Strategies…
If you develop PF on only one heel, then you probably are imbalanced, left-to-right. Having PF on only one side doesn’t necessarily prove that you have an imbalance left-to-right, but it does look suspicious and should be checked out. This may be a contributing cause of the specific case of PF.
If pain is too debilitating, soft padding and springy arch supports may provide relief. This may be necessary in the worst stages of PF, but it should be kept in mind that orthotic remedies are very similar to cushy running shoes which lead to PF in the first place. Use shoe and orthotic remedies with caution. If your arch has failed (past-tense) then you have no choice. You must rebuild the arch. Muscle strengthening alone will not be sufficient. You must use both strengthening and structural support. There’s not just plantar and muscle change that must take place. You must also reshape the cartilage of the arch. This is not a quick process, and can take four years of therapy in the worst cases. Without therapy, it simply will never go away. If pain ever goes away, it will be after scarring and arch failure, and the patient simply gets used to the failure. This type of failure means the natural mechanical benefits of the arch are forever gone.
The first part of your strategy should be to stop aggravating the injury. This may involve complete inactivity for a period of months.
Return to the basics of proper running mechanics. Develop proper “spring” and elasticity, and strengthen the muscles of the feet and ankles. Also practice proper weight transition through your stride, making sure your arms, body and legs – your entire center of gravity – are properly positioned at all phases of your stride. Foot muscles should be strengthened for shock absorption and smooth control, but the best shock absorption of all is “free elastic energy” response from limber, healthy stretched muscles and tendons.
Never over-stride. The foot should land directly beneath the center of gravity. The foot should have very short ground time. Long strides should be achieved through air-time, rather than leg reach. Improving natural bounce is essential to remaining injury-free.
Saturday, June 19, 2010
Plantar Fasciitis, Part 2
Simply put, plantar fasciitis is caused when you stress your plantar beyond its structural strength. This is basically true of all injuries. Nothing breaks – or begins to break, tear, etc. – until you stress beyond its structural integrity. When you demand more from tissues than they can withstand, they begin to fail.
Much stress is accumulative – tissues normally develop tiny micro-tears, which heal quickly. The healthier the athlete, and the better their diet, the faster they heal. Still, if you don’t allow normal micro-tears to heal before stressing again, micro-tears become bigger tears, which take longer to heal, and scar-tissue accumulates, which is almost permanent and can lead to other injuries.
PF Cause...
There are numerous ways to develop PF, but all instances are caused by exceeding the strength of the plantar attachment and/or demanding more than the plantar can sustain.
Extremely weak, sedentary, and over-weight individuals have extremely weak muscles (which doesn’t allow proper shock absorption), and bad walking form. They often walk straight-kneed, landing on their heels, inflicting direct trauma to the plantar attachment area. When walking, this heel trauma is followed by shifting the weight forward, yanking on a relaxed plantar, surrounded by weak muscles that are doing nothing to help.
At the other extreme, athletes may be trying to conserve energy by relaxing as much as possible – including their arches – causing some atrophy of the foot muscles.
Modern shoes do an amazing job of making running easier, allowing bad foot-form while running. Minimal footwear normally causes discomfort over time and forces runners to use foot muscles to produce all bounce and shock absorption, but soft, springy shoes lead to laziness.
Athletes who are most likely to develop PF tend to be heavier than average, older than average, run many more miles than average, or a combination of these factors. People who specialize in downhill running put far more stress on their plantar fascia than people who specialize in uphill running.
It’s not necessarily that an athlete’s foot muscles are “weak”, but they are not strong enough in proportion to what is demanded.
With the popularity of ultra-running, and consecutive hundred-mile-weeks, coupled with modern running shoes, PF is more common than ever, even for skinny teen athletes.
Common symptoms of PF sufferers are very tight calf muscles, weak shin muscles (imbalanced with calf), weak or insufficiently strong foot muscles. Many suffer from cramping calf muscles during the PF development stage.
Falling arches tend to cause your ankles to sag inward and your toes to point outward (duck-footed) even if the heels are still pointed straight. Sagging ankles lead to over-pronation. Over-pronation may lead to PF, or falling arches may lead to over-pronation. Either one may cause the other. Not all these symptoms are experienced by all PF sufferers – it depends on what type (cause) of PF they have.
