Tag Archives: stress reaction

Back to basics

In the long run, coping with life’s challenges and hardships can provide unforeseen benefits such as a more grounded perspective and sense of empowerment. Similar strengthening can also occur during a runner’s battle with injuries. For instance, I’ve emerged from prior injuries having learned critical lessons in patience and adaptability. Yet this growth has often also been accompanied by an awareness of concomitant physical losses, including reduced strength and stamina, missed races and training setbacks. My most recent injury, however, has demonstrated that when the injury is severe enough and the struggle to recover is sufficiently trying and lasting, even these physical losses can be converted into gains. How, you ask, could a five-month hiatus from running, ignited by a metatarsal stress reaction followed by a lateral foot injury and then severe calf pain, turn one into a stronger runner? By radically transforming their technique and definition of running.

Too often we address injuries with a patch; we treat the pain and inflammation with drugs, ice, orthotics, creams and bandages, until the symptoms disappear, without ever understanding how they originated in the first place. A frustratingly stubborn recovery, for which these quick fixes are ineffective, can force a deeper understanding of the biomechanical imbalances that frequently lay at the source. While each runner is unique and must listen closely to their own body to learn such lessons, let me share a few personal experiences that may strike a chord with some readers.

As the cause of my injuries was not immediately apparent, I initially tried to treat them while adhering to my ingrained, unhealthy running habits. Only when I finally realized this old routine would no longer cut it, I launched a new approach to my recovery with a clean slate. I abandoned my goal to rebuild mileage and became determined to simply learn to run again – correctly and painlessly – which I’ve approached by incorporating frequent short, easy and mindful barefoot runs. This simple tool not only teaches proper running biomechanics, but has also revealed subtle differences between my shod and barefoot running form that have likely been the culprit of injurious, inefficient running.

Metatarsal stress reaction

The ignition to my train of injuries, a stress reaction in my left metatarsals, was assumed to be a classic result of too many miles in too little shoe, before my feet were strong enough. Yet this explanation seemed at odds with my intentionally very gradual, cautious transition to a minimal shoe and foot strengthening efforts through barefoot walking. A recent barefoot run confirmed that the culprit may not have been the miles and weakness, but rather, poor running form transferring undue stress to the forefoot. During this particular run along a harsh urban route – my only unpleasant barefoot run to date – I adopted a rigid, tense and sloppy foot strike as I traversed uneven, rough terrain. The consequence was an aching, swollen top of foot, disturbingly remniscent of my old injury.

Lateral foot tightness

Just as my stress reaction was healing and I resumed gentle running, I became plagued with a nagging ache along the lateral foot (presumably the flexor digiti minimi brevis / abductor digiti minimi muscles), from the cuboid to the base of the fifth metatarsal. To no avail, I tried massage, ice, heat and running on every imaginable surface, from concrete, dirt and grass to an Anti-gravity treadmill. It wasn’t until replacing my already minimal shoes with an even lighter, less cushioned and less supportive shoe that I found relief. The subtle arch support of my prior pair had evidently been encouraging excessive supination, placing undue strain along my lateral lower leg and foot.

Calf strain

Finally recovered from my foot ailments after months of rest, I launched back into running cautiously but soon discovered my calves were not up to the task. A month of running with tight calves culminated in intense pain and swelling that spread throughout my calf, ankle and foot, forcing me into another two-week running hiatus. Despite common logic that weak, strained calves would benefit from cushion, support and soft surfaces, I discovered a peculiar phenomenon that the calf pain appeared instantly when running in shoes, but I could run painlessly barefoot … on concrete.

Could it be that each of these injuries did not in fact result from too many miles, aggressive training or insufficient support, but instead stemmed from running with unnecessary tension and improper biomechanics? 

Admittedly I’m eagerly awaiting the days when I can enjoy endless miles with full strength and endurance; but for now I’ve discovered a new source of joy from running. Rather than progressing in terms of mileage or speed, I’m gaining satification from my gradual improvements in form which allow me to run free of pain, tension and injury. These lessons have spawned a new era of growth in my evolution as a runner, one marked not just by improved biomechanics and strength, but also by a rekindled appreciation for the pure joy of running.

