Acessory Navicular Syndrome

I visited my podiatrist yesterday to help get a handle on my latest injury.  About 4 weeks ago, I started having arch pain after a 20 mile long run.  I was able to manage the pain with ice and NSAIDs, and kept running.  However, the pain hasn't been getting better.

I initially thought it was a case of PF developing so I started stretching my calves again (hadn't stretched in a very long time).  And then, after about 2 weeks, I thought it might have been a sprain in my abductor hallucis since that's where the pain settled.  Most recently, the pain has settled in the navicular region, which is the prominent bump on the inside of your foot, below the medial malleous.  This is where the posterior tibial tendon inserts on the under side of your foot, so my injury has developed into a minor case of tendonitis. 

It turns out, I have an accessory navicular bone, which makes my bump protrude a little more than normal.  It's something that you're born with.  I've been running with no problems with it for years.  However, I'm guessing the combination of extra hill work, combined with lunges, combined with trying to save a little money by running in worn out shoes caused me to fall off the edge.  Training/running is about finding your edge, taking your body to a point of extremes, without falling off the cliff.

This problem can lead to falling arches, and increased pain with physical activity, and possible posterior tibial tendon problems.  This can be manageable, but often results in surgery if the pain doesn't improve.  For now, my doctor has taped my foot to help provide more support for the arch.  However, the taping appears to be aggravating my navicular bone even more.  My arch doesn't hurt anymore, it's just the navicular. Anyhow, he suggested that I try to run, but even walking is painful now.  He also feels that I need to be in custom orthotics.  I've been wearing Superfeet Green for about 4 years, after trying a pair of custom orthotics early in my running career.  I've got insurance coverage for it, so it's worth a shot.  And, if we can't get the pain under control, it would eventually result in the removal of the extra bone, and about 6 months of recovery.

My Grand Canyon run is in 6 weeks.  Or, it could just be a vacation to see the Grand Canyon as a tourist, and not as an ultra runner.  It's just running.  It's amazing to me that runners put so "much" into our sport.  It's also a little disturbing to me at the same time that we put so "much" into our sport.  Perhaps injuries are a good time to self assess, and perhaps take a step back.  Runners often push themselves too hard, in some case (present company included), we go too far.

Ready or Not

I haven't written anything on here in awhile.  Yet life goes on and I'm still running.  More than ever.  In the previous 2 months, I've had arguably the best training cycle of my life, reaching a new lifetime peak mileage of 325 miles in 30 days.  I ran my first 50 mile trail race.  And I've been healthy!  No problems, and training was going very well.  On Facebook, I mentioned that I was trying to find my edge, but without falling off the cliff.  Unfortunately, I think I found my edge a couple of weeks ago.

During the 50 mile trail race in mid April, I ran the first 34 miles with a pair of trail shoes that are slightly tight in the toe box.  And then I switched shoes, and used a Superfeet insert that did not have a cork metatarsal pad (used because of my Morton's Neuroma). Near the end of the race, I felt a twinge of pain in between my 3rd/4th toes, but thought it was just because I was nearing the end of a 50 mile very hard effort on the trail.

The following weekend, I made a significant push for one bigger weekend, running 15 miles on Saturday, then 15 on Monday, and 25 on Tuesday.  That was apparently my edge, because on Wednesday May 1st, my foot was on fire.  The Morton's Neuroma pain was there between the toes, and the ball of my foot was incredibly tender.  It really came on without any notice.  Tuesday I was fine, Wednesday, I was a gimp.

I immediately called my podiatrist on Thursday to get in for an appointment for the following week.  In the meantime, various folks on the Internet recommended stuffing a piece of cotton between my toes to help alleviate the pressure. Well, that apparently worked.  I eased down to let my foot rest, and by last Tuesday, the pain was mostly gone and I was running again.  I had the doctor put some new metatarsal pads on new Superfeet inserts, and we both decided that a cortisone shot was not necessary (I had one before two years ago). 

