24 February 2013

An attempt to run a marathon using SCIENCE: part VII ("Niggles")

Runners don't like to take it easy. After last Sunday's long run was replaced with an epic afternoon of photography - due to some niggling pain in my right foot and a tight left calf/back of knee - I managed to contain myself for one more day, playing it safe on Monday with a swim. Then it was back to running on Tuesday with a 12k. The rest of the week involved a punishing interval session combining 1500m and 200m repetitions (in below-zero temperatures), weird foot stretches, early morning hill runs, physio, an "easy" 5k and finally a 25k long run that resulted in a surprise half-marathon PB.

Fastest 21.2k ever - during a 25k run!
I know, I know, I've only got myself to blame for the niggles. But over the years, running has come to form such an important part of my routine that it's hard to stop for more than a couple of days. Any longer than that and I find myself fidgeting while trying to write and pestering Mr Hayley half to death... poor Mr Hayley. He does suffer so.

Since it's sort of difficult to apply SCIENCE to deal with niggles in general, we have to use common sense to tell when a "niggle" is actually something more serious, when to give ourselves a break and when to consult a professional. This is a point that was made very well in a copy of Runner's World I happened to leaf through in the waiting room at my physio appointment. Niggles can easily turn into injuries and injuries can turn into months of being unable to run. (Ultimately the worst fate a runner can suffer, pretty much besides death.) Ignore niggles at your peril.

My particular niggle turned out to be serious enough to require me to book in for a full assessment next week, but not serious enough for the physio to suggest I stop running. But in the meantime, I have been doing what I've been told... which is this:

Ice. Yow!
Unfortunately, though, sports medicine - like any type of medicine, I suppose - is not always as straightforward as simply diagnosing the problem and treating it, as I'll explain. The snippet of SCIENCE I have to offer this week relates to that foot and a bit of it I didn't even know existed. (Despite being a biologist by training, I have almost no clue about anatomy.)

It turns out there is a chance I may have something called plantar fasciitis - put that into Google and you will get some scary pictures of foot braces. This condition affects the tissue in the base of the foot; the connective tissue (plantar fascia) that joins the toe bones to the heel and forms the foot arch. Among runners, plantar fasciitis is relatively common - 8% of all running injuries! However, it does also affect people who have recently gained a lot of weight, presumably because the foot arch suddenly has to support that extra weight.

Plantar fascia, apparently...
According to a long, incredibly fastidious and very well referenced blog post by John Davis at the RUNHAPI injury clinic in Leesburg, Virginia, there is no evidence that plantar fasciitis is related to inflammation - as the suffix "-itis" would usually suggest. Instead, rather more worryingly, it seems to be caused by degeneration of the tissue itself. Unfortunately, this means that treatments like ice, which should work for inflammation, may not work for plantar fasciitis. Or, at least, they may only be beneficial in the initial stages of injury, before degeneration sets in. So that bottle of ice I've been rolling my foot on? Well, let's see if I have plantar fasciitis or not first. I'm really hoping NOT.

The exact causes and risk factors for plantar fasciitis are hard to pin down. Possible risk factors, including being flat-footed (check, I have flipper feet) and having a job where you have to spend a lot of time on your feet (nope, I barely move all day). As for treatments, it seems there is little to inform treatment in runners specifically, but some evidence for calf stretching being of benefit more generally. You can also do a more specific stretch for the plantar fascia itself, which involves pulling your toes back. So, as I wrote a couple of weeks ago, stretching before and after running is probably of little benefit, but specific injuries may call for stretching at other times. Other options include wearing a really uncomfortable-looking splint at night (oh great), taping to support the arch, shortening and quickening your stride pattern to reduce impact (hmm, difficult), and, um, electric shocks (oh, come on, really?).

As with a few of the topics I've looked at in this series of posts, there's a lack of high quality evidence in this area. It will be interesting to hear what the physio has to say in his full assessment, simply to see whether he really knows his stuff... If you're interested in reading more about plantar fasciitis, and especially if you think you might be suffering from it, I would really recommend Davis's post as it cites proper research in proper journals. I've given a very basic summary here, but his is really the most comprehensive non-academic article on this topic I've seen.

So boo to niggles - and niggles that may turn out to be injuries. Thankfully, I'm not in huge amounts of pain and there seem to be *some* sensible treatment options. And like an alcoholic at an AA meeting, I've taken the first step by admitting I have a problem. Fingers crossed.

No comments: