Chris asked me to write about my summer. Luckily for Chris I haven’t spent the summer months on a Mediterranean cruise as that wouldn’t have made great reading! Instead I’ve been really busy treating lots of runners in the clinic and also treating a big injury of my own.
How I became well and truly broken!…
Around 50% of my Physiotherapy caseload is made up of runners including recreational and elite runner and of course some barefoot runners. Over the years I’ve treated all kinds of injuries, although there are lots of recurring themes- shin splints, achilles tendinopathies and knee pains are the bread and butter of any running clinic. As a runner myself since my teens I’ve had my fair share of all the common over-use injuries and I’ve always joked that the fact that I’d had every running injury known to man was what made me a good Physio, It made me ‘experienced’!
Then last year I got the daddy of all injuries, right when everything was going really well and I was least expecting it…
The start of 2012 was mostly spent running. I enjoyed meeting up with various barefoot and minimalist running groups across the country, leading workshops and experiencing my old hobby of running with a totally new perspective. The only problem was that underneath all of my running coaching enthusiasm I still had a sore ankle.
It had been sore for a couple of years, ever since I’d twisted it badly diving out of the way of a car, on a marathon training run. The pain had moved around a bit and hadn’t really fitted any common clinical pattern. I’d had it MRI scanned and that too was inconclusive. Technique, shoes or orthotics didn’t make any difference. It hurt with walking, squatting, walking down stairs- running or not running didn’t make any real difference either.
It had been sore for 2 ½ years and I’d tried everything. We simply couldn’t find what was wrong with it… that was until I had a Cortisone injection last summer!! Cortisone can be great for basically ‘shutting pain up’ although this is often short-term. Meanwhile it’s not very good for the body’s tissues and can make tendon tears etc worse. Sports people often have cortisone shots to give them a window of reduced symptoms in which to complete a specific match or competition. I was really fed up with my sore ankle and willing to try anything…
Big mistake! I became a statistic, one of the unlucky ones whose injury becomes significantly worse due to a cortisone shot. Soon after the injection my ankle started giving way as I walked around the house or around the supermarket. It became very inflamed and painful and I ended up having to go back to the hospital for another scan.
To our dismay we found that the cortisone had caused my ‘flexor retinaculum’ to rupture. This is an incredibly rare injury that had apparently never happened in this country before. We can only guess that my original, mystery ankle pain was a tear in the retinaculum- it would certainly tie in with the fall I’d had and the unusual symptom behaviour. The cortisone had then made the tear into a rupture, whereby the retinaculum had now fallen apart.
Without the flexor retinaculum the Tibialis posterior tendon is left unprotected, to move about. It feels like somebody is flicking your ankle bone forcefully as you walk! Like this the tendon is extremely vulnerable and highly likely to rupture too.
Surgery was now my only option. With a ruptured retinaculum my ankle was completely unstable. I had to walk (limp) with a flat foot and my ankle was giving way every time I stood on an uneven surface.
So 11 months ago I went in for surgery to make an artificial retinaculum and relocate my dislocated tendon. They needed to make a 6-inch incision along the inside of my ankle. There’d be lots of drilling and pinning and I was told I might never run again.
Back to square one
3-months in plaster and a boot conveniently coincided with the middle of winter. I did lots of reading, as I couldn’t leave the house! At the weekends friends took me to coffee shops- coffee had never tasted so good!
Early rehab was mostly wiggling my foot about. My ankle joint was completely ridged from being kept still for so long. It was also really sore and numb. I added lots of novel and complicated routines over the coming weeks which I won’t detail here as it’ll take all day and (maybe) bore you all to death! Lets just say I left no stone unturned.
The heat wave in July really helped. I walked every morning, in my bare feet as much as possible. I also took advantage of working a few hundred yards from the beach and made myself walk on sand. Sand really hurt at first, but it gradually hurt less and it definitely felt like a ‘good hurt’.
I gradually started running for short sections of my road walks, starting with about 50 metres at a time. There was never a stride where my ankle felt comfortable, but the soreness gradually dampened and 50m intervals gradually became ¼ mile, ½ mile and then 1 mile. Between May when I ran my first few steps I have gradually built up to 4 miles. Its been 11-months and I’m ‘getting there’. My balance is around 80% of normal and the ankle joint is slowly loosening although at the moment it would still be classified as a ‘frozen ankle’ (similar to a frozen shoulder). Pain is slowly reducing as the joint gradually loosens. My ankle joint is completely intact now but it still hurts, and I can’t yet hop very well.
My shoe experiments
I’ve been a big fan of minimalism and barefoot running for the last few years, letting the foot do its thing, and evolutionary medicine. The thing is though, in cave man times, where running was a matter of survival, without my flexor retinaculum, I’d be dead! A cave man with an injured foot would have instinctively tried to protect it or make it more comfortable- perhaps wrapping it in animal fur or leaves. At the moment I can walk barefoot with minimal discomfort for short distances, but running barefoot is still too sore.
This prompted me on a mission to try as many different running shoes as I could! Initially I tried traditional running shoes for the first time in 4 years, but they felt horrid- they made my running form really clumsy. I could feel myself heel striking and the awkward, breaking running technique reverberated up through my sore ankle.
I’ve found that anything completely barefoot-style hurts. Slightly cushioned with a 4mm drop has proven to be my favorite shoe for the time being. I’ve got a pair of Inov8 road X 155 and I feel I can run well in these. They’re making my ankle more comfortable whilst keeping my form light and quick.
My quest for the ultimate rehab shoe has even had me trying Hoka’s! Before trying them I thought I’d hate them and I also thought they were about as far away from minimalist running as is physically possible. But, (dare I say on a barefoot running website!!) I actually really like them. They have a 4mm drop and are really light so they don’t ‘get in the way’ of good running form (too much) and allow for a mid-foot landing. The cushioning feels really nice for my sore ankle. Pete Larson over at Runblogger (http://www.runblogger.com/2013/06/an-update-on-my-wife-and-her-hoka-bondi.html) has talked a bit about Hokas recently as his wife has positive experiences of running in them following an injury.
My plan for the time being is to continue gradually increasing my mileage whilst continuing a thorough gym-based rehab and strength programme. I’m doing lots of work on running form and drills and some barefoot walking. I’m going to continue experimenting with shoes (and no shoes) and hopefully as my ankle gradually becomes less sensitive I’ll be able to do some running in my beloved Luna sandals and vivobarefoot’s again. I’ll keep you all posted on my shoe experiments! For now I’m just really excited to be able to join my friends on runs, feel my heart racing and my lungs full of air. I’ve been busily coaching other runners this year without being to join in myself. It’s great to be able to demonstrate techniques again and to share in my clients running enthusiasm.
These days I run with huge grin on my face saying to myself ‘I’m running! I’m running! I’m running!!! It’s been a long hard slog to get here, I will never take my health or my ability to run for granted again!