Soup to Nuts - Letsrun Train Me

Sorry, forgot to mention CONGRATS on the fine half marathon time. Very impressive in its own right, even without considering the condition you were in 6 months ago.

Lurker,

First, thanks for the encouragement. It is very much appreciated.

In terms of the injury and my chosen mode of cross training at this point, the treadmill hiking.

Quack had posted earlier in the thread that he had had some success with climbing stairs and the stair stepper not affected a similar injury.

Euro replied to that with an anecdote from some reading he had done about how elites found that steep hill walking was about the only exercise that didn't effect most running injuries.

Although there isn't a complete lack of impact, the walking does seem to minimize the impact and gives me something to do in a cardio sense in the absence of purchasing a stationary bike, which might be a step I take here in the near future.

I have found that my legs do feel better after these hikes than before. So I don't know if they are therapeutic or not, but they don't seem to be doing any further damage.

Impossible Dream wrote:

I'm with ya, as long as I can get my damn legs to cooperate! No running yet for me. I was going to give it a shot last night but my achilles is still feeling tight and sore.

Have you completely ruled out a stress reaction or fracture?

Any thoughts on what I can do to enhance my chances of a quick recovery?

I think obviously I need to stay away from exercise(running) that is going to have a force impact on the area until I feel the soreness and tightness have completed subsided.

Any moderated stress to those areas that increase bloodflow will probably accelerate the healing. Calf raises are great. It's ok to feel pain while doing these, but just keep asking yourself if you are causing any more damage and obviously don't do that.

I would also be taking supplements for joint health/connective tissues. Glucosamine, hyaluronic acid, and MSM. I do take some Osteo Bi-Flex that has all these ingredients. This plus keeping the slow protein trickle going and you have given your body what it needs to build muscle and connective tissue.

So work the injured area without causing more damage and give your body repair materials.

PhysMech wrote:

Have you completely ruled out a stress reaction or fracture?

I have not, but in my very amateur opinion I don't think that is what it is. It seems very much to do with the tendon and surrounding soft tissue.

Thanks for the tip on the supplements. I'll definitely look into that. Would you recommend any calcium supplements as well?

A stress reaction can be as simple as a very small area of bone that has basically been crushed a bit and lost it's structural integrity. This may or may not sound horrible to you, but the resulting slight change in geometry in that area can cause situations where things just don't seem to be getting better and any amount of the same activity that caused the problem seems to irritate the problem at a rate out of proportion to the activity level.

As far as calcium, there has been some interesting research published recently. Calcium increases the turnover of bone cells and can add strength to bones in the months after supplementation. Calcium does do that and you can count on that process working. However, there is an inverse relationship between milk consumption and hip fractures in later life. Milk drinking societies have a much higher incidence of hip fracture in the elderly.

So they have concluded that the bone cells are like all our cells and have a limited number of time they can turn over before the damage to the DNA kills the cell. Normal aging. So calcium makes the bones strong now, but accelerates the overall aging.

So it seems we have to choose our times to have strong bones. As for me, I would choose to be taking small amounts of calcium supplements during a masters running comeback. And perhaps bump it up a bit if I suspected it was a time that I needed it.

Well, I reread my post and there is a direct releationship between calcium consumption and hip fractures in later life, not inverse.

More on the supplements I mentioned earlier:

Glucosamine apparently helps grow connective tissue.

Hyaluronic acid is an essential part of generating the lubricating gel-like stuff between tissues like knee cartilage and our bones. If you run short of this lubricating gel, you get more wear on the connective tissue with activity. In my view, this might also be a factor in the sheath area in the achilles, where lubrication is essential.

Glucosamine and hyaluronic acid (HA) are synthesized in our bodies normally, so I always cycle my supplementation on and off, but definitely increase the consumption when I'm having a problem that I think it might help. Normally, my intention is to bump up my level and hope my body increases it's synthesis when I stop the supplementation cycle, as a compensation. I try not to continually supplement synthesized elements, as I don't want my body to stop its own creation processes, sensing there is a constant overabundance. I have read that our synthesis of these slows down as we get older.

MSM (methylsulfonylmethane) is really just a good source of sulfur. Unless you eat lots of whole eggs or tons of green veggies, you might benefit from some more sulfur, as it is a critical element in building connective tissues. Sulfur isn't synthesized so you don't have to cycle. I guess you can lower your supplementation level if your farts start smelling bad and your neighbors start thinking you have a meth lab in your house.

PM,

From what you wrote and little research on my own the Osteo Bi-Flex seems like a no brainer. I'll be running by the drug store today.

Thanks for the advice.

BTW - Do you think regular proper hydration can be a factor in recovery. Sometimes I don't do well in that area. I never seem to be thirsty and I ofter forget to drink water on a regular basis.

