Wednesday, August 5, 2009

Back to Reality: Plantar Fasciitis Rehab

In spite of our hopes to run our next marathon in the fall, it turns out that I'll have to wait a little longer. The heel pain that started a few weeks before the marathon has proved a greater hurdle than I'd expected. When a couple of post-marathon, post-rest easy 4 milers turned up the heel pain once again, I went to the doctor and was officially diagnosed with plantar fasciitis - which I had already figured was the case via Dr. Google.

Having faced a hip/butt injury a couple of years ago, and done the frustrating roller coaster ride of reducing my mileage, feeling better, and then increasing my mileage only to re-aggravate the injury, I decided to do things differently this time. This time I was going to stop running (*gasp*) to let the injury heal. I just finished a marathon, and needed some mental and physical down time anyway, so what better time to take some rest? I signed up for a two month intro membership at 8 Limbs Yoga just up the street, lined up several of the various PF-related foot and calf stretches and strengthening exercises that I'd collected, and decided to focus on cycling for my summer exercise rather than running.


Reconsidering Proper Running Technique: Pose Method
This down time also inspired me to look into a running technique that I'd first come across a few years prior, when my butt injury didn't seem like it would ever go away. The version I'd explored was the Pose Method, which essentially promotes forefoot running (versus heel striking). The proponents essentially argue that running forefoot is a more natural way of running, and that running more naturally can prevent running injuries. Modern running shoes, they say, essentially force us to run on our heels (heel strike) even though anyone who takes off their shoes and tries to run barefoot will almost invariably land in more of a forefoot stance. Heel striking (where your foot lands out in front of you) puts all sorts of impact and stress on a part of your body not at all built to handle that impact, while forefoot striking (where your foot lands directly beneath your body) has you landing on a part of your body that is designed precisely to absorb shock. Just try jumping up and down and notice where you land. You'll be on your forefoot, not your heel.

The forefoot running proponents (Pose Method, Chi Running, Evolution Running -they all seem to me to be different "brands" of what is more generally referred to as forefoot running) propose getting back into flat racing shoes reminiscent of the 1970's flat Nikes we all knew and loved, as a means of adopting the proper technique more easily. The Pose Method suggests that running barefoot can also be incorporated into training to help learn proper running technique.

I found this technique fascinating back when I first read about it, but wasn't ready then to make a wholesale change in my running. Plus, there didn't seem to be a lot of information about it available, which made me wonder about its credibility. Around that time, my butt finally began to heal (thanks in large part to the massage services of Sarah Ellis, LMP - whose contact information I will gladly pass along to anyone in the Seattle area who would like it. She's fantastic!). So while I tried to pay some attention to landing slightly more forward rather than less, I didn't actually adopt the Pose Method back then (2005-ish).

But in 2009, feeling angry at the prospect of being injured again for a long period (there are plenty of PF horror stories out there), I decided that being forever injured was just not an option and that there had to be a better way to do this. So I went poking around the Pose website again, and decided this would be a great time to make the shift to what I was convinced would be a healthier (more natural) running technique, to hopefully rehab my bum foot, and maybe start running in a way that would not have me perpetually facing one injury or another.

Making the Switch to Forefoot Running (May 30, 2009)
I wrote a message to several of my running buddies letting them know I was going to try something new, primarily so I could have some other runners to talk with about this transition, runners who would ask questions and share their opinions about it all. I wasn't trying to convince anyone else that they should do this – buy just wanted to bring my friends into the loop on what I was up to.

I sent them a great, short video clip – from the New Jersey Sports Medicine Performance Center that shows a nice side by side comparison of one runner’s before and after videos. It shows a runner's original running stride versus their stride after two weeks of instruction in forefoot running. I thought it would be a good way to show them that I wasn't trying something crazy -- it looks quite normal when you see it on tape.

I also went out and bought my first flats: Puma Salohs without any heal cushioning at all. As soon as I put them on I could feel how the lack of heel cushioning affected my gait. They immediately made it feel more intuitive to run forefoot. Sure enough, when my body could feel that there was no cushion under my heels, I didn't even come close to wanting to run on them. It was a very weird realization. So I started doing short drills and foot stretching/strengthening exercises to get previously unused or underused foot/ankle/calf muscles ready to work. I had heard about some even more minimalist shoes, the Vibram Five Fingers which allow you to feel even the shape of twigs and rocks beneath your feet, but at the time, I certainly had no intention of going quite that far.

