Posterior Tibial Tendonitis: For the person who left a comment asking about how I got over it

I’m sure you know having struggled with it for several years that it’s a difficult injury to get over. The location of the tendon is such that it doesn’t get much of a blood supply, so healing happens slowly. Though I did several things along the way to aide in healing, here are is what, I believe, ultimately lead to me getting over it:

1. Active Release Therapy. I spent so much time in physical therapy with the tendonitis that at some point, I think I may have actually been experiencing more soft tissue pain than tendon pain. After a year of PT* I got fed up and decided to give ART a try. Within one session my ankle/shin felt 80% better and within two sessions, I was essentially cured. If you are in the Boston area, both Dr. Kelly and Dr. Steinley at Active Recovery Boston are great.

*To elaborate on the PT part of it, I have no doubt that PT did help me and addressed some muscular imbalances that were contributing to the problem, especially in the beginning when the tendon, itself, was obviously inflamed. But as the injury progressed, I believe it became less of a tendon problem and more of a soft tissue injury, I just didn’t know it as I had been in PT so long for pain that was in the same area of the body, that I had forgotten what the pain originally felt like. Looking back on it, as PT progressed, the pain moved higher up my leg in the lower shin area. There was still some pain on the inner part of the ankle but it wasn’t nearly what I had been experiencing when I was first evaluated.

2. Orthotics. I went through several different versions of (insanely expensive) orthotics until I found a pair that really worked for me. I found an amazing gait analysis/custom orthotic person. I believe it was my third pair and I am still using that pair. For anyone in the Boston area who might be interested, her name is Rebecca Arner-Brown at Boston University PT.

3. Warming up properly. I forced myself to ride the bike or hop on the elliptical for 10 minutes before I completed a stretching routine and ran. Prior to that, I had always stretched the muscles without warming up first. I know there are different thoughts on stretching, when you should/shouldn’t, etc. but I really believe being warmed up made a difference.

4. Always wear shoes. Never, ever, ever walk anywhere without wearing a pair of shoes, and preferably a pair of shoes with arch support. This is especially important when the tendon is inflamed. And by never, ever, ever I mean never, ever, ever. Still to this day, I wear Crocs in the shower, keep a pair of slip-ons next to my bed to wear when I get up in the middle of the night, etc. While I've been doing some reading up barefoot running and believe there is some validity to the new train of thought that we weren't meant to run with cushioned shoes and arch support, I also know that my arches literally touch the ground and when I walk barefoot even for a short time, I feel it. Wearing shoes all the time has worked for me and having dealt with this injury for a long time, I have no plans of changing what works.

5. Orthotics in my bike shoes. I spend a lot of time on my bike. Though you’re not stressing those tendons as much as you would be if you were running, you’re still stressing them, not to mention I’m often getting off the bike and going straight into a run. Anyhow, these things are great and relatively cheap: Superfeet

I hope that was helpful and good luck with your injury. It’s definitely a frustrating one!

Here is my hip

I am not sure if I'm excited or freaked out by the fact that it looks like it's wearing a wedding band.

I had an MR Arthrogram today. For those unfamiliar with it an MR Arthrogram is a proceudure where your hip joint is injected with contrast dye before MRI images are taken of the hip. I left with a cd full of images that mean nothing to me (see betrothed hip above). Hopefully some answers on the hip pain will come tomorrow.

This has been a pretty effed up day for me. I was, still am in fact, totally freaked out by this whole procedure and I'm not exactly sure why. I have had surgery before...elective surgery where they knocked me out and the whole nine yards. I was fine with that. I mean, not fine, but I wasn't bothered by it and in comparison to that, I would say that I was about 100 times more freaked out about having pictures taken of my hip than having surgery. I've been trying to reason it in my head all night and I still haven't come to a conclusion. My current theory is that I'm more freaked out by the outcome of the procedure than the procedure itself. The fact that it's done and I'm still freaked out validates that hypothosis.

A few points before I have a diagnosis. This is all stuff that I've realized only because of this injury/downtime/whatever it might be.

1. I have a favorite MRI provider. WTF? This isn't right (btw, it's Shields. If you live in the New England are and are in need of an MRI, go to Shields).

2. I have a fovorite MRI provider for a reason. I know some of you think I'm crazy. Hell, sometimes I think I'm crazy. Injury is such a perspective thing. I have some friends who have been in the sport of triathlon for years and have never experienced a minor injury, let alone a serious one. I started athletics at the age of 28(ish) as a type 1 diabetic/undiagnosed celiac. Between that time and now (5 years) I have spent over a year in physical therapy for posterior tibial tendonitis, 1 tibial stress fracture, 2 stress fractures of the femoral shaft and 1 femoral shaft stress reaction. When stuff goes wrong I just assume the worst and not to sound like a punk but for f*ck's sake, can you blame me?

