Training log - Week ending 9/29/13

This week was 37 miles of “real running” plus 6 “miles” pool running, and 9000 yards of swimming (and a lotta stepmilling) -- training log is here.  

Another week and we're still progressing.  The sciatica's pretty much gone.  And the plantar is progressing nicely, enabling me to ramp up the running again.  It's not gone yet, but it's following that familiar path of improvement.  Fingers crossed. 

Plantar Fasciitis, like any tendonitis, is a bitch to deal with.  While stress fractures and broken bones have a clear time line and protocol for how to handle, connective tissue injuries can be really individual.  They can be gone in a week, or linger for months to years.  What works for one person screws up another.  And so you get the conflicting advice.  One doctor tells you to take Ibuprofen, the other tells you not to.  One person swears by orthotics, the next by going barefoot.  Some say you should run, while others say you should rest.

After giving it way too much thought, here's my hypothesis.  (And no, I have absolutely no medical/health training.  But this is my blog, so I'm allowed to waste pixels on stuff like this).

There's a lot of discussion about the role of inflammation in healing.  It's an oversimplification, but inflammation is how you heal - it's the body sending resources to the site of the injury to repair.  However, too much inflammation can be a bad thing - if the inflammatory process is a crew of construction vehicles going to a work site, then too much inflammation is gridlock.  Plus, the swelling that results from inflammation can itself irritate tissue, and perpetuate inflammation.

But, on the other hand, if you have NO inflammation, then you don't heal.  Tendonosis, not tendonitis.

So, it seems to me that healing a soft tissue injury is about hitting the optimal level of inflammation.  Not too little, not too much.

And different people are....different, with differing levels of inflammatory response.  One person might have a very strong inflammatory response, and need to beat it down with NSAIDs, ice, and rest.  Those are probably the people that can take Aleve and rest for a few days, and then be ready to go (hate them).  Another might have a weak response, and need to kick start it with stuff like dry needling and exercise.

Or maybe you're in the middle or have some mix of the two.   That's where I think I am.  If I just rest, absolutely nothing happens.  If I work it gently, then I get a bit of inflammation, which promotes the healing.  Of course, if I overdo it, then I inflame it too much, or damage the tissue, and set myself back.  For myself, it's all about hitting the proper balance.  When a tendonitis issue is in its initial stage and really inflamed, then I need to stay off of it, and maybe pop some Aleve.  But as soon as I'm over that first hump, I need to be provoking it, carefully, to heal.  Two weeks of gentle runs (starting at a mile or so, and building) is a lot more effective than two weeks off (I've tried both).


And yes, if you're curious, here what does and doesn't work for me for plantar fasciitis.  NOTE: this is for me, not for anyone else.  Everyone really needs to figure out what works for them.

Works:
massage foot with golf ball, ART, dry-needling, heating pad (after initial flare has passed), strassburg sock, walking around barefoot (after initial flare has passed), gentle running in low drop shoes, foot strengthening, eccentric heel drops, stretching calves.  Also NSAIDs, but only during initial flare.

Doesn't work:
full rest (after initial flare), ice foot bath, iontophoresis, orthotics, heel pads, very cushioned shoes.


Dailies

Monday:   In the morning, 50 minutes of pool-running for "5 miles", followed by upper body strengthwork and injury prevention work.  Foam rolling at night.

Tuesday:  In the morning, 8 miles easy (8:25), and then a stepmill workout of 8x2:00 hard, 1:00 recovery, followed by 1500 yards of swimming.  Foam rolling at night.

Wednesday:   In the morning, 7 miles very easy (8:42), followed by yoga and then 2500 yards of swimming.  Massage at night.

Thursday:   In the morning, some upper body weights and then a yoga class, followed by 1500 yards of swimming.  Foam rolling at night.

Friday:  In the morning, 10 miles, mostly easy, but with a mile at 7:12 pace to test things out, followed by a stepmill workout of 6x2:00 hard, 1:00 recovery.  Foam rolling at night.

