From Tom Slick on Sat, Dec 28, 2013 at 08:49:11 from 69.171.160.60
Hey Rhett, hows it going runner man? I see your gettin' in some TM time.
From Teena Marie on Sat, Dec 28, 2013 at 09:02:38 from 65.130.22.183
Hi!!! So ... I haven't been checking blogs much. This morning I was thinking of how I wanted to send you a quick thanks for the nice Christmas card which then made me think about how I never did hear back from you regarding your hamstring question. So then I got on your blog to see how you were doing!!! Man ALIVE!!! Okay, I haven't talked to you much and I could be dead wrong here but the things you have been writing lead me to believe that the calf is not the primary problem right now. Well, not exactly anyway. The reason I say that is because if the calf were truly strained or severely injured running up hill would increase the pain. When your foot is dorsiflexed it puts the calf muscles on stretch (like uphill running) which is often quite painful when they are injured. With that said, if you have a tibia stress reaction and or fracture of if you have tibia periostitis the pain is often referred to the calf. Also, often with stress reactions running on steep uphills is much less painful because it drastically reduces the impact. It is not an impact free exercise (like pool running) but it is much less impact than running on flat ground or downhill. And lastly, walking on your toes greatly reduces pain when having a stress fracture or reaction as well.
PLEASE be careful and email me if any of this doesn't make sense.
Like I said, I may be wrong (and hopefully am).
And, thank you for the Christmas card. It is always so good to hear from you and Doone! :)
From Rhett on Sat, Dec 28, 2013 at 17:23:21 from 199.117.154.54
Slick I wish running was going better, but besides that life is great! I hope you're having a wonderful holiday season,
From Rhett on Sat, Dec 28, 2013 at 17:26:57 from 199.117.154.54
Teena, I'm almost positive it is muscular. I've done the stress fracture thing already and this is way different. Today I did the elliptical for 30 minutes and had some tightness but not bad. After that I did some calf raises, first seated then standing with straight legs. Seated I could feel the strain on the muscle, but standing it was like nothing was wrong with my calf so I figure that means it is the soleus muscle. Who knows. I think I just need to give it time, which unfortunately means I probably won't be able to do the Phoenix Marathon on March 1, or at least not like I would like to do it.
From Tom Slick on Sat, Dec 28, 2013 at 17:56:23 from 69.171.160.163
Oh Rhett, stick with the program and it will get better. I've been following the thread with Teena. Shes got some great points but you've got hands on experience.Keep it massaged and stretched...
From Teena Marie on Sat, Dec 28, 2013 at 18:16:13 from 172.56.9.64
Well that's good!! :-) Feel around the tendons by your medial malleolus. Any pain there? What shoes have you been running in?
From Teena Marie on Sat, Dec 28, 2013 at 18:38:38 from 172.56.9.64
More specifically I want you to palpate the posterior tibialis tendon.
From Rhett on Sat, Dec 28, 2013 at 20:29:14 from 199.117.154.54
I poked around and discovered that my peroneal tendon is tender. It more lateral not medial, but it is only tender above the ankle and doesn't go all the way up but starts to dive in about mid calf so probably the peroneal breves.
From Teena Marie on Sat, Dec 28, 2013 at 20:41:39 from 65.130.22.183
Wow. I wasn't expecting that. Any arch pain?
From Rhett on Sat, Dec 28, 2013 at 20:50:55 from 199.117.154.54
Nope my foot feels fine. I think I'm just going to have to rest it. The question is once I get it better how do I prevent it from coming back again as this is the same injury that stopped my running this summer.
From Teena Marie on Sat, Dec 28, 2013 at 20:54:43 from 65.130.22.183
And you don't believe it is the shoes, right? And the PT stated that the range of motion in the injured leg was normal, right? And is this the leg that usually gets injured or does it vary?
From Rhett on Sat, Dec 28, 2013 at 21:39:14 from 199.117.154.54
The PT said I only had 10 degrees of flexure on that foot and 15 on the other. He said normal was 20, so maybe I need to do something to increase the range of motion. While the peroneal tendon is tender I don't think it follows up the the muscle that is hurt. I'm a mess.
From Teena Marie on Sat, Dec 28, 2013 at 21:45:31 from 65.130.22.183
Goniometer measuring is definitely not exact (especially at the ankle). I wouldn't worry too much about those numbers but I would make sure your stretching your calves (both bent and straight knees, which I am sure you knew already). I am really interested in knowing is if your injuries are consistently on this leg or if it changes. That I do believe is important.
From Rhett on Sat, Dec 28, 2013 at 21:58:49 from 199.117.154.54
This particular injury has only been in the right leg. It is also the same leg I had my tibial stress fracture. My upper shin injury which felt a lot like a stress fracture last year was my left leg and the time I ruptured my PF was my left foot.
From Tom Slick on Sat, Dec 28, 2013 at 22:52:50 from 69.171.160.163
Hey Rhett, isn't that Teena great! I realize that runners want every ache and pain to go away as fast as possible, but we're an impossible lot. We want everything to happen yesterday, especially injuries. It just doesn't happen that fast, as I well know with my myriad of maladies. Sit back, take a deep breath and a chill pill, and focus on the path to better health and running. You sir are a gifted runner....do whats right and not just the quickest way back to the two lane black top. You will be better in the long run, ya know what I mean???
