Sunday, October 12, 2014

Plantar, PRP, and Injury Doldrums

My hiatus seems to have turned into a bit of a hibernation.

I feel like I could have written an inordinate number of posts with this particular title over the last several years. Nonetheless, I'm not really planning on venting here or anything, and generally I like these things to be primarily of entertainment value, but this time around it's more for informative purposes, since plantar fascia problems seem to plague so many runners, and at the moment it's the bane of my existence as well.

Seriously, if I had a buck for everyone who came into the running shop asking for me a shoe or insole to fix their ailing plantar, I could have totally retired like 5 years ago. Funny thing is, a lot of them aren't even runners, so I've never even thought of it as a "running injury." Come to think of it, I've never even thought of it as an "injury" at all. More like one of those silly nagging little things that seems to afflict almost everyone at some point and you just kind of learn to tolerate it and manage it and eventually it goes away or whatever. Like, you know, heartburn or an ingrown toenail or something.

But I seem to have been mistaken on several counts. My bad.

Mine dates back to the day after Gate River Run back in March, when I just abruptly noticed my heel was just really sore the day after the race. But it would come and go and over the next few months in varying degrees and that's just kind of what it did, and I didn't worry much about it. The only time it was what I'd consider to be legitimately painful was the day after a race or a hard workout in flats followed by a second run, but otherwise I just blew it off aside from the usual icing, calf stretches, and golf ball massage and stuff.

One thing I have come to notice is that I am particularly horrible at figuring out how bad is "bad." Like, how bad is something supposed to hurt before you actually acknowledge that it does in fact hurt? It seems like that shouldn't be that hard to figure out. I have heard people call this a "high pain tolerance," but that makes it sound like a positive attribute or like praise, which is sort of twisted in a way, and I think it would be more accurately referred to as a "Shi*ty Sense of Self-Preservation." So shi*ty in fact, that if this were prehistoric times, I'd have been picked off by a saber-toothed tiger a long time ago after failing to hobble away quickly enough. The predators always go for the lame, gimpy, or sickly ones first you know.

But this isn't prehistoric times, good thing, so whatevs.

Not only that, but I look at my workload and compare it to that of my marathon friends' and think, "no way should I ever be banged up, I don't even run 100-140 miles per week!" But such is life, everyone's got a different threshold and you have to work with what you've got and forgive yourself for what you can't do I guess.

Anyway, I know quite a few runners afflicted with this Shi*ty Sense Of Self Preservation and I have yet to see it serve any of them, myself included, well. But it does give me company pool running at the Y though, so there's that.

So rewind back 5 weeks and 4 days ago, when I decided to go on hiatus for a couple weeks to fix my foot and just get back to overall feeling good and feisty again, where I was all eaten up in angst over fear of becoming a marshmallow (I'm getting there now.), and after some time off and after getting the opinions of a couple PT friends, we decided the best course of action would be a cortisone shot to knock out the remaining inflammation, take a couple more weeks off, and ease back into stuff. Typical plantar treatment protocol after conservative measures fail. Everyone does it and I didn't give it a second thought. Cake. Easy peezy lemon squeezy.


I had to work pretty hard to convince this particular doc to shoot a steroid into my foot (fortunately, in retrospect). I was on board, but I needed to get him on board too, and it was hard to make that happen. This was owing to the fact that cortisone, while it can benefit some things, also has the unfortunate characteristic of rupturing weak and/or degenerative soft tissue, and also of making things feel okay without actually fixing anything, which is why shooting it willy-nilly into anything and everything can be a potentially horrible idea. He very grudgingly agreed to consider it (or he was just humoring me, bless his heart) but only while viewing it via ultrasound. As it turned out, while it may have been mere "plantar fasciitis" at one time, now there was a huge tear in it. Bad news bears. No cortisone for me. Boo hiss.

Don't worry, this is not my baby. This is my mangled plantar. See that big, black gap? That shouldn't really be there.

If you study it closely and use your imagination, the actual tear looks like the pincher of the rainbow mantis shrimp:


Anyway, all this is to say a cortisone shot would have certainly ruptured it, if running didn't do it first. Good thing we dodged that little bullet. Point one for my little runner guardian angel cherub that rides around on my shoulder (and who has always been kept very busy) and mad props to that smart Dr. Mazzola.