Saturday:   In the morning, a pretty tough yoga class followed by 2500 yards of swimming.    Upper body weights and foam rolling in the afternoon.

Sunday:   In the morning, 12 miles as a progression run (8:33 for first 3.5 miles, 7:43 for next 5.5, 7:03 for next 2, and then jogged a half mile cooldown to get me to 12), followed by a stepmill workout of 6x2:00 hard, 1:00 recovery and then 1500 yards of swimming.   In the afternoon, took a yoga class.  Some foam rolling at night.

Training log - Week ending 9/22/13

This week was 28.5 miles of “real running” plus 20 “miles” pool running, and 6500 yards of swimming -- training log is here.  

The rehab/return continues. I'm making progress, though not as fast as I would like (to be fair, I NEVER progress as fast as I like :)).  The foot continues to improve, and the sciatica is much improved (more yoga and real running/less pool-running is doing the trick).

Since I've cut back on the pool-running, I was missing an outlet for hard intervals (biking and rowing were tweaking my sciatica, and my foot didn't like the arc-trainer).  But never fear - I've found something new - the step mill.  

It's the holy grail of cross training - doesn't seem to aggravate anything, and kicks my rear.  I had originally thought I'd do 8-10 reps of 3 minutes hard on it, to match track workouts.  Nope - I learned my lesson quickly.  Going "hard" on this is basically like a hill workout.  4 intervals of 2 minutes each is very hard; 6 intervals of 2 minutes each has me doubled over at the end.

It's awesome (I think).  And feels like it should translate over very well to running.  Plus a workout is fairly short - just under 20 minutes, excluding my 5 minute warm-up.  

But hopefully it won't be too long before I get back to real workouts, as I'm on the right track.


Dailies

Monday:   In the morning, 40 minutes of pool-running for "4 miles", followed by upper body strengthwork and injury prevention work.  Foam rolling at night.

Tuesday:  In the morning, 8 miles very easy, and then a stepmill workout of 4x2:00 hard, 1:00 recovery, followed by 1000 yards of swimming.  Foam rolling at night.

Wednesday:   In the morning, 50 minutes of easy pool-running for "5 miles", followed by yoga and then 2000 yards of swimming.  Foam rolling at night.

Thursday:   In the morning, 7.5 miles easy, followed by a step mill workout of 6x2:00 hard, 1:15 recovery.  Foam rolling at night.

Friday:  In the morning, 50 minutes of easy pool-running for "5 miles", followed by yoga and then 2000 yards of swimming.  Foam rolling at night.

Saturday:   In the morning, 9 miles very easy, followed by upper body strengthwork and injury prevention work.    Yoga and foam rolling in the afternoon.

Sunday:   In the morning, 60 minutes easy pool-running, followed by 2500 yards of swimming.   In the afternoon, did 4 miles easy right before yoga.  Some foam rolling at night.

Training log - Week ending 9/15/13

This week was 25 miles of “real running” plus 26 “miles” pool running, and 6500 yards of swimming -- training log is here.  

Yup, rehabbing and coming back.  Rehabbing a soft tissue injury is a careful, tentative process - I have to put enough stress on the area to stimulate it to heal and remodel, but not so much that I set it back.  So run on it until I get that bit of tightness and pulling, then stop. Then assess how it feels over the next 24-48 hours, before running again.

As of the end of this week, I've worked up to 8.5 miles with no pain during the run.  Just some moderate soreness that appears an hour or two later, and is gone by the next morning.  That's a considerable improvement over where I was just a week ago, and tells me that I'm heading in the right direction.  So good.  

But this stuff is always an emotional roller coaster.  An an example, I ran on Friday morning.  A bit of pulling, but no pain in the foot.  And then I went in for dry needling.  I know that dry needling almost always makes things hurt much worse over the next 24-48 hours, before substantial improvement (makes sense, right?  Poke needles in something, and it's going to be sore).  But still, it was hard not to get depressed when my foot hurt like heck all Friday night and Saturday morning.

