Posts Filed Under: The Trouble with Tendons


16 May

Half Full of Thanks

Posted by on May 16, 2013 at 10:32 pm

On New Year’s Eve, my brother Drew and his wife Simone decided to sign up for the Thanksgiving Point Half Marathon in order to increase their chances of sticking to their resolution to get in shape. Honestly, when I heard that they’d registered for this event I was a little skeptical. It takes some determined training to get ready for a half marathon and I wasn’t sure if they had it in them. But any chance for them to chicken out clucked away with a click of our mouse. At the end of February, we, along with our friend Jeremy, added our own names to the registration list thus making it impossible for Drew and Simone to back out gracefully…and simultaneously impossible for us to retreat without disgrace.

We did most of our longer training runs with Andrew and Simone. The many miles go faster with some chatter.

We did most of our longer training runs with Andrew and Simone. The many miles go faster with some chatter.

While the largeness of our group convinced us that this race would be a winner, Jason and I had some apprehensions about finishing it as losers. Since the event was so early in the spring, we were a little concerned that the weather would inhibit our ability to prepare for it properly. Just train indoors you say? Are you aware that jogging 10 miles around a track would require roughly 70 laps and would likely be about as exciting as listening to an insurance policy manual on tape? I think I’ll pass but if you like extreme monotony by all means give that revolving tedium a whirl. As it turns out, for us, no worry over weather was warranted. Our outdoor workouts ended up working out. Sure, we had to dash in rain, snow and frost but we also got to sprint in some pretty darn perfect conditions. Jason and I stuck to our training regimen like filthy flies on fresh poop. We ran 4X a week with an extended session every Saturday. At the peak of our training, this totaled to 24 miles per week. Admittedly, it was a little tiring donning our tennis shoes for those distances but the main problem with our program was actually the time involved. Extra-long runs take an extra-long time. Our perseverance and sacrifice paid off though. We were ready and confident come race day.

No, my enthusiasm did not last but my legs did.

No, my enthusiasm did not last but my legs did.

This half marathon stays entirely on the Thanksgiving Point property. From paths around their tranquil gardens to trails on their swanky golf course, you’d be hard-pressed to find a prettier run. However, being pretty has a price. Usually that drawback is narcissism or an expensive shopping habit but, in this case, it’s hills. The half marathon routes we’ve done before have primarily descended but this one makes you struggle up for every step it lets you ease down. Talk about an incline infestation!

Spring flowers created a landscape of color all around us runners.

Spring flowers created a landscape of color all around us runners.

This course may have its ups and downs but the weather while we scurried along it was solely an upper. The conditions were ideal! Unlike my last half marathon, which ended with dehydration followed by puking, I did not overheat. I wised up after that experience and carried a water bottle with me this time to encourage buy lasix without prescription liquid uptake; the pleasant temperatures did the rest. Barf really doesn’t make the best trophy; sure it’s showy but it kind of stinks.

At the nine mile point, the path went up a giant hill. Ugh! I wasn't the only one that struggled up that incline; I noticed two vomit puddles on its slopes.

At the nine mile point, the path went up a giant hill. Ugh! I wasn’t the only one that struggled up that incline; I noticed two vomit puddles on its slope.

I completed the race after 2 hours and 25 minutes. This beat my former time of two and a half hours and met my goal. I was pleased with myself and very proud of all the other runners in our group. Jason crossed the finish line at 1 hour and 47 minutes. His objective was to finish in less than 2 hours and he definitely succeeded. Drew and Jeremy came in only 6 seconds apart right around 2 hours and 13 minutes. And Simone was about 10 minutes behind me. Way to go everyone!

Jason's exuberant thumb reflected the quickness of his run.

Jason’s exuberant thumb reflected the quickness of his run.

From these pictures it's apparent that I was zoned out through most of the race. Hey, when you have over 13 miles to conquer Rachel Land ain't a bad place to be.

From these pictures it’s apparent that I was zoned out through most of the race. Hey, when you have over 13 miles to conquer Rachel Land ain’t a bad place to be.