If your plantar is too tight, your toes may point straight or inward, and you might suffer from under-pronation. Under-pronation may lead to PF, or tight arches may lead to under-pronation. Either one may cause the other.
In “Brain Training for Runners” by Matt Fitzgerald, Tim Noakes, they say over-striders try to land softly. “Unfortunately, the softer you land, the more “free” elastic energy you waste, because it dissipates before you can reuse it. You transform yourself into a loose spring.”
Free elastic energy is a quick process, like a pogo stick. If you were on a pogo stick, and you tried to use your legs to lengthen the amount of time on the ground, you’d see the wasted affect. You’d actually expend more energy to accomplish less.
Fitzgerald and Noakes call the proper use of free elastic energy “ballistic action”, which is short and fast. “Many distance runners believe that the ideal pattern of muscle action during running is sustained and gentle. The idea is to use energy evenly throughout the stride, landing softly, staying relaxed, and avoiding wasteful “peaks” and “valleys” in muscle work. In reality, the best runners have a ballistic style of running.”
The fact is, even distance runners who are well aware of these principles often fail to properly implement them. They get tired after long hours, or they don’t rest/sleep enough, or they have other foot issues that keep them from being able to fully implement ballistic action.
Much stress is accumulative – tissues normally develop tiny micro-tears, which heal quickly. The healthier the athlete, and the better their diet, the faster they heal. Still, if you don’t allow normal micro-tears to heal before stressing again, micro-tears become bigger tears, which take longer to heal, and scar-tissue accumulates, which is almost permanent and can lead to other injuries.
PF Cause...
There are numerous ways to develop PF, but all instances are caused by exceeding the strength of the plantar attachment and/or demanding more than the plantar can sustain.
Extremely weak, sedentary, and over-weight individuals have extremely weak muscles (which doesn’t allow proper shock absorption), and bad walking form. They often walk straight-kneed, landing on their heels, inflicting direct trauma to the plantar attachment area. When walking, this heel trauma is followed by shifting the weight forward, yanking on a relaxed plantar, surrounded by weak muscles that are doing nothing to help.
At the other extreme, athletes may be trying to conserve energy by relaxing as much as possible – including their arches – causing some atrophy of the foot muscles.
Modern shoes do an amazing job of making running easier, allowing bad foot-form while running. Minimal footwear normally causes discomfort over time and forces runners to use foot muscles to produce all bounce and shock absorption, but soft, springy shoes lead to laziness.
Athletes who are most likely to develop PF tend to be heavier than average, older than average, run many more miles than average, or a combination of these factors. People who specialize in downhill running put far more stress on their plantar fascia than people who specialize in uphill running.
It’s not necessarily that an athlete’s foot muscles are “weak”, but they are not strong enough in proportion to what is demanded.
With the popularity of ultra-running, and consecutive hundred-mile-weeks, coupled with modern running shoes, PF is more common than ever, even for skinny teen athletes.
Common symptoms of PF sufferers are very tight calf muscles, weak shin muscles (imbalanced with calf), weak or insufficiently strong foot muscles. Many suffer from cramping calf muscles during the PF development stage.
Falling arches tend to cause your ankles to sag inward and your toes to point outward (duck-footed) even if the heels are still pointed straight. Sagging ankles lead to over-pronation. Over-pronation may lead to PF, or falling arches may lead to over-pronation. Either one may cause the other. Not all these symptoms are experienced by all PF sufferers – it depends on what type (cause) of PF they have.
If your plantar is too tight, your toes may point straight or inward, and you might suffer from under-pronation. Under-pronation may lead to PF, or tight arches may lead to under-pronation. Either one may cause the other.
In “Brain Training for Runners” by Matt Fitzgerald, Tim Noakes, they say over-striders try to land softly. “Unfortunately, the softer you land, the more “free” elastic energy you waste, because it dissipates before you can reuse it. You transform yourself into a loose spring.”
