Anatomy of An Injury

Monday, April 13, 2009

Injury is every athlete's nightmare. It can be a result of an accident (e.g. a bad fall) or misuse. Most runners' injuries I surmise fall under the second category, which can be further broken down into two sub-categories. First is wanton disrespect for the body's need for rest and recovery - often riding on the belief of "no pain, no gain", disguised sometimes as "mind over matter," harking back to memories of youthful invincibility, and fueled incessantly by dreams of greatness or perhaps illusions of grandeur. The other is unfortunate and innocent lack of appreciation of one's limits and ignorance of the body's mechanisms to cope with physical stress.

If one limps as he walks and he cannot run no matter how hard he tries, I supposed that qualifies him as injured. I was in that condition last week of February 2009. After several weeks of denial, I finally graduated from "being sore" or "in slight pain" to accepting I was "injured." The thing is I do not know really what kind of injury hit me and what under what category of injured do I fall: the disrespectful or the ignorant? Obviously the injury was not an accident; the closest it came to that was being an accident waiting to happen.

Injury was something I abhorred from the start and took pains to understand so I could escape it. It hit me nevertheless and it better not hit me again (well may be one or two more time(s) is allowed, but nothing more, okay?)
As I surface from this rut called injury, I look back and attempt to understand what hit me.

I never had running injury from 2003 to 2006. During those years, the severly overweight me would jog at slow pace of 7-8.5kph on treadmills, almost everyday (sometimes twice a day) for up to 3 months to lose weight. During those brief periods of running and quick, massive, weight loss, I managed to squeeze in races from 5K to 25K. Yes, I progressed rapidly in distance but maintained my relatively slow pace. Back then, I did not know what taper and tempo meant. Pronation was alien to me, but I instinctively selected shoes that are wide, well-cushioned inside and pliable at the mid-foot. I would often choose New Balance for it was the only one with the wide E size. The last NB shoe I could remember using then was NB 716 which was actually a cross-trainer.

When I decided to run again in August 2008 (to lose weight once more!), the NB 716 I bought in 2006 was miraculously still intact. I used it to run on treadmills once again (3-4x a week) and on two mini-sprint triathlons, and one each of 5K, 10K and 15K. I used it till first week of November 2008, when I finally decided to retire it and reward myself with a new pair in time for the New Balance Powerrace. From August to November I progressively upped the speed ante a bit to a max of 9-10kph, in preparation for the Powerrace. The only discomfort I felt during the period was some knee pain, which was quickly eliminated when I applied what I learned in the Running Aid series about slightly bending your knees when you run. I would still say my 2008 re-entry to running was still injury-free.

The critical period I think was that surrounding the Nov 16 Powerrace. There were 3 variables at play: distance, speed and shoes. One month prior to the race I made the crazy decision to run the 25K. While I have done this distance twice years before, it was a bit too soon for me to jump to 25K just two-and-a-half months after I resumed running. It was a crazy and ambitious plan but I managed to slowly increase my mileage, peak and taper within a month, with twice a week rest days even tucked in. For the race, I also slowly increased my speed from steady 8kph to 9/10kph during training runs. Lastly, I bought NB 859 a week before the race. Having read about pronation and motion control shoes, I chose this high stability pair for my supposedly wide, flat feet.

I finished the Powerrace in my NB 859 good enough relative to my level of preparation (time was 3:07 for 25K), but I was dead-tired after. My legs ached but not as much as my left heel hurt. My left foot became a concern that I even had to blog about it 2 weeks later (read here). I had signs of plantar fasciitis in my left heel.

To protect my left heel, I diligently tried to change my foot strike from heavy heel strike to mid-foot strike. I spent almost the whole of December doing this modification. I successfully eliminated my heel pain, but I suffered from mid-foot pain and symptoms of achilles tendinitis. Nevertheless, in December I somehow managed to run as far as 36K using the mid-foot strike.

In January, afraid of further hurting my delicate mid-foot bones and achilles tendon, I tried to settle for a foot-strike that was somewhere in between my original heavy heel strike and the exaggerated mid-foot strike I was recently doing. The pain in the mid-foot and the tendon disappeared, but some mild plantar fasciities symptoms reappeared. I consoled myself by saying that PF was the lesser evil. I lessened my mileage but PF was still there up to1-2 days after each run.

In February I decided to get a new pair of shoes as alternative to my sole pair that was NB 859. I was checking out some high stability (motion control) shoes of ASICS but the stores do not have my size for the model I want. Out of frustration I blurted out to the store clerk, "So what else do you have?" The store personnel suggested I have my feet checked first so they could better recommend shoes, and so I relented. I was made to stand on a contraption made of mirrors so the personnel can check my foot arch. I got the surprise of my running life when they told me I had high arches! How can that be? I have always had that image of having wide, flat feet. But the mirrors and two wet-feet-on-paper tests later did reveal I have high arches. I ended up buying the latest neutral cushioning shoes of New Balance, NB 1063. With this pair I managed to finish the 15K Power Run despite very low recent mileage prior to race, as well as do reasonably ok in the 5K run leg of the Ateneo Aquathlon. The best thing was I got rid of the plantar fasciitis symptoms.

I thought I already found salvation in the NB 1063, when one training run on asphalt oval I found myself running ridiculously slow (almost 9min/km). What the hell was happening? I was supposed to have the lastest cushioning shoes so why did my legs feel weak? I felt even worse the day after that I decided to skip work and went to see a doctor. Doctor said I did not seem to have stress fracture (I could opt for an x-ray if I wanted to be sure) and that what I had was probably muscle strain. A physical therapist did some stretches to my legs, applied gels on my calves and used ultrasound, but none of these seemed to have any temporary or medium-term effect. In fact, I even felt worse. From that day onward I did not run, not even bike.

