Thursday, December 11, 2014

Musings about pain...

It started not long after the Avengers Super Heroes Half Marathon. A weird sensation in my foot. Not a stabbing pain, more like a dull ache, made worse by activity. Maybe not even an ache? At night, lying in bed, it felt ... like I imagine a subterranean fire to feel... a slow, hot burn.

I stopped going to boot camp -- it hurt to run or jump on it, and I've never been good at pacing myself. I didn't want to hurt myself more, and knew I needed to rest it.

Two weeks after the race, after feeling like things just weren't right, I went to the doctor.

I love my doctor -- Amy Deans. She's always patient, honest, and pretty conservative. She's not one to order a battery of tests just because.... though she makes a point of telling me what's available, what it might or might not tell me, and what her recommendations are. She'll also tell me when she doesn't know something off the top of her head, or wants backup.

She started out by telling me that she doesn't know a lot about feet. After all, she's an internist. We quickly ruled out broken bone (no really sharp pain, no swelling, no bone poking out of the foot...), which left us with a stress fracture, or tendonitis, or tenosynovitis, or even an inflamed ligament. She said that x-rays wouldn't tell us anything, and we talked about an MRI... but knew that seemed a little excessive.

Especially when, most likely, the recommended treatment would be... REST. Sigh. She also reminded me that, for most people, two weeks of rest isn't really that long. Double sigh.

The key, she told me, was to find a way to walk or stand that didn't hurt. Which sounds a bit silly, but I actually understand. I was offered a few different options to help keep my foot immobilized, from a borrowed boot (thanks Carrie!):

to a "post-operative shoe":

I tried both around the house and actually found them a bit more painful than just wearing shoes all the time, rather than go barefoot. (That said, being snugged up in the boot while I sit down with my foot elevated feels pretty darn nice...)

In the meantime, I have been pretty inactive. No boot camp, no running. This week I walked to work 3 days, but I took it easy.

Still, as I sit here typing, I feel the weird "burn" in the top of my foot. Not pain, just ... smoldering...

It reminded me of an article I read recently on entitled "The Science of Running and Pain". That, even after a body has physically healed itself, the brain may still be protecting the body by signaling pain. Which isn't so much "the pain is all in your head", but that pain is the perception of threat to your body.
In many cases, this is a good thing, as pain helps protect you from damage. If you put your hand on a hot stove, you want the body to feel pain. If you tear a muscle or a tendon, pain is a necessary reminder to stop using the injured limb. The problem in running is when the brain decides to continue saying "ouch" after the tissue has healed. After an injury, the body retains discrete memories associated with specific painful experiences. Sometimes when healing occurs, the body may treat these painful memories as reality even when there is discord between the brain and tissue.
The author goes on to recommend ways to transition to pain-free running by creating new memories ... notably by running intervals. The idea being that you can have good, pain-free experiences and re-train your brain not to prematurely put on the brakes by signaling pain. He recommends running 1- to 5-minute intervals in sets, whereby you can accumulate mileage while not overtaxing yourself, willing "easy victories" along the way.

And, being a nerd, this may be my favorite blurb of the article:
Think of pain as a bug in the operating system, not necessarily a hardware fault. Inputting the right code with easy victories, running drills and soft tissue interventions can help reprogram the subconscious brain to view running with the same enjoyment that our conscious brain brings to the sport.
Clearly I'm in the "did you turn it off and on again" part of the process... and a smart person would probably continue to rest a little, then starting off pretty gently with some short runs.

But whoever said I'm smart ... at least when it comes to running? Saturday we'll be running the Donner and Blitzen 21K as part of the Santa Runs Tacoma race. Yes, I will take it easy -- my only goal is to finish, after all. Well, that and wear my sweet "Ugly Sweater" tech tee:

(Full disclosure: I work for Brooks. The "Ugly Sweater" tee was my idea, and I'm thrilled that we produced it. I get no kickbacks of any kind. I just love love love this shirt!)

I have been super lucky, and I have rarely been injured in other than a few nagging aches and pains. Wish me luck out there on Saturday -- I may be in for a long day!

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