Free elastic energy is a quick process, like a pogo stick. If you were on a pogo stick, and you tried to use your legs to lengthen the amount of time on the ground, you’d see the wasted affect. You’d actually expend more energy to accomplish less.
Fitzgerald and Noakes call the proper use of free elastic energy “ballistic action”, which is short and fast. “Many distance runners believe that the ideal pattern of muscle action during running is sustained and gentle. The idea is to use energy evenly throughout the stride, landing softly, staying relaxed, and avoiding wasteful “peaks” and “valleys” in muscle work. In reality, the best runners have a ballistic style of running.”
The fact is, even distance runners who are well aware of these principles often fail to properly implement them. They get tired after long hours, or they don’t rest/sleep enough, or they have other foot issues that keep them from being able to fully implement ballistic action.
Plantar Fasciitis, Part 1
Over the past 15 months, I've received more erroneous info on PF than beneficial. It has been enormously difficult to figure out the correct remedies for my own PF because there are too many one-type-of-PF mentalities out there and too many people dish out virtual absolutes about what you should do without realizing there are different collections of situations that lead to PF and therefore various proper therapies. One of the problems is I was given lots of advice that is correct - but wrong for my specific type of PF (falling/failing arch). I found lots of medical studies online, but none (not even specialist reports from sports orthopedic surgeons) describe all the various types of PF and various therapies like I have here. Yet all of my PF report has been gleaned from various reports and learned friends. There just isn't any single report that seems to have all of this in one place.
There have been a few times in the past many months when I figured I knew it all and my report would be accurate, but then I'd hear/see/read more that blew the problem into a more complicated mess. Again, i think I have it right, but these five reports are subject to change.
I hope this helps other people who have PF to get on-track immediately.
Definitions and diagnoses
Fascia is connective tissue. Its purpose is to keep your soft tissues positioned at the proper locations. The plantar fascia continuously elongates during the contact phase of gait. It goes through rapid elongation before and immediately after mid-stance, reaching a maximum of 9% - 12% elongation between mid-stance and toe-off. During this phase the plantar fascia behaves like a spring, which may assist in conserving energy. In addition, the plantar fascia has a critical role in normal mechanical function of the foot, contributing to the "windlass mechanism”; the plantar fascia being the cable, the metatarsal head the drum, and the handle, the proximal phalanx. Plantar fascia is not a muscle, not a tendon.
Muscles are dynamic cells which can actively change length.
Tendons are elastic tissues which connect muscle to bone.
Ligaments connect bones to each other, most importantly at joints. Ligaments are meant to limit the range of motion to keep joints inside the optimal range of structural integrity.
Fascia most often connects soft tissue to soft tissue, but some fascia connects bone to bone, such as the plantar fascia. The difference between ligaments and fascia is that ligaments have no mechanical roles. Ligaments bend, flex, and stretch a minimal amount. Fascia is meant to stretch even less. The role of the plantar fascia is similar to a hoist-cable on a crane, but inverted.
There are generally two causes of PF, but one way can be divided two different ways. One is blunt-trauma; the other two are from the plantar tearing. Tearing can be caused by over-stretching (low and falling arches), or it can be caused by tightness (arches that are too high), which may or may not then lead to falling arches.
Plantar fasciitis (PF) can be the first stage of “falling of the arches”. The plantar starts to tear, usually from one of the attachments, and most commonly from the heel.
Some misdiagnoses occur when other injuries nearby are mistaken for PF.
Sometimes, rather than the plantar tearing off the heel, they develop fractures near the plantar attachment.
Enthesitis (Inflammation Where the Ligaments Attach to the Bone)
Inflammation of the enthesis, where the joint capsules, ligaments or tendons attach to the bone, is a hallmark of ankylosing spondylitis (AS). This can be felt in multiple areas of the body where your doctor can check for pain and tenderness. The sites are sometimes referred to as "hot-spots." They can lead to swelling and tenderness along the back, pelvic bones sacroiliac joints, the chest, and the heel. The heel can be significantly affected, in which case the pain and tenderness can have a serious impact on a person's mobility. The two areas of the foot that can be affected are the Achilles tendon at the back of the heel, and the plantar fascia at the base of the heel. Reiter's syndrome is part of osteoarthritis and rheumatoid arthritis. These two are not sport-injuries, but chronic conditions.
