The A.R.T. of Injury

So you’ve finally figured out what it is that has been hindering the comfort and enjoyment of all your recent runs: an overuse injury. Perfect, now all you need to do is go to your local pharmacy and purchase an overuse cure. All set, right?

Ah, if life could be so easy. The problem with overuse injuries is that most of the time the symptoms of the injury are not the cause. You may find you have pain in your calves, an ache in your foot, a pinch in your hip, some or all of the above. And nerve pain makes it all the harder to understand where the source is. Today it’s your calf, warm, numb or tingling and weak, tomorrow it’s the back of your knee, your hip or your foot. If the location of the pain isn't even consistent, how can you determine what is wrong in order to treat it?

This has been my problem for a long time. And I don’t think the traditional sports medicine route was helpful to me. While I agree that RICE and ibuprofen can be helpful, I tend not to want to take large chunks of time off from training without some specific, targeted diagnosis and course of action rather than a more general approach that seems to be the first step in a series of non-active steps that may or may not ever solve my problem(s).

I took some advice from a fellow runner after the KBVCM hobbled me and headed to a local chiropractor who uses A.R.T and Graston procedures to help, among others, athletes return to form. I was pretty skeptical, but also desperate.

Here is how it went down, and some things I learned. My first visit consisted of the typical paperwork (drawing pictures of types of pain on a body outline and answering a long list of questions). But as soon as I sat down in the Dr’s office, I knew things were going to be different. First of all, I was asked what I wanted to achieve from these visits. How could something so essential be so often overlooked? For people who don’t get their daily dose of mind-balancing and spirit nourishing medicine from running, it might be fine to sit on the couch, hopped up and propped up, icing away and clicking through the endless drivel of tv land. More than I want to run, I need to run and it seems this Dr, different from the few orthos and general practitioners I’ve seen, was happy to be complicit. His clear argument was, “how do I know whether what I’m doing is working if you don’t get out there and get the bio-feedback”? (this was of course after he was sure there weren't any signs of serious injury).

Great, so we have a common goal. Now how to go about it? The beauty of A.R.T, at least as it was applied in my case, was that the Dr never focused on one particular site, but rather along a nerve pathway. He felt rather confident that my injury involved some nerve impingement, and with nerve impingement, you cannot always be sure of the source simply from the symptoms. Pain in the calf might be directly related to a compressed nerve in the hip (and so on). Especially when the pain is felt in multiple places along a nerve pathway, it is important to treat the areas along that pathway to ensure you’re getting at the source.

I’m not going to say A.R.T. is entirely comfortable. The basic idea from a layman’s perspective is that your practitioner will move your affected limb in a plane of motion to search for weaknesses and irregularities. When found, pressure points will be applied in key areas as you move your leg dramatically along that plane, sometimes slightly beyond a stretch of comfort. The key is to break up scar tissue, to encourage circulation and to induce increased nerve freedom through nerve flossing (moving the nerve throughout the plane of motion to free it from impingement).

Session 1 was good. I felt improvement right away. Did I go home and run 50 miles…. No. We’re not talking magic here, but we are talking sound science.

During session 2, I was introduced to the Graston technique. Compared to Graston, A.R.T. is cake and ice cream. Graston takes a much more crude approach to breaking up scar tissue. Basically, strategically shaped steel instruments are used to rapidly and repeatedly go over affected areas and break up amassed scar tissue (which may be impacting nerve pathways and generally affecting mobility and comfort). Taking a blunt instrument to an already sensitive area and repeatedly mashing it in a raking motion is certain to induce beads of sweat on ones brow and a certain stiffness in ones spine. But we’re runners, right? The pain is the pathway to the greater good. So after gritting my teeth a bit, soon it was over.

Once again, when I stood up, it was clear SOMETHING had changed. This time, I really did go home and run. Not fast and not far, but progress was made.

My Dr pointed out that often times you may feel better as the day goes on after a session, as more blood and oxygen gets to affect areas as nerve pathways open up. I don’t know if the sensation was related or not, but my calf, which has had areas of tingling and numbness for a while, started twitching a lot after the second session and started to feel much more lively, the numbness having gone away. I would say other muscle areas in the leg started feeling more activated as well and I could really sense that I just plain had been overloading certain muscle groups to compensate for lack of mobility and weakness in other areas in the leg. This is a very clear way to get yourself injured. It’s also another way to mask what the true issue is. If you’re overloading your Achilles, you get Achilles pain. The reason you are overloading your Achilles might be an improperly healed hamstring though, or weakness in your glutes. Even if you fix your Achilles issue, you’re still prone to further injury until you discover what the source of the problem is and work on that. In that sense, these A.R.T. sessions helped me to first gain sensation in muscle groups that were previously feeling numbness, gain sensitivity to areas of discomfort and weakness during the sessions and focus on ensuring the entire leg was working in concert to give me the most efficient running motion possible.

