Friday, June 8, 2018

Finding stability

I've been stubborn and stupid, but I think I'm finally getting better..

So I can enjoy more of this.

It's almost 8 weeks now since I damaged myself running through the ice storm. I've basically had two issues: I've been unable to put weight on the ball of my right foot without pain through the outside of my lower leg - particularly when landing on my forefoot as I do when running, or when toeing off - and my tibialis posterior (right behind the ankle bone on the inside of my right leg) has been really grouchy at the severe over-pronation I've had since I blew my ankle to smithereens back in February.

No bueno.

I worked with my osteopath on the lower leg issue to try to address what we thought might be a peroneal tendon issue, but then my coverage for the year ran out just before my DNF at Seaton Soaker. Somehow it seemed to get a bit better after the race, which is definitely not what one would expect from a tendon issue that I'd run on for more than 5 hours. My osteo also suggested I try some stability shoes, since it was clear that my right foot was over-pronating (rolling inward) quite badly when I walked and ran.

I resisted. I'd tried stability shoes back when I first started running and had very poor experiences with them. Having trained myself (at great effort through the spring of 2010, coming off another injury) to run on my forefoot in neutral shoes, I've never really looked back. I also have rather a large stock of neutral running shoes on hand, and running shoes are EXPENSIVE. I decided to try to strengthen my hip, glute, lower leg and foot muscles to try to correct the pronation without mechanical aid.

It didn't go super well. I continued to run, but only occasionally - like twice per week.

Far cry from the clockwork consistency I usually maintain, shown by 3 pre-injury weeks at the top.

It simply hurt too much to run more frequently, so I'd end up just doing my Wednesday post-work run down through Cooksville Creek Valley and maybe go out and hit a trail (or, you know, jump into guiding someone for 20km..) on the weekend if I could. It was all I felt I could do, while the clock ticked ever closer to the Niagara Ultra. I didn't seem to have much in the way of improvement with the pain in the outside of my leg (though there was some), which made it difficult to do much in the way of calf strength exercises - essential to ankle stability. I worked my glutes and hips, did heel drops and walked on my toes as much as I could bear, and did foot exercises in an effort to strengthen my collapsing arch.

Because that's not a great angle for an ankle under load.

I did eventually cave and try to buy some stability shoes, but they turned out to be ill-fitting so I had to pay to return them. I have trouble finding shoes at the best of times, which is why I buy extra pairs when I find something I like (and thus have so many un-used pairs of neutral shoes waiting in my stash). With nothing else on my radar as a suitable option, I decided to try a pair of insoles that are designed to help control pronation. Sticking them in the neutral shoes I already owned offered a bit of relief, but I was still having my best runs on the trails in shoes that offer a bit of stability.

Also: in calf sleeves. I'll get to that in a minute.

I managed to run on back-to-back days this past Saturday and Sunday, in a last-ditch effort to get some mileage under my belt before Niagara. 10km at Puslinch Tract, then another 6.66km (heh) on the Royal Recreation Trail on Sunday. Both went ok, though were not without their moments of wincing...and frantic flailing as the massive population of mosquitoes attempted to drain my last drop of blood.

Worth every single bite.

Nothing better for my soul than roots, rocks, rivers and sunshine.

I took Monday off as my poor leg and ankle were feeling a bit worn out after their first back-to-back runs in ages. I also resolved to take a different approach to running: I'd try much shorter distances more frequently, instead of the larger but rarer bursts of running I'd been doing lately. With the support of the inserts and a bit of strength starting to return to my right lower leg, I could feel the beginnings of my stride coming back...but only as long as I didn't fatigue it too much. I had to shake the stupid mindset that anything less than 5k or 30mins didn't really count as a "run" - totally a result of the Slowtwitch 100 runs in 100 days challenge, and certainly working to the detriment of my return to pain-free running.

On Tuesday, a few things happened. First, I got an email from my osteopath asking how I was doing - really just a courtesy follow-up, but it got me thinking. The only pain I was still having when walking and running was just below my right knee on the outside, right at the head of my fibula (the smaller of the two lower leg bones, which runs from your outer ankle bone to the outside of your knee). It would only happen when my knee was bent; I could do straight-leg calf raises with no problem. I did some searching around the internet, and turned up some tales of fibular subluxation - basically the top of the fibula moving out of position, and pressing on the peroneal nerve, causing pain up the outside of the lower leg. 