There have been a few times in the past many months when I figured I knew it all and my report would be accurate, but then I'd hear/see/read more that blew the problem into a more complicated mess. Again, i think I have it right, but these five reports are subject to change.
I hope this helps other people who have PF to get on-track immediately.
Definitions and diagnoses
Fascia is connective tissue. Its purpose is to keep your soft tissues positioned at the proper locations. The plantar fascia continuously elongates during the contact phase of gait. It goes through rapid elongation before and immediately after mid-stance, reaching a maximum of 9% - 12% elongation between mid-stance and toe-off. During this phase the plantar fascia behaves like a spring, which may assist in conserving energy. In addition, the plantar fascia has a critical role in normal mechanical function of the foot, contributing to the "windlass mechanism”; the plantar fascia being the cable, the metatarsal head the drum, and the handle, the proximal phalanx. Plantar fascia is not a muscle, not a tendon.
Muscles are dynamic cells which can actively change length.
Tendons are elastic tissues which connect muscle to bone.
Ligaments connect bones to each other, most importantly at joints. Ligaments are meant to limit the range of motion to keep joints inside the optimal range of structural integrity.
Fascia most often connects soft tissue to soft tissue, but some fascia connects bone to bone, such as the plantar fascia. The difference between ligaments and fascia is that ligaments have no mechanical roles. Ligaments bend, flex, and stretch a minimal amount. Fascia is meant to stretch even less. The role of the plantar fascia is similar to a hoist-cable on a crane, but inverted.
There are generally two causes of PF, but one way can be divided two different ways. One is blunt-trauma; the other two are from the plantar tearing. Tearing can be caused by over-stretching (low and falling arches), or it can be caused by tightness (arches that are too high), which may or may not then lead to falling arches.
Plantar fasciitis (PF) can be the first stage of “falling of the arches”. The plantar starts to tear, usually from one of the attachments, and most commonly from the heel.
Some misdiagnoses occur when other injuries nearby are mistaken for PF.
Sometimes, rather than the plantar tearing off the heel, they develop fractures near the plantar attachment.
Enthesitis (Inflammation Where the Ligaments Attach to the Bone)
Inflammation of the enthesis, where the joint capsules, ligaments or tendons attach to the bone, is a hallmark of ankylosing spondylitis (AS). This can be felt in multiple areas of the body where your doctor can check for pain and tenderness. The sites are sometimes referred to as "hot-spots." They can lead to swelling and tenderness along the back, pelvic bones sacroiliac joints, the chest, and the heel. The heel can be significantly affected, in which case the pain and tenderness can have a serious impact on a person's mobility. The two areas of the foot that can be affected are the Achilles tendon at the back of the heel, and the plantar fascia at the base of the heel. Reiter's syndrome is part of osteoarthritis and rheumatoid arthritis. These two are not sport-injuries, but chronic conditions.
Friday, June 18, 2010
Jim Romero's 70th
Jim Romero's 70th - interviewed on the news
The link above is about Jim Romero's 70th birthday. Jim is one of the original inspiring people I ran with who helped me lose my mind and decide to run ultras. Okay, so I had already previously lost my mind in many ways, but Jim helped me lose it in an additional way.
He is an amazing, positive, warm, and caring soul. He doesn't simply inspire to run, but to live more fully. Yet he never lives his own life more-fully at the expense of others. He places family first, in all things.
The link above is about Jim Romero's 70th birthday. Jim is one of the original inspiring people I ran with who helped me lose my mind and decide to run ultras. Okay, so I had already previously lost my mind in many ways, but Jim helped me lose it in an additional way.
He is an amazing, positive, warm, and caring soul. He doesn't simply inspire to run, but to live more fully. Yet he never lives his own life more-fully at the expense of others. He places family first, in all things.
Sunday, June 13, 2010
Second Opinion
I was told by a sports orthopedic surgeon that I don't need surgery. Also, the latest x-rays show two things... The sock I've been cramming in my armpit to help pry the crack shut works. But... so much of the jagged edges started filling in over the first three weeks that the crack can never fully close.