In total, I did about 6 sessions of A.R.T./Graston. There are times even now when I have feelings of nerve issues in my hip and calf. But part of proper treatment is to ensure I’m doing the proper self-treatment as time goes on. I really think this is essential to keeping your legs healthy. After every run, and trust me, more often than not it’s the last thing I want to do, I use the stick to massage my leg muscles, then I use the foam roller to get at my hamstrings and calves. At work I keep a pointed massager so I get can into my hips and lower back. It’s not comfortable and I don’t enjoy it, but I keep it up because it keeps me healthy. Without that maintenance, I feel like I’d be right back on the A.R.T. table in too short of time. Foam rolling and the stick will help your muscles reform in a much more regular pattern after exercise breaks them down. Forming in a regular pattern helps to ensure you don’t get any issues with scar tissue build-up causing problems with nerves and mobility.

I highly recommend A.R.T. therapy. That I was able to keep running while getting treatment not only helped me get more targeted treatment, it kept me sane and helped me get a better understanding of all the connected issues at play, leading me to the source of my injuries rather than simply the symptoms. If you’re looking for a recommendation, definitely contact me and I’ll put you in touch with my Dr, who was great, very helpful and informative and effective. And most importantly, make sure you do your maintenance. Running is obviously the largest part of the workout, but not the only part. Use the foam roller and the stick and anything that works to massage out your legs after a run.

Foot Strike and Injury Rates in Endurance Runners

Of late, I feel like I've been sharing a lot of posts from the The New York Times's Well blog.   If so, its because they do a damn good job of staying on top of the latest scientific studies about running.

The latest study comes to us from Harvard University, where researchers reviewed four years' worth of data recorded by the long distance runners of Harvard's cross country and track teams.  The Times cites the study as finding that:

"About two-thirds of the group wound up hurt seriously enough each year to miss two or more training days. But the heel strikers were much more prone to injury, with a twofold greater risk than the forefoot strikers."

An abstract of the study is here.  It notes that heel strikers were more likely to incur repetitive stress injuries; there was no significant difference with regard to traumatic injuries.  Other factors contributed to repetitive stress injuries as well, including sex, race distance, and average miles per week.

I'd like to try to read the whole thing.  People are already citing it for all sorts of things, such as the proposition that barefoot running is best -- which is kind of funny since no barefoot runners were involved in the study.

injury status report

it's been two weeks now since i made my last mistake of trying to run at any serious pace.  since august 20th, when i had to stop my run because of the pain in my calf, i've run only 3 times.  2 of these times were races, and each of these times started great and ended very badly in terms of healing this calf problem.

still, i think the fact that the BULK of that time was rest has been very good for healing not only my calf, but my legs in general.  i will say that lately, apart from my calf, my legs have been feeling better than ever.  when i was running with a high level of frequency, the down-time would involve a lot of slow, slightly painful slogging around.  the idea of running out to catch a football, for example, or play basketball was a painful one, as my legs really needed to be warmed before they were any good.  these days, with all that rest, i feel energy back in my legs, the spring back in my step.  my feet, which are especially problematic during a heavy running phase, are feeling good enough that i can make it down the stairs in the AM in less than 10 minutes.

the three things i have focused on during the rehab of this injury are compression, massage and minimal exercise.  the compression was a surprise and something i tried just for the sake of it.  as i've said, i don't really know if it does much for me when running (i also haven't tried it enough to know), but i do know it is very helpful when i am not running.  i wear the sleeve at work, walking around home, etc... and at this point i have very minimal pain when walking around.  i believe that compression not only just feels good on the leg, it also stimulates bloodflow, which is key to healing injuries.

the stick is another useful too.  i wrote previously about using a foam roller to perform self massage, but i found that to be a bit cumbersome for daily use.  the stick is a bit easier to use, despite the fact that you will have to put some elbow grease into it if you want to get anything out if it.  i use the stick in any situation where i would want to stretch and also in the mornings and evenings.  i can't say for certain that it is working, but i'm improving and the lumps i can clearly feel when using the stick on my leg seem to be getting a bit smaller.

the most important aspect to this all is minimal exercise though.  if bloodflow is key to healing, doing a bit of exercise is the best way to get the blood flowing.  the problem is finding the balance.  running is too much.  even slow running is too much at this point.  i've started using the elliptical for 30-45 minutes a session and swimming (to keep the cardio going).  and now i've started walking on the treadmill with it at full incline for a period of time.  the most surprising thing is how much of a workout i get!  i had though i could do the elliptical or walk on an incline without breaking a sweat...  no chance.  not only that, but i'm working muscles that are not normally touched in my running workouts...  these are the glutes and the hamstrings just below the glutes.  i think building strength in these areas is a large part of what is helping me get the spring back in my step.

it'll be a couple more weeks before i start running again regularly, but i am starting to get exciting about the prospect that i can do exercises now that will make me a better runner when i am ready to start picking up the miles.  getting injured in the first place was certainly a result of mostly too much too soon, but also a by-product of muscle imbalances and poor form.  if i strengthen the areas that are weaker and balance the imbalances, i'm almost certain it will do wonders to improve my form.

it's very, very hard not to be out there pounding out the runs...  but i'm trying as hard as i can to do the right thing, let the calf fully heal, and to prepare myself for some serious marathon training come november.