However, fast forward a few more days, and the ball of my foot is still tender to walk on.  Enough that I feel it with every step.  I don't have any pain between the toes, but the ball of my foot hurts.  This could even be a case of Metatarsalgia as well. And I question how the upcoming 3 Days at the Fair will go.  I'll be on my feet for 64 hours (well, with breaks of course).  And I really don't know how it will turn out.  I'm nervous.  I'm angry that I've come this far, with the ideal training cycle, only to come up lame a couple of weeks before the race.  Was this my edge?

Indiana Trail 50

This was my first official 50 mile race, although I've run 50 miles twice before as part of the North Coast 24 hour Endurance runs.  Training leading up to this has been ideal, and I've hit a new 30-day PR in the process.  Leading up to this race, which was held at the Chain O Lakes State Park near Albion, Indiana, the area received 5 to 7 inches of rain, so a lot of the course was flooded.  This resulted in 48 ankle-to-knee deep water crossings on the 3 lap course, but otherwise, the weather was perfect.  Starting temp in the mid 30s, finish temp in the mid 40s, with sunny skies.  Lots of mud too, but tough courses make tough runners.  Really, this race was a near-perfect execution for me, although I did end up tying my shoes too tight on the last lap to prevent them from being sucked off in the mud, which gave me a case of extensor tendititis on my left foot.  Live and learn.  Because of the water and mud, I also tried 2Toms Sportshield for the first time ever, coating my feet before the race.  It's a silicone-based lubricant that worked extremely well.  My feet were constantly soaked in water, yet I had absolutely no chafing or blisters, period!  Overall, an awesome race, finish time 10:23:26!  Finished 24th out of 77. 

Progress? Perhaps, with a Price.

My run this past Tuesday was a great run.  Over the last couple of weeks, I've really been focusing on just running on the treadmill at the gym since cold weather seemed to aggravate my knee.  After a full day of rest, I really pushed my pace on Tuesday, and was able to run 4 miles, without stopping, at an average 9:20/mile pace.  I haven't been able to run that fast since early November.  In other words, it was a great day, and gave me immeasurable confidence in the progress I've made post injury.

I did a 6 mile run yesterday, at a 9:30 pace.  My knee did bother me a couple of times later in the run, but every mile or so, I'd stop and stretch out my right hamstring, which helped ease the pain.

Today, I had to ease down as I had pain in my knee, not severe pain, but enough that I had stop and stretch every mile.  So, while I was able to do a fairly hard run (for me) on Tuesday and Wednesday, it doesn't come without its price, in that I ultimately end up with some knee pain later on in the week because I pushed it so hard earlier in the week.  That's OK though, I've learned a great deal though about how much I can do, and how hard I can push, and now know what the price will be.  My cardiovascular capacity seems to be returning a bit, as it was definitely diminished a couple of weeks ago, but it's gradually increasing as well.

Just have to keep moving forward, and have to keep my stretching routine up.  I've been trying to wean myself away from it, and also trying to wean myself off the Aleve (have not used it in over a week??), so these are all steps in the right direction, and that's all I can ask.

Home Ultrasound Unit

After some debate about whether it was a worthwhile purchase, I decided to buy a home-use ultrasound unit.  As I mentioned before, I truly believe in the power of ultrasound to create deep heat in your muscles and joints, which ultimately causes cavitation in the cells at a microscopic level, which ultimately makes the blood vessels get bigger. This brings more blood to the affected area, and also helps to carry away more waste, which also helps to eliminate the underlying inflammation, the most important thing. So, after doing some research, and a cost analysis, for me, it was worth the expense.  I have to say, after a week of using it once (and occasionally twice) a day, I think it's really helping, and a lot of my pain in my knee is gone.  I still get pain in my knee on longer and more intense runs, but it's getting much, much better, and I have to think it's a combination of everything I've been doing. 

The unit I purchased appears to be the most common, and from all accounts, the most reliable.  It's sold by the Mend Me Shop, and comes with a special blend of medicated gel.  Yes, the unit is somewhat pricey, but given it's potential use over several years, it's an investment in my overall health and well-being, which I personally can't put a price-tag on. After using it for more than a week, I have nothing but good things to say about this unit!  It has 3 level of intensity, has 3 different timer settings, and has a continuous and pulse setting.  It also came with a detailed instruction manual on how and where to use it.  I'd definitely not be hesitant to recommend this to someone who is dealing with their own aches and pains, and I feel comfortable in the quality of the product.

