Tag: Posterior Tibial Tendonitis (PTT)

The One Where I Admit That I’ve been Foolish

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One of the many things I love about running is how strong and powerful it makes me feel, and the fact that that I always feel better after a run than before one. Or nearly always. Today, for the first time running since my Angkor Wat Half Marathon on Dec 1, I neither felt strong nor powerful, and I finished my run 1km short of my 21 km target feeling sore, worried and annoyed. Annoyed with myself because over the past week I had pushed my pace so hard on three 13, 10 and 10km runs that not only are my legs tired even after a rest day, my foot hurts at the site of my PTT (Posterior Tibialis Tendonitis) injury. Annoyed that I may have been a bit foolhardy. This isn’t good news two weeks before my first Half Marathon of the year, the Malaysia Women Marathon (MWM).

My training program has been flexible to say the least though I do try to alternate easy and hard days and run no more than 60km a week. I love to run every day, and rarely think of it in terms of race preparation but rather as a wonderful experience in itself. The trouble is that in the past two weeks I’ve developed a taste for pushing my pace far more than I ever dreamed possible and this need for speed has become addictive. It’s hubris really, and a desire to feel good about myself, that pushes me to run faster – and of course those little crowns on Strava are also very addictive! And to be honest running fast (for me) felt good!

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But my foot is complaining now so my ego has to take a back seat and I have to rest. I had physio on Friday and though my hamstrings were soft, the muscles in my calves, ankles and shins were very tight and my left Achilles Tendon was screaming (actually it was I who screamed when my PT touched it). The Achilles feels ok today but the right Posterior Tibialis is sore to walk on.

I didn’t write this post to bore you with my injury niggles, nor to entertain foot fetishists, but to serve as a warning against doing too much, too fast. I hated the way I felt running this morning – heavy legged, and ultimately sore footed – and it means I can’t run tomorrow unless my foot feels significantly better in the morning and even then it can only be a short, slow recovery run. I know, I know, I probably shouldn’t run, even if it does feel better.

Exactly four weeks ago, I ran a personal best 21km which inspired hope of repeating the effort at MWM. After today, I am concerned that I may not be able to run the race at all. Another of the great things about running is that you learn a lot of things  – humility, resilience, respect for your body’s power and limitations, and how sometimes if you get carried away, as I have done (a few times!), that a price must be paid. Let’s hope it doesn’t come to that.

Tips:

  • So, runners, remember rest days are very, very important so find some low-impact activity to do on these days if you can’t bear not doing any exercise at all.
  • Alternate easy and hard workouts. Hard workouts would be tempo runs, long runs, interval training, hills etc.
  • Strength and stability training of ankles, calves, quads, and glutes is a no-brainer (yeah, I’ve been lax on that one too). The core and upper body should not be neglected either.
  • Stretching out those tight leg muscles after a run is essential to aid recovery and prepare your body for your next run. Not doing so will lead to the formation of adhesions and scar tissue which will ultimately lead to pain. I’ve got into the habit of stretching my calves while I’m waiting for the coffee machine, microwave and brushing my teeth. I assume I’d be even worse off today if I hadn’t.
  • Listen to your body, preferably before it starts shouting abuse at you as mine is doing now.
  • No matter what your race goals are, if any, ultimate responsibility for your health lies with self. Running isn’t bad for you (it’s the best thing evva!), running irresponsibly, as I have done recently, can be.
  • Do as I say, and not as I have done.

Temples & Toilets – Angkor Wat Half Marathon 2013

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passAngkor Wat Half Marathon was, for me, dominated by toilets rather than the temples. And judging by the queues at the portaloos pre-race and the number of people scurrying behind trees and rocks during the run – I’ve never seen anything like it! – I wan’t the only runner thus challenged. Still, I’ll try and put my loo issues behind me – ahem – and focus on other aspects of the race.

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Snapshots of Siem Reap, Cambodia

Firstly, Siem Reap is a lovely town of low-rise buildings, teaming with stalls, shops and restaurants. Angkor Wat Temple is about 15 minutes drive out of town. The race was SUPPOSED to start at 6.30AM on Sunday so we left our hotel at 5.30AM and arrived in plenty of time to queue up for the loos. My friend and I joked that it was better to wait in line for the loo and to time a last wee just before the gun went off than to go in the bushes and end up hopping from one foot to the other with nerves at the start line. Mistake! As we ran from the portaloos in the direction of the start, we realized that the race had already started – without us! And it was only 6.24!

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My broken Nathan bottle race cap.

