Healing achilles tendonitis and plantar fasciitis

Too much of a good thing

I had planned on finishing my 2013 six month ultra running and racing season with the Mount Desert Island Marathon on October 20. But then a couple late season opportunities came up that I just didn’t want to pass up. The main one being the 100k La Ruta Run trail race in Costa Rica. That meant that I had to prolong my season by an unplanned month. A wiser me would have turned that month into a nice long relaxing sauna-session, focusing more on heat training than over training. But the newbie ultra-runner in me didn’t feel confident enough to leave well-enough alone and during the few weeks after the MDI marathon I stacked up a couple 30 mile training runs and then some short fast trail races. It was a really fun month and I figured why take a break when nothing’s broken? 

Ouch, that heel pain.

I knew I was in trouble the week before La Ruta when I felt a tell-tale sharp pain in my right heel. Fortunately I had a taper week ahead of me and I spent most of it on a bus toodling around San Jose. The dull achy pain migrated around my heel from side to side and front to back. Not always worse in the morning, sometimes completely gone, and then back again. I don’t take pain killers and I didn’t have any tape so I just kind of hoped for the best during the race itself. Which in the end turned out to be fine and almost entirely pain free despite the 8,000 feet or so of elevation gain. Compared to how Joe Fejes describes his achilles pain during his six day run at Across the Years, I got off easy!

The straw that broke the runner’s tendon

If I had just stopped there I might have spared myself, but noooo, the Crows were planning an early morning Thanksgiving run up and down Cadillac Mountain, how could I possibly miss that? Coming down the mountain I felt an ominous crackling in my Achilles tendon. It’s a feeling no runner wants to feel. That “oh shit, this is going to take a long time to heal” feeling. I limped home and pretended I was fine while standing on my feet all day cooking.

The next day my sister and her kids invited us on a hike up and over Champlain Mountain. Again, how could I possibly miss that? Four hours into the hike my foot and ankle throbbed and burned and I whimpered back to the car, tail between my legs. I know better. Really I do. A week off turned into a month, and then another month started to slip by. I ran 8 miles total  in December. I wasn’t too bummed because I had planned to take it easy for a month anyway, but when middle January rolled around and I was still limping I decided it was time to get more serious about healing myself.

1) Identify the obvious source of stress

I had stopped running but my injury wasn’t healing. There must be another source of stress causing the tendon and fascia to stay inflamed. One obvious culprit was my diet. Ever since the VT50 I had really let my diet slip. Gu and Tailwind (or any sports drink) are like gateway drugs for me. Add a few holidays to that and suddenly sugar and grains had crept into almost all of my meals. A muffin here, a cookie there. Here a pie, there a pie, every where a pie pie . . .  until a couple of weeks into the New Year I looked in the mirror and noticed a pair of puffy tired eyes staring back at me. As if the Achille’s pain wasn’t enough of a warning sign now I was showing other signs of systemic inflammation. My back ached, my period was painful, my sleep was sucking and my mood was bleak.

2) Take away the most obvious source of stress

Out went all the sugar and grains. In came at least 30 different vegetables and fruits a week, a good amount of super-high quality protein in the form of locally raised and pastured furry and feathered beasts and super-high quality fats like avocado and coconut. Within a week my heel pain had subsided enough to get back to running every other day. The third week I ran 35 miles and this past week I joyfully skied 60 pain-free miles. (Why run when you can ski?).

 3) Prevent future occurrence

I’ve been backing up my clean-diet with some other  healing strategies. First, I’m trying to get 8-9 hours of sleep a night, especially on the days I’m running.  I’m not great at this but I’m working on it because there is a ton of evidence that sleep promotes recovery and decreases inflammation. Second, I’m cross-training as much as possible by xc skiing, biking on my inside trainer when it’s really crappy (or dark) out, and swimming, and third, I’m working my ass off. Literally.

Look for other sources of stress or causes of imbalance

Besides treating the systemic inflammation, I need address the obvious alignment and strength issues that I know added extra stress to my Achilles tendon and right foot during that period overtraining at the end of the season. My achilles was just the weakest link in a stressed out chain. To heal that link I’ve got to strengthen the whole chain.

I’m practicing glute and adductor strength routines four days a week (classic Pilates mat classes plus this “myrtl” routine). I’m also consciously working to keep my intrinsic core muscles awake and firing while I run. To help with my alignment I’ve gotten a few chiropractic adjustments though ultimately my left hip is so dysplastic that skeletal symmetry is not going to happen for me in this life time. The adjustments do seem to help me access my glute and hamstring muscles more and I think that helps take some load off my right foot.