Last PT Visit

Today was my last PT visit I think.  After the Okoboji HM yesterday, my knee is a little sore, but essentially, I believe that additional PT visits won't be that productive.  I know what to do and how to manage the pain.  Although, I may consider purchasing a home-use ultrasound unit, as I feel that really helps to knock out the inflammation, on a microscopic cellular level.  They seem to be somewhat affordable, and given my recent experience with no-pain runs after the ultrasound therapy, it's worth a shot.  I also opted to get fitted for custom orthotics today. The PT feels that it would only help, to make sure that my feet are in proper alignment, which will help with any pains I might have elsewhere.  Plus, insurance will cover 85% of the cost, so I might as well take advantage of that benefit while I've got the chance.  The orthotics used here are made by Sole Supports and utilize the MASS approach (Maximum Arch Supination Stablization).  I think they will really help me in the long run, and are worth a shot in my opinion.

Another PT Visit

Another PT visit today, same routine, just a different day.  Full round of ionophoresis (ultrasound), an Empi patch (iontophoresis), and out the door.  Since the pain is nearly gone, I don't think I'll have many more visits, at least that's what I'm thinking right now.  It seems that I'm getting a real handle on the pain, what caused it, how to treat it, and how to manage it.  When I'm running, if I feel the pain coming on in the insertion point on the lateral (outside) of my knee, I just stop and stretch my left hamstring, and also do an ITB stretch for my left hip.  That usually helps keep the pain at a minimum during my run, and I can keep going.  The pain is much, much better than it has been, but still there from time to time.  I also ice my knee after every run, no matter what!  Keeping the inflammation to a manageable point is the most important thing.  There is no pain during normal activities, like bike riding, walking, etc, so as long as I just keep doing what I'm doing, I think I'll be OK!

Wow, Knee Pain is Much Better

I have to admit, my knee pain is improving greatly!  I think a combination of everything is working!  I was able to run this evening, 8 miles, without any pain until near the end.  Amazing!  Woohoo, finally on the road to recovery.

Today was also Independence Day.  I did have to work, and we had no solid plans for the evening.  It was a cloudy, drizzly, cool day today, so we decided to just do a BBQ at home, then go to a movie.  After work, I decided to "run" to the movie theater to buy tickets, then run home.  The round-trip was 8 miles.  We then had a great BBQ, and we all enjoyed, as a family, Ice Age 3.

Bottom line, I'm a firm believer in both phonophoresis and iontophoresis as treatments for ITBS.  They work!

Second PT Visit, Pain Improving

Had my second PT visit today.  Today, she did a round of phonophoresis with dexamethasone, which uses ultrasound (sound waves) to inject or enhance the delivery of the medicine into my ITB insertion point. She also gave me another Empi patch with dex too.  The Empi patch is a multi-hour therapy, which electrically injects the anti-inflammatory into my joint over a 5 hour period (it's powered by a  ring of watch batteries).  This, in combination of Aleve twice a day, along with the various stretches that she has given me, and continued icing of the knee after every run is really helping with the pain. I feel that I might actually me making a significant improvement.

First PT Visit

Today, I visited a physical therapist in hopes of getting some help with my ITBS.  I've been dealing with this on my own for the last 6 weeks, with not much improvement, despite my best effort to try various stretches, etc.  After visiting with the PT for a bit (she's a very competitive marathoner, and now has a doctorate in PT), she's given me several stretches to try to get my body back in alignment.  She feels that my hips may be slightly out of align, and has given me a toolbox of things that I can do to get back on the mend, including stretches, and also hip positioning techniques.