So I was three minutes into the race crossing the start line, which makes my ranking on the results look bad, but heh I was never going to be in the Top 20 anyway so there’s no use in being upset. Actually upsetting, was the fact that the valve on my Nathan bottle collapsed at the start, sending my Accelerade drink all over my shorts and leaving me with no fuel for 21 km. Water stations provided 350 ml bottles of water every 2.5 km and I ended up carrying one for most of the race; this did nothing for my posture but made me feel more secure about staying hydrated. The disadvantage of starting so far back was the need to overtake slower people who had started at the front. Weaving in and out, and avoiding slamming into the back of runners who stopped to take photos, dominated the first 5 km, which I took easy, breezy and dare I say I would have enjoyed if it hadn’t been for the constant need to swerve around people. At about 8km, I looked longingly at a gel a girl was taking though I had none with me as in the past they’ve made me feel nauseous. Another girl had a bag of Haribo gummy bears but she didn’t offer me any;( Of all the rear ends I saw on Sunday, one stuck out from the crowd. ‘How’s my Running? Call 1-800-EAT-DUST!’ was printed on a girl’s shorts. Love it! Somehow, after running around a slower lady, I got dizzy, and felt my stomach lurch. I took the next few kilometeres at a pretty good pace, keeping an eye out for a toilet, debating whether it was worth the loss of time or not. At around 10 km, I spied a sign for toilets and bolted out of the race and into the loos. I never thought I’d sabotage a race thus, but I did. Somehow my pace never recovered after this. Having passed so many runners before the pit stop, I couldn’t muster the will to try and pass them again. In fact I don’t really remember much of the last 10 km; probably due to a combination of lack of endurance training (I had a stitch for 9 km), lack of electrolytes (may also have caused the stitch), and the fact that I’d been sick for the 10 days prior to the race. I’m afraid, I wasn’t running with joy, more a sense of a chore that needed to be completed. I didn’t at any point run fast enough to get out of breath – during the first half I was afraid to in case I ran out of steam, during the second half I simply couldn’t because of the stitch.

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My detour!

Compared to tropical cities like Singapore, Jakarta and Kuala Lumpur, running at Angkor Wat felt fresh and breezy. The route is very flat and the surroundings are beautiful. Local children lined the route cheering, their hands outstretched for runners to clap, collecting water bottles which they can make money from recycling. Distance markers were clearly painted across the road at every kilometer. At some water stations, there was a can of something I didn’t recognize on offer but I didn’t risk it. By the end, the sound of water sloshing around in my stomach was enough to put me off drinking anything, so I’d probably even have refused a 100Plus if it had been available. Still, it would have been nice to have a sports drink on offer at a few water stations 🙂Image

Strangely, I crossed the Finish line feeling cold, my skin covered in goosebumps. I was delighted to meet a friend who gave me water as there were no refreshments distributed on the finish line. The medals were hard to find too; eventually, after asking many people, I found some children handing out medals to anyone who asked, in the middle of the finish line melee. My husband, who ran the 10km, got a medal identical to mine, stating Half Marathon. I’ve read complaints on Facebook that there were no medals left for Half Marathon runners who came in around the 2:30 mark which seems very unfair! Image Unfortunately we couldn’t hang around after the race for more than a few moments as we had a flight to catch back to Kuala Lumpur. My time was 1:56, which was a PB, but the fact that it could have been nearer 1:54 without the pitstop is hard to let go. Still, one MUST be positive. My foot, which I had taped, didn’t hurt at all during or even after the 21 km which, if I wasn’t such an ungrateful cow, should have been my opening line on this post.

I’d love to return to do the Angkor Wat Half Marathon in 2014 but as we’re moving to Perth, and there are no direct flights from Perth to Siem Reap, I’ll probably not have the opportunity. If we were staying in Malaysia, I’d definitely return (wearing a nappy – kidding!). I’m determined to master this 21 km lark. By this I don’t necessarily mean improve my timing – though this of course would be nice – but to cross the Finish line feeling a sense of achievement. Looking back I can see that the races I’ve enjoyed most, or that have given me a sense of accomplishment, have all (three) been 15 -16km. I haven’t registered for another Half until March, so I’ve plenty of time to work on my stamina and endurance to see if I can ‘master’ the 21 km distance. Image

In the meantime, I’ve ordered new race caps for my Nathan bottles and I will continue with physio for my PTT. And then there will be race toilet training which I have now added to my New Year’s resolution list for 2014!

Quit at Never

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This morning I ran 8 km dressed in irony. I wore my race shirt for tonight’s BSN Putrajaya Half Marathon which shouts Quit at Never from the back. I’d dreamed of showing my back to the majority of ladies running tonight but thanks to my Posterior Tibialis Tendonitis I’m hardly able to run 10 km so racing 21 km is out of the question. Quit at Never? Hell no, I’m quitting before I even start!

