Carrying On

Another update on the Achilles injury.  Last post I mentioned that I would be seeing a new doctor that my chiropractor recommended, Dr. Terry Nicola at UIC.  I first saw him in late June.  He thought that the Achilles tissue was essentially better (this being consistent with the most recent look that Dr. Settergren took via ultrasound).  Nicola thought that the peritenon—the sheath surrounding the tendon, which usually helps it move more smoothly—may be stuck in an inflammatory process, and thus hindering things and causing pain.  He put me on a topical NSAID patch to calm things down with the peritenon, and I did about a week with no running, but a lot of uphill walking on the treadmill.  I would do around 45:00 at 15% grade and 4(+) mph.

I saw Dr. Nicola again last Tuesday (a week ago), and he thinks that the NSAID patches seem to have helped with the peritenon.  However, I'm still using them for the time being (you wear them 24/7, putting a new one on every 12 hours).  He's started me on a program of walk/run alternations, with the goal of progressing to 10 miles by next week.  With an odd day or two off in the last week, I've built from 5 to 8 miles, and I'm now running 3 minute segments to 2 minutes walking (I started at 2/2).  I've also continued to ice, stretch, do eccentric calves, etc.  I'm still biking a fair bit and doing some uphill walking, as well as general strength work, so I'm staying fairly fit.  

The heel seems to be responding fairly well to this.  It's a bit tight at the beginning of runs—just the first running segment or two—but then it feels about 99% good after that.  It also hasn't been very tender post-run, which is a good sign.  It feels great to be back out running, even if it's interrupted with walking.  I run at a decent pace, maybe 5:45-6:00 pace.  Assuming things feel OK, my plan for the next 7 days is:
7/11 - 9 miles (3 minute run, 2 minute walk)
7/12 - 10 miles (3 min run, 2 min walk)
7/13 - 8 miles (4 min run, 2 min walk)
7/14 - 10 miles (4 min run, 2 min walk)
7/15 - 8 miles (5 min run, 2 min walk)
7/16 - 10 miles (5 min run, 2 min walk)
7/17 - 10 miles (5 min run, 1 min walk)

I see Dr. Nicola on the 17th, so we'll see what he has to say at that point.  He was fairly encouraged after our last visit and thinks I'll be in the clear soon.  After such a long time dealing with this crap, I'm a bit less optimistic.  Hopeful, but more of the attitude: I'll believe it when I'm cranking out 100+ miles a week again.




6 comments:

  1. Keep it up, I can't wait to see you back in action!

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  2. Thanks Mark, I appreciate it.

    Further update, I've finally decided to pull out of TransRockies. Justin Ricks (a two-time past champ of the 3-day individual TRR race) was my planned teammate, but he's found someone new in light of my issues. Went ahead and just scratched everything from my 2012 schedule. I'll worry about when/what to race once I'm fully healthy. Tired of getting my hopes up and making plans, only to cancel them.

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  3. What's his rationale for having ou continue to train through the discomfort? There seems to be a lot of disagreement. I almost had AT kicked (I've been dealing with AT for over 16 months) and then started running again and then I was back to square one. Going to do a PRP injection tuesday and then be put in a boot for a month. I'm hoping that along with a SLOW ramp up does the trick.

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  4. Hmm. We didn't talk rationale for training through discomfort too much, but pretty much everything I've read and everything I've heard from physicians is that injuries like mine do not get better with rest. They require stress to get stronger and back to normal. This in turn requires some discomfort. There's certainly a line to be walked—one can push too much—but that's part of the challenge. I think I'm pretty in tune with my body and know when to back off a bit. For instance, I've been doing the run/walk thing for the last two weeks, building up gradually, and I'm at 10 miles of 4 min run /1 min walk now—BUT, I've taken several days off in these couple weeks, erring on the side of caution with the stress I'm placing on the Achilles. But again, I believe that it does need to be stressed in order to get better. I'm no expert, but I believe this is pretty much a consensus.

    I don't know much about the PRP either, but I gather this is to heal damaged tissue. My tissue is nearly all good, so we may not need PRP at all. (That said, there is still a little "rough spot" we saw on the sonogram, which may ultimately require attention, hard to say.) It seemed like an inflamed peritenon was at least part of what was holding me back. I have another appointment tomorrow with Dr. Nicola, and I'll see what he says then. I think I've made some progress, though I'm far from in the clear yet.

    Finally my situation is a bit unique, as it's not a running/overuse injury. It's an injury caused by direct trauma in a cycling accident. Sorry to hear of your issues, this stuff is frustrating to be sure. Best of luck with your therapy.

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  5. Matt -

    Mine wasn't running/overuse either. It was trauma as well. I don't think it really matters - it's damage to the tendon regardless. I know what you mean about balancing working it and resting it. I've never been able to find that perfect balance. I'll let you know how the PRP goes.

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  6. Any updates? I'm doing the rehab after my PRP and it's progressing. Back onto the weighted heel drops. The achilles is somewhat sore but I can walk without any issue. Won't try and run until it's pain free with pinch test. If I can't pass the pinch test in a few weeks I'm going to try some NSAID treatment like you are doing.

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