And then it felt great on Saturday night, and the best it's felt yet on Sunday during my run.   8.5 miles felt much better than 3.5 had seven days before.  One step back to take a step and a half forward.  That's the roller coaster of soft tissue injuries.

My sciatica is improving as well.  It got triggered again by the two weeks I spent pool-running exclusively.  I blamed it on lack of yoga, but my PT also noted another culprit - pool-running is an open chain exercise (i.e. my foot isn't pushing down on anything fixed), while running is closed chain (foot pushes against ground).    The thought is that doing exclusively open chain exercise is triggering the sciatica.

So, I have cut back on the pool-running (ironic for a pool-running blog, huh?) while amping the running and yoga back up,with positive results. I've also added in more swimming to substitute for the pool-running.

So yay for progress, and on with another week.  I wonder where the roller coaster will take me this time.

Dailies

Monday:   In the morning, just yoga.  Foam rolling at night.

Tuesday:  In the morning, 5 miles easy, and then "12 miles" in the pool, including a workout of 8x3:00 hard, 1:00 easy, followed by getting my foot dry needled..  Foam rolling at night.

Wednesday:   In the morning, 5 miles easy, followed by yoga.  Later did 1000 yards of swimming (took afternoon off from work).  Sports massage at night.

Thursday:   In the morning, 80 minutes easy pool-running for "8 miles" easy in the pool, followed by upper body, core, and injury prevention strengthwork.  Foam rolling at night.

Friday:  In the morning, 6.5 miles easy, and then "6 miles" in the pool, including a workout of 8x3:00 hard, 1:00 easy.  I followed this with 1500 yards of swimming and some injury prevention work and then an appointment for dry needling.

Saturday:   In the morning, some quick upper body weights and injury prevention work, and then 2000 yards of swimming.   Foam rolling at night.

Sunday:   In the morning, 8.5 miles easy (did as a split run of 4.5 and 4, with a yoga class between the two, since I started late). Then did 2000 yards of swimming.  Some foam rolling at night.

Training log - Week ending 9/8/13

This week was 5 miles of “real running” plus 64 “miles” pool running, 10.5 miles on the bike trainer and 4000 yards of swimming breathing drills -- training log is here. 

Week two.  I got my MRI results back, and they weren't too bad.  Granted, they weren't "wave a wand here and all your problems will disappear," but they were probably about the best I could expect.

DX?  A bit of everything -itis.  More specifically, plantar fascitis and tenosynovitis of my peroneals - which explains why the outside of my foot was hurting. (it was the fact that both sides were hurting that raised the concern about something else).

[so you don't have to google - tenosynovitis is inflammation of tendon sheath; tendonitis is inflammation of tendon]

Plus some really mild stuff associated with the achilles, peroneals, posterial tibial, and anterior tibial.  (for all that stuff, I'm not sure how much of it is just normal for any active person of my age and mileage).  Having ruled out anything worse, I'm now free to rehab with dry needling, eccentric work, and light running.  Yay. 

Of course, I'm now getting a return of my sciatica in the left leg, sigh.  It's one of those things that flares when I cut the running and (more importantly) the yoga/lunges/squats.  The cortisone shot broke the cycle, but the past two weeks off started a new one.  So I'm working on rehabbing that as well.  Luckily, I've got a TON of experience dealing with both my silly left leg and soft tissue injuries, so I've got a road map.


Dailies

Monday:   In the morning, 100 minutes of beltless pool-running for "10 miles" and then upper body, core, and injury prevention strengthwork.  Foam rolling at night.

Tuesday:  In the morning, "12 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy, followed by injury prevention work.  Foam rolling at night.

Wednesday:   In the morning, "8 miles" beltless in the pool, followed by 1500 yards of swimming and somelower body strength and injury prevention work.  Foam rolling at night.

