I made 36 incentive charts today, chronicling the next 72 weeks of my life: recovery, with the goal of returning to an actual running program.
I've been fighting through yet another round of plantar fasciitis since last year, it now being a chronic enemy twelve years in the making. The first bout struck in NYC in 2008, after naively changing my daily commute from taking the subway to taking a crosstown stroll amounting to 3 miles of walking, each way, in flat-insoled Keds. PF shows up in a variety of ways, the most obvious one being a change in duration and frequency of activity, in a short amount of time.
Couple that with a poor choice of foot bed support, high arches, and a runner's tolerance for activity - and you're a prime target for the enemy.
Back in 2008, I was fresh off my first marathon and no stranger to aches and pains, so I probably didn't pay attention to the specific healing that would need to happen, in order to stave off a repeat attack. This causes scar tissue build up, which is like PTSD for your feet. Basic PF treatment includes decreased (re: zero) jumping activity, and lots of stretching of the calves and icing of the feet. I did a little icing, and some stretching, and probably threw out the Keds.
Over the next few years, I suffered two more cycles of PF and had to get smarter about the recovery: incorporating more stretching, less maniacal increases in activity, considering orthotics, and throwing night splints into the mix. (If you don't know what night splints are, I don't know that you've ever had a truly terrible case of PF.) I even began using essential oils on the soles of my feet (somewhat effective). I avoided the more intense treatments: cortisone shots, ESWT, surgery - convinced my case wasn't that bad.
Again, as the pain subsided, I went back to a "normal" athletic routine - now with more cross-training activities - and didn't think I would have to deal with the enemy again.
Fast forward to this past year, when I stupidly thought I could "train through" a recovery period, culminating in a 10K through the rolling hills of the Presidio. The race was great; the next day was not. Welcome back, you stupid, stupid affliction. Welcome also to my re-education around how to treat PF.
On New Year's Eve, I made a commitment to "Recovery" with a capital R. I was tired of dealing with what seemed to be a chronic condition, and I wanted a real solution. I called up my podiatrist (very pushy on the orthotics), got a referral for PT (physical therapy), and re-invested in (softer) night splints. I also started reading a lot more about PF and the treatment progression; I seemed to be dangerously close to "surgical solution", which I desperately wanted to avoid.
Through the following weeks of consults, chiropractic adjustments, acupuncture sessions, and physical (painful!) manipulations, I miraculously landed in a former-orthopaedic surgeon-turned-chiropractor's office for what was to be a MAJOR TURNING POINT in this war.
The Ultrasound. (and the QL.)
Sitting in a small chiropractic office surrounded by diagnostic manuals and strange machines, I explained to this doctor-turned-healer my entire history: all the treatments I had followed, the years of "recovery", my marathons, halves, 10-and-5Ks, and my insistence that I could not accept a "You-Can-Never-Run-Again" prescription. He said little, but told me he was going to look at my plantar fascia with an ultrasound, so we could accurately assess the damage before talking about alternative treatments.
In all my years of treatments for PF, I had never actually seen imaging of the inflammation supposedly plaguing my ligaments, and so finally, that day, seeing the thickness of the fascia (having built up scar tissue for years), and hearing the doctor-guru say I was 170% past the normal range for fascia thickness, I burst into tears at the reality of the enemy. I had only been able to imagine that my feet were recovering from this stuff, only to now see that I'd been piling on scar tissue and more inflammation over the course of 12 years.
Battling a chronic condition is tricky; preventing internal injury and recovering from past damage to the body carries a particular mental burden because it's invisible, and the only sightline you have is through how you feel. Often, through recovery, you can feel like your body is betraying you - acting as if it's fine, only to have it break down again the next day. Or, in my case, feeling fine, but having layers of scar tissue patched over a still-healing wound.
You're suddenly on alert about every little ache and pain, and often become obsessive to the point of annoyance about stopping activity when you're hurt. What once was an attitude of "just push through it" is now replaced by a hunch that nothing will ever be fine, ever again.
I realized, in that doctor-angel's office, I had been subconsciously convinced that nothing would ever be fine, ever again.
So we began ESWT treatments - or, for those following closely along - the last hold out before surgical remedy. Doc-genius also added quadratus lumborum manipulations, because (WHO KNEW? NOT MY PODIATRIST!) the QL is the actual source of the biomechanical issues inviting PF back into my life for so long. In order to fix PF, I would need to subdue the symptoms, and fix the very basics of how I moved.
The treatments gave me hope that we would actually be diffusing the inflammation, in conjunction with a rigorous routine of stretching (10 different ones), fascia rolling (frozen golf balls are effective), and - of course, the got of my goat - resting. Because I was taking this seriously, I informed my trainer that we had to switch to only upper body strength sessions (nothing involving flexion in the forefoot allowed), I began driving to work (cringe, sorry Earth), and reduced activity to barely walking when necessary. I donated all my shoes that did not have a strong heel counter nor arch support, packed away the flip flops, and invested in some serious hiking boots.
About two months into treatments, I was given the go-ahead to try walking for 10 minutes, on a treadmill, to see if I could start resuming some level of activity. I only got there by systematically monitoring my pain scale during morning stretches, then reporting back during office visits - noting that there had been improvement from level 4 down to level 3, then to level 2 (finally!) within the two weeks leading up to March.
The most difficult part of the treatments was not the investment, nor the vigilance - it was the realization that I expected to one day wake up and be perfectly fine. For years, I had neglected the conscious attention to my recovery. I'd never wanted to pay that much attention to incremental improvements: I wanted to wake up and be fine, go back to normal. I avoided finding the source of the pain, waiting until it simply dissipated. That neglect left me with no realistic expectation of how long my recovery actually takes, or should take - or what recovery even feels like. I had no basis for comparison, only a nagging enemy that kept showing up regardless of what measures I took to treat it. I now needed to pay more attention to whether or not waking up this day was better or worse than yesterday.
So here we are, paying rapt attention to the level 3 discomfort on Monday that increases to a level 5 on Tuesday, probably because I was walking for longer than 20 minutes. Never before have I been so obsessed with data differencing.
Now, 40 days into a shelter-in-place, I've finally had to accept that the road back to running isn't going to happen fast. In lieu of treatments, I need to aggressively scale back my activity (not hard to do), but increase the physical attention to improving how I move, and soft tissue stretch-and-roll protocol. I estimate that it will take about 12 weeks to get back to a non-inflamed, appropriately aligned kinetic basis. Then, I can start walking.
Cue the incentive charts. I've mapped out a walking program that gradually increases in duration, intensity, and frequency (not all at once!), culminating in a threshhold considered to be the starting point for re-introducing load-bearing into a runner's recovery program (Steve Cole - wherever you are - thank you). If I'm vigilant and diligent enough, I can hopefully start plyometric training in November.
And, if I can maintain that training, I may be ready to start jogging again in January of 2021.
Mapping out the actual timeline of expected (re: slower than you anticipate) recovery nearly made me weep. I counted: 72 weeks until I get to a normal "mileage" program, if I'm consistent and dedicated to this recovery phase.
I don't know how it will go. I want to rush through it already. Seeing "walking" on my incentive charts for 34 weeks feels infuriating, and like overkill - but the breakdown is purposefully slow, and dedicated to not re-injuring myself. What has always been for me a great stress release (a good long run), or a mood booster (quick walk around the block), are now potential landmines for my biomechanics.
The hardest part of recovery is the shift in mindset. I can't keep doing what I thought I would do to get better, if I want this to heal and prevent PF from ever returning. I not only have to change how I move, I have to change how I think about moving.