I guess I was perhaps looking for a smoking gun, and a magic bullet to get me on the road to recovery, but in the end, I think it will just take time.  One thing she did do was give me an Empi patch, which essentially micro-treats the pain location with an anti-inflammatory medicine called dexamathasone.  This technique is called iontophoresis, which uses a small electric charge to deliver a medicine directly through the skin. But, this should really help to knock down the inflammation in my knee.  She also suggested a full course of Aleve, twice a day for 10 days.  The pain is a result on inflammation in the insertion point of my ITB, and until that goes away, neither will the pain.  Icing my knee after every run will also help.  She also suggested that I think about custom orthotics, since my feet pronate a bit.  At the very least, she suggested I try some OTC orthotic inserts like Superfeet, to start getting my feet in the right position.

Hopefully, all of these things will lead to a solid recovery!  At this point, I need all the help I can get.

Decided to Visit the Doctor

I decided to visit a sports medicine doctor today since my knee pain just doesn't seem to be getting better.  After the run at the Rocky Mountain Half Marathon in Denver this past Sunday, I guess I need to get this checked out.  In hopes of avoiding the middle man, I skipped a visit with my family doctor, and went straight to a well-known sports-medicine group here in town.

The good news, after taking a series of x-rays, the doctor is sure that I haven't really torn anything and that I just have a very tight ITB.  This puts pressure on the knee, which leads to the the pain on the lateral side at the insertion point where the ITB connects.  My knee-cap is slightly displaced on the lateral side (just grew that way), which also compounds the problem.

The solution is to see a physical therapist, since there's no real damage that a doctor needs to repair.  I've made an appointment for June 25 with one of the leading running PTs in the area.  She has run numerous marathons, winning 8, and has qualified for the last 3 Olympic Trials.  I'm pretty sure she knows her stuff.

New Reusable Ice Pack

To help aid the healing of my knee, I decided to buy a reusable ice pack.  I've been using a ziplock bag filled with ice cubes, then using an Ace bandage to wrap the bag around my knee, buffered by a kitchen towel.  While that works, it's not the most desirable solution.

Since this may be a long term issue, I decided to buy an upscale ice pack, one that is reusable.  After shopping around a bit, I stopped at the local "See the Trainer" store and purchased a 9x24 Elasto-Gel ice pack.  It can also be used for heat therapy, and can be wrapped just about anywhere.  Most importantly, it's reusable, and has elastic straps, and also has it's own microfiber cloth to protect your skin.  If you need a long-term solution, I'd highly recommend something like this.

Or, you can make your own homemade reusable ice pack too by using rubbing alcohol and water.  Add 1 part rubbing alcohol and 2 parts water to a freezer-style ziplock bag, then place that bag into one more bag (just to prevent spills).  This will make a gel that you can mold around body parts if necessary.  Just make sure to use a towel as a buffer though, because this homemade icebag seems to get super cold, much colder than a standard bag of ice cubes. You can also experiment if you need to by adjusting the ratio of alcohol to water.  The more water you have, the more frozen it will get. 

Pro Tec ITB Strap

Since my knee is still hurting pretty badly, and I still want (need) to run, I decided to try out an ITB strap.  Now this isn't really a solution to my problem, more of a bandaid if you will, but at least it will help get me through the pain.  Essentially, it's a strap that you wrap around your knee, slightly above the insertion point of the ITB (where the pain occurs).  This is supposed to keep your ITB from vibrating too much, or to keep the ITB from bouncing flopping against the bone, which should help alleviate some of the inflammation.  Again, it's not the solution, but I'm willing to try anything at this point.  While there are a couple of different brands, the most common one that I've seen is the Pro Tec band.  But, they all work the same way, as far as I know.

Iliotibial Band Syndrome??

After my second half marathon race in as many weeks, I believe I may have stressed my Illiotibial Band (ITB). It's a tendon that runs the length on the outside of the thigh and connect your hip to your knee. This typically causes knee and hip pain if you strain it, and is a result of possibly running too much, too fast, too many hills, or on a cambered road, running downhill too much, or simply from having a tight ITB to begin with. It can also be caused by leg length differences.

In my case, in may be a combination of all of the above, since during my race on Sunday, I did start off with some knee and hip pain, but then it went away during the race, but then came back on strong after I got home. The race course itself was pretty hilly, I was running beyond my comfort zone to try and reach a PR, I did another race just 2 weeks ago, and I do have leg length issues. When you combine "all" of those into one day, it's no wonder I have issues. Doh!

