Sunday, November 23, 2014

Posterior Tibial Tendon Dysfunction-Shades of Grey

Before I write about my Dizzy experience I want to take a moment to look at my foot/leg "injury".  I put that word (injury) in quotes because I'm not entirely convinced it was a real injury.

There is sometimes a fine line between discomfort and injury.  Discomfort can certainly lead to injury. You will most certainly have discomfort with an injury.  But there is a point at which discomfort turns into actual pain and that is usually when injury is either imminent or has already happened.  Because I'm very much like the Princess in the children's story, for me that fine line is like a vast mountain range.  When something hurts, I generally perceive it as isn't black and white, it's's always grey.

However, in the last four years I have been attempting to learn the difference and embrace inevitable discomfort that comes with endurance sport.  When you cover a large number of miles (large is a relative term...) there WILL be discomfort.  Being able to determine if a sensation is actually pain is difficult if you don't have experience with discomfort in the first place...until you've crossed the line and end up with a diagnosis that confirms actual injury.
Side story...the first athlete I started coaching learned about this dividing line the hard way.  She was feeling something in her leg quite a bit, but she defined that sensation as discomfort (and didn't tell me about it), until the day she realized she couldn't walk properly.  She had more than one stress fracture!! 
The athlete in my side story is much tougher than I am.  See, I don't like to be uncomfortable.  I know some of you are laughing.  How can anyone who doesn't like to be uncomfortable participate in long course triathlon?  How could anyone who doesn't like to be uncomfortable go out in sub-freezing cold and jump in a lake to start a race with 140.6 miles to cover before the finish line?  How can anyone who doesn't like to be uncomfortable run a marathon?  That's why I redefine what is comfortable.

So when I woke up that Saturday morning with undeniable pain in my leg I knew not to run that day. When that pain dissipated it became less clear what to do.  I went to the doctor in the hopes he would tell me the feeling I was having was simple discomfort.

He didn't tell met that.  He said there was a chance it was a stress fracture because when he pressed on the bone in one specific spot it was very tender.  (It wasn't shin splints because the pain wasn't anywhere else except that one spot.)  However, I was most tender on the tendon that runs right beside the bone.  That could have meant it was a fracture right under/beside that spot, or it could have meant the tendon was "irritated" (inflamed or possibly torn).  

He STRONGLY encouraged me to not run the 50K that was to happen just four days later but he didn't have an actual diagnosis for me.  There was about a 70% chance an MRI might give an answer, but there was a 30% chance it would either give a false negative or be completely inconclusive.

I left his office and cried.  I felt like I was right back to where I had been two years ago with my shoulder.  The first doctor I saw for that issue told me I had tendonitis in my bicep tendon and I needed to completely rest it.  I did rest it but, because of a weakness in certain muscles and some bone spurs, even every day movement caused it to be irritated. This new tendon issue (if that is what it was) was likely pretty much the same thing in a different place.  You can't walk without using that tendon.

But I wasn't convinced it was a significant issue.  First of all it had stopped really hurting.  Second of all, it didn't hurt when I walked around.  And third it didn't hurt when he had me put a load on that tendon by pressing my foot into his hand in different ways.  Those same kinds of tests with my shoulder HURT in unmistakable ways.

As convinced as I was it wasn't a significant issue, I was convinced it was on the dangerous side of the "injury continuum".  (If I were better at graphics I would draw a really cool picture to insert here to illustrate this idea, but alas, I'm not!) If no discomfort is "white" and full on injury is "black"...this was more dark grey than light grey.  I knew this because I had been having some issues with the underside of my foot and my calf off and on for a while.  I had attributed it to the discomfort that comes with an increase in mileage.  It was usually gone within around 24 hours so it seemed reasonable.  It made sense that these three issues were all related, quite possibly to the tendon in question.

But, in my mind, I had two distinct options.  I could decide to take the safe path and stay off of it for a while until there was no discomfort at all at any time.  This would assure me, as much as possible, I would go back into the "white" area on the continuum.  Or,  I could test it out to determine how grey the situation really was.  I decided I would not live in fear.  It was silly to me to stay off of my foot in anticipation of it being a full blown injury. I wouldn't really know until I tested it out.  Usually a test would be a short run (or something even less "offensive") but if it was a ("light grey") tendon issue I wanted to give it as much time as possible to resolve before the race.  So I elected to stay off of it as much as possible until the morning of the 50K, and let each mile of that race be the test.  I committed to myself (and my entire support system) that I would not start the race if it hurt that morning, and I would stop if it started hurting.

The hard part was going to be making the delineation between hurt and discomfort.  Doesn't it all go "grey" in a 50K?  I was about to find out. be continued...

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