As I review my first week of non-running re-hab, I realise that today marks 76 days until TMBT. Eleven weeks, which includes at least another week of full-on physiotherapy related exercise involving Not Running. Then the ever familiar road to recovery, hopefully culminating in a pain free ultra at the end of August and a good solid attempt at the arduous climb that is the ‘short route’ of The Most Beautiful Thing distances.
Being told not to run, even if it’s for the long-term good, is the last thing a runner wants to hear. I had been explaining to my Pilates instructor Jayne that I was sick of the Hamster-wheel of injury, followed by time out for recovery and the never really being able to test myself for fear of re-injury. My current/ ongoing issues are the result of over-training and racing, but the underlying reasons are poor biomechanics and hip stiffness which I’ve traced back to childhood. Jayne suggested an assessment with a physiotherapist who specialises in podiatry and also Paralympic rehabilitation. OK then!
After a video assessment (walking, running, with and without shoes) and various strength and alignment exercises, some interesting issues came out which I’d never heard from previous sports injury professionals:-
My right leg (which currently carries the afflicted Achilles tendon) is my ‘good’ leg and tracks straight with good pronation, neutral gait and no podiatry issues
My so-called ‘good leg’ on the left is rotated inwarded severely enough that I supinate and run without the use of my big toe! What?!!!!!
If I continue to run longer distances using only the smaller toes of the left foot, it’s likely I will cause stress fractures in these toes, as they are not strong enough for the duty I am giving them, which should really be harboured by the big toe and the second toe. My right leg can only do so much to compensate!
The tightness in my soleus and Piriformis started in childhood and is likely not easily or quickly correctable without suffering injuries down the leg-chain. Orthotics (practically a dirty word in my vocabulary) were suggested to correct the gait.
I can re-train my foot not to dorsi-flex when I run and to correct the S-shape I form during the foot strike (it should really be a outer heel-strike, rolling forward to toeing off diagonally, with the big toe- minimalist shoe and barefoot running fans, please look away now!). This can be done by Not Running and performing repetitive movements to create new neural pathways which the brain and thereafter the muscles, will recognise. In time, I should be able to run more efficiently, without thinking about it.
So in summary, my right side is compensating for the left and the outside of my legs are very strong compared to the inside sets of muscles which are very weak.
Things I already knew were:
- My Achilles is thickened and nodularised, possibly with neovascularity, that is, an increase in the number of blood-vessels in the tendon area; as my bodies attempt to get more healing blood into the area
- The tightness of the Achilles is what’s causing me pain and this is primarily caused by very tight calves (years of wearing very high heels won’t have helped). I need deep stretching and lots of rollering
- I have high arches, which are fairly rigid and don’t really want to help me out by pronating nicely through the heel-toe pattern, which allows for shock-absorption through the running gait.
Every day I must perform
3 x 15 sets of eccentric calf raises: up and down on the steps, gradually adding more weight. I do this FIVE times a day, every day. I’m currently loading with 2.5 Kg.
2 x 100 ankle flexes with toes scrunched up. This is to train the ankle NOT to use the toes to lead the movement and to stop me dorsi-flexing thus helping me pronate, not supinate, on my left foot. I do this twice a day; which doesn’t sound like much but it takes a lot of concentration not to use the toes, keep the foot in plantar flexion and I can’t stop my mouth from pursing into a tight frown at the same time! Come ON Neural pathways – form already!
A variety of piriformis stretches including the more traditional post-run stretches as well as some moves borrowed from pilates/yoga.
After all this, there’s barely enough time for Life and Actual race training!
So, I am breaking in my orthotics, which have been custom built to help me pronate more (!) on my left foot and help my very high foot arches to collapse in the proper way. Increasing the hours every day, I am walking in them and if there is no pain, I can attempt a run on Day 13. I’ve promised myself I will start with a 20 min jog 🙂 After that, I have to schedule an ultrasound to check on the status of the Achilles, which may or may not result in an injection to get rid of the extra blood vessels and yet another two weeks off from running, whilst the swelling recedes. I may have to have this done when I’m in the UK as the procedure is a little specialised and I’m not sure if the local hospitals have the know-how. But I will check. Another two weeks off from running……..(sigh).
Until then, building back up from a 20 minute jog into the realms of what will likely be at least 5 hours of climbing through trails and forest in Sabah, will be a challenge but I hope that my previous mileage PLUS all the swimming, cycling and other cross-training I’ve been doing- coupled with better biomechanics (not to mention my highly renowned mental determination) will allow me to have any amazing experience at TMBT in September. I hope everyone else’s training is a bit more traditional than mine.