I suppose hydration is important and it's worth noting that we lose our sense of thirst as we get older.

It's also interesting that the same area of our brains that register thirst also register hunger. It is believed that we may actually think we are hungry when we are actually thirsty.

For a while now, I have believed in a SALT --> THIRST --> HUNGER process going on in our society from the food we eat. Our food has too much salt, making us thirsty, which is misinterpreted as hunger by our brains. If we eat instead of drinking, we dehydrate ourselves further, making us thirsty. This is misinterpreted as hunger again, so thinking about eating seems like what we should do again. So the salt is making us eat too much. Maybe.

Impossible Dream wrote:

I'll be running by the drug store today.

I thought you were injured!

Sorry, I couldn't resist. :D

I have been struggling with a pretty nasty case of tendinitis for the past 5 weeks. What is really saving my life right now is having access to a heated pool (they keep it at around 90-95 deg). I'm able to do laps or pool run in it and then stretch in the water after. It's making ALL the difference in the world for me.

Tendinitis is tricky because you might still be able to do certain forms of x-training, but it's really difficult to know for sure when it's beneficial and when it's slowly making the problem worse. In my case I found out overtime that the easy biking I was doing was making it worse and more tired.

The heat in the pool really helps with blood flow and it makes stretching SO much more effective because you don't have to lean so much or support your own body weight at the same time.

One other tip that might help (if you do have access to a pool) is you can gradually add %body weight to your running. My PT was explaining that in the deep end, you are basically 100% supported by the water. But say you are up to your neck, you are about 50% supported. If you go shallower, and pool run with water below your shoulders, it's closer to 25-30% weight bearing. This might allow you to gradually strengthen the tendon.

I liked both because I was able to get a great aerobic workout in my doing a lap around the entire pool (so it would be about half and half). I would try stuff like hard efforts on lengths and easy efforts on the widths. Or I might do something like 30sec hard/30 sec easy or even just do intervals.

Neliah2507 wrote:

Tendinitis is tricky because you might still be able to do certain forms of x-training, but it's really difficult to know for sure when it's beneficial and when it's slowly making the problem worse.

Bingo! I very much relate to this point. It seems like a bit of a crap shoot on what I should be doing as I'm not sure if I'm perpetuating the problem.

Unfortunately, I don't have easy access to a swimming pool.

I should say, though, it sounds as if my injury may be minor compared to yours. Keep us updated on your progress back, please.

Of course any and all tips are appreciated!

Well, I've decided to officially go on injured reserve. The more I read about achilles tendonitis (not exactly the correct term) the more I believe that is what is ailing me and that the very best solution for the most rapid return to running is to avoid any activity that aggravates the condition.

Although I would only put the severity of the injury at a 4 or 5 on the scale with 10 being the worse, everything I read and my actual experience over the past 3 weeks or more tells me that it will get worse if it doesn't get better. It isn't getting better with the cross training. I suspect pool work outs would help me maintain fitness and not aggravate it more, but I don't have any realistic access to a pool.

So, the plan is this. I will continue supplemental training that doesn't aggravate the achilles. I may even attempt to create a cardio type experience with very light weights, but I will not be running, hiking, or using the elliptical until I can walk down a flight of stairs without discomfort. That will be my key.

Since we own a 2 story home and generally the first physical thing I do every day is walk down the stairs, I'm going to be pretty clued into this key.

Obviously this plan is likely to compromise my fitness. The big picture though is that I want to be at my very best and fulfill the goal of this thread 12 to 16 months from now. If I lose a little fitness over the next few weeks and compromise my short term goals a little for the benefit of my long term goals I think that is a smart trade off.

I really think this is the best course forward and I'm at peace with it, despite being a bit disappointed to halt my progress.

Sorry to hear it hasn't recovered. I was kind of hoping that when you got over the half, it would have vanished. But you're on the wisest course.

The fitness you earned over months of hard work will return in a fraction of the time when it has gone. In the meantime if you can work on the diet (which is way tougher than any normal training routine, and unlikely to exacerbate the injury!) for a couple of weeks, you'll still be on the way to a good 5k this summer...

Thanks Euro! Kind words are appreciated.