This would totally explain why the upper outside of my calf would hurt when pressed on (like laying on my right hand side in bed, or foam rolling). With some more searching, I found some mobilization techniques and a kinesiology tape application for the issue. Since I keep some tape at the office, I gave it a try, taping the head of my fibula forward after mobilizing it. 

Just one half-length piece of tape.

Relief was not 100%, but it was instantaneous. I tested my leg with some bent-leg calf raises, and it was like a damn miracle! I hated that it had taken me so many weeks of suffering to come to this point, but at least I'd found a working diagnosis of the issue (which had previously ranged anywhere from a previously un-diagnosed fracture in my ankle through sciatica) and a working solution. I wondered if my long runs in calf sleeves had felt better due to the compression helping to properly position the head of my fibula..?

I also came to the conclusion that I simply was not going to be able to strengthen my ankle enough to stop the painful over-pronation with the insoles alone, and found a couple of likely candidates for stability shoes that might a) fit me decently, and b) provide enough cushioning for an ultra on a paved path. I ordered them, and then - with my fibula firmly taped - set about putting my new "run less, but more often" idea into practice.

With my first Tuesday Night Trailrun of the year!

I kept it short: just 3.5km on a smooth, flat trail. My knee and calf responded fairly well, but I stupidly wore a pair of shoes that I selected for their cushion...but also happen to be about the least stable footwear known to man. I might as well have been running with a tennis ball strapped to the sole of each foot, and my poor tibialis posterior rather suffered for it.

I stuck the insoles (which I'd also neglected to wear) in a more stable pair of shoes, and packed up my kit for Wednesday. I couldn't miss Global Running Day!

Or the chance to run some of my favourite bits of trail.

With the tape assisting my fibula and the insoles supporting my arches, I could definitely feel my stride starting to return...but my tibialis posterior was still sore, and my right calf - which had been severely under-used as of late - was definitely worn out from my return to forefoot running. Feeling a bit mithered after runs on 4 out of the prior 5 days, I fully expected to take Thursday and Friday off...but then my 2 pairs of stability shoes turned up. I tried both on to make sure they fit, wearing them around my office for a while as I walked and sat at my desk. I knew the one pair would likely be good for me as it was essentially a shoe I already owned, only with the addition of a medial post, but wasn't as sure about the other.

I believe these will be my Niagara Ultra shoes.

So, I ran again on Thursday night to test them out.

Could they make the medial post a little more obvious?

It was only 2.6km, but it was almost as magical as the taping application had been. Without even adding the supportive insoles, the Brooks Ravenna 9s kept my arch from collapsing and the slightly higher hell-to-toe drop than I'm used to (10mm instead of <8mm for the rest of my shoes) gave my tight, sore calf some relief as I trotted around our neighbourhood for the first time in ages. The cushioning turned out to be much plusher than I'd feared when just walking around my office; like a heavy-duty suspension, it needed the load of a running stride to bring out its best aspects. I ran 95% pain free, even if it was only for 15mins or so.

The face of someone who thinks they see a light at the end of a very dark tunnel.

I feel like an idiot for having waited so long to get myself into some stability shoes. Apart from not wanting to spend the money (and gawd knows the two pairs that just came in cost a pretty penny, and the insoles weren't cheap either) and having SO MANY PAIRS of neutral shoes already in my stash, I was also stubbornly against the idea: it felt like admitting weakness, that I wasn't strong enough to keep my errant foot under control.

I realise how foolish that sounds. I used a brace for my wrist after I broke it, to support it while doing strenuous activities while it healed and regained strength. Why should my ankle be any different? I can't expect it to be the same as it was before after undergoing so much trauma in the last few months, and I can't get too down on myself for not being able to correct it completely with a few weeks of glute and hip workouts. For that matter, there are elite runners - people with more amazing talent than I could ever hope to possess - who run in stability shoes because their biomechanics require them. I do hope that I'll be able to return to neutral shoes in the coming months and years, but for now (at least) I need the extra assistance of a medial post in order to keep from doing more damage.

The most important part is that I'm finally able to get back to some running consistency. While I'm taking today off, I've now successfully run 3 days in a row, and 5 out of the last 7!

This is the best things have looked since mid-April.

I'm nowhere near completely cured, but I'm definitely much closer to it than I was at the beginning of this week. I've made an appointment with a chiropractor for Monday to see if he can assist me with proper alignment of my fibula, but even after the tape came off in the shower last night (after clinging tenaciously for almost 3 days) I don't seem to be having any regression. I'm moving better than I have in over a month and a half, and I'm so grateful to seemingly be on the right path at last.

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