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Thursday, July 19, 2012

Final Injury Update-Extensor Tendonitis

*Here is a link to my first Injury Update, which explains more about the injury itself, and is the basis for which I formulated this post.

It's been a little over 2 months since I began feeling pain in my foot from switching to barefoot running.  I am no longer running barefoot, but I am running quite well with a pair of minimalist shoes (Saucony Kinvara 3).  I've logged around 100 miles over the past 5 weeks in these shoes and my foot is feeling completely better.  I figure that since my injury is completely behind me...knock on wood...I should post an update to the treatments I used.

Ice:  This continued to be a lifesaver for me.  I continued to ice my foot, as described in my previous post, throughout my healing process.  I also began a routine of applying heat, friction massage, then ice which I'll describe later.

Compression:  I continued to wear an elastic bandage throughout the day, especially if I knew I would be walking a lot.  This helped for the first few weeks, but around week 3-4 it started to feel like it made things worse.  I discontinued wearing the wrap after that.  I think the discomfort was caused by the added pressure from the wrap on the top of my foot where the inflamed tendons travel along my foot.  Initially it provided comfort, perhaps by adding stability and cushioning to my fore-foot.

Wear Running Shoes:  I continued to do this throughout the entire recovery process.  I started out with my old Mizuno Wave Rider shoes (This link will take you to the current model, but mine are 12's).  The WR's had been through a marathon and much more, so they were pretty shot.  I switched to a pair of Kinvara 3's about 3 weeks post injury.  My Kinvara 3's felt better than any other pair of shoes I own so I wore them everywhere until about 7 weeks after injuring myself.

Forefoot Padding:  I actually quit using this after about 3 weeks or so.  After switching to wearing the K-3's all of the time, there was no need for additional padding.  The extra padding did seem to help initially though, so it may be worth trying.  As a side note, I read several internet posts about people placing cotton balls between their toes to relieve stress from inflamed tendons in their foot; however, this didn't seem to provide any relief from discomfort for me.

Stretching:  Stretching continued to be a great help for me, especially calf stretching.  Once my foot was feeling a bit better (about 3-4 weeks post injury) I started doing a stretch on the top of my foot where I would sit in a chair, place the ankle of my injured foot on my opposite thigh, and use my hand to gently bend my toes downward.  I would have to apply counter pressure with my thumb on the bottom of my foot near my arch.  I would recommend any leg stretches that don't seem to aggravate the injury while doing them.

Friction Massage:  I stumbled across friction massage several weeks into my recovery and this seemed to help tremendously.  It's not entirely comfortable, but it really helped to pinpoint the injured area and also seemed to alleviate pain for hours afterwards.  Here is how to perform friction massage.  I highly recommend this!

Toe Raises:  I actually quit doing these shortly after my original post.  I quickly decided that strengthening exercises weren't helpful early on in recovery.  I would recommend these for injury prevention, but not for treatment.

Running:  I definitely don't recommend running while injured.  I went on a few light runs, but decided that it was actually making the problem worse.  I could feel pain in my foot while running, but since it wasn't severe I thought I could just run through it.  I did; however, find that after about 2-3 weeks of rest I could walk/hike relatively pain-free.  I started walking as much as my foot would allow.  I tried to just listen to my body.  If my foot started getting sore, I toned down the walking.  If I felt good I kept going.  I actually did several 5-10 mile hikes with my 1-year-old son in our Baby Carrier Backpack.  This may not work for you if you're injured, but I think it really helped me recover.  I think that stimulating the tendons, without causing pain, is very beneficial to recovery.

Rest:  I ended up taking another 2 weeks off from running completely, with the exception of a few light "test" runs, for a total of 4 weeks off.  In order to keep my sanity I started walking and hiking quite a bit to at least stay somewhat active.

Now that I've revisited all of the previous treatment methods I mentioned before, I'd like to mention the heat, friction massage, ice routine that, in my opinion, was more helpful than anything else.  First thing in the morning I would apply a heat pad by wrapping it around my foot and securing it in place with the elastic bandage I used use to wrap my foot.  I would leave the heat on for about 20 minutes, making sure that the heat was concentrated on the top of my foot between my toes and ankle.  Next I would conduct a friction massage for about 10 minutes as described in the link.  During the massage I would start rubbing very gently and as time went on I was able to increase the pressure.  By the end of each massage my thumbs would be very tired from applying so much pressure.  By the end of the massage I could feel the pain centralize to a very specific point on the tendon, maybe the size of my fingertip.  After the massage I would apply ice for 20 minutes.  This felt SO good, as the massage isn't exactly pleasant.  By the time I finished this ~50 minute process my foot felt absolutely wonderful, and it only got better the more that I did it.  Occasionally I would end up applying ice again later in the day if my foot was really bothering me.

