Running Again...

...but perhaps I am not out of the woods yet.  It's a real challenge when you don't feel 100% coming back from an injury.  I recall in 2012, when I dealt with an Achilles injury for about 8 to 10 months, I kept expecting to feel perfect and fully healed at some point.  I thought that only then could I return to running.  But not all injuries work like that.  I slowly came to the realization that I wasn't going to feel great, that there would be some sort of management of my pain and weakness as I came back.

To visualize the process, you can imagine a ceiling on what the Achilles could tolerate at any given moment.  The ceiling was quite low after injury, and I was trying to raise it.  Doing nothing wouldn't raise the ceiling.  But if I slowly pushed to near its limits, it would adapt and slowly rise over time.  Overstep that invisible line, and you may find yourself back at square one.  But some use of the tissue, some level of stress, was required in order to get better.  I began running very slowly in October 2012 and didn't know I was fully back until I successfully competed at the 2013 Napa Valley Marathon in March.  There were certainly times early in that comeback where I was convinced I was still injured.

And so I find myself in a similar situation now.  I've been dealing with a flexor tenosynovitis issue in my second toe since last summer.  Off from running since the new year, I've chronicled the treatment process previously.  Most recently, my doctor (Dr. Joel Kary) at St. Vincent Sports Performance drained some fluid from my toe and we did some platelet-rich plasma (PRP) therapy.  I'm now a month out from the process.  

I began running easy last week (Strava log here) and it's been a bit of a mixed bag.  I haven't really experienced any pain yet, but there has been some definite swelling in the toe.  I went back to Dr. Kary on Monday and we talked through options and what's going on.  Basically, while the tendon seems OK (via ultrasound and other manual tests), the cyst-like fluid in my tendon sheath has returned.  This is a byproduct of inflammation, and it's unclear exactly why it has come back.  It's possible that it happened as a result of the PRP, which is a pro-inflammatory process, but it concerns me that it seems to swell a bit more from running (even if there is no pain at the moment).

For now, we're going to leave it be as I slowly ramp up training.  Wait and see.  His next thoughts on options would be to drain it again and possibly inject an anti-inflammatory.  The latter possibility would not be an injection into the tendon itself (which many say is harmful and very risky), but rather, an injection to where the cyst is; in the tendon sheath (I think), but not in the tendon.  The bottom line is that the cyst isn't a problem necessarily, but only a problem if there's more going on and/or if it causes pain or a changed gait.

So right now I just don't know.  If we do drain the fluid again and/or try the anti-inflammatory, what is the course of action if the swelling and fluid comes back again?  More time off?  I gave it quite a while—over four months of no running—but perhaps it needs more.  It's hard to imagine I wouldn't recover from this eventually with enough time off, though it's hard to say how long that is.  It is of course extraordinarily frustrating to have such an indefinite timeline, since I'm currently pursuing running full time.  You start to question the viability of that if you are looking at 6, 9, 12 months off, etc.  Not that I necessarily will have to be out that long.  But sometimes I do worry that that's where this is headed.

Like in 2012, the picture isn't clear yet.  Maybe I'm on the road to a total recovery and it's just hard to know for the first few months as I slowly build.  Or maybe I'm still injured and will be back on the sidelines in the next few months.  It really is hard to say.  Of course I'm hoping for the former!  We shall see, and I'll be sure to keep the blog updated with any relevant news.

This is me wearing my friend Tracy's sweater (no real relevance to the above post).