I went to the park and ran a few short distances barefoot, just drills to play with the forefoot technique and strengthen my feet. I also started running short distances in my flats, starting with just 1/2 mile. My calves burned the next day, but a few days later I went out again and ran 3/4 of a mile. Then a few days later, a mile, and eventually, two. But all of this yoga, stretching, strengthening, uber-short runs in the flats, walking around a lot barefoot to get all my foot muscles engaged -- I was doing all of this over the course of three months (while cycling to get my "real" exercise).

Late July 2009 - Born to Run
By late July, I was really antsy to get back to real running again. My PF definitely seemed to have improved (though it was by no means completely healed), and I felt like a little more active rehab was in order. I decided to start doing some mileage --initially just 2 or 3 miles at a time-- in the flats. At about this same time, a friend recommended that I read Born to Run by Christopher McDougall. It had been on my 'read eventually' list, but her recommendation inspired me to get it right away.

And wow, am I glad I did. This is one of my favorite books of all time, and could very possibly be a paradigm changer for the running community. It's certainly a paradigm changer for me. The book tells the story of the Tarahumara Indians of Northeastern Mexico, and their ability to run ultra long distances - without injury and in very thin sandals (huaraches) unlike anything the modern running shoe industry offers. Beneath the overarching story of these people, and one man's effort to organize a race between some of the fastest ultra marathoners and the fastest Tarahumara runners, there were snippets of information about the technical aspects of running that I found captivating. Like the description of how different animals are built differently to maximize oxygen intake and thus to run more efficiently. And the related theory of persistence hunting, which contrary to common myths about how running is so "hard" on our bodies, suggests that we actually evolved precisely for the purpose of running long distances (and thus eventually outlasting, even if not outpacing, the sprinting animals that we were trying to chase down for dinner). And then it got into running shoes, and how the shoe industry has been building bigger and heavier shoes that do nothing at all to help us run better, but may instead be contributing to injuries (or at the very least weakening our feet by keeping them overprotected and immobile). Anyway, you can read all about the substance of the book elsewhere, but my primary takeaway is one paradigm-shifting lesson: Running is not bad for the body. In fact, we were designed precisely to be able to run, and to run long.

Paradigm Shift, the Earth Moves
I'm built to do this? I'm not bucking some innate resistance to running long distances and perpetually subjecting my body to potentially serious harm just so I can keep the weight off and stay fit? I'd bought into all of it at some point.

"Of course, I'm injured. I'm a runner."
"New shoes at 6 months or 400 miles, whichever comes first, no question."
"Running a half marathon is one thing, but a marathon -- well, that's just a little extreme and asking for trouble. We weren't built for that."
"Running is just so hard on the body."

The book's argument in this regard was right in line with what I'd already read from the Pose Running folks -- that being a runner need not (in fact, should not) involve perpetual injury, and I was glad to see the message repeated. When I first read about Pose, there was so little information out there. Now I found myself reading a book that had been getting a lot of (well deserved!) buzz in running circles. And now suddenly lots of people were talking about running technique, and forefoot running, and barefoot running. All of the ideas I'd been exploring were now becoming part of the mainstream conversation, and I was beside myself with relief! Not only because I had felt like I had been walking a fine line between bold and crazy by trying a new non-mainstream technique, or because people were finally talking about this big thing that I very much wanted to be talking about, but because of one of the bottom line lessons of the book:

As a runner, I do not need to accept being injured. Running is good for me. I was built to do this.

Yippee! If running really is good for me, then everything changes. If running is good for me, then if something hurts, I simply need to change how I run -- I don't need to change the fact that I run. I can stop worrying about trying to hit that perfect combo of shoes, yoga, training practices, and nutrition so that I *might* avoid getting injured. I don't need to buy into the notion that plantar fasciitis is the incurable monster that is going to bug me for the rest of my running life. If running is good for me, then I can get back to running, and know that running (properly) can potentially actually help me heal.

Barefoot-Ish
Born to Run talks quite a bit about barefoot running and the Vibram Five Fingers (VFFs) that I once thought were out of the question for me. But after reading the book, and having been going down a road heading that direction for the past three months already, I ordered a pair of the VFF Flows, figuring I'd use them as a tool to improve my forefoot running technique.

Now that my VFFs have arrived, I've decided to blog about my transition - to barefoot-ish running, to forefoot running, to healing from PF. I've seen several website posts from people saying they overcame PF in various ways, but I've really wanted more details. How long did it take? What did you try that worked? What didn't? How long did it take?!?! So I thought I'd keep a blog to offer up some of those kinds of details. I'm convinced this is going to work, but we'll just have to see how. I'm a run-of-the-mill 39-year old female runner who's tired of being injured, and excited to run another marathon some day. Let's see how it goes!!

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