From Rhett on Sat, Dec 28, 2013 at 23:16:56 from 199.117.154.54
Slick, I think you are right. I just need to learn patience.
From Rhett on Sat, Dec 28, 2013 at 23:18:47 from 199.117.154.54
And yes, Teena is wonderful.
From Teena Marie on Sat, Dec 28, 2013 at 23:24:56 from 65.130.22.183
I think you are pretty dang good with patience, Rhett! Also I think you are right on with what you said earlier: "The question is once I get it better how do I prevent it from coming back again as this is the same injury that stopped my running this summer."
I sure wish you lived closer!
We will talk more pre-hab later.
Good night you two. Sleep well. :-)
From Teena Marie on Sun, Dec 29, 2013 at 09:53:07 from 65.130.22.183
Okay, maybe I am a PT nerd but your lower leg injuries kept me awake last night. So I did what any nerd would have to and started going through your blog entries close to injuries. I have a theory (mind you it is only a theory since I have not physically examined you and/or looked at your running gait).
Background:
Your last three injuries seem to follow a very hard track workout on tired legs (this injury, the one prior to your last Phoenix marathon and the one prior to that). Also, twice (this time and the first one I mentioned you spoke of pain both in the soleus and fibulari muscle areas).
Here is my theory (reminder: only a theory, since I don't have all of the tangible info that I would like to have) is that you are over pronating (atleast during speedwork). The reason I think that is because your calf muscles would be stressed no matter what during speedwork since they eccentrically have to work much harder to control the slowing down of your tibia during late swing phase, but if you are overpronating then your fibulari muscles would have to eccentrically work crazy hard to control/slow down the increased supination that would have to take place for you to get enough toe-off (due to the excessive pronation that took place following heel strike) to allow you to hit the speeds you were during your workout. (Okay, I admit that was a mouthful, but I really believe it makes sense.)
It makes sense because neither the Brooks Pure Connect or the Asics Tarther have much arch support to control pronation (if someone is over pronating). Furthermore, with both of these shoes you have less than the average heel to toe drop in running shoes (average is roughly 12 mm whereas the Brooks Pure Connect only has 4 mm and the Asics Tarther has 9 mm) so the calves are stressed more. (Which is fine, especially if someone is wearing them who has previously had anterior low leg injuries. Like me, I love the 4 mm heel to toe drop. BUT you have to be careful to give your calves enough recovery time after speed or hillwork.)
Which leads me to my final point, I think your biggest obstacle to overcome (which is the obstacle I continue to fight as well as many runners) is simply giving your body more recovery time in general. Both you and I struggle running as many truly easy miles as we should when we feel good. It's not really until we start feeling injured that we truly do that. I don't know if it is a boredom, time management or fun issue. But I think you would agree that we both have that issue.
Anyway, sorry this is so long, but those are my thoughts.
Maybe I am totally off, but it is a theory.
If you agree or have questions email me and we can talk about things to address the possible over-pronation. :)
Have a great Sunday.
Sorry this is so lengthy. I should have just sent an email but I was already here and had no idea I was going to be so wordy! :)
From Rhett on Sun, Dec 29, 2013 at 14:02:39 from 199.117.154.54
You are good Teena, like the Sherlock Holmes of PT. I agree with everything you said. You mentioned the stress put on my calf at toe off. I think that is why I can run uphill and walk on my toes without pain, because my push off is much shorter so I don't get the stress at toe off. I have really high arches, but do you think moving to a stability shoe for speed work would help?
Oh, and for me it is a fun issue. I just love running fast. It makes me happy and is so much more fun than running slow. Maybe I need to start going back to cross training on the day after speed work.
Do you think there is any type of strength training or flexibility work I can do to help the situation?
Thanks for all your help. I wish there was a PT around here that had the passion for helping runners like you do.
From Teena Marie on Sun, Dec 29, 2013 at 22:00:33 from 208.54.38.210
People with high arches generally over supinate --- which definitely puts a lot of stress eccentrically on your fibularis muscles. Yes, there are definitely things you can do. I will try and email you some stuff tomorrow. Also, I would try some good over the counter orthotics that fit your arch. Do you have a good running store close by who could fit you in one. Have you ever tried orthotics?
Watch for my email for the exercises tomorrow.
Hope you had a great day. :-)
From Rhett on Mon, Dec 30, 2013 at 09:27:42 from 24.121.26.213
I have custom orthotics from when I used to get PF. I don't like to run in them because they feel clunky. Maybe I'll try wearing them when I do speed work.
From Teena Marie on Mon, Dec 30, 2013 at 09:36:52 from 65.130.247.17
Custom orthotics tend to be too heavy and big for most runners to deal with. I would look at over the counter ones made for athletics/running. MUCH better to run in (in my opinion) if you find the right one. For example, I often recommend the Superfeet brand. Trick is you need to find somewhere that you can try a lot of them on.
From Rhett on Mon, Dec 30, 2013 at 11:18:47 from 24.121.26.213
I'll have to do that when I'm out of town next time. We don't have any running stores in Havasu. :(
How do you know if you have the right fit when you're trying them on?
From Teena Marie on Mon, Dec 30, 2013 at 11:24:45 from 65.130.247.17
The best way I can explain it is it should fit the contour of your unweighted foot. Then when you put it in the shoe (replacing it with your insole) and jog around for a bit it feels like home. When you start using them break them in slowly. 1 mile the first time (to see how your body responds the following day) then two miles the next time, etc. ☺️
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