3. Can we elaborate on that 5 years in sport thing? Dave and I were chatting today about "having what it takes" in general. That's not somthing that you can teach. Having what it takes....what it takes to do whatever (be an Elite athlete, do a triathlon, lose weight, whatever it might be) takes a certain amount of "something" given your current situation. I honestly believe that something is the only thing that has gotten me to where I am today. I mean seriously, I am not an athlete. I've been a bump on the log for except for the last 1/2 decade of my life, few years of my life if you want to get technical about it. I have fallen apart at every turn. I mean seriously, who breaks their femurs? Those are some hard bones to break! And after breaking their femurs, who keeps going? Totally unbalanced people like me keep going. Oh, I broke a femur? Oh well. How long will it take for that to heal?

Priorities. I love sport. I hated my life before sport. Sport brought me Dave. Sport brought me perspective. Sport brought me positive influence. Sport brought me all the stuff I've been missing my whole life. Like I said, how long will it take for those femurs to heal?

I started thinking about my life over the last year and what it would mean if I suddennly couldn't compete like I wanted to. My husband asked me if the consequenses of this year were that I couldn't compete anymore (a very realistic possibility), if I would take this last year back. Holy crap that was a hard question. I went from having 0 medals to having more than a dozen within one season.

Priorities.

Yes. I would take it back in a heartbeat if it meant not having to worry like I have for the last few months. Take the medals, I don't care.

Pain in the butt, no hip, no butt...?

Things got a little bit worse, and better, and worse again since my last post. This is most definitely the most frustrating injury I've ever had. On some days I can't walk without wincing in pain and on other days, I feel almost normal except that there's just enough pain there to let me know that something isn't right.

Everything was feeling decent when I went for the test run last week. I made it 6.5 miles (surprisingly at a respectable pace without even trying) and it didn't feel too horrid. I felt tight and a little sore in the butt, but didn't have any of that sharp pinching pain I had been previously experiencing. I woke up the next day and felt the same as I had the day before except for quite a bit of pain in the middle of my butt cheek and some occasional numbness traveling down to my calf and bottom of my foot (presumably my piriformis muscle compressing my sciatic nerve). That night, I foam rolled my butt and sat on a tennis ball for awhile - that hurt so badly it made my eyes water but before falling asleep, I felt pretty good....until I woke up the next morning.

For the next few days, it was all I could do to walk a block. Each step caused radiating pain down my leg, mostly in my groin. I was sure, now, that what I have is a labral tear and that I'd made it worse with the tennis ball. I was so sure, in fact, that I scheduled the appointment for the MR Arthrogram. And I was still sure of it this morning waking up with the same pain as the previous two days. I dragged myself to the pool in an effort to rid myself of my foul mood. The swim felt great (more on that later...I am swimming really well right now) but my leg still ached. Quickly becoming cranky again, I forced myself to do some core work and for good measure before hitting the grocery store, I decided to foam roll a little bit on my hamstring and the front of my quad. I did this for about 2 minutes, stood up and immediately noticed that the pain was gone....like COMPLETELY gone. I went shopping, walking up the stairs at Whole Foods without any pain whatsoever (which I haven't been able to do for at least 2 weeks), came home and still no pain. As I type, things have not changed...no pain aside from a strange stab in my butt here and there.

Consider me baffled, crazy or plagued...because each of those is probably true. I have no idea what's going on but I'm not giving up. On tap for next week:

Monday: 1 hour deep tissue massage with a new person I've heard amazing things about.
Wednesday: Another ART appointment
Thursday: Physical Therapy evaluation with a Manual and Manipulative Physiotherapy expert.
next Monday: MR Arthrogram to check for torn labrum.

I am still hoping that I'm able to cancel the last one on that list due to progress with the other three.

It's funny, really. I am in an awesome mood right now because I'm not in pain and that gives me hope. It's crazy this roller coaster I've been on. I'd almost rather be in pain all the time than have these ups and downs. They are hard to cope with.

Good News

First, thanks for the comments. DM – I did get a massage from my therapist and it was a HUGE help. HUGE! It felt about 75% better after my last appointment and I have another scheduled for today. And HG – I did have an MRI done as a fracture was the first thing I suspected (having had 3 femoral shaft stress fractures in the past). The MRI showed everything was normal, no fractures. I have an MRA (where they inject dye directly into the hip joint and then do an MRI) scheduled for a few weeks but the good news is, I don’t think I’ll need it.

