Well, it’s not really that bad. I’m just taking a sabbatical from running for … a while.
In late August, I started getting some twinges of plantar fasciitis. I was running in Colorado for most of the late summer/early fall, on a flat rail-trail. Because of the altitude, I couldn’t go super fast/hard. And I stopped using my Newton shoes, since I didn’t want to take two pairs on the trips with me.
When I cam back in mid-October, I put on the Newton’s and went out for my last long (2.5 hours) run before Ironman Arizona. After a 20-30 minute warm-up, I was due to do 3 ten minute intervals at my half marathon pace – pretty quick and tough to throw into the middle of a long run like that.
Half way through the second interval, while going downhill pretty hard, I got a really SHARP pain in my heel, which I knew was the plantar fascia insertion point screaming out to STOP. So I did. I walked for a couple of miles, muttering to myself about how “No way was I going to not do Ironman Arizona, even if it meant walking the whole way, or trotting with very short steps, or whatever.”
I was able to shuffle on home the last 2-3 miles at a pace equal to what I would be running in the race. But the next morning, I could not walk without a cane. It was that painful. I clearly couldn’t run for a while, how long I didn’t know, and I only had 5 weeks to go before the race. I needed to somehow balance the requirement to maintain a semblance of fitness with allowing time for the injury to heal.
I decided I would start running again after a week, but only at an easy pace, and on flat ground as much as possible. Doing that, I was able to work up to a 12.5 mile run 3 weeks before the race. I took it easy again the week before the race. What I really should have been doing, of course, was not running at all for a month or two. Each and every time I came down on my right foot when running, it hurt. Thing was, it never got worse while running, and sometimes it would feel a bit better as the run proceeded.
On race day, I noticed hardly any pain at all, and after the race, the pain was gone. When I tried my first run 10 days later, it was my right knee which made me quit after 5 minutes. I got to San Diego, and did some runs along the highway by the beach, and then on the sand itself. All seemed well, so I started running every day, 3-5 miles.
On the 10th day, I ran on the local college track early on a frosty morning. I was feeling the usual twinges in my heel, and went on to work. During the day, the pain got worse and worse. A 3 miles run the next day forced me to walk once again, My PF was clearly saying, “You’re grounded, buddy.”
I don’t know how much of my injury recurrence was due to frequency vs. stupidity. What I probably should have done after the race was just shut down the running for another 6-10 weeks to get full healing.
But I thought, with the improved sensation, why not see what frequency will do as opposed to volume or intensity. My whole 12 year running career (all after age 50) I had run 3-4 days a week, rarely three days in a row, and only sometimes 2 days in a row. I thought this played a part in keeping me injury free. But I read a lot about frequency having value over volume for “senior” runners, and also Daniels’ and Lydiard’s prescription for just running often. So I thought I’d give it a shot.
Maybe the message is: even though the pain of the IM marathon is gone, there may still lingering repair work which needs to be done. Running every 2nd or 3rd day allows that to continue; running every day doesn’t allow enough forward progress on the repairs. I had a high motivation for success in Tempe, and that over-rode any pain I might have felt. But, in hindsight, I clearly needed a lot more healing time that I thought I did on, say, Nov 29th.
Luckily, I have no early season goals; and I have Jan and early Feb planned for 3-4 weeks of skiing, as well as another oral surgery about Jan 20th. Also, I am simultaneously concentrating on re-building my swim stroke and strength after my injury last year, and have been swimming 5-6 times a week for that. So it should be pretty easy to just shut down running entirely until President’s day at the earliest.
The funny thing is, I always thought I hated running. But I’m kind of anxious about giving it up for an extended period. I used to struggle to get out the door for every run. Now, I am struggling with myself to not run. And this even with the evidence that last spring, after not running for three months, I came back to my previous form and speed within 4 months of training.
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Someone called my attention to a recent cardiology study posted online about heart damage in endurance athletes. It seemed a little scary, so I looked it up, and posted a review at Endurance Nation:
The study, from Australia, looked 3 hour marathoners, 5.5 hour HIMers, 8 hours/200 km cyclists, and 10.5 hour IMers, about ten each. The heart size of the IMers and the marathoners were the same, and larger than the other groups.
What they basically found was evidence of heart muscle damage, reduced heart function (right side only), and, in five of the 40 athletes studied, fibrosis of the heart muscle between the two ventricles. Importantly, they studied the heart function 2-3 weeks before, immediately after, and 6-11 days after the race; the test for muscle damage were done before and immediately after, and the test for scarring was only done 2-3 weeks before the races.
Describing muscle damage post race is simply stating the obvious. For those who have ever done one of these races, remember how your thighs felt for a few days to a week afterwards – they hurt, and your legs couldn’t move as well. That’s cause you’ve got muscle damage in your quads. Your body knows how to repair that, and it does. A few weeks later, you can start running again, and your legs eventually will work all right. Same concept with the heart, it seems to me. The heart muscle is very good at repairing the minor damage which occurs during these races. It is not the same as the damage which occurs during a heart attack. Then, the blood flow is disrupted, and the muscle dies. In our case, the blood flow is just fine, which is why repair can occur. The study also demonstrates the obvious, that the damage is greater and the repair takes longer, the longer the race. Age, weekly training volume, or years of endurance sport competition did not seem to affect the repair process.
But apparently, over time, there is a risk of that repair leading to fibrosis, or scarring, which has the potential to lead to deadly arrhythmias
Why is scarring scary? The heart is a muscle with a intrinsic electrical system which causes a coordinated contraction about once a second. The electrical system can be interrupted if there is scarring, and thus rhythm disruption can occur. Cardiologists know about this mostly from people who have heart attacks which damage the muscle, and then a rhythm disturbance can occur. Depending on the specific timing of the disruption, this can be an annoyance or deadly. So these guys found scarring in 20% of the athletes. It was more liklley to be found in those who were longer term athletes (20 vs 8 yrs), with a greater predicted VO2 max. They also had larger hearts, but that goes along the the greater VO2 max. So, knowing what they do about post MI patients, they speculate that these guys might be at greater risk for a deadly arrhythmia.
Remember, all of the scarring was found before the race, via a cardiac MI gadolinium injection (I have no idea what that is). So, theoretically, one could be screened for this, and then evaluated further by a cardiologist if scarring were found.
My takeaway? Rethink the timing of races within 3-4 weeks of each other (maybe including the final race rehearsal before an Ironman?) IM: no closer than 4 weeks; race rehearsal: 3 weeks seems to be cutting it close; marathon and HIM: 2 weeks separation. Also, next year, after this article has come out in print, I’ll get a referral to a cardiologist and see if I can finagle a cardiac MI.
Still and all, I’m much more worried about prostate cancer and freeway crashes than I am about a deadly arrhythmia from too much exercise and racing. In the past 10-15 years, there have been 1000’s of elite IM athletes training and racing. If this were a significant issue, we should have started hearing about it from doctors in Colorado, California, etc. Or, maybe this is the canary in the coal mine.