I don’t know if it was the race’s many hilly miles or just my body’s many years of miles but the rest of the day, following the event, my hips and knees were pretty sore. It hurt to sit and it hurt not to sit so my options for avoiding pain were pretty limited. Jason fared no better. In fact, he suffered like a fussy baby without a binky and almost cried as much. My thigh muscles may have been grumpy about going down stairs for a few days but Jason’s calves reportedly felt like they were going to rip in half. I guess, considering his finishing time, he earned the right to be a little whiney. (And yes, in case you’re wondering, my calves are much tougher than his.)

Jason leaped like a gazelle as he neared the finish line. I don't know how he had bounds of energy left.

Jason leaped like a gazelle as he neared the finish line. I don’t know how he had bounds of energy left.

My finish was much less dramatic than Jason's...and considerably slower.

My finish was much less dramatic than Jason’s…and considerably slower.

My ankle, as my physical therapist predicted, handled this whole affair, including the prep workouts, pretty well. It would hurt after my lengthier runs and swell a little but it didn’t declare all-out war; I was satisfied with that precarious truce. Yeah for ankles that tolerate and can be tolerated!

I was proud of everyone in our group. Their diligence paid off.

I was proud of everyone in our group. Their diligence paid off.

The Thanksgiving Point Half Marathon was a great experience. I’m glad Drew and Simone initiated our participation with their hasty resolution. The race was lovely, though horizontally challenged, and our training for it went according to plan. Our large troupe provided added motivation and entertaining running buddies. Yup, misery really does like company even if that company is prone to dispense harassment. Peer pressure and persistence got us across the finish line with our dignity intact. It’s nice to be barely at the brink of summer and already in such great shape. Now we’ll just have to continue hitting the pavement in order to keep that shape from sagging into the recognizable silhouette of a bowl of Jell-O.

27 Mar

Ankle Outcomes Part II: Getting Physical

Posted by on March 27, 2013 at 10:05 pm

When I went to see my surgeon in November to discuss my most recent ankle drama, he gave me a prescription for physical therapy. I opted to wait until after Christmas to start those early morning sessions with my physical therapist because I knew my treatment would not be over quickly. Although it took three months of intensive work before I graduated to just doing exercises on my own at home, all the aches and early risings were worth it. My physical therapist brought my foot back from the brink of uselessness. Here are all the details of my rehabilitation that will keenly interest my ankle buddies but completely bore everyone else.

One of the first things my physical therapist told me on my initial visit was that both of my ankles are very strong. The balance on my left ankle, my bad ankle, was surprisingly better than my right, according to preliminary tests, but the mobility on my left was impaired. (Subsequent tests showed that leftie was inferior to righty in balance as well so I’m not sure how it fooled the system at first.) My PT worked me good that morning and made me a bit sore but a couple of days later I was back for more.

Over my next couple visits, my therapist started making things harder for me. Apparently, with tendinosis you have to drive the tendon a little crazy to get it to heal. Tendinitis requires delicacy but tendinosis needs toughness. In tendinosis, the tendon is in bad condition and the tissue isn’t regular. Usually, a lot of scar tissue is present. Scar tissue contains significant quantities of type III collagen instead of type I, which is what a healthy tendon is primarily comprised of. A tendon in this deteriorated state has to be encouraged to rebuild itself in a better, more normal, way. That encouragement, unfortunately, must come in the form of aggressive insults. Tendinitis is much easier to deal with than tendinosis but you know me, I don’t like taking the easy road.

What determines if a tendon injury will result in tendinosis or tendinitis? Here’s what my PT said: The condition of the tissue before the injury is important. My ankle already had scarring prior to this latest incident so please put a check in the tendinosis box for me. The severity of the injury is also a factor, the more severe the damage the more likely tendinosis will occur. My sprain was bad news so, once again, it looks like I was destined for tendinosis. And lastly, how much the foot is allowed to rest and mend after it’s wounded also plays a part in how the tendon reacts. If you try to do too much too quickly then you are asking for tendinosis. Before you start pointing an accusatory finger at me on this account, you should know that, despite my usual tendencies, I was pretty good about letting my ankle heal this time. I say “pretty good” because I may not have given it quite as much pampering as most would have but I gave it significantly less grief than most Rachels would have. My previous experiences with this particular foot convinced me that it was probably unwise to hike to the top of a towering peak the day after I rolled it. (And yes, that is exactly what I did the first time I tore my tendon but didn’t realize it.)