I have long suspected that something was up with my road bike fit. I noticed when I was riding the Computrainer a few months ago that I was constantly pushing myself back on the seat. By constantly I mean, like every 10 seconds or so and by shoving myself back on the seat, I mean taking my hands and forcefully pushing my ass back and trying to maintain that position (which probably explains why I always have sore shoulders). I knew this probably wasn’t right but since it wasn’t hurting me to ride I didn’t really think much of it until I started having all these hip problems so I thought I’d get it checked out.

I did some research on local fitters and decided to make an appointment with Hussam at ATA Cycle in Concord. I won’t go into details (check out the videos on the link for info, it’s pretty cool) but I was highly impressed with Hussam from the moment I stepped into the bike shop. It’s obvious he knows his stuff.

First, the body measurements. Guess what? I am an oddly shaped person. I think he called me a “challenge.” For starters, I’m short – that’s strike one, but I’m not just short, I’m all out of proportion. Here are the odd things:
1. I have the shortest torso, like, ever.
2. My arms are short but relative to my torso, they’re actually long.
3. My legs are so short I couldn’t even fit over the measuring stick thing that they jam between your crotch to measure leg length.
4. I have extremely long femurs relative to my leg length. This should make me a powerful rider (yay…something good for once).
5. My hands and feet are tiny. Like smaller than child size tiny.

Now the bike fit. Two statements from Hussam that were like music to my ears:
1. You must have an incredibly high tolerance for pain.
Why? I ask.
2. Because surely riding in this position had to hurt. You were putting all the pressure on your hips, not your legs. This most definitely would have developed into a chronic injury if you had kept riding this way. Especially when climbing, your femurs had nowhere to go so you instinctively shoved your butt back on the seat to give them room and all that extra force was being applied to your hips. I’m amazed that you were able to ride a whole season this way.

And there you have it. There is a reason for all the problems I’ve been having. Hussam has developed his own fully adjustable lab bike (again, check out the link for details). He put me on it and tweaked some stuff, starting me off with a close to optimal position. It felt different, but good. As he does this, there is a meter on the floor which reads the wattage you are producing. After warming up a bit, we played with a few things to find the right comfort/higher power output. I never realized how big of a difference a tiny adjustment can make in terms of power output. I watched my power increase more than 30 watts based on tiny little changes. After we got things tweaked and I had been riding for awhile in that position, Hussam switched me back my original position and I could instantly feel pain in my hips and lower back – I can’t believe I didn’t notice it before. In the end, we ended up raising my seat over an inch (I think it was closer to two inches). We also decided a different handlebar would suit my setup better as we should drop the bars a bit but can’t with the type of bar I have right now. But I like my bars and I’m fine with leaving them as is for now. Maybe I’ll look in to changing that before Strong Like Bull.

It’s been longer than two weeks since my last run. As of right now I am pain free and tomorrow I am going to attempt a short run. I have been near pain free for days and let me tell you, it’s been hard not attempting a run already! But I am on my Coach prescribed off season so I’m not supposed to be running anyway. That said, I have a feeling this run will go well and that I’ll be able to cancel that MRA appointment. I really hope so because even though I see needles many times on a daily basis, I can’t get used to the idea of a giant one being shoved right into my hip socket. Ouch.

Leg Woes Update

The update is that I don't really have an update, I guess. My hip is still bothering me but has gotten a little bit better...I think? It hurts less when just sitting around and walking but after another week off of running, I attempted a few steps and the run was a no go. I get pain all down the front of my hip during the run (which lasted all of one block this time) and then after the fact, it hurts in my glute and the side of my hip.

I saw my ART doctor last week who is a bit stumped as well. Symptoms fall into the category of either torn labrum, sciatic nerve tension or soft tissue issues -- take your pick.

The thing that gets me is that cycling makes it feel better - especially pushing heavy watts. On Friday, I participated in a study with Kerry Litka at UNH and had V02 max and lactate threshold tests where I pushed in excess of 325 watts (350 I think?...don't quite remember). When I got off the bike, besides feeling like a rock star pushing more watts than I ever knew I could, my leg also felt great and it continued to feel great throughout the day. However, two days later I tried to run and the pain was still there though not quite the same as it was. And today I hopped on the dreaded elliptical for an hour. The elliptical also made my hip feel better. It hurts a little bit during the beginning but the higher I up the resistance and the longer I continue on with the torture device, the better I feel. I'm no doctor but this does not seem indicative of a torn labrum.