To alleviate this, I used some ice on Sunday, took Ibuprofen, and have been doing various stretches to help make my ITB more pliable. It seems to be working since I was able to do a 3 mile recovery walk/jog today at the gym, after doing some light non-impact swimming on Monday. The stretches I've been doing involve doing side lunges, step downs, a lying ITB stretch, the piriformis stretch, wall bangers, and a couple of standing ITB stretches, and also using the stick to massage the thigh muscles and ITB crossways (not up and down), and also using a foam roller to roll out any kinks and knots and break down any scar tissue that might be developing there. It all seems to be working OK, so I hope to continue on the path to recovery. I also may start taking a glucosamine supplement, but I'm not sure if there's any scientific evidence that it actually works, but I don't believe there are any serious side effects either.

I have another 5 mile Boystown Fun Run on Memorial Day that I've registed for, to run with a coworker, but I have no intentions of racing it, I just need to run it for fun. My wife and daughter will be doing the 1 mile fun run/walk that day too. 

This knee pain sucks though, it's not fun.

What Did I Do...

Ei yi yi, what did I do?  After running the Papillion HM marathon yesterday, I was only 16 seconds off my PR pace from two weeks ago.  Immediately after the race, I felt fine, but throughout the day yesterday, my left knee continued to progressively get worse, and worse, and worse.  Today, it hurts so bad, I just don't understand it.  I can barely walk, can't go up or down stairs, and it hurts to bend my knee.  I think the hills, and running extra hard near the end of the race really may have done me in.  I decided to do some light swimming today at the gym, nothing strenuous, only for the fact that I can't really do anything else.  Ouch, my knee hurts.

Pain is Decreasing

Today was a scheduled rest day, but it was hard since it warmed into the lower 60s. I ached to get out and run today, but knew I had to take it easy. I started an extended stretching routine today, to try and frequently stretch my lower calves. I did stop by the local Running Store, Peak Performance, to ask whether or not my shoes needed inserts. They felt that the pain was 1) expected, 2) sounded as if it wasn't that bad, and 3) think I should not train as hard.

This evening, the pain is almost gone, but the calf muscle and Achilles tendon still feel tight. So, perhaps the stretching is helping. Of course, not putting the strain on it with additional training is helping too. The running store did suggest I use a heel lift in my shoe to help take the strain off the muscle when I'm walking around too, so perhaps I'll stop at Walgreens to see what they have. He suggested that if I'm still having trouble in a week or two, to come back in to possibly look at different shoes. I'm using Nike Air Pegasus 25+ shoes now, and they feel good, but if they are they are the cause of the problem, I would definitely consider changing.

It's kind of weird that I was a bit anxious to get out and run today, since only 3 weeks ago, I approached my runs with some trepidation. Even with the pain yesterday, I otherwise felt really good, before, during, and after the run, and was excited to be outside running for the first time. Just wish I could have taken advantage of the warmer weather today, but these days will come again soon.

Lower Calf Strain

Here we go again. I'm a dumbass! Yesterday, I complained about some minor pain in my lower right calf. Well, today, the pain had diminished. It was still there but just barely noticeable, so I decided to do a light run to see how it felt. Plus, it was bright and sunny and temperatures had warmed into the mid 40s, and I was extremely anxious to not waste the day. So, I put on my Forerunner 305 (GPS pedometer) and went for a light jog through the neighborhood. First, let me say that the run felt awesome. It felt good to NOT be running on that stupid treadmill, and the time seemed to pass by very quickly. The Forerunner watch was very cool and worked flawlessly and definitely glad we made the purchase (now we might have to buy another one, hmmm). The pain in my calf wasn't too bad, just a low dull ache, but I was able to run through it.

At about mile 2.4, it hurt a little more, so I walked for a couple of minutes, but was able to start running again and completed 3.1 miles (5k). This was after being awake for 17 hours, so it was my evening, and it just felt good. The bright sunshine sure helps knock down the case of SAD I've had the last couple of days.