20131019-111640.jpgOn the positive side, it’s school mid-term and I’m heading to the beach (where, lesson learned by my Achilles Tendons, I will resist the urge to run). My girls (age 11 & 12) and I are flying to Lombok, Indonesia, a tiny island adjacent to Bali for a few days. We’re going to snorkel, visit some craft villages and chill out poolside away from homework and little brother. Pre-injury, I booked the only hotel on the island with a fitness room so I hope to hit the treadmill a few times to continue the fight back to fitness. Unfortunately, I can’t take my physiotherapist with me – think of the gossip! – but I am still packing for rehab: tennis ball ( to roll out my arch), Theraband (ankle strength training) and aqua belt (to give bored people something to stare at in the pool). I’ll be relying on the hotel bar for ice 🙂

Tonight, I plan to watch the final three episodes of Dexter Season 8 and try not think of all the folk shuffling their feet at the start line in Putrajaya. It’s hardly the stuff of dreams, it may even be the source of nightmares, but when it comes to television box sets at least I’m still able to Quit at Never 😉

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The Danger Zone

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aqua
I’ve returned to the danger zone. My foot no longer feels sore, so my body keeps sayin’:
‘Go for a run, just a little run, wearing your Aircast brace, why don’t ya, go on, just to see how it goes, you’ll be fine, run, run, run! What’s the harm?’
The harm, my brain keeps reminding me, is that if I go back out too early as I did two weeks ago, I will probably end up even more injured than before, and benched for months. That’s the harm, you darn run devil!
On the bright side – and believe me with the dream of having my name appear for posterity or at least until terrorists destroy the Internet, on the results of the Standard Chartered Half Marathon website now destined to remain just a dream that can now never come true, bright is far from how I felt yesterday – but on the bright side, I’ve been trying new things instead of running.
Here they are in no particular order of preference-they all suck compared to getting out on the road but can be categorized ‘better than sitting on your ass all day, with ice on your ankle’:
Pool running-this one I had never heard of until three weeks ago, but since discovered to be a favourite amongst injured runners or people who write about activities for injured runners online, and Australian marathon runners (according to my friend Deb). Please search YouTube for a demo video as I’m certainly not making one. No impact in the pool makes this a winner but gosh is it boring. I’m lucky enough to have a pool only 3 mins walk from my house, and in the mornings it’s usually empty (and 27 degrees C). I guess any smidgen of sympathy those of you in Northern Europe might have felt for me has totally evaporated now, hasn’t it? Still please, swallow your envy, and read on.
Pool running looks weird – sort of high-legged running on the spot except floating in the pool while moving slowly forward – so it’s not something one might want to do in front of an audience or indeed alongside proper swimmers. It requires an aqua

ursula

 belt which is very like the belt Ursula Andress wore in a famous still from a Bond movie, except instead of a dagger tucked into the belt, there are six brick-shaped floats attached. This is the sexy version.
Another type is much bulkier and is made totally from styrofoam; it looks nothing like anything a Bond girl would be seen in and I suspect is popular among geriatric aqua aerobics fans. It might however last longer than my ‘sexy’ blue number. Over the four occasions on which I have used my belt, one float out of six has gone adrift, shearing off from the belt, unable to take the pressure I guess. At this rate, I will sink to the bottom of the pool by the end of October. The bottom of ‘my’ pool is unfortunately a bit too shallow for pool running so I wont drown. I am getting better at this pool running lark as this morning I barely stubbed my big toe at all on the tiles. belt
Cycling – now the first time I sat on a stationary bike for an hour watching Grey’s Anatomy was almost enjoyable but afterwards sitting on anything at all hurt for a few days. Having recovered normal sensation in my ass, I tried out a Spinning class. Definitely the nearest thing so far to an elevated heart rate was achieved with this one, and I sweated buckets, so I’ll probably do this again. I may even do a class a week when I get back to running. When!
Elliptical Trainer– I’ve tried this once and I suspect that, done properly, it’s of great benefit in keeping up cardio fitness as well as working leg muscles. The trouble with this one – and the bike really – is the same trouble I have (had!) with the treadmill. It’s boring and so it’s difficult to keep pushing oneself, instead of popping off for a coffee and a scone. It’s probably good training for racing though, as preparation for that point about 2 km from the finishing line -irrespective of whether I am running a 10km or a 21km – when I’m cursing my hubris in thinking I could race well and am fighting the urge to stop and stroll the rest of the way.
To be honest, other than the singular Spinning class, none of these attempted workouts have been anything near a good run in fitness terms. They’ve been of a very exploratory, non-focused nature.
I’m still icing my foot several times a day in case any of these moderate activities cause inflammation. I’m also wearing the Aircast brace when I have to walk a lot. I have my third Shock Wave Therapy session tomorrow and am toying with the idea of wearing my running gear. Nothing like getting dressed up in the hope of having somewhere to go – which in my case will be the treadmill at the clinic to have my running gait assessed. Yes, tomorrow I’m going to do something else I’ve never done before. I’m going to beg to be allowed go on a treadmill. Told you I was in the Danger Zone.

