Sunday, October 7, 2012

Running High Mileage with Plantar Fasciitis

It makes me so sad.  When I first started running I jumped up in the mileage pretty quickly.  What resulted, other than stronger legs, was a case of Plantar Fasciitis.  I struggled with it for months before going to a foot doctor.  He diagnosed me with PF and sent me to Granite State Physical Therapy.  This is when I met Brian Verville, the owner, for the first time.

Over the course of several weeks (maybe 6?) Brian got me back up and running using the techniques that I will describe in this post.  During this same time I also realized that my shoe choice might be another factor and began experimenting with more minimal, less cushioned and more flexible shoes.

The net result is that it went away.  I wasn't sure how much was due to the PT and how much the shoe change, but all that mattered was that it was gone.

Now years after that first bout, and in the other foot, the ugly PF monster reared it's ugly head again. It started late last year.  At first it was very subtle, so I just did some simple deep tissue massage and hoped to keep it at bay.  It stayed at a very manageable level for the next few months.  But as I ramped up my training I decided to run hills every day for 2 months.  That seemed to really make things worse.  After a few trips to Brett Coapland at Performance Health I realized that my PF wasn't responding as well to his methods.  This was a big bummer. I really like Brett.  He was instrumental to keeping me well during my attempt at running 6 100 milers last year and has become a true friend of mine. He cured my tendonitis with A.R.T and dry needling. He even crewed for me at the Vermont 100 this year.

So, feeling like a cheating spouse, I called Brian. He immediately started me on the same treatment regiment that worked well for me years ago.  Since I have been asked by so many people how I've been able to continue to train through it I thought it might be helpful to explain what he has been doing.

I feel that the single most helpful part is the Iontophoresis. Wikipedia defines it as "a technique using a small electric charge to deliver a medicine or other chemical through the skin.  It is basically an injection without the needle.  Brian puts an anti-inflammatory drug on a sticky pad, puts it on the area of the heel where the pain is, adds another pad to my leg to use as a ground, then hooks it up to a device that adds electricity to draw it into the area.  It feels a little uncomfortable, mostly on the ground area, and takes about 15 minutes.

Pad with medicine.
Grounding pad

Pad, applied to heel
Grounding pad applied to leg
Putting the electricity to everything
Area of irritation after it's over

After Brian is done zapping me, we then often move on to a laser treatment.  This thing scares me.  We have to put on goggles and Brian keeps the laser moving back and forth over my heel.  If he stays on an area to long it gets super, super hot.  And it happens quick!  This thing would give you some really nasty burns if it wasn't done correctly.  Fortunately for me, Brian is excellent at using this piece of equipment.  He told me that it provides deep heating to the facia.  It really feels better afterwards.

Frikin Lazer....
The laser wand.
The next thing that he does is a deep tissue massage.  This hurts the most out of all the treatments, and it also seems to provide the most relief.  When it hurts at home, this is what I try to do on my own.  Brian has a techical term for the type of manipulation he uses, but I forgot what he called it.  I'll add some more info to this post once I get it from him.

First he applies some message lube.

Then he beats the shit out of my foot.  Often he pushes my toes back to increase the tension on the facia and then goes side to side, like playing a guitar.  It hurts!!
Occasionally he ends the session by taping my foot to give me some additional arch support.  I have to leave the tape on for several hours.  It feels great when he does this.  It relives a lot of pressure that always seems present in my heel.

Arch taped and session done.

I've been going to see Brain twice a week for the last 3 months.  This has allowed me to keep the PF at bay and keep running. During the last 5 weeks I have been able to run 70, 89, 81,100 and 86 miles per week. Now I start to taper down for the Oct. 27 running of the Ghost Train Rail Trail Ultra where I hope to run for 30 hours in my quest to see how much further than 100 miles I can go in a race.