I bought a BOSU ball so it would be easier for me to do my therapy exercises at home.

I bought a BOSU ball so it would be easier for me to do my therapy exercises at home.

At this point, I could tell that physical therapy was pushing my foot to aggravation. Doing my “homework” caused stiffness and pain and so did my visits to the PT. But apparently, since pushing is the purpose of this therapy, everything was going according to plan. In fact, my physical therapist gently told me to get used to the agony because he was just going to keep making things tougher on my ankle with each visit. Fantastic.

Before my next PT appointment, I went snowboarding for the first time since my sprain. Snowboarding hurt but it hurt in a way that I wasn’t expecting. The pain was in a different place than it used to be before surgery. The discomfort was more in front of my ankle bone than below and it was so severe that I almost called it quits early on the mountain, which is not normal for me in any way. When I explained where the painful spot was to my PT, he was certain right away that it was my sinus tarsi. The sinus tarsi is a small cavity that contains ligaments and joint capsules. It’s a crowded area where a lot of things intersect. My issues in that region, he believed, were a result of a buildup of scar tissue, AKA fibrosis. Scar tissue creates stickiness and impedes the motion of connective tissues. In the sinus tarsi, which is packed tightly anyway, a little fibrosis can create quite a bit of friction. This, for obvious reasons, doesn’t feel good but it’s common after a serious ankle sprain like mine.

My next few trips to the PT passed with nothing new to report: more exercises and more discomfort were the name of the game. Finally, after a number of meetings, I felt the time had come to ask my PT a question I was almost afraid to have answered: Is my foot in good enough shape to participate in a half marathon at the end of April? His response? Probably. He gave me permission to begin training for this event but he cautioned me to only increase my running distance by 10% each week. He also warned that if my ankle starts swelling or becomes persistently painful for more than a couple of days after running then I’m overdoing it and I need to back off. Let pain be my guide, he suggested…maybe not the best advice for someone as stubbornly and irrationally prone to ignore aches as me.

On my next visit I progressed to the hardest exercise stage, known unfancifully as level 3. Those advanced exercises didn’t go over so well with my foot, especially the side-to-side jumps. My ankle would hurt for hours afterward and swell in an odd fashion. It would bulge at the sinus tarsi, which is where I expected problems, but also up closer to my toes in a strange little bubble and in an area beneath the backside of my ankle bone. My PT said that all of this puffiness was probably due to just my sinus tarsi swelling. Apparently, with inflamed tissues, bits of fluid break off and get lodged in random places like that. Well, I’ll be a monkey’s uncle. My PT wasn’t pleased with how my ankle was handling my advancement to level 3. Evidentially, therapy exercises shouldn’t cause pain for more than a couple of hours; even therapists have their sadistic limits. I was put back on a routine in between level 2 and 3. My PT also recommended that I give my sinus tarsi a mean rub every day to help break up the scar tissue that was causing me so much grief. And I do mean mean!

As my number of PT visits was getting into the double digits, my therapist informed me that I needed to do my home exercises for six more weeks but I was almost done coming to his office. After another three or four weeks he said I should try doing the advanced exercises again, the ones that my ankle had previously rejected, every other day to see if it would handle them okay. He also said that it’s entirely possible that my ankle will never be able to do those types of activities without hurting but, since they are specialized movements, I probably won’t notice any issues while performing my day to day activities. Despite his reassurances that, either way, I won’t have many restrictions on what I can do, I wasn’t happy with the idea of permanent limitations. “You may never be able to do that.” is a phrase that just doesn’t coincide with Rachel ideology.

In my last full hour appointment with my PT, he told me that my ankle should keep improving in stability and mobility over the next two or three months and then it will be about as good as it’s going to get. He tested my foot on his fancy machine and, at that point, my medial/lateral stability (side-to-side) on my left ankle (AKA baddie) was within the normal range but it wasn’t as good as my right, which had better than normal stability. My front-to-back stability was about the same on both my ankles.