Thursday:   In the morning, an hour of beltless pool-running for "6 miles" easy in the pool, followed by upper body, core, and injury prevention strengthwork, and then a PT appointment for dry needling.  Foam rolling at night.

Friday:  In the morning, "16 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy, and then 12x45 seconds very hard, 45 seconds recovery.  I followed this with 500 yards of swimming and some injury prevention work.  Foam rolling at night.

Saturday:   In the morning, 1.5 miles easy, followed by 10.5 miles on the bike trainer and then 1200 yards of swimming breathing drills.   A bit of upper body and core strength work plus foam rolling in the afternoon.

Sunday:   In the morning, 3.5 miles easy, and then "12 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy.   I followed this with 800 yards of swimming.  Some foam rolling at night.

Training log - Week ending 9/1/13

This week was 4 miles of “real running” plus 69 “miles” pool running, and 5000 yards of swimming breathing drills -- training log is here.  

Yup, in the pool.  Stupid right heel.   It's not totally clear what's wrong with it - the normal conclusion would be plantar fasciitis, but I know plantar fasciitis, and this doesn't feel quite like it (though the longer I stay off of my feet, the more I start getting that tell-tale stiffness in both feet). 

My podiatrist originally diagnosed infra-calcaneal bursitis, but then we decided to get an MRI since some of my symptoms pointed to it maybe being a stress reaction in the calcaneus (if so, caught very early).

It's fairly important to know exactly what it is, since the proper treatment differs for each condition, and treating it as one could set me back if it's something else.

• plantar fasciitis - stretching, eccentric calf dips, Graston/dry needling, roll foot out with golf ball, maybe NSAIDS, plus gentle running.
• bursitis - max out the NSAIDS, minimize the weight bearing activity, touch heel as little as possible.
• stress reaction - bone stim, absolutely no NSAIDS, minimize weight bearing activity, touch heel as little as possible, maybe boot.

Until I know, I'm in flux.  But pool running and swimming is fine regardless of what I have, so I'm doing that.

I got the MRI done on Saturday morning, and of course I booted up the disc of images as soon as I got home.  (Don't judge, I can't be the only person that does this).  I have no idea what I'm seeing when I look at these images, except that it's a foot (probably mine - it's pretty cute) and that that there's no metal objects in my foot (I knew that anyway).  Hopefully I'll get the official report and findings on Tuesday or Wednesday.

Of course, like any idiot with an imagination
and an internet connection, I self-diagnose.  Looking at this,
I keep thinking that little lump ain't supposed to be there.
Dunno if I'm right, or what it is, though. 
PF?  Bursa?  Mark of Cain?

Dailies

Monday:   In the morning, 4 miles easy (8:40 pace) followed by 30 minutes of pool-running for "3 miles" and then upper body, core, and injury prevention strengthwork.  Foam rolling at night.

Tuesday:  In the morning, "12 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy.  Foam rolling at night.

Wednesday:   In the morning, "8 miles" easy in the pool, followed by 2500 yards of swimming and injury prevention work.  Sports massage at night.

Thursday:   In the morning, "9 miles" easy in the pool, followed by upper body, core, and injury prevention strengthwork.  Foam rolling at night.

Friday:  In the morning, "16 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy, and then 12x45 seconds very hard, 45 seconds recovery.  I followed this with some injury prevention work.  Foam rolling at night.

Saturday:   In the morning, "5 miles" easy in the pool and then 1000 yards of swimming breathing drills.   Upper body and core strength work plus injury prevention work and foam rolling in the afternoon.

Sunday:   In the morning, I started with seated leg strengthwork at the gym, and then did "16 miles" in the pool, including a workout of 10x3:00 hard, 1:00 easy, and then 12x45 seconds very hard, 45 seconds recovery.   I followed this with 1500 yards of swimming.  No foam rolling - I ended up with some sort of mild food poisoning in the afternoon, and just laid on the couch.