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Adventures in healing

Today marks the 8 week anniversary of my perplexingly stubborn foot injury. Had I known back in February that I would still be unable to run today, I likely would have resigned myself to a period of springtime hibernation. But every day brings new reasons for optimism and I can now confidently report having entered a stage of progressive recovery. In retrospect, the unpredictable ups, downs and surprises of this frustrating period have also been immensely character-building.

Like many runners, I tend to have an inflated sense of how in touch I am with my body; I am thus continually humbled by how poorly I sometimes interpret its messages! If you read my last post, you’ll recall that I initially self-diagnosed my top-of-foot pain as extensor digitorum longus tendonitis. However, after 6 looooong weeks of unsuccessfully treating for tendonitis, I began to suspect a more serious injury … could it be a dreaded metatarsal stress fracture? An MRI revealed no clear fracture line, but showed “abnormal signal intensity” throughout the foot, reflecting edema in the bone marrow, consistent with a diffuse stress reaction (for a great review of stress fractures and reactions in athletes, see Fullem, 2012). Oddly enough, this finding came as a huge relief, finally providing an explanation for my excruciatingly slow healing. No surprise that treating weakened bones for tendonitis would be completely ineffective!

At the same time, this diagnosis taught me a critical lesson. Equally important as listening to your body and heeding signs of incipient injury is accepting you don’t always have the answer, and remaining open to all potential causes of a problem. My symptoms appeared perfectly consistent with tendonitis, and perfectly inconsistent with a fracture: aching that moved around along the path of the tendon from shin to ankle to top of foot, but no swelling or pain upon pressing the metatarsals. With an athletic history void of fractures yet scattered with tendon issues, I was convinced this was just more of the same. But to my surprise, under the combined stressors of marathon training and aggressive transitioning to minimalist running, my metatarsals gave out before my tendons.

Over the last 2 weeks I’ve conducted extensive research which has led me to incorporate several new treatments. Although it’s impossible to attribute improvements to any one intervention, together the following appear to have been highly effective at promoting healing in my stressed metatarsals:

Supplements
During injury recovery, the body requires additional nutritional support beyond the demands of normal maintenance to ensure active repair of damaged tissue. For bones, this support includes excess calcium, with vitamin D, magnesium and vitamin K, all of which are essential for building strong bones. Silica has also been shown to promote bone health (Carlisle, 1981Jugdaohsingh et al, 2004; Seaborn & Nielsen, 2002) and as a nice side effect, purportedly also improves hair, nails and skin (although I have yet to notice newly lush locks or a vibrant complexion!). In addition, I’ve been supplementing with glucosamine-chondroitin and omega-3’s for joint support and inflammation control, respectively. I’ve also become rather obsessive about maintaining a balanced diet rich in vitamins, minerals and protein.

Bone stimulation
There’s considerable evidence that stimulating fractures with ultrasound can accelerate bone healing (Heckman et al, 1994; Nolte et al, 2001). I purchased a bone stimulator (Exogen 4000) a week ago and – coincidentally or not – have experienced the most marked improvement yet over this past week. Such devices are relatively pricey and not easy to track down (I found mine on Ebay), but are user-friendly, FDA approved and scientifically validated.

Homeopathy
Comfrey, or Symphytum officinale, is commonly referred to as “knitbone” due to reports of its phenomenal ability to heal bone fractures. I have been applying a comfrey salve topically to the foot as well as taking a homeopathic dose of symphytum multiple times a day.

Activity
The traditional prescription for stress fractures or reactions is complete rest from all forms of weight-bearing activity, often including a boot for walking. For later stages of recovery I’ve seen conflicting advice, with some therapists suggesting the incorporation of pain-free weight-bearing exercise to encourage strength building. As a firm believer that our bodies are more resilient than we’re often aware and under some circumstances are most nourished by active healing, I have opted for the less conservative course. Granted, during the first 6 weeks, my decision to use the elliptical machine, walk and hike (barefoot of course!) was based entirely on a misdiagnosis of tendonitis. Now knowing the state of my bones at this early post-injury stage, I suspect this excessive activity almost certainly delayed my healing. Since my foot has advanced beyond its original highly vulnerable state, I currently follow a simple guideline: engage in any activity that does not cause discomfort. Given my high pain tolerance, I set my threshold at discomfort rather than pain. Running through “discomfort” is what triggered this injury in the first place! This approach currently permits me to walk, do the elliptical and one other secret indulgence to be shared in a coming post (intrigued, aren’t you?)!

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