I rested my legs for at least 2 weeks. The first week my calf muscles (gastrocnemius and soleus) were tense but weak. At one point during a recovery swim I accidently stumped on my left foot with slight force and my calves instantaneously tensed up and cramped up. The tension abated but lasted a few days more. The second week seemed to provide some improvement. After two weeks the pains and tension were gone. I was not in the best physical condition but I was strong enough to do a 15K LSD using my NB 1063. But how slow it was - about 9-10min/km.

At this point I was already in a deep quandary. I already rested for 2 weeks. Why couldn't I return at least to my easy jogging pace of 8min/km? No specific part of my legs were in pain, but my legs seemed to be made of jelly - too soft to prop up my weight and carry me forward. The only hypothesis that made sense to me back then was that my leg muscles were so used to motion control shoes that they were at a loss now with all the freedom of movement that a neutral cushioning shoes brought. Maybe I needed a transition shoe - something that still gave support but was flexible enough. It was then I decided to scout for light stability or supportive cushioning shoes.

My search for light stability shoes, greatly aided by Runner's World, led me to New Balance's 769 and ASICS Kayano series and the 1100 series. An NB fan, I was leaning towards the 769, but for a change I decided to try ASICS. I can go back to NB for the next pair if indeed light stability is the shoe type for me. This time around, I let my feet decide. For some reason, my feet did not like the feel of Kayano 14, but they received well the Gel 1130 model.

I broke-in my ASICS Gel 1130 during the 10K Run for Their Lives. From a 9-10min/km an LSD week earlier, my race pace averaged 8min/km. I even had moments when I was running comfortably at below 6min/km. Just like that I ran better. The result was so overwhelming I quickly shifted from wondering if I could run the Condura 21K to thinking what my 21K pace ought to be. The shoes and Condura weaved their magic and I ran at average pace of 7:30min/km, two weeks after a self-imposed moratorium from running.

Hoping to prove that my Run for Their Lives and Condura performances are no flukes, I did the Men's Health 10k Miracle Run yet another week after Condura. I even did better and average 7min/km. The best part was I seemed to be free from symptoms of plantar fasciitis and muscle soreness. The recovery periods after each race or run was fast shortening from as much as 4 days to as little as 24 hrs.

I have since done several short runs and LSDs completely pain-free. I have resumed biking and have begun increasing leg weights while in the gym. So how exactly did I recover? Was it my running moratorium? Was it a simple matter of changing shoes? Can I attribute it to the intensive stretching and yoga poses I did? I wish I could have experimented on myself and alter each variable separately to determine true causation. Unfortunately, I am not a guinea pig.

My hunch tells me the most critical factor was the shoes. After my personal experience, I have grown wary of motion control shoes. Moreso when I learned from a friend who bought the same NB 859 for his wide flat feet that he suffered doing his 10K Powerrace. He would stop and walk every now and then during the race, and would require deep sports massage after. When the same friend did the 21K Condura (his next race after the Powerrace), he wisely used his old trainers and easily and happily finished ahead of me! To think all the training my newbie friend had after Powerrace and prior to Condura were 5-8Ks you could count in your one hand.

The right shoes are so important that I am thinking of going to Second Wind Store for personalised foot analysis by store owner Hector Yuzon before getting my next pair. While I am leaning forward now to the concept of running shoes being ideally neutral and non-stride altering, I think my best ally and defense against the ardent (and possibly self-serving) marketing people of shoe companies is a person like Hector who knows his shoes. Like Hector, I am now inspired to learn more about shoes, running form and injuries. While still new in the learning curve, it is helpful to learn from someone who has already been there.

Next to shoes, the other important consideration is recovery time. I admit I tend to make dramatic increases in race length or run mileage, but I think those could still be done had I made time for recovery. In my haste to make progress and puffed up with confidence that I could actually ran longer distances, I pushed, pushed and pushed until my body finally threw in the towel! I forgot the cardinal rule: progress is not made during the run, but while in recovery. I do not get faster and stronger by doing intervals and long runs. I become so when my muscles finally adapt to the stress inflicted on them.

Lastly, I belittled the importance of stretching. I would cool down but not stretch after races or runs. When my muscles remained tight even during my running moratorium, I realized how much tightness my muscles accumulated through the months. Since the realization, I would devote at least 30 minutes to doing deep muscle stretches or yoga poses.

I often learn my lessons the hard way. I hope my lessons have been hard enough - etched forever in my mental and muscle memories so I will not forget them.


Bong April 14, 2009 at 9:50 AM  

Very helpfull post. For the likes of me. :)

Amado L. Castro, Jr. April 14, 2009 at 10:06 AM  

In running the SHOE could be your BEST FRIEND or your WORST ENEMY. Stretching is starting your engine in NEUTRAL and without stretching it is like starting your engine in DRIVE. You are not alone we all learn the hard way and the good thing about it is it's difficult to forget that way.

Anonymous April 14, 2009 at 12:38 PM  

Very informative bro...Nice post!
Injuries are inevitable, it can happen to a sprinter, marathoner or ultramarathoner. We must listen to our bodies, don't overuse it and most of all, take plenty of rests if necessary. Remember, we are not machines...

God bless.

Rico Villanueva April 14, 2009 at 10:14 PM  

Hi Bong, glad you found this useful. It took me a long time to document this. I think we share at least two things: we are both heavy runners and we both long to do a marathon in the near future.

Thanks for dropping by Sir Amado. True, the best and most enduring lessons are those learned the hard way.

Hi runnerforchrist. Congratulations on your recent ultramarathon. True, we are much, much more than machines. Probably God's finest creations.

Anonymous December 7, 2010 at 9:18 PM  

Hi, very interesting post, greetings from Greece!

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