Monday, January 23, 2012

Injury Bug

Well, after two years of near injury free training, it finally caught up to me and over the past two months I've been trying to fix myself. A funny thing goes through most athletes' heads in ignoring the inevitable for fear of losing time and training, but if I would have listened to my coach, my body, or just common sense, I wouldn't be in as deep a situation as I got into. I wouldn't have an educational blog posting either, so lets at least stay with the positive!

After Kona I took two weeks off from really most anything except light spin classes. Another week on top of that and I started light running, just for something to do. Three weeks out, going crazy in my own head, I decided it was time to go long again. Stupid! Not only that, but I looked up the Strava segments for my routes ahead of time thinking to go crush them, not smart (Note: I think Strava is awesome, but you need to control yourself on run segments and keep with your workout goals). This attitude went on for a few weeks until a sharp pain started appearing when I'd push hard on the track. Figured I'd take a week off as this was a slight issue between Canada and Kona, and it would go away pretty easily. I'd gone over the edge already and the damage was already done. A week later I finally realized a lump had formed on the back of my heel that was probably causing the pain from the insertion of my Achilles.

Good Heel:
Bad Heel - Note bump at Achilles insertion

After a month of no running, and feeling really ornery, I was off to Presidio Sports Medicine to get checked out to make sure there wasn't anything seriously wrong with me.  I tried to self diagnose ahead of time, thinking it was bursitis in my heel, and hoping a quick shot of cortisone would be a cure-all, but unfortunately, and fortunately, my new buddy Tyler diagnosed it as tendinosis, an evil cousin of tendonitis, but more of a thickening of the achilles and luckily less painful.

Some of the causes we came up with were:
#1 Overuse - Really, three IM's in a year does that to you?
#2 Poor form - Running on tired legs leads to poor form and that puts strain on all sorts of parts that are not used to it.
#3 Heel Striking - Having changed to a short, mid-foot strike two years ago this really surprised me, but as a result of the above two, a heel strike on my left foot developed in my stride.

"Tendinosis is a diffuse thickening of the tendon without histologic evidence of inflammation caused by intertendinous degeneration. This condition is common in persons older than 35 years and may gradually develop as a result of ongoing microtrauma, aging, vascular compromise, or a combination of these factors.12 Pure tendinosis may produce no clinical symptoms or present as a painless, palpable nodule on the Achilles tendon.

The tendinosis cycle begins with an increased demand on the Achilles tendon. Factors such as vascular compromise and aging result in inadequate repair of the tendon matrix and tenocyte death.6 The cycle leads to further impairment of matrix production, causing increased predisposition to injury and microtears within the tendon.2 The cycle ultimately results in collagen degeneration, fibrosis, and calcification within the tendon. The diagnosis of tendinosis is made on physical examination when a thick unilateral or bilateral nodular cord is present. Treatment of tendinosis is the same as that for tendonitis."

Now I'm saddled with "fun" rehab exercises such as heel drops, stretching, band walking, and other pilates like hamstring strengthening movements.  Tyler said my hamstrings and glutes were weak, go figure, I'm a triathlete.

Another aspect to speed the recovery, and get rid of this lump, is "scraping" (which doesn't hurt so much as other parts of the body since there isn't much soft tissue around the heel), ultrasound, and ART (Active Release Techniques).  Going in for weekly treatments, but I've read from the above article that they think 2 a week could be better.  Not sure I have the time for that.

To keep my "run" legs going, and try to maintain at least 20 miles a week I'm utilizing the Alter-G at M2 Revolution.  This past weekend, second week back running, I managed to run pain free at 90% body weight and perform a "Yasso" workout with 3:00 800's.  Amazing how time flies when you can incorporate a detailed workout, instead of slogging through miles on a treadmill. After running, even without pain, its still a good idea to ice the heel as I do notice some inflammation.  It gets under control quickly though after 15-20 minutes of icing.

Hoping to go another week reducing the weight again to gain confidence in my heel and make sure by body performs a proper mid-foot strike.  The biggest part is making sure my stride is proper so I don't re-injure the heel or other things from favoring my left side.  There is definitely a mental block that is causing me to favor my left foot strike in anticipation of the dagger feeling I experience.  With luck, the Alter-G will help kick that thought out of my head.  Here's a video from M2 featuring another athlete from the studio recovering from knee surgery.

Starting to let myself get excited for the season now as once I'm running outside I can start setting goals.  Oceanside and Wildflower are targets of mine and I would love to improve upon last years times.


  1. I am sorry that you have been injured. I hope that you are feeling better real soon.

  2. Thanks Christi. Luckily it only effects my run so my off-season has been bike and swim focused. Sucks though since running is my favorite thing to do.

  3. Hope you get on your feet -literally- quickly. Seems like you spent some time finding about your ailment. Good read and your assessment and treatment plan seems spot on. Hope it heals up quickly.

  4. I'm proud of you for focusing on aiding your injury, not worsening it :). It'll all get better soon!

  5. That's a nasty looking bump on your achilles! Interesting to read about your rehab - you're really lucky to be able to use an Alter-G treadmill. How is the 'scraping' going? I've had achilles injuries on and off for a while and it's something I think might help....