During our final chats that morning, my PT said that as long as I’m not snowboarding every other day then it’s okay if I hurt on the slopes. This was not a callous comment but a professional observation. His meaning was that just because I’m in pain doesn’t mean that I’m damaging myself. I guess it’s comforting to know that I won’t be hurting my ankle even if it’s hurting me. With my therapist’s approval to go ahead and suffer, my sneaky ankle must have realized the futility of grumbling about my favorite winter pastime. When I went boarding in mid-February it behaved much better than it had a month earlier at Powder Mountain. It didn’t throb much while I was on the slopes. However, upon doing my therapy exercises the next day, it became very shaky and remained achy for over 24 hours. What the what ankle? Why must you mar my victories with your drama queen tendencies!

On my follow-up visit three weeks later, my PT tested my ankle’s stability once again. Drum roll please! It had improved drastically in those three weeks. Yes, I had been doing my homework; I am a teacher’s pet after all. The medial/lateral stability on my left ankle was still not as good as my right but that gap had been narrowed substantially. Both my ankles have better stability than normal now. No, you wouldn’t want to go head to head with these feet because they are mean, not green, stable machines.

At that meeting, I spoke with my PT about how my half marathon training was going…or resisting going. My ankle had started giving me grief as soon as I increased the length of my runs past what it was used to. My therapist said that this was to be expected given the degree of scarring in my foot. He recommended that I ice my foot after each run. He also suggested that I not do my home exercises on running days.

Somewhere in this discussion, the subject of my odd gait came up. My PT found it professionally quite interesting that I run/walk on the outside of my feet. This strange habit was partly blamed for my first tendon fiasco and, according to my PT, is quite uncommon. Walking on the inside of the foot is the normal way most people step incorrectly. I guess I’m weird. No, don’t bother telling me that you already knew that.

And that concludes the intriguing tell of my ankle’s diagnosis and recovery. I am still in the process of training for my halfy, in fact my foot is on post-run ice at this very moment. So far that training has been going as well as I’d hoped, which is to say not spectacular but not awful. I’m still moving onward and upward though with my most troublesome of appendages. I’ll be sure to keep everyone updated on the exciting life of lefty in future yawner posts.

By the way, if anyone that lives in these parts needs a physical therapist, I’d highly recommend mine. He is very competent and made the miserableness as pleasant as possible. Just holler and I’ll be happy to pass his name along.

20 Mar

Ankle Outcomes Part I: Surgical Advice

Posted by on March 20, 2013 at 10:34 pm

As many of you are aware, at my birthday party last June I rolled my ankle severely. Then, when my foot wasn’t healing as quickly as it should, the similarities between my current predicament and my previous tendon tear experience prompted me to drop in on my sports doctor. Multiple visits to my physician and an MRI later, the verdict was that I had developed advanced tendinosis in my peroneus brevis tendon from this latest injury and an associated tear. Another tear? !*&*#$+?!!! This was the same spot that I had had exploratory repair surgery on about four years ago so I was quite grumpy about the prospect of another miserable slicing event. Could an operation be avoided? I had to wait months to find out and now the wait is over for you too.

At the end of November, I was finally able to see my orthopedic foot surgeon to learn if surgery would be necessary to fix my newest tendon rip. After viewing my MRI, he had a slightly different take on my problem than my sports doctor. It was his opinion that I had hurt more than just my tendon with that roll. He believed that I had suffered what is called a grade III ankle sprain. In a grade III, the ligaments that run on the outside of the ankle are completely torn. He thought that my ankle joint had most likely been damaged by my misstep as well.

Not all of his news was bad though. He told my thankful ears that ligaments heal quicker and better than tendons. Tendons don’t get good blood flow so they recover slowly and often not completely but such is not the case with ligaments. In short, my ligaments should mend on their own. What about my temperamental tendon? He said that at this point another tendon surgery was not necessary or advisable for several reasons. He had me at “not necessary” but, for the curious, here’s his explanation why:

For starters, tendon repair surgery is most beneficial the first time around. Subsequent surgeries typically don’t see as good of results. More scar tissue and less blood circulation with each operation mean that you’ve got a onetime shot of fixing a tendon before things get a lot more complicated, as in artificial sheaths, grafts, and other complex unpleasantness.