And with respect to the "I'm no doctor" part of that paragraph, I am in continued contact with my doc. about all of this. Right now we are proceeding with ART as though it's some sort of sciatic nerve issue. If it doesn't clear up after some time, we'll figure out where to go from there. In the mean time, I'm allowed to cross train but not run. Flip turns seem to hurt as well so I've stopped doing those (blessing in disguise).

If there's one thing that is for certain, it's that I really SUCK at being injured. Add in 30 degree weather in the 2nd week of October and, well, I become pretty miserable. I had a complete breakdown in the grocery store parking lot yesterday. It was cold and snowing, my hip was bothering me and my Renaud's acted up worse than it ever has. My fingers were so white and painful that I couldn't even bend them. The store was busy and parking spots were scarce so some guy was parked behind me with his blinker on waiting for me to leave. My hands were literally as useless as stumps so I cranked up the heat as high as it could go and was waiting for my them to regain some life before I attempted to drive off but it just wasn't happening. The guy waiting for the spot started honking his horn and eventually drove off, flipping me off as he passed. I lost it completely and started bawling right there in the parking lot. I guess you could call that my low point of the season.

Times like this make me realize how important triathlon is to me. I can deal with diabetes, celiac, Renaud's...all that stuff as long as I have my "something" to look forward to. That something, for me, is triathlon. I get asked a lot where I find my motivation to do some of the things I do and the answer is usually something along the lines of proving that I CAN do difficult things even with all these setbacks. My health issues fuel my triathlon and triathlon fuels my desire to not give up due to my issues. As it is for any injured athlete, it's really hard for me when something I can't control stops me from making progress doing the thing I love to do but for me it goes beyond just not being able to do the sport. Triathlon helps me stay positive about almost every aspect of my life.

I'm not really sure what my point is to this entire post, I'm pretty much just rambling. Maybe I just wanted to get all that out. Everything I've shared on this blog this year has been all sunshine and roses. Right now it's not sunshine and roses. That said, now that I got my yearly cry out I'm trying to be more positive about it because it's all I can do.

You know what's frustrating?

Surviving my first season EVER without injury followed by getting injured during off season.

I ran the 5k I talked about in my last post and then a 15 mile run shortly after and all was well and good. A few days later I went to run and called it quits after a mile because of some pain in my right leg/hip flexor area. It wasn't drastic but it was enough to make me back off - and if you know me, you know it takes a lot to make me back off (perhaps a bit less after having four stress fractures).

I decided to take several days off since we had the wedding reception looming and I just didn't need the extra worry. There was quite a bit of pain dancing at my reception but I tried to push that out of my head. I woke up the next day and after much fretting, scheduled the MRI as I suspected a femoral neck stress fracture.

MRI results revealed no fracture. That might be one of the happiest moments of my life as I was sure of the fracture. So, in typical PJ fashion, I went for a run that night of five miles. Five torturous, painful miles. Happy turned to frown pretty quickly after that.

We are still not really sure about what's going on in this stupid hip so for now, the rule is don't do anything that hurts and hope it gets better on its own. If it doesn't, the next step is ruling out a torn labrum.

If you read my blog, please send "it's only a muscle pull that is mimicking torn labrum symptoms" vibes my way. I would very much appreciate it.

And, so as not to be all doom and gloom, here is the good stuff from the reception:

The best wedding cake ever that Dave's mother made (she is so talented):









Dave feeding me nicely:



Me feeding Dave less nicely:






















Dave expressing his feelings about me feeding him less nicely:



The best man's speech which included a tribute to Team Type 1 (IE, the best, best man's speech ever):

How to look like you’ve swallowed a cow

Answer: Win a 5k and have them post what might be the worst picture of you, ever, on the internet for all to see.

While my first thought was to write the CoolRunning people and beg them to take the picture down, my second thought was “Holy crap I won a (very small/local) race and they took my picture!” That’s kind of cool so I am willing to suck it up and share (well at least post the link, you actually have to click on it to see the cow in my body).

Truth be told, I almost didn’t run the race as I had biked 50 miles the day before and woke up to pouring rain in the morning, but Dave was going to support his former Team in Training coaches, who help put this race on to commemorate the memory of Cynthia Lucero, a woman who died of hyponatremia while running the Boston Marathon in 2002, so I wanted to show my support for Dave and all he does for the Team in Training program (he’s a mentor and really puts a lot of time and energy into helping out). I had no idea that I’d actually find some legs once I started running! And it’s no secret that I fare better at hilly courses and the course profile for this race looks something like this:









It’s a really cool course – you should all run it next year!

Note: Dave is 100% convinced that I won because this was my first race registered with the shiny new last name. I think his last comment before bed last night was. You are 1 for 1. Now you have to keep winning!

No pressure…..:)