Sunday, 22 April 2018

London 2018 Part 2 - ....and the rest of 2017

Through a lot of the training build up to the 2017 London marathon I'd been increasingly aware of something not quite right with my left ankle. I had no issues when running, but after I'd been sitting down for a while, when i got up my left achilles would be very tight and painful to walk on for a few yards before freeing up anf feeling normal to walk on again. I realised I was developing a painful region on the tendon which eventually became a noticable lump. As I could still run with relatively little discomfort I continued training. I found that by introducing eccentric/concentric heel drop and raise exercises after each run it helped to reduce the stiffness/discomfort which I was experienceing after rest. My train of thought was that if I could get manage it ok through to the marathon then a decent rest and training reduction after that would hopefully sort it out. The cuouple of months or so post London involved travel for work (to Mexico City!), 2 trips to Cornwall and a week in Scotland, so my running was fairly on/off and whenever I could fit it in. Running in Mexico City was fun, althought the altitute made it hard work and the UK holiday trips gave oppotunities to run in some beautiful places, including the South West Coast Footpath and the West Highlands. the downside to this was the inherent lumpiness of the trails I was running on, which my achilles did not like!
Beautiful Running Scenery in the West Highlands of Scotland

By June I was pretty unfit (due to sporadic running), heavy (post marathon food bingeing) and had an achilles which still did not feel in good shape! I'd knocked the running volume back and was enjoying getting out on my bike, in the pool and open water swimming at Ellingham Lake (6am Wednesdays!), but the heel drop/raise exercises I was doing weren't really getting on top of the achilles issue. So I got an appointment to see Rob Edmondson at Therapeutics Physiotherapy in Eastleigh. 


I've seen Rob on and off for a number of years and he's be great at getting my running related issues sorted. He diagnosed a chronic tendinopothy and we looked at how to manage loading the tendon. Left along the tendon was unlikely to heal well as it doesn't have it's own blood supply, so we needed to figure out how to load the Achilles enough to promote a healing process but not overload it and do further damage. Contrary to rational thinking my achilles was actually happier running at at faster paces! The thinking goes along the lines of the faster speed means the foot is in contact with the ground for a short period of time per stride and so the overall 'loading' time on the tendon is less. So I ended up doing interval sessions with walking recoveries. The basic rule of the injury rehab was to do active loading on the tendon a minimum of 24 hours apart, to allow the breakdown/repair cycle to take place. The active loading activities consisted of 'loaded' heel drop/raise sets (3x8-10) with increasing weight in a rucksack and fast pace running workouts with interval lengths depending on how the tendon reacted. I filled in for the reduced run volume with swim and bike work (which was very nice riding in the New Forest through the summer). This continued for a couple of months, but my achilles didn't really show much sign of resolving, with a sore lump still present on the tendon. I stopped running completely from mid Auust to September and still things didn't seem to get better.


So in September I took the decision to get a consultant appointment to get the injury reviewed. This coincided with starting a new job after 12 years with my previous company, so there was a fair amount of upheaval with work travel and getting into a new working week routine. The consultant (Dr Mark Wotherspoon, also team doctor for England Cricket) got the tendon ultrasound scanned which confirmed Rob the physio's diagnosis of a chronic mid-portion achilles tendinopothy. The scan images looked a right mess of clearly not nice and straight collegen fibres­čśč. The recommendation was to get back and continue working with Rob to progressive try and get the tendon to heal through controlled loading, but it might take months even years to get back to normal, not great news. We considered Shockwave therapy, but Dr. Wotherspoon was uncertain whether it would help given the chronic and not acute nature of the injury (Shockwave is more for pain elleviation).


Back at Therapeutics with Rob an updated action plan was devised based on the Consultation feedback. I could run, but needed to determine how much the tendon could tolerate. So we started with a simple 'Couch to 5k' run/walk apporach, starting with 6x(4'30" Walk/30" Run), increasing the run segments by 30" & reducing the walks by 30" every other day. Then loaded heel drop/raises on the other days and as much road bikes as I could fit in commuting etc...


This seemed to do trick after a couple of weeks the tendon discomfort (to touch) was greatly reduced, but still with a pronounced bump. It was good enough that I could switch to short fast runs again and I ran East Coast parkrun in Singapore, while away for work in October, with no problems or reaction from the tendon. I did a couple more 5x1M speed sessions (walk recoveries) while in Singapore, supplementing with hotel gym cross-trainer time. 




parkrun - Singapore Style - 8am, 29DegC & 95% Humidity!

Through October and November I stuck to keeping the runs well spaced and mostly done at speed with walking warm-ups/cool-downs and recoveries between intervals. The weekly mileage hovered around the 20 mile mark. I was getting very regimented with my heel drops/raises, doing unloaded sets after every run and every day before bed. I also experiented with some different shoes (thanks to Scott @ Alton Sports in Eastleigh for sharing a few of his pairs with me to try out, luckily we're the same foot size!) and found I got on very well with the Adidas Supernova. Up to then I had routinely run in lightweight shoes, with the Adidas Boston Boost and New Balance 1400 being the favourites. The Supernovas, especially when worn with Superfeet insoles for extra heel support, really felt like they helped my injury, probably by not making it worse! I've continued to use the Supernovas (with insoles) into 2018 spring marathon training and do think that they have contributed my general lack of injuries since January 


Coming to the end of 2017 by early December the lump on my tendon was noticably reduced in profile and any tenderness had largely gone. The Christchurch Christmas Pudding 10k was my first proper race (barring parkruns) since London the previous April and I was very happy to run just over 37mins in iffy wet and windy conditions, felt strong too. I suspect the focus on fast running intervals had actually given me reasonable 10k fitness! So as Christmas approached a final Physio check-up gave the all clear to start, cautiously, increasing weekly mileage into spring marathon training....


2 comments:

  1. um.. you mean 'Coming to the end of 2017', don't you? Unless you;ve been eating the time-travel jellybabies again... :-)

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  2. Well spotted, now corrected, what happens when you try writing blog posts at midnight when you can't sleep from all the caffeine consumed in a marathon that day!

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