Now that the two halves can contact each other, they can fuse, but it also means more pain. There's still almost no pain, which kind of freaks me out. No pain meds necessary. I hated them - so hard to wake up the next day.
He told me to join a gym and use the bike - a lot.
Wear the sling for 10 weeks. Already done it 3 so 7 to go.
I can run in 5 weeks on flat terrain. Trails are another matter. I can't afford to fall hard again. In fact, that means no Aspen Golden Leaf in late September. But mild trails in 8 weeks. So trail running is going to be hard to do this summer.
Meanwhile, I'm posting the Denver Trail Runner Thursday runs this month, even though I can't actually run them. I've been getting some walking in, though. We were at Apex Park. It rained. Everything is lush and green this time of year. Sage and everything else was growing so fast you could almost see it squirting out of the ground. And the scent! Man, right after rain, with the sage and everything, it is the best smell in the world!
I had my son help me replace the radiator in my old CR-V. Although the radiator is good as new, there's still a long list of things to fix. He wants to learn to be an auto mechanic when he graduates in a year. Let's see if he's still interested after busting his knuckles on stubborn bolts, etc. It's enough to make you real religious. Why, I talk in tongues all the time, when I work on cars.
- replace windshield
- fix the shorted-out electrical system that drains the battery dead in 3 days
- fix the gimpy moonroof
My Subaru Forester has lots of great luxuries, not the least is that everything works. The moonroof is HUGE!!! The stereo kicks pooster. But considering the design and engineering functionality, nothing will ever beat the old CR-V design. Everything is slightly better than the Subaru, if only it weren't so old and broken-down. Too bad Honda abandoned the great old design and basically turned the CR-V into a miniature mini-van in 2002.
In spite of lots of BS at work, and my broken arm, and my broken-down CR-V and drained bank account from buying the Forester, I'm very happy and contented these days. Very happy. This is an awesome country to live in. If only we wouldn't destroy the ocean, and others stupid stuff, but I do appreciate freedom, and that the average American really cares, even if they don't agree with each other and bicker about it. At least we can bicker about it without worrying about being sent to prison for subversion. I can go to work without worrying about being hit by a bullet or getting blown up.
Now that the two halves can contact each other, they can fuse, but it also means more pain. There's still almost no pain, which kind of freaks me out. No pain meds necessary. I hated them - so hard to wake up the next day.
He told me to join a gym and use the bike - a lot.
Wear the sling for 10 weeks. Already done it 3 so 7 to go.
I can run in 5 weeks on flat terrain. Trails are another matter. I can't afford to fall hard again. In fact, that means no Aspen Golden Leaf in late September. But mild trails in 8 weeks. So trail running is going to be hard to do this summer.
Meanwhile, I'm posting the Denver Trail Runner Thursday runs this month, even though I can't actually run them. I've been getting some walking in, though. We were at Apex Park. It rained. Everything is lush and green this time of year. Sage and everything else was growing so fast you could almost see it squirting out of the ground. And the scent! Man, right after rain, with the sage and everything, it is the best smell in the world!
I had my son help me replace the radiator in my old CR-V. Although the radiator is good as new, there's still a long list of things to fix. He wants to learn to be an auto mechanic when he graduates in a year. Let's see if he's still interested after busting his knuckles on stubborn bolts, etc. It's enough to make you real religious. Why, I talk in tongues all the time, when I work on cars.
- replace windshield
- fix the shorted-out electrical system that drains the battery dead in 3 days
- fix the gimpy moonroof
My Subaru Forester has lots of great luxuries, not the least is that everything works. The moonroof is HUGE!!! The stereo kicks pooster. But considering the design and engineering functionality, nothing will ever beat the old CR-V design. Everything is slightly better than the Subaru, if only it weren't so old and broken-down. Too bad Honda abandoned the great old design and basically turned the CR-V into a miniature mini-van in 2002.