Also, after tendon repair surgery the tendon usually thickens. While this dense material isn’t normal tissue, that thickening does help prevent the tendon from tearing again. Therefore, according to my surgeon, most people don’t come in repeatedly for this type of operation unless they are obese. He estimated that the minor split in my tendon should remain minor as long as I stay petite and as long as my MRI was accurate, which they are in about 80% of cases. If I don’t gain weight, I will most likely never have to have my tendon fixed again, which is why my doc forbade me from following my tendon’s thickening example. What a bummer, I was planning on gaining 100 pounds this summer but I guess I’ll have to delay my plumping project indefinitely.

Remember this? This misshapen glob is my ankle a couple of hours after I rolled it.

Remember this? This misshapen glob is my ankle a couple of hours after I rolled it.

Although surgery wasn’t needed, my surgeon didn’t expect my ankle to come bouncing back anytime soon. Due to the history of my foot, which apparently is quite sordid, he thought it could take up to a year for it to heal. My doctor distinctly remembered my peroneal tendons as some of the worst he’s ever operated on. Great. Glad to know that my ankle is famous for being screwed up. However, even with my foot’s baggage, he thought it should continue to slowly mend from last summer’s insult and, as long as it keeps improving, that lengthy recovery is no cause for concern.

He had some advice on how to encourage my ankle back to its version of normality: 1. Wear my brace on any uneven surfaces for the next six months at least and longer if my foot is still not feeling very strong. 2. Participate in physical therapy to improve my balance and decrease pain.

He told me a couple of comforting tidbits in closing: 1. Although my injured ankle feels weak to me, it’s actually very strong. I guess I am tougher than I realize even at my flimsy points. 2. This awful sprain was a fluke of bad luck. Despite my ankle’s problems, this type of injury shouldn’t happen to it again…unless I get really unlucky again.

With the threat of another foot operation removed, it was time to relax and concentrate on the discomfort of rehab. Next week, on Ankle Outcomes, I will be discussing my many exhilarating visits to the physical therapist. This installment will be full of unbridled anguish, unstable characters, and profuse scarring. You won’t want to miss it. Until then, although the suspense is gripping, I’d recommend not holding your breath or falling off the edge of your seat.

19 Dec

The Sum of the Run

Posted by on December 19, 2012 at 9:00 pm

Every summer Jason and I end up participating in quite a few races. We welcome these events because they provide good motivation to train a little faster or a bit longer. Plus, they are an excellent way to measure your athletic progress. While we were involved in our normal number of competitions this year, they didn’t exactly proceed normally for us. For one, Jason’s pace throughout the season was curiously faster. I, on the other hand, kept up my middling speed nicely until I hurt my ankle and then sluggish limping was the best I could do. Oh woeful foot! As the weather gets frigid and the races dwindle, let us look back on all the sprinting glories and frustrations that have come to pass these last months.

Jason zipped to the finish line at the Thanksgiving Point 5K beating out all but two of his competitors.

For years Jason has been able to outpace me on the track. Every step his long legs take requires two of my own. It doesn’t exactly seem fair but it does give me a lovely excuse for lagging. My quick hubby has nearly placed in several races before but he’s never quite managed a win until this summer. This year he was third in his division not only in the Thanksgiving Point 5K but the Lehi City Roundup 10K as well and then he won 1st in his age group at the Night of the Running Dead. What happened to make that boy so speedy? He got old. Jason’s last birthday placed him in a different age division, an age category where he’s among the youngest instead of the oldest. That bit of help was all he needed to become a leader of the pack. But hey, the dude finishes a 5K in about 22 to 23 minutes; I’d say he deserves some recognition for that whether he’s ancient or not.

We were enthusiastic at the Thanksgiving Point 5K from fresh start to sweaty finish.

Our racing plans had to be halted mid-summer because of my accidental ankle altercation. Ironically, I completed a 10K just hours before I tore my tendon and various ligaments for the second, and hopefully last, time. Leftie took me out of the competition circuit for about 5 weeks. My first race after the injury, Sandy’s Moonlight Run, was awesome because it started at midnight under the full moon but not awesome because I barely crept along its course with my braced ankle. Although I made it to the finish line, I was well behind hundreds of hardly runners. If they had handed out a prize for the pathetically slow but stubborn I definitely would have won it.

I promise I actually was moving when this was taken.

