Injury – My Story

This video was taken at the end of the long run. These runners just completed 80km's as a single run after having ran about 70km's the preceding two days. Watch this video to the end to see what support can do as motivator.

Background

If one speaks to any runner it becomes apparent that two things are certain, (1) runners will find any reason to run, this is typically due to their competitive nature and (2) runners will get injuries, this unfortunately is also due to their competitive nature.

Such is my story. It started with gradually increasing my weekly distance to 80km’s with weight, at which point I decided to work on my speed. The benefits were great. My 10km time came down to 50:03, and it was at this point that competitiveness dominated good common sense. For 8-months of training good common sense repeatedly held me back, it ensured that I remained careful and that I remained injury free. But then it happened, common sense took a break and I started chasing a sub 48min 10km, and a sub 1h24m 15km.

It was on a sunny afternoon three weeks ago that I chased the illusive 1h24m on the 15km. I was doing really great, I was on target, feeling relaxed and full of energy and then a steep embankment presented itself. Without thinking I ran the embankment knowing that with sufficient momentum it would not be a problem, and it wasn’t. I reached the top, unfortunately with my left calf muscle in less than perfect condition.

As I am confident other runners will attest, I reasoned that the pain I felt could be dealt with by continuing. After all, keeping the muscle working and warm will correct the problem and the pain will subside soon enough. Unfortunately 4km’s later I was reduced to a walk as the pain was simply too intense when I ran. Then the fear set in. The pain was localised about 8 cm above the base of the heel around the same point where I could feel my Achilles tendon emerge and the worse was feared.

Initial Treatment

Arriving home, I gave this injury the respect it needed and immediately made appointments with my local GP, a physiotherapist, a biokineticist and a specialist sport chiropractor. As all of these individuals specialise in sport injuries, with the exception of my GP, I assumed that they knew something about treating such injuries.

Well that was a very wrong assumption to make!

My GP was, as a general practitioner, the most helpful. His diagnosis was that it is not the Achilles tendon (some excellent news) but it was definitely a muscle tear. He gave me something for the pain, some anti-inflammatories and some cortisone and suggested I see the physiotherapist urgently.

And so my journey started.

The sport chiropractor was about as helpful as a McDonalds meal is to a person on diet. All she did was to look at my running shoes for 10 min to tell me what I already knew. I showed no signs of pronation so I am a neutral runner. She then proceeded to look at my back, my hips, my knees, shoulders and everywhere else except at the problem. I was then told how brilliantly I am built for running an ultra-marathon, how my hips and everything works together, and yes just as the McDonalds meal, her assessment and treatment cost me money, and lacked any real value. Her prognosis, it is a muscle tear and I need to get to the physiotherapist urgently.

So I found myself at the physiotherapist.

The particular practice was used because they are the official physiotherapists for one of the provincial rugby teams in South Africa. My logic in selecting them was that as they deal with rugby injuries they should know something about muscle injuries, again a bad assumption to make. At this point it seems as if I was on a roll in making bad assumptions and using these assumptions to base my decisions on.

The physiotherapist that worked on my calve, once worked on the wrong leg and only after I pointed it out, responded that it is because it is healing so well that she was unable to tell the difference. I received some electro stimulation on the area and some gentle rubbing for more than a week. During this time I cycled 10km’s per day on a relatively flat route and avoided putting serious strain on the calve.

At the same practice the biokineticist assessed me and suggested some exercises that would, if followed to the letter, make me invincible.

Yet, after more than a week the pain was the same and my hope of running was by no means on the horizon. The medicine managed the pain and to some extent the swelling, but I was making no headway. In retrospect, however, I should have anticipated this. The physiotherapist was a women in her early 50’s who has probably not participated in any sport in the past 30 years and the biokineticist was probably 20 to 30kg’s overweight and had not seen a gym, or participated in any real sport or exercise for a good portion of his adult life.

Real Treatment

At the end of 2-weeks I decided that my lack of recovery and progress demanded some radical rethinking of my treatment strategy. I approached the High Performance Sport Centre of the University of Pretoria and met up with a young physiotherapist called Jaco. He is a qualified therapist with 3-years of therapy experience, what is more important; however, is the fact that he is an active athlete. He runs, participates in mixed martial arts and works with real sport injuries on a daily basis.

His assessment was thorough and the source of the injury was identified. I had torn the soleus muscle, a Grade 2 tear in which I tore between 30 and 50% of the muscle fibres and which could take between 4 and 6 weeks to heal completely.   

The treatment was simple. First the application of a heat pack for 5 minutes, this followed by Deep Dry Needling (DDN), and some deep muscle massage ending with light binding to limit movement. The DDN is intended to trigger an inflammatory response in the muscle, which means the body tries to heal the injured area. Dry Needling involves the insertion of needles directly into the muscle, Deep Dry Needling means that these needles are inserted deep into the muscle (about 20mm deep).

The pain is minimal for the period the needles stay in which is about 5 to 10 minutes, but for a brief moment at the beginning it creates a sharp pain that is followed by a dull sensation.

I received some simple stretch exercises to do and after two treatments took to the street doing a run-walk combination 10km. I was able to complete the distance with a 60% run, 40% walk ratio in 1h15m with little discomfort during and after the run. Today I ran a 15km in 1h40m with little to no discomfort.    

Routine & Rehabilitation

As an ultra-runner my focus is on distance. At the time of the injury I was running 85km’s per week with a 7.5% weekly increase, the plan was to continue increasing the distance to 180km’s per week. My immediate aim was to maintain as much of the distance without causing more damage. As the Soleus muscle works hardest during running, walking caused little to no discomfort as did cycling.

During the first week I cycled 10km’s per day on a relatively flat course but felt that it was simply not enough. During week 2 and 3 I continued to walk most of my usual run routes. During week 2, I walked 65km’s and week 3 completed a total of 70km’s. I will continue to walk for the next week during which time I will have 2 more physiotherapy sessions and will complete 80km’s.

I have also decided to return to running with a new strategy.

(1)    I will alternate running and walking days as standard for my training from this point forward. This will have primarily two advantages, firstly it will ensure that the impact on my legs are reduced and secondly that I work a high level of walk miles into my regime,

(2)    I will have 2 consecutive weeks in which I increase my miles, then I will reduce my distance during the 3^rd week and rebuild distance from this reduced point,

(3)    More time will be spent on strengthening muscles through stretches and some light weight training, and

(4)    My primary focus will remain on building endurance instead of speed.

Lesson Learned

The question is what have I learned from this?

The answer is summarised in the following points:

(1)    Never allow a medical professional to treat your sport injury unless they participate in a similar sport themselves, and

(2)    In my view the more important point, avoid injuries through personal discipline, self-restraint, and always being careful.

I have learned that as tough as our bodies are, they are equally fragile. A moments carelessness, costs more in time and enjoyment than what the potential gain for such carelessness is worth. I have now resolved to run further but slower, and to compete less, but enjoy it more. This does not have to mean stagnation, as the distance increases the speed will follow, but this will be more gradual, more restrained, better planned and more carefully executed.

I hope this helps some of you.

Thanks for visiting my blog. As you may have seen, this blog exceeded 11,000 page views a few days ago and that was only achieved through your participation.

Regards

Genis