The PT that I currently go to is phenomenal at Active Release Technique and different types of deep tissue massage that are specifically geared towards aiding in the healing of injuries. He has about 4-5 athletes he's currently seeing right now for Achilles Tendinitis and one has Tendinosis. They usually come in at the same time I am there in the mornings and depending upon the amount of inflammation, he always does tissue mobilization stuff for them which they RAVE about. Three of the athletes are runners and they've battled achilles problems off/on pretty chronically and they have been saying they have never seen improvements like they have on a daily basis with the help if his ART/massage therapy. He doesn't really do anything too fancy. He was explaining to me and one of the runners last week that what you want to avoid is degeneration of the tendon. It's not going to take too long to heal of it's just inflammation, but it's when the fibers begin to heal in an "unorganized fashion" that he said is where you find more chronic pain and weakness even after the inflammation is gone. He says it's because when your Achilles lays down new tissue to repair the damaged tissue, it's not the same consistency (studies say it's thinner). Also, because the area has hardly any blood flow, the healing process is very broken up and just not very thorough. The goal of his massages is to aid in blood flow (once MOST of the inflammation is gone) so that it quickens the healing process. He says it usually cuts the average healing/strengthening time in half. He was even telling them even if they can't see an ART therapist that we would benefit from combination of ice/heat and then really gentle/therapeutic massage. He always starts in the upper calf and works his way down. Once he gets to the achilles he will put his thumbs around the tendon itself and move slowly up and down (all the way to the bottom of the heal). He also will hammer the bottom of the foot (plantar fascia area) to loosen that up. But the Achilles is never hammered -- just lots of tissue mobility stuff for blood flow.

Sorry that is long, but when I say these patients are raving I mean every word.

I have tendinitis in my hip-flexor but it's because I had surgery on my hip about 8 weeks ago. It's a post-surgery problem because the tendon is pretty shut down after surgery for a few weeks so a lot of people develop it as they are healing. It's getting better everyday though so I can't complain :)

Neliah, I don't think "Active Release Therapy" was an active buzzword when I was working, but what you describe agrees pretty well with what I and the sports massage therapists I know did/do.

My opinion/bias/training is that most cases of tendinopathy in runners tend to come on because there is spasm in areas of the calf; and when the calf can't relax fully on each stride, it increases the peak force sustained by the tendon. So it's really, really important to get the whole calf healthy and make sure there are no locked-up compartments in there, and then the healing process should go faster. A few good massages is the best way to do it. Strength work for the calf, applied sensibly and progressively with a good stretch on each rep, can also help.

Most runners are quite capable of running fast with a good chunk of their calf muscles cramped up - indeed that's probably not unusual in heavy training - and they don't realise what state the muscle is in until someone starts to get their fingers or thumbs in there. We don't have the right kind of nerve endings in muscles to tell us when things are tensed up, unless they get prodded.

ID - I'm sorry to hear about the achilles. I think you're probably right about the pool, if you can find one. I'd also make sure you're getting in the usual small-muscle exercises *if* and only if they don't hurt -- hip abduction / adduction, toe raises to strengthen the tibialis anterior muscle, etc. Again, if it doesn't hurt, the full set of ankle sprain exercises isn't a bad thing to do, if you're not already doing them -- one-leg balancing, drawing the alphabet with your toes, and toe/foot flexion/extension or toe raises, followed by icing afterwords.

But remember that as with any strengthening, doing those too early can make things worse, not better.

The thing I've noticed with the stairmaster and my current injury (currently on its way out, thank goodness!) is how important the angles my ankle goes through are. Again - not for achilles tendonitis - but for this anterior tibial tendonitis, I find that the SM makes the ankle go through a much more limited range of motion than running or the elliptical, which I think has been key for me. But I'm guessing that this is pretty injury specific.

And nice job on that half marathon. 1:18 is awesome from where I'm standing.

PM, congrats on being able to partake in an amazing Boston, and VF, congrats on your new PR!

Me, I discovered this week that I'm not a good 800 runner. Kind of a weird one - my university has a "random distance run" where you don't know until midway through the total distance you're going to have to run, so it's wasn't quite a standard 800. The actual times aren't up yet, but I think I ran about a 2:29 (forgot to hit stop on watch; was too busy trying to remember how to breathe). The running calculators tell me that's about 7 seconds slower than I should have given my other current distance/times. I had no expectations for this one, so I'm not disappointed (nor did I rest going into it, and it was raining), but there might be a lesson in here about my training being *too* LSD-ish. That was the first time I've run sub-5:00 pace other than in little 100m strides in ages, and I'm a bit sore from it.

I've shifted my marathonning plans by one - I skipped the Georgia half, and plan to run the Pittsburgh half instead of the full. Will find some fall marathon instead; perhaps Columbus, maybe Philly.

"My opinion/bias/training is that most cases of tendinopathy in runners tend to come on because there is spasm in areas of the calf; and when the calf can't relax fully on each stride, it increases the peak force sustained by the tendon. So it's really, really important to get the whole calf healthy and make sure there are no locked-up compartments in there.."

Eurodonkey,that makes a lot of sense, thanks! Do you do massage work and/or PT? Very true that it's easy to abuse an already overworked muscle. I've been feeling improvements each week in PT (I always get a massage w/ART at the end). It's not nearly as painful as it was the first session and I am beginning to appreciate how much more relaxed I feel in general. Do you do other specific types? And I am curious what types you use for specific injuries.