Now, back to this pain. After a 5 hour nap, my lower calf is very tight, just like it was yesterday. It's not an extreme pain, just sore. After doing some research, it seems that I may have just strained it, or it could be a case of Achilles Tendinitis. The cause is probably the combination of not enough stretching, too much mileage and too many hills too fast, and possibly the way I run (over pronating more than my shoes allow). I did test my foot type and it seemed to be neutral, and my shoes fit that profile, but perhaps when I run, that changes. I believe there are some shoe inserts that I can use to try and fix that. Anyhow, the remedy is RICE, or rest, ice, compression, and elevation, taking a break from training, and more (a lot) stretching.

I've come so far, and I'm actually looking forward to the running now, and certainly don't want to back down, especially if the weather is nice. But, if I'm injured, it will only get worse and I'll never get back on track. So, despite my anxiousness about continuing my training, I guess I'll have to ease off for a few days and let this heal.

In retrospect, I definitely have pushed it too much. I still have 12 weeks left until the race, and I've been able to accomplish a lot more in just 3 weeks of training than I ever had envisioned, so taking a few days off now is probably not the end of the world. Slow and steady wins the race.

No Pain, No Gain...Um No Way

There's that old adage, "No Pain, No Gain." But, that doesn't sound fun. Today during my run, I started to get a sharp pain in my right calf about halfway through. At that point, I decided to ease down, and end the workout since I didn't want to strain any of my muscles any further. I had run about 2.3 miles, short of my 3 mile goal, but at the same time, you can't train if you're injured. I was doing a hill-setting on the treadmill, running about 6.3 mph when I started to notice the pain, so perhaps it was just too much too fast, and was my body's way of telling me to back off. So I did.

I also really started to stretch for the first time after my 4 mile run yesterday too, so perhaps I just put too much stress on that calf muscle. Now, it's not that I can't walk, or have a limp, it's just that my right calf muscle feels very tight, even well after the workout. So, I'll give it a couple of days to heal and will begin again.

The run was particularly hard today since I felt as if I had the weight of the world on my shoulders, and just couldn't let it go. I was also tired, after only getting about 5 hours sleep (stress will do that), so all in all, it just wasn't a good day. Temperatures are supposed to warm into the mid 50s the next couple of days. While that sounds like a great opportunity to get out on some local trails here in Omaha, I'll just have to take it easy and definitely not overdo it.

More Milestones...And Injuries

When I woke up this morning (after a hard workout yesterday), I was pretty sore. Took awhile to get my body moving again. After dropping my daughter off at school, then doing some Internet browsing on Geocaching, I headed back to the gym this morning for round two. Today, I was able to run for 25 minutes nonstop, running about 2.5 miles, at a constant 5.3 mph pace! I felt a sense of accomplishment after completing the workout. In fact, I finished strong, and felt I could have gone longer, but decided to not push it.

However, about 3 minutes into the run, I had an immediate, sharp, stabbing pain in my mid/lower right abdomen, right under my ribcage. The sharp pain faded to a low dull ache through the remainder of the run, and is still tender this evening. In fact, had another attack about 2 hours after that too. Not sure what I did, but it sure hurt for awhile, but I was able to run through it. Probably pulled a small muscle in my abdomen, not totally sure. It's not my appendix since I've already had it removed. I've had this type of pain before, and often thought it might be a mild form of gall bladder attack based on Internet searches.

Anyhow, after a 30 minute period of relaxation in the sauna, I stepped on the scale to reveal 155lbs! That's the lowest weight I've ever been (not accounting for when I grew up and went past this weight the first time). Granted, that's after sweating out a lot of water in the sauna so it's probably just a little one the low side, but I did wake up at home this morning at 157. Sure wish I'd lose the fat in my belly roll though, instead of everyplace else, since as it is, my ribs really starting to show, and I still have this belly roll that makes me feel (and look), well fat. Duh.

So, it was a day of milestones. I ran for 25 minutes straight (2.5 miles), weighed 155lbs at the end of my workout, but also experienced some kind of injury and mild pain in my abdomen, and it still hurts this evening. And why exactly am I doing this?