WOW. I thought I had made at least one post since late June when I made a major discovery. I was surprised when I checked in and saw that I hadn't.
Plantar Fasciitis
So here it is. The major cause of my PF was the shoes I was wearing. A couple years ago, when I decided I'd start training for a marathon, I went to a local reputable running store to have my stride checked out, to see if a different shoe would be better for me with the increased mileage. I had always been running in a neutral shoe with no issue, and over the past 10 years, had two different running stores tell me a neutral shoe was fine for me. However, when I went in for this fitting, I was put into a shoe (Nike Structure Triax) with some extra inner heel support, specifically because the person thought they saw some minor collapse of the left heel upon impact. So I started using them. That was in October of 08.
I ran the half marathon at the time in those shoes with no issues, and ran half of the 09 season in them with no issues until the IT band issues came up. Went through PT for that, got it resolved (or so I thought, more on that later), and started the '10 season in the new type of shoe. Then suddenly, whamo - PF. Long story short, since I had spent over a year in the 'new' shoes, it never occured to me right away that the pain I was feeling in my left heel was exactly where the extra support of that shoe is!
Once that fact dawned on me, I dug out an old old pair of shoes (neutral) to use as every day shoes, went out to the Nike store and bought a new pair of old faithful Air Pegasus. Within one week, the heel was feeling noticably better. Within two, the improvement was pretty dramatic. That was back in the beginning of July. It has been about 6 weeks since then, and although my heel can still get sore, it only appears briefly after a run. Within a couple hours, the heel feels fine again.
Moral of the story? If something is working and someone tells you to try something different, dont be so hasty to make the switch. Get another opinion, or follow your own personal experience, not the 'expert' opinion of some dude in a shoe store with one hours training who looks at your stride for all of 15 seconds.
IT band
So that was one major monkey off my back. Unfortunately, right around the same time, my left IT band started acting up again. It was noticably different than last year - last year I went from nothing to pain almost instantly. This year, I have felt no pain, but I have been able to feel distinct rubbing when things get aggrevated. Then, after a day or two, things are back to normal.
The good news about this is that it has provided me with an opportunity to tinker around and try new things and monitor the results without having significant setbacks.
All the details that have come about over the past six weeks are quite lengthy, but here's the main gist:
- It is possible that the structure triax shoes were actually contributing to IT band issues also. By not allowing the heel to rotate and move as it naturally wanted to, my left leg may have been bowing out every so slightly, which puts additional tension on the band.
- I'm still pretty certain that having 'runners hips' (weak gluteus medius and week abduction of the leg) didn't help. This was what PT was aimed at fixing. So the efforts of PT were not for naught.
- I still did too much too fast. My speedwork started out with mile repeats. That puts a lot of stress on the muscles that have forgotten how to efficiently handle lactic acid. As a result, I think they were tightening up rather quickly (only a few minutes into the repeat) so that by the end of the mile, the IT band had been rubbing harshly against the bone for at least a few minutes. Not good. I think I'd have been better served doing speedwork like I did for the half marathon a couple years ago - starting with 1/4 mile repeats and gradually building up from there.
- Although I had been stretching on a regular basis using the roller, it needed/needs to be refined. I've since gone to get a deep tissue massage, and that has helped loosen up some knots of tension that I didn't know existed, specifically between the area where the quad connects with the IT band. While the roller is great, it lacks the precision that a deep tissue massage, or the instrument known as 'The Stick' (which I've since purchased), can provide.
- I slacked on the strength part of PT once the running started up in April or so. I did some of the exercises once in a while, but should have been better about doing them regularly.
- Finally, and this is an idea that only came to light today that still needs testing out: I think I had been warming up incorrectly. When I did a warm up run, it was usually just a few minutes, followed by some stretching, and the if I was doing anything but a long slow distance, I'd go right into running fast. Today I took a more gradual approach - I started off slow, and let my legs speed up only as they felt ready. When they did speed up, it was just a small amount - I'd stay at that new speed until things felt comfortable, when I'd allow the speed to pick up a bit more. The end result was that by the time I was in the mid-160's for heart rate, it didn't feel nearly as intense as if I have started off the gun at the faster speed. My thinking is that this approach is similar to approaching speedwork starting with 1/4 mile repeats - by allowing time for the blood to really get going before working any harder, lactic acid buildup was minimal. Therefore, muscle tightening was minimal.
While that is all well and good, the reality is that I still have an issue with the IT band because the inflammation is still there. I wouldn't be surprised if it'll take an offseason for it to completely diminish, but I'm hoping I can keep it under control for the rest of the season so it doesn't cause any more issues, doesn't get worse, and with some luck, will actually improve a bit. That would be ultimate validation that I've gotten this thing figured out.
Plan for next year
If my thinking on the IT band is close to accurate, I think I've formulated a plan for next year that'll help keep it at bay.
First, no running or biking for 2-3 months. At least December and January - but possibly November, depending on the weather. The weather during December and January is crap, and the roads are crap - so that's almost a forced offseason. During that time, continue with the stretching, using the roller, the stick, and self-inflicted deep tissue massaging. Visiting a masseuse on a regular basis is too expensive.
Once the end of January comes along, start biking on the rollers in the basement for 30 minutes, 3 times a week, no resistance. The purpose of this is not to get fit in an aerobic sense, but simply to get the knee and muscles used to the movement. Want to train things to accept activity without resorting to tightening up. Continue this for 2 months.
Towards the end of March, start working running into the picture. Again, nothing intense, just run 3 times a week for 30-40 minutes. Maybe even start with only 20 minutes. Continue this for 2 months. During the running off days, start cycling outdoors, gradually building up intensity (nothing more than spurts of moderate intensity, though) and distance to about the 20 mile mark. That puts me at the end of May.
Around June, start running speedwork with 1/4 mile repeats. Do these once a week. Also continue building up cycling mileage to 30-35 miles. Allow more intensity in cycling as appropriate. Also allow a couple days between a more intense bike ride and a running speed work session.
That should set me up pretty nice for the Webster Lake tri at the end of June. Re-evaluate at that time.