I hope this helps someone make it through a tendon injury.

Happy Running!

11 comments:

  1. Hi. Thanks for posting this blog. It sounds virtually the same as what I am dealing with right now so I am now much more optimistic about getting some resolution. One question though: my pain is much worse in the morning or after sitting for a long time. I don't see that in your description anywhere. I wonder if this difference is important because everything else you have described is the same as me, even down to the barefoot experiments and the old Wave Rider 12s.

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  2. Thanks for commenting Anonymous! It's been awhile since my injury, but, in general, I experienced more pain when I was 'cold' or stiff like what you're describing. The podiatrist I saw told me that most of the time if pain decreases with stretching and movement then it's probably not a skeletal injury like a stress fracture; it's probably a muscle or tendon injury. That was true in my case, but he also followed up that comment with "...but, there are always exceptions." Thanks for reading.

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  3. Incredibly helpful information. I followed your regiment of heat, friction massage, ice, and I am having incredible results just a few days in. The pain was severe enough to prevent good sleep, running, or even much walking, so I am deeply grateful you took the time to detail so much. Thank again and happy running!
    Tyler
    AZ

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  4. I'm glad to hear that my post is aiding in your recovery Tyler! It sucks to get injured, and I know how frustrating recovery can be. I hope you get back on your feet soon. Thanks for reading.

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  6. Nice post! I've been suffering from an extensor tendonitis since April 1st... I tried pretty much everything with no results... however the massage+ice seems to help!
    I relate all my misadventures in my blog
    http://dickheadmarathon.blogspot.com/
    Take care!

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  7. I was reading that heat isn't always good for inflammation. Did you start heat after the inflammation was gone or right away after the injury? Thanks!

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    1. You're right about heat aggravating inflammation; however, I applied heat prior to the friction massage to help loosen the tendon. I followed up the heat and friction massage by applying ice to reduce my body's inflammation response to what I had just done. The key is to do the routine in that particular order.

      In response to your question, I would apply ice, and skip the heat and massage, if there is noticeable swelling. Once there doesn't seem to be any swelling I would start the routine of heat, massage, and ice. Ultimately you'll have to experiment with what works best for you though. I'm just a runner, and this is what helped me recover.

      Good luck in your recovery!

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  8. THANK YOU THANK YOU THANK YOU! i thought no one understood how frustrating this injury was and i was SICK of hearing people tell me it was a stress fracture!

    anyone else here bike through this injury? thoughts??

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    1. You're quite welcome Anonymous! I biked, ran in the pool, swam, hiked, and eventually got back to running during my recovery. It's just a matter of listening to your body to determine what is aggravating your injury, and what is promoting healing. I started with swimming, then biking, then running in the pool, then hiking, and eventually light (very light!) running. I'm completely opposed to doing absolutely nothing during recovery, but you need to be honest with yourself when something hurts.

      If you think you might have a stress fracture a simple x-ray or MRI can rule that out. If you have a stress fracture, then immobilization is the route for recovery, and not anything I mentioned in my blog post. That will likely just make it worse.

      Initially I was opposed to seeing a doctor, but after talking with a sports podiatrist and getting an x-ray I was very happy I did. I expected a doctor to just tell me to sit on the couch with my foot elevated for 6 weeks or something like that, regardless of what was wrong, but that wasn't the case at all. After insuring that I didn't have a stress fracture, he told me to do any physical activity that didn't aggravate the injury; biking, swimming, walking, basically anything low-impact.

      Good luck with your recovery Anonymous!

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  9. I'm in a bit of a pickle...I started training for a team relay about 2 months ago (I was in good shape but hadn't been running at all) and really ramped up my runs a couple weeks back (8+ miles with 1000+ ascend and descend) and have started feeling some soreness on the top of my foot. Luckily it doesn't hurt when I run, but kills afterward and when I first get up in the morning. I have started icing and stretching and it has helped some but I don't want to leave my team a man down for the relay in 2 weeks (because my training was going so well, I ended up with some of the harder legs).

    Thinking I'll just continue icing and stretching for the next couple weeks while substituting some biking instead of running to keep my impact lower, and then do some good recovery after that.

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