Thankfully, broken parts tend to eventually mend, even scarred silly parts like my tendon. My ankle comeback felt complete when I won 3rd place overall at Easton’s 5K a little over 3 months after I gracelessly wounded myself. Yes, I already discussed this win in another post but what’s the harm in mentioning it another time or two or three? Surely, it’s not an unforgivable sin to continually call attention to what will probably be the sole running triumph of my life.

Moonlit runs in the wee hours of the summer are my favorite so I wasn’t going to let a grumpy ankle stop me from participating in this midnight adventure.

That pretty much sums up the summer season of races for us. Jason ran fast. I ran sort of okay, hurt myself, hobbled along, and then picked it up a bit. We look forward to the spring when the world thaws and the competitions commence. Then Jason can once again conquer the other old men and I can further my longstanding mediocrity.

2 Oct

MuckTales

Posted by on October 2, 2012 at 7:34 pm

I think somewhere in the scriptures it says, “He who is not dirty let him become as a little piggy.” No? Well, I’m sure it’s going to make the next edition.

Jason and I did the Dirty last week with Abigail, Jeremy Rowley, my brother Drew, and his wife Simone. The Dirty Dish is a filth fest for runners. It’s really more about freeing yourself from acceptable hygiene practices than getting exercise. As you slosh your way through a 5 or 10K, whichever you’re tough enough for, you’ll find yourself in slimy pits, on top of muddy ramparts, or in the midst of a stinky lake.

I made duck feet and feathery tails for me and Jason. They went from pristinely clean to filthy in just five minutes.

Most members of our team were Dash veterans so they knew what we were in for. We expected muck in places where the sun don’t shine and being worn out beyond reckoning. We were surprised by one thing though: this year’s obstacles were a lot wetter. The water to dirt ratio was significantly higher than last time; there was less soggy soil and more pools of filth. We were in one of the first groups out the chute so the temps up in Soldier Hollow were still in the 40s and all those puddles were awfully cold. Most of us had numb hands and arms after our first dip but we kept moving to discourage our chilled extremities from giving ideas to the rest of our bodies.

You had to either go over or under these pipes. Under was a guaranteed mess but over was more precarious.

The slop ‘n slide was sloppier this year, so naturally more fun.

Another change for me from last year was the condition of my ankle. Tearing my tendon 3 months ago meant that this time I had to contend with a testy foot. Thanks to my injury I couldn’t just jump into the murky depths, I had to carefully navigate my way through them so as not to damage my tendon any further. That caution and instability made me feel infinitely weaker, a bit like an old lady, a curious state for an unabashed mud seeker. But even with all that extra care my ankle was still pretty aggravated with me after the run. I guess there’s just no pleasing some tendons.

Simone bypassed quite a few obstacles so she didn’t look like she had fallen into the vat of Hershey’s extra chunky chocolate that had swallowed the rest of us.

Jeremy, Drew, and Jason were giggly with delight throwing globs of mud at each other.

This year we continued our juvenile costuming tradition by naming our team MuckTales and dressing like ducks. Yes, MuckTales is a play on DuckTales, that Disney cartoon you watched incessantly when you were a kid. Jason and I came as two of the triplets. I believe we were Dewey and Louie but don’t quote me on that. However, you can quote me on this universal truth: sopping sweatpants make running really uncomfortable. The white sweatpants Jason and I wore to represent our duck feathers were a very bad idea. They absorbed all that muddy liquid like sponges and we came out of each trench about 15 pounds of gross sludge heavier. You don’t know chaffing until you’ve sprinted while sporting gritty dripping sweatpants. Although most of the other participants didn’t seem to recognize our characters, everyone caught on that we were ducks except for a delirious couple that thought we were piggies for some reason. (The feathers and beaks didn’t clue you in?) I guess with all our layers of goo we probably looked more like sewer treatment pond scrapings than anything else.

Our group, with the exception of Simone, looked like we had been dredged up from the bottom of a bog by the time we crossed the finish line.

We had a lovely grubby time running the Dirty Dash again. It was a bit chilly and I think our whole group was still cold hours later from that foul freezing water but it was all worth it for the chance to completely put aside cleanliness and see Jeremy get hit in his open mouth with a mud bomb. I will long treasure my mucky memories and the grime I keep digging out of my toenails. Dirt and fond recollections are the gifts that just keep on giving.