So, we talked options. 1) I could take like forever off (F that), or 2) we could try this magical stuff called PRP (platelet rich plasma therapy) and expedite the healing process by about a million months. Needless to say I opted for door #2.

For those that are intrigued by medical sciencey things, in a nutshell, PRP involves drawing a bunch of blood, spinning it in a centrifuge to separate out the blood plasma, and then extracting it and injecting it back into the damaged tissue. It's about as delightful as it sounds, but it has a super high success rate when it's used to treat Achilles, plantar, ACL, rotator cuff, and other injuries to really avascular structures that heal poorly, if at all, on their own. It basically jump-starts the healing process and ideally reverses the damage over a period of time. I think I got most of those facts straight anyway.

I remembered Ryan Bak telling me not very long ago this was the route he took for a very long standing Achilles injury of his, where he was told they could operate, but that he'd have a 50% chance of being unable to ever run again as a result of it, or they could try PRP. It obviously worked out well for him, his comeback race was Club Cross last year in Bend, he was 7th and has been on the up-and-up ever since.

It normally costs a hefty chunk of change though, which I didn't have, but lo and behold I got one "donated" to me. Two points for my running guardian angel cherub and to the good doctor. I have all the luck.

Nevertheless, my little hobby of running through stuff till I can't anymore is getting a bit expensive, not to mention inconvenient, and it's probably not ideal for promoting running longevity, so it needs to stop like yesterday.

It is one of those things though where before it gets better, it gets worse. It swells up, gets super sore, and basically regresses. It feels right now (a week later) about how it used to feel after a hard race. In other words: like crap. They'll send you out with a boot and crutches and a lollipop and then you cross your fingers and wait and hope it works its magic.

Kidding about the lollipop, they do give you narcotics though. :)

Here's my weird-colored semi-sausage-foot the day after (the poor choice in nail polish color is unrelated to the injection and is not an unfortunate side-effect):

I've done the usual but-how-did-this-happen-and-how-can-I-keep-it-from-happening-again analysis that accompanies the aftermath of most injuries. Having never really had many foot issues, all I can think of is that maybe I compensated for so many miles on a meniscus tear all last year, then possibly even more so late last year and earlier this year coming off of surgery, and maybe just made the opposing side (the grumpy plantar side) do more than its fair share of work and it finally just gave up. Who knows.

So anyway, that's kind of where stuff's at right now. I won't lie, I was feeling pretty upbeat about it all for the last few weeks. I was all proud of myself for bypassing my usual 45 stages of grief (about 43 of which are some form of denial), going straight to accepting the situation, taking it in stride, and maybe even--what's that Coach Line? Oh yeah, "maturing as an athlete." I was excited that I was attaining (sort of) a sense of balance in life! Which I normally am not especially adept at. I mean, I've read a bunch of books, done a bunch of core, haven't cross trained overly obsessively, haven't gotten weepy or angry at the cruel world, I've made a bunch of cookies, and gotten some kittens...

But it's been six weeks now and that gloomy, mopey, cloud of doubt over whether something will ever heal and whether I will ever run again settled over me while listening to everyone recount epic races up at the Trail Running Conference in Estes yesterday. I know it will get better, stuff always does. I have a hunch this will work, and my hunches aren't usually just wishful thinking. But that stupid, mopey, cloud of doubt and funk always seems come floating along eventually, even though it could totally be worse and I'm lucky that it's not. I've sort of shelved any fall race plans, which sucks, because I love love love XC and it's also been the nicest fall ever. It's been all golden and shiny and warm outside. But then, I keep reminding myself that I got to have the best season I've ever had this summer, so to be honest, I don't really regret the aftermath all that much, even though it's super lame so far.

At the same time though, I think I'm done coming back from setbacks at some torrid rate then trying to race everything and train as much as I can year around--which is what I've always done and I like it, it's not drudgery to me--but then wondering why stuff goes wrong. Gee I dunno, because you're not invincible? Because there's this thing called recovery? There is too much stuff that I want to be able to do coming seasons; next year I want to do well at Zermatt: which will be my first marathon and my second US team and my first international race; a pretty amazing opportunity. I want to have a crack at sub 2:35 on Pikes Peak and go under 70 minutes at Mt. Washington, and I want to race my first 50k in the fall. Longer term goals make it a bit easier to see the big picture and not miss the forest for the trees I guess, and you sure miss a lot of opportunities if you're always running in the deep end of a swimming pool.