You have to be careful with this method, because it can lead to injury to the plantar fascia or the achilles tendon, but if done slowly and carefully, it has worked wonders for me.
2. Strassburg Sock/Night Splint - Technically, this is really another form of stretching, but it was quite new and different for me, and I suspect for many others too. You wear one of these at night to keep your foot flexed instead of laying flat. This keeps your calf stretched throughout the night to prevent the tightening described above. I have used the Strassburg most nights for a few weeks, and the difference was remarkable. I noticed a big difference the very first night I wore it. In fact, when I was forced to stop wearing the Strassburg for a week and a half to avoid aggravating my toe injury (which was on the same foot as my PF), I noticed an almost immediate worsening of symptoms, particularly in the mornings. The Strassburg Sock takes some time to get used to, so you may have one or two nights of less than ideal sleep, but I don't notice it much anymore. I have heard the same about night splints. Of all the treatments so far, I think the Strassburg, and possibly insoles (discussed next), have made the most difference.
3. Insoles/Orthotics - arch support is very important to avoid and treat PF. I credit wearing insoles with great arch support for really helping me to keep the PF pain at bay and to help me get better while I'm doing all the other treatments. At the recommendation of heelspurs.com, I got Powersteps (the original Powersteps for my day to day shoes, and Pinnacles for my running shows), which have been a godsend. Once I got used to wearing insoles with such aggressive arch support (which took a couple days), I noticed a big reduction in PF pain, even on days when I hadn't worn my Strassburg, stretched much, or iced my arch (discussed below). There are other good over-the-counter insoles out there (I have also used Superfeet, which are OK, and Sole, which could be great but the arch support hit my foot at the wrong spot and caused a huge blister... and Spenco seems to have been the industry "standard" for awhile), but the Powersteps seem to come the most highly recommended by podiatrists. Powersteps were a little harder to find (I had to trek out to a specialty running shop in St. Paul, which is way out of my way) but they are worth it for reduced foot pain.
4. Ice - ice is also great because it helps control plantar fascia inflammation. I purchased a couple of great general purpose, reusable ice packs from Target (there are also specialty ice packs designed specifically for ankle and foot injuries, like the ActiveWrap, but these seemed overly expensive and even harder to find than the Powersteps insoles). (By the way, the ice packs I did get, the ThermiPaq, is by far the best ice pack I've every used. It uses a ceramic clay material that gets cold fast in the freezer, but holds its cold for longer than traditional gel packs... they also come with a great washable cloth cover with a velcro strap for securing it to wherever you need icing). When my PF was at its worst, I would ice my arch immediately after I got up in the morning while I ate breakfast minutes, 3-4 times a day while at work, and 1 or 2 more times at night (with at least 1 immediate before bed), which each icing being for at least 10-15 minutes, and preferably 20-30. I also did my best to ice it immediately after a run. Icing helps a lot because not only does it reduce inflammation (which causes pain), but it also causes the blood vessels to contract and essentially massage the "junk" (for lack of a good technical term) out of your tissue.
5. Ibuprofen - like icing, ibuprofen is also good to help reduce inflammation, and if you are really hurting to help reduce pain (although you should be taking it for the inflammation... if the pain is so great that you can't tolerate it without ibuprofen or some other pain killer, you might want to see a podiatrist because your PF is much more advanced than mine). I didn't use ibuprofen as much as the other treatments because I like to avoid taking drugs if I don't have to, but if I'm having a bad day and my arch feels particularly sore, I do take some to help.

So that's it for my treatments. I am not all the way to being pain free (as a couple of my recent workouts show), but when I am aggressive with these treatments, the pain usually stays at bay and I am able to keep running while still healing, which is what is really important when training for long races.

Clumsiness Can Ruin Training Plans

I'm sure all my readers (I have had a grand total of two hits so far) have been wondering "Hey, what gives!? You claim to be a runner, but there hasn't been a single post about a workout (except for yesterday's walking workout. Are you just funnin' us?"

No, gentle reader... I am not "funnin'" you. The reason for my lack of posts about workouts is because last Sunday, I stubbed the forth toe on my right fit (i.e. "the ring toe") pretty badly and have been out of commission every since. I didn't stub it while running or doing anything else cool. I was just clumsy and hit it on a doorway on my way through. In fact, for a few days I was worried that it might be broken and that I was either going to have to drop out of the half marathon I was scheduled for in October because I couldn't even start my training plan for that race, or I was going to have to join a gym and start pool running (more on what pool running is in another post). Now, I think it is just bruised/sprained, and that after another week or so of rest and icing, I should be ready to get back into my training.

My whole point for this post is "BE CAREFUL!" A few seconds of clumsiness can undo months of hard work. Obviously, injuries are going to happen as part of any training for a long race like a marathon or a half marathon, but that doesn't mean you should help the injuries along by not paying attention. I wish I had taken this advice... because even if my toe is only sprained, I have still lost two weeks worth of running workouts that I will have to make up. This will screw up my training plan because I was counting on having that two weeks of base endurance training when I started my half-marathon training plan, and now I will have to build that endurance training into the schedule and take out some other speed/strength work (granted, I'm fairly new to long-distance training, so I didn't have too much speed work anyway, but that doesn't mean I wanted to get rid of it).

Walking/Injury Workout: 3.3 miles

Distance: 3.3 miles
Time: 1 hour, 21 minutes (approx.)
Avg. Pace: 24 min/mile

I went for a long walk with Andy (my son) and Steph (my wife) today. This was the first "workout" of any kind since I sprained my toe (more on that here). We also stopped for dinner and ice cream along the way (although the dinner is not reflected in the total time), so we weren't exactly in a hurry. My toe felt fine mostly, but there was still a little twinge now and then. I am going to give it a couple days off and try a very easy jog for about 2 miles on Wednesday. If it still feels fine after that, I will try a normal 4 mile run on Saturday, and again if it still feels fine a 6-7 mile long run on Sunday. If it doesn't feel fine after any of those, I'll look into the pool running route.