Injuries Suck

achillesI am injured.

I was just worn out, beaten up, planned on taking a few days to recover and snap out of the rut. Now, I’m not sure. I went for an easy run with Natalie Saturday in LA. Very chill and slow, about 7 miles along the canal path down to the beach. I have run seven miles easy tons of times in the last few months without problem. But not this time. The last few miles my left big toe started to hurt the same way it did back in March. Again, at first, it just felt like my shoe was sort of rubbing, then pinching, then it hurt sharply. It was sore the rest of the day, but fine. I wasn’t too worried because my toe hasn’t bothered me in months. My heel had been bruised since Santa Cruz and the arch of my foot has been sore from the orthodics that are supposed to take the pressure off my toe and stop it from hurting — which is why I didn’t wear them on Saturday, because I was more worried about my heel and arch than my toe. But, my toe hasn’t hurt. Until now.

Still, I wasn’t worried.

Yesterday, I tried to go on my long run and two miles in my toe started to hurt. I kept running for a bit trying to decide if it was really hurting and then trying to decide if I should stop. Eventually, I turned around and I had to walk almost two miles back because it was hurting so much at that point.

It’s not exactly the same as the bone spur that put me out of commission for three months earlier this year. The pain isn’t at the base of the big toe, where the two bones are rubbing together and causing a bone spur. It’s in the tendon that runs along the top of the big toe, all super painful and inflamed. And, it hurts on push-off, not impact. So, it’s a little different, but same general idea.

Since I’m not really sure what caused it, but I am pretty sure the doctors aren’t going to have more of a clue this time around, there’s really not much to do right now besides rest, ice and anti-inflammatories. If I’m lucky, I can take this week off from running and use all the crazy anti-inflammatories I have left from before and it’ll be fine. But, I’m not super optimistic. If it doesn’t clear up, I’ll have to go back to the doctor and they’ll probably say something like, ‘Have you tried not running?’

It’s all very discouraging and I’m not excited about water running. Maybe I’ll be more optimistic tomorrow.

Cortisone Shots: Why I Got One

(Edit Note: OK, so what I wrote yesterday about why women who qualify should get their elite license clearly hit a nerve because it got six or seven times the usual readership and people were quite worked up elsewhere on the internets. To be clear: I am not calling out anyone specifically. Like I said, there are plenty of individual reasons not to upgrade, but on the aggregate when far fewer women make that choice there’s a problem. At some other point I will perhaps expand on why, if triathlon was really done the way I want, we should have amateur, elite amateur, and professional categories. But since triathlon’s not run the way I want,  we gotta do the best with what we got.)

UPDATE: I wrote this post about how the cortisone shot worked out for me at Boston and after.

This morning, all other things aside, I got a cortisone shot in my foot. It looked just like this:

It won't hurt at all.
It won’t hurt at all.

Actually, I didn’t even notice the needle that much because the doctor had sprayed stuff to freeze my foot and numb it.

There are lots of reasons not to get cortisone shots. And, at first, it seemed that my toe joint was getting better with regular anti-inflammatories and ice, so I wasn’t worried and wasn’t going to get the shot. But, after running on it last week, it simply stopped getting better. It seemed that I had badly inflamed one spot and it just kept hurting. The doctor thought a cortisone shot would bring the inflammation down enough to make the pain go away. Since I’m planning on running Boston either way, it would be better if it didn’t hurt when I did that.

But, if you start reading about cortisone shots, there are lots of problems. They don’t solve the initial cause of the pain, so often that problem comes back. And, that will likely be the case for me. It seems that I also have a small bone spur at the base of my toe that rubs when it bends or pushes off, so that’s causing the inflammation and I may eventually have to get it filed down or whatever it is you do with a bone spur.

Lots of times people get cortisone shots for things that aren’t really things cortisone shots will fix. Cortisone is just a steroidal anti-inflammatory, so no, it’s not going to fix a tear or muscle problem.

There can also be side effects, like increased stiffness or pain or possible infection at the injection point. And, the doctor did tell me that I would likely have more pain and swelling for a couple days. That also means that often you can’t do activity or are supposed to let it rest for a couple days, which is typically counter-productive to why you got the shot in the first place.

The biggest side effect, though, is that by masking the pain people are able to ignore the cues their body is giving them and can do worse damage. I was assured this was not the case for my problem, since I was getting the shot in a toe joint and not in a tendon or ligament — which really doesn’t sound like a good idea. You can also only get so many cortisone shots, because it can damage the ability of the cartilage to grow.