In spite of lots of BS at work, and my broken arm, and my broken-down CR-V and drained bank account from buying the Forester, I'm very happy and contented these days. Very happy. This is an awesome country to live in. If only we wouldn't destroy the ocean, and others stupid stuff, but I do appreciate freedom, and that the average American really cares, even if they don't agree with each other and bicker about it. At least we can bicker about it without worrying about being sent to prison for subversion. I can go to work without worrying about being hit by a bullet or getting blown up.
Thursday, June 3, 2010
CR-V R.I.P.
Well, not quite. I still have the CR-V, but I also have a 2006 Subaru Forester XT.
I like Honda, but the newer CR-Vs don't have the right rear seat design to fold flat for sleeping.
Nothing beats a Jeep Cherokee rear for flat and spacious, but their mpg sucks.
Ford Escapes, well, they're Fords. Otherwise, the rear design is good.
I might have found a more satisfying vehicle, but I've been searching with what very little free time I have, and this one seemed okay for the price. It lacks the ground clearance I prefer, and the power will take some getting used to. But the back is big enough and flat enough to bed me down before and after races (if I'll ever stop jacking myself !up! and can get back to it).
The old CR-V will get worked on by my son and myself. Maybe he'll drive it a while, or maybe I'll park it at Goodwill like I did the last one.
But at least I'm not marooned in town anymore.
I like Honda, but the newer CR-Vs don't have the right rear seat design to fold flat for sleeping.
Nothing beats a Jeep Cherokee rear for flat and spacious, but their mpg sucks.
Ford Escapes, well, they're Fords. Otherwise, the rear design is good.
I might have found a more satisfying vehicle, but I've been searching with what very little free time I have, and this one seemed okay for the price. It lacks the ground clearance I prefer, and the power will take some getting used to. But the back is big enough and flat enough to bed me down before and after races (if I'll ever stop jacking myself !up! and can get back to it).
The old CR-V will get worked on by my son and myself. Maybe he'll drive it a while, or maybe I'll park it at Goodwill like I did the last one.
But at least I'm not marooned in town anymore.
Tuesday, June 1, 2010
New Exo-skeleton
I got tired of not getting any sleep, and the lack of stability, so I made a cast out of 1/2" foam, Velcro, a cinch strap, and some duct tape. Voila! A redneck shoulder cast!
First step is to wrap my bicep in Ace bandage, and put on a short-sleeve shirt.
Then I cinch up my strap-on! (tehehe)
Then slip my sling on over the bottom of the foam cast.
Finally, over all that goes an additional shirt (with my arm inside) to help plaster it all a little more firmly in place. Usually a sleeveless running jersey works best.
During the days, however, the bones just keep moving around. I doubt the broken bones have even begun to heal.
And during all this, my old CR-V has died, so I'm walking and taking Lightrail. Kind of hard to shop a new car, get to doctor appointments, etc. Friday, it boiled-off an entire radiator full in three miles of uphill driving. Fill it and its empty in three more miles. Downhill, I drove 20 miles back home without having to stop. The radiator fans weren't working, but when I tried to fix them, they mysteriously started working again, before I could find a problem. I wasted all of Memorial Day putting a temporary epoxy patch on my radiator leak.
So no spare time in my life these days. Hoping my CR-V will get me to the dealership tomorrow to look at a 2006 Subaru Forester.
First step is to wrap my bicep in Ace bandage, and put on a short-sleeve shirt.
Then I cinch up my strap-on! (tehehe)
Then slip my sling on over the bottom of the foam cast.
Finally, over all that goes an additional shirt (with my arm inside) to help plaster it all a little more firmly in place. Usually a sleeveless running jersey works best.
During the days, however, the bones just keep moving around. I doubt the broken bones have even begun to heal.
And during all this, my old CR-V has died, so I'm walking and taking Lightrail. Kind of hard to shop a new car, get to doctor appointments, etc. Friday, it boiled-off an entire radiator full in three miles of uphill driving. Fill it and its empty in three more miles. Downhill, I drove 20 miles back home without having to stop. The radiator fans weren't working, but when I tried to fix them, they mysteriously started working again, before I could find a problem. I wasted all of Memorial Day putting a temporary epoxy patch on my radiator leak.
So no spare time in my life these days. Hoping my CR-V will get me to the dealership tomorrow to look at a 2006 Subaru Forester.
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