New pair of Hoka Bondi Speeds

Brians treatment has been a huge factor in being able to put up such high mileage weeks.  The other factor that I'm convinced has been equally as important are my Hoka One One Shoes.  I am way overdue in writing a shoe review of the Hoka Bondi Speeds, but since getting a pair in July I have run almost all my mileage in them.  For some reason I can run for mile after mile, road or trail, in these shoes without my PF hurting.  I find myself coming in from a run and telling Amy that "I just love these shoes".  I even bought her a pair!  After breaking her tailbone, running has frequently caused her pain to flair up.  So far, every run in the Hokas has been pain free for her.
The best testimonial I can give these shoes is that after 400 miles I just bought a new pair.  The old pair still has lots of miles left in them, I just want to make sure I have a fresh pair for my next race.  For 36 of my last 50 runs I have chose to put Hokas on my feet.  I have never received any shoes or even a discount from Hoka, but I continue to buy them at full price ($170!!).  I get quite a few pairs of free shoes to test and blog about, but I will continue to put up my money to make sure I have these in my arsenal of tools.  I honestly don't know if I would be able to train as hard as I am right now without them. In my mind that makes them worth every penny, and then some!


Anonymous said...

Hi Nate,

You are one hardcore dude..

Running all that mileage through PF, I cannot imagine.
I have seen about 5-7 different therapists, none of them knows how to treat PF properly and you can hardly find anyone adopted the minimal regim.

I understand its getting u through the miles, but is it actually getting better ? With all that mileage ?

My symptoms are very small compared to yours, and am now coming back to barefoot running and minimal to strengthen my feet slowly, running 15mins every other day. I compensate by spending way too much hrs on my mountain bike, who are doing a comeback these days because of that.. The passion tough, remains for running & I cannot wait to get back on trails and put an ultra on early 2013 running board,


Miriam @ Sometimes Sporty said...

The most frustrating thing about PF, seems to be that different methods work differently for different people. I did the Iontophoresis, massage, taping method when my plantar first started getting bad. It made it worst. I did the specialized inserts, I could barely walk anymore when one of the inserts ended up breaking.

The only thing that seemed to work for me, was to go almost fully into barefoot running (mind you I think my PF was mostly related to my foot muscles being so weak from being naturally flat footed). Of course I never tried Hokas.

Now I mostly maintain my occasional rebouts of PF by doing some minimalist shoe training (usually low mileage), yoga (especially standing poses), keeping weight down, and avoiding shoes that make it act up. I don't think it will ever completely go away for me. But I pretty much avoid all doctors and physical therapists for chronic injuries now. I had such a bad experience with 3 years of being jerked around and spending too much time and money on PT only to make my PF worst.

I'm glad what you are doing is working for you!

Anonymous said...

Hello Biker Nate,

I too suffered from PF on both feet for more than two years after taking up running again after almost 10 years of non-activity. I was a heel striker and I paid for it and got PF. I tried all kinds of NSAID'S AND painkillers, massages - but not the complicated and probably expensive treatment you featured here. I got constant back pain, headaches and other bothersome effects of not being able to walk properly. I also did the stretches. It worked for a couple of days only. The pain returned again and I was back to square one. I tried putting thick inserts and insoles for cushion...but still the pain lingered. One day I read about a yoga exercise that aimed at strengthening the ankles and the feet. It was called the one-legged yoga stand. I was very much surprised to feel that it was very effective in stretching both my feet, especially the affected part, although at first it hurt like hell. I did the pose three times a day for two weeks. I don't know what happened during all the days I did it but the pain dramatically subsided until on the third week it was almost gone. From then on it was all downhill as I continued doing the exercise. Today, I can say that it's never ever coming back no matter how hard or far I run on concrete or asphalt roads - so long as I continue doing the pose.

By the way, I use the Skechers resistance trainer for road running, and Fila for treadmill and track.

I know from your blog that you are very experienced runner and that it brings you much joy and fulfillment doing it, so I wish you the best in your running and pain management and I hope you get well permanently so you can continue doing what you love most.

More power to you.


Plantar Fasciitis Annapolis said...

It seems so painful, just thinking about the pain..!