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.
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.
full rest (after initial flare), ice foot bath, iontophoresis, orthotics, heel pads, very cushioned shoes.