Posterior Tibial Tendonitis

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When I first went to the doctor at the sports clinic, 12 days ago, I suspected tendonitis. No, no, it wasn’t tendonitis, she said with professional certainty; I had sprained my ankle (without noticing), pulling my deltoid ligament. Humph. Weird that I could turn my ankle and not notice, I thought, but she was a doctor, I’m not. So as advised, I stopped running, left my race bibs in a drawer, went to physio several times, initially for ultrasound and then progressed to ankle strengthening exercises. Rehab was going well.

Still perturbed over the whole ankle sprain diagnosis, I continued my self-diagnosis by Google, and came up with Posterior Tibial Tendinitis (PTT), a common complaint among runners and a condition which left untreated results in flat feet. The symptoms fit, the cause fit; it made sense. The physio conceded that it might be PTT, rather than a pulled ligament, then directed me to the balance board where I remembered why I’m such a lousy skier. She seemed to think it was ok for me to try running again if it didn’t hurt. I can’t blame her for buckling in the face of my determination. And my ankle no longer hurt!
I started running again, a week after the ankle sprain diagnosis. I ran on three consecutive days, ankle taped for support, making sure to ice the foot after each run. Two runs went really well. I was even able to do a decent tempo run. I was back! The third run unfortunately involved some hills due to a road closure. Don’t ask! The foot ached a bit during the 8km loop but pain certainly didn’t prohibit my enjoyment. I started to envisage the start line of the Standard Chartered KL Half Marathon again and dared to hope I might get to cross the finish line too. Yes, I thought, I will be able to run! Whoohoo!
But after the slow hilly run, the foot was sore and became swollen. It was time to get help from a professional who was experienced in treating runners (as clearly, the folks at the sports clinic weren’t). I needed someone who understood not only running injuries but also a runner’s impatience to tie up their laces and get out on the road again as soon as possible.
Now, in my previous life I worked with surgeons in the UK developing orthopaedic devices, and in such milieux, the chiropractor was not highly regarded. As a result, I have held a deep prejudice against such practitioners for two decades. But by last Friday, I would have allowed the man who comes to read the electricity metre to examine my foot if he’d shown any interest, or vague knowledge about ankle anatomy. A chiropractor, in a Joint Specialist clinic, who had been highly recommended by some running folk, did seem somewhat more qualified for the job then the meter man. So off I went again, sitting in traffic for 20 mins, thinking how I could have run to the clinic in 10. But of course, if I could run, I wouldn’t be going to the clinic. Sigh.
After much prodding and poking (what I would call a thorough examination), an x-ray, the subsequent appearance of bruising in my inner foot which I was assured was not related to prodding and poking, a close look at the wear pattern on my running shoes, and another round of somewhat painful palpating of my medial ankle, the chiropractor concluded that it was my posterior tibial tendon and not my deltoid ligament that was injured. Sometimes, it doesn’t feel good to be right.
So two weeks after the initial (mis) diagnosis, I’m back to where I started. Actually, as I’ve made the foot worse, I’m even further back than that. Rest, ice, for a few days, then I will start ultrasound therapy again. As to the cause of PTT after 20 months running? It might be my shoes – I’ve become an over-pronator as I’ve moved from heel to foot strike running, and my shoes are not designed for such – or it might be related to tightened Achilles Tendons, the souvenirs of my blissful barefoot runs on a beach in Vietnam back in April. It’s probably a combination of these factors together with my recent increase in training pace.

Either way, I’m still benched, and I’m back to finding alternative ways of keeping up my fitness and strength without pounding pavements. When the SCKL marathon was postponed in June because of the Haze, I never dreamt that I’d miss the race altogether but I now I certainly will. Thankfully, I think I’ve now found a clinic that will help me back to full fitness. Whether it will be in time to run the BSN Putrajaya Half Marathon on Oct 19th remains to be seen.

p.s. I decided not to treat you to a photo with this post. Frankly, I’m sick of looking at my own feet, and think you must be too. If there’s one minor consolation – and I do mean minor – over not running, it’s the prospect of a decent pedicure and prettier toes.   Hopefully, this improved version of my footsies will be strictly temporary.