So, all that makes it sound like not a great idea. Yet, I got the shot.

Largely, many of the issues and problems sounded like they weren’t going to be problems for my specific injury. I can’t do long-term damage; it’s just going to hurt like a mother. And, because the main source of my pain is the inflammation, the shot may bring that down enough to help fix the overall issue.

But, mostly, I got the shot because it’s sort of a last resort. I’m going to line-up at the start of the race on Monday pretty much no matter what at this point. The main hindrance to finishing well is going to be how much it hurts. If we can get it not to hurt enough, then I can race, rest for a good amount of time after (since I don’t have anything else on my schedule), and possibly fix the underlying bone spur problem.

At least that’s the plan. Plan B was: hope. That’s still our back-up solution right now.

Have you ever got a cortisone shot? Tell me it worked out great.

Things I Have Tried to Get My Foot to Stop Hurting

My foot was getting consistently better every week and I wasn’t too worried that it would be ok in time for Boston. I was mostly worried about fitness. But, since Monday, it’s been sore and not getting better. I don’t know why. I’m frustrated and mystified, obviously, but with nine days until the race, I mostly just want it to stop hurting in time.

Here are things I’ve tried now:

  • Resting
  • No running (Alter-G and water running)
  • Icing
  • Anti-inflammatory cream
  • Anti-inflammatory pills
  • Super intense anti-inflammatory Flector patches (I really thought these were going to make a big difference but they haven’t so far, so I’m starting to doubt that the problem is inflammation)
  • Hot lasers

I’m sure there are plenty of things left to try? Just to get it to stop hurting enough for a little over three hours of running.

Fixing Injuries with the Flector Patch

Monday, after the race, I was very down, slow, and exhausted. It’s easy to recognize that logically I was just tired and didn’t eat well during that day — all of which was toying with my emotions. But, that didn’t change the fact that I didn’t want to get off the couch. Floyd the Cat has been sad too because he doesn’t have any friends, so we didn’t do any work and just laid around.

Workouts have been sluggish all week and pretty much just chances for me to be a bitch to people. In my Masters lane? Chances are I yelled at you. Trying to pass me on the mountain bike trail? Want to make a clever comment while I’m doing drills after my run? Yeah, you don’t want to do that.

The only good thing had been that it seems like my ankle/foot pain (which was always sort of mysterious in the first place) is clearing up.

After my foot got irritated and pain was shooting up from the inside of my arch along the inside of ankle, I went to A.R.T. last week. It seemed like A.R.T. got a lot of the gunky shit out of my foot and heel, but it was still really sore all week. The whole area was just inflamed and tender to the touch. What do you do then? I was torn. The inflammation was pinching things and needed to heal, but I didn’t know what that meant I should do.

I did all the usual stuff — ice, stretch, roll, easy workouts — but what finally seemed to really help was: The Flector Patch.

What is the Flector Patch?

When Steve was hurt before — some kind of Achilles injury, his doctor gave him some topical anti-inflammatory cream and a couple of sample anti-inflammatory patches. There were two of the anti-inflammatory Flector Patches left, so I stuck one on overnight Friday and the other all afternoon/evening on Saturday. And, then, I was able to race without a problem.

Just slap the Flector Patch on there.
Just slap the Flector Patch on there.

The idea is that it’s a topical anti-inflammatory or nonsteroidal anti-inflammatory drug (NSAID), made of diclofenac epolamine, that you stick right on the site of the pain. The medication is absorbed for up to 12 hours and bam, pain gone. It’s also, as I understand, like $75 a patch if your doctor doesn’t just give you samples.

I joked with Coach Mario that it was some strong shit and I wasn’t even sure it would necessarily pass a drug test. And, it was a joke, but hell, I’m not sure. It’s a mainstream nonsteroidal medication proscribed by a doctor, so it has to be ok, right?

I couldn’t tell at first if it worked and I’m still not totally sure. It made the area go numb and certainly didn’t hurt while it was on, then once I took it off my whole foot would feel tingly and weird. But, after the race, it barely hurt at all. Now, it seems like it’s getting better, less sore. Whatever the medication did it gave my foot and ankle a chance to recover and a break from the inflammation and pinching of tendons/nerves that was a whole mess.

I’m inclined to think it works. Steve had similar results when he used it on his Achilles last year. So, it seems like a silver bullet, even if the Flector Patch website includes this quote:

As with other NSAIDs, the way FLECTOR Patch works to relieve pain is not fully understood.

Have you ever heard of the Flector Patch? Or tried topical anti-inflammatories? Do they work for you?