Back from a year-long injury?

On July 1st 2018, I ran my first 42k race, Marathon du Mont-Blanc. At the end of the same month, I also ran the 32km Saarschleifen Run. But somewhere in between on a training run, I jumped over a small stream and landed on the embankment with only the forefoot of my left leg.

I didn’t give much thought to that small insignificant event, and in fact I cannot say with absolute certainty if that small misstep was day 1 of what would be my first plantar fascia injury; but two months later in mid-September at the Ring of Steall 29k 2500 Hm trail race in Scotland I almost had to DNF around the half-way point because the pain in my left foot had become too bothersome.

But after each painful day, I usually recovered sufficiently over the course of the same week to continue with training. So continued preparing for another 2018 highlight, Mourne Skyline MTR in late October; and completed that hard 35k race with 3300Hm of elevation change without too much trouble.

Except that somewhere in my foot, the injury was still lurking. And it reared its ugly head on November 6th 2018, when I was at the track and intended to restart track training for the upcoming winter season with a classic 10x120m sprint training. The first 120m, at a very leisurely pace, ended up being my last. I cut the training short due to intense pain under my foot, and when I woke up the next morning I couldn’t put any weight on it.

Two weeks later, I had a doctor’s appointment, briefly followed by an MRI. The diagnosis was for plantar fasciitis, albeit with the silver lining of not having any bone spur or other worsening factors.

With that initial diagnosis and a prescription for 8 physiotherapy sessions (which included shockwave therapy) I thought I was on an easy track to recovery. The doctor prescribed a “walk and run” training regimen to slowly build up volume again.

It didn’t work very well. By the end of 2018, I had finished my 8 physiotherapy sessions and the injury wasn’t much better. I was able to run a few kilometers, but no matter whether I did or did not run on any given day the pain level was ever-present at a level of about 3 or 4. Not earth-shattering, but still entirely too much to do any meaningful training.

And then I made the mistake of not following up with my sports doctor anymore, to say “it’s not working”. I thought I could solve the problem on my own if I just gave the foot some rest. I ran just twice in January, tentatively increased the amount of running again in February (50km monthly volume ) and March (75km) but by April I was severely limiting my outings again. What used to be a long run was now my monthly volume, a total of 18km spread out over just 3 sessions throughout the month of April.

May wasn’t much different, so I embarked on another running break in June (and did a whopping 6km total). Instead, I concentrated on road cycling. I rode almost every other day that month; and over the course of the year I would ride more than double of what I’d done in previous years.

Over summer, a quick vacation to Andorra tempted me to cover quite a bit of ground in the mountains on foot, running some bits of it. I was able to overcome the unpleasant feeling in my foot for a day or two, but the injury was still ever-present. On our big summer vacation that also took us to Mont Ventoux, I couldn’t resist lacing up my shoes for a small trail run up to the summit. It was magical to move efficiently in the mountains, and the views of the mountain and cloudscapes as a storm was approaching were breathtaking; but once again my foot was quite painful the next day. I realized that I had to change something because I missed both everyday running but also training for bigger races in the mountains.

Due to vacations and my status as a “hobbyist runner”, it took me until September to get to see the sports doctor again; and once again he prescribed shockwave therapy; but this time with the added disclaimer that I had to “feel relieved when the session is over“. In other words, the intensity of the treatment had to be quite high.

There was just a little immediate improvement, but after a handful of sessions my everyday pain levels went down from 3-4 to maybe 2-3 on a level of 10. An improvement, for sure, but still not enough.

At the insistence of my physiotherapist, I tried mesotherapy (small-scale anti-inflammatory infiltrations). The two sessions I did brought some more relief, bringing the pain down to maybe 2 on average.

At some point I made the flippant remark that my injury had just celebrated its first anniversary. For one year it had been present, albeit not overbearingly, every single day.

I continued with shockwaves, and after around 12 sessions of that the physiotherapist said on a whim he’d try a manual adjustment of the navicular bone. I was not expecting much, but a few hours after the session I could feel a marked improvement.

The pain level had gone down to 0-2. What this meant was that at some point during the day, I would suddenly realize that there was no pain at all. This was a feeling that I hadn’t had in over a year.

Was it the adjustment of the bone that had released some tension on the plantar fascia, which in return had brought down inflammation? Or was the bone adjustment just the icing on the cake and what really did the trick was 12 painful sessions of shockwave therapy?

As with lots of other things in life, everything is connected; and with complex issues it’s difficult to isolate an exact cause and effect.

Either way, it’s now almost thirteen months since the fateful day on the track and I feel like I’m finally seeing a light at the end of the tunnel. While the left foot still feels a bit off from time to time and I’m not sure that the injury is really truly a hundred percent gone; it has improved to the point where I’m now once again considering setting foot on a track again, maybe not to outright sprint but at least to see if maybe I could.

I’ve been able to do 120km of trail and road running in November, which is by far my best month in 2019. Let’s hope that the upwards trend will continue in December.

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