Becoming my own expert

Over the last few months I’ve researched a lot of advice about plantar fasciitis (aka fasciosis) and Achilles tendonitis (aka tendonosis). There are “experts” coming from all different angles. Some say you need more arch support, some say you need to go bare foot, some say you need flat shoes, some say you should only run with heel lifts. Some say you just need to align your toes and stretch the front of your ankles while others say you should align your hips and stretch your calves. Some say only run on flat even surfaces and others say trails and hills are the way to go. What all of this tells me is that the origins of pain in the lower leg and foot are varied and complex. Ultimately:

The key to resolving pain is to bring the system back into balance. How you do that depends on what took you out of balance in the first place.

As a yoga teacher and an athlete I have a few generalized templates of balanced alignment and action that I keep in mind as I help people reduce their stress and get out of pain. I often know what I need to do in my own body to get there and I can often help other people move toward balance too, but the reality seems to be that human health is an ongoing experiment. Not all things work for all people, we are biological not mechanical and the attributes of sensitivity and responsiveness are critical in a healthy biological system.

You are the experiment

That’s why at no point in this injury cycle have I been tempted by the quick-fixes of pain killers or shots. I need the sensation of pain as feedback to assess my healing strategies. I need to know if I got enough sleep the night before, if running barefoot or in shoes (and which shoes) is helping or hurting, and I need to know how that breakfast of turkey and spinach is treating me. I don’t need an expert to tell me to avoid lateral standing poses in my yoga practice (side angle, triangle, warrior 1 and 2 . . .) when I have the wisdom of pain to warn me away, and I don’t need a company-funded study to tell me that their $500 pair of orthotics is my only salvation when a cheap pair of boots with the insoles taken out feels great.

The usefulness of pain

Pain is complicated but it’s not that complicated. At a basic level pain provides us with critical information about how we’re managing the stressors in our lives be they emotional, environmental, dietary, biomechanical or other.  We think pain is complicated when we’re sure we’ve done all that we can to mitigate the stress but the pain persists. And it’s true, sometimes you’ve done all you can but your pain is in fact a result of a stress that is not under your direct control. When you are in this kind of pain it can really really suck to realize that you are not the master of your own universe. I’ve had this experience too many times (like the time my wrist bone broke and died and then took three painful years to dissolve and in the mean time I couldn’t open doors or slice my own bread. Holy crap that sucked.)

Pain is a sign of stress

The message of pain is “You are overloaded by the amount of stress in your life”. Stress from a combination of sources that are personal to you (accident, illness, birth defect, environmental, diet, life style, relationship etc.) You can respond at the first niggle of pain, or like me you can wait until the pain becomes intolerable. Either way your response should be to systematically remove the stressors that you can, starting with the easiest and most obvious ones. Hopefully for most of us most of the time this will give us relief. For me diet is one of the easiest places to start and that’s why I offer my seasonal cleanses – because it is my experience that by removing dietary and some key life style stressors pain often resolves itself. At best it’s cheap, low risk self-care, at worst it’s a good start.

When a clean diet and rest aren’t enough

For those of you actually experiencing plantar fasciitis or Achilles tendonitis I want to share some of the useful resources I’ve come across. Remember, there are as many ways to get back into balance as there are ways to get out. Some people need to take their shoes off, some need to put shoes on. Some people need to strengthen their feet and some people need to strengthen their butt. The key is to be sensitive and responsive – which means sensible and responsible in your own recovery process. Sometimes pain just needs you to change your socks, sometimes it needs you to change your life.

Resources

I’m absolutely loving ROLL Recovery‘s R8 contraption. The cost seems totally outrageous but considering how expensive bodywork is it has more than paid for itself over the past month. Seriously, the ability to work trigger points along the sides of my shins and ankles and get blood flowing to the belly of my calves and hamstrings, plus the targeted work I can do on my ITB (not just smashing and trashing it with a foam roller) is absolutely fantastic. Oh, and I’m using it to tease apart the scar tissue from that old wrist injury too . . .

As a barefooter with good strong feet I found the Sock-Doc’s recommendations for foot and ankle stretches to be really helpful.

If you are a shoe-wearer Dr. Ray McClanahan at Northwest Foot and Ankle has some good thoughts on how poor foot wear and toe alignment can contribute to PF and AT.

And here’s another one geared toward how stiff ankles and wearing shoes with toe-spring might contribute to plantar fasciitis. I don’t wear stiff shoes with toe-spring, but if you do, you’ll want to check this article out.

And finally, if your misery needs company listen to Caity McCardell’s funny and poignant rant about her own struggles with plantar fasciitis and the wide spectrum of remedies she’s tried.