I’ve nursed quite a few injuries/health issues in the 13 years that I’ve been a runner. My personal list includes metatarsal stress fractures, a busted up ankle, peroneal tendonitis, IT-band issues, and anemia. Although I should say, in running’s defense, only the ankle and IT band can be blamed on running – the others, not so much. But I have never – never, ever, ever, ever, EVER encountered anything as fussy and frustrating as this current battle with my plantar fascia. [I’ll be discussing the details of how I’ve been treating my PF in an upcoming post.]
If I were my own client, I would have the following conversation with myself:
Coach Me: How does it hurt (ache, stabbing pain, etc.)?
Client Me: Usually it aches. But sometimes it feels like a pulling, or even a burning.
Coach Me: Is it binary, like, it hurts, or it doesn’t?
Client Me: No way. There are a LOT of in-betweens.
Coach Me: So when does it hurt the most?
Client Me: Erm…Sometimes it’s sore in the morning (but sometimes it’s not)…and in the evening, too. And sometimes (but not always) in the afternoon..
Coach Me (looking for a pattern): How about in relation to a specific activity?
Client Me: Swimming doesn’t hurt. Sitting doesn’t hurt. Most of the time, walking in supportive shoes doesn’t hurt.
Coach Me: OK. So it hurts at all OTHER times? Like, when you’re standing on it and don’t have shoes on?
Client Me: Well, no, not exactly. Sometimes I’m doing that, and it doesn’t bother me at all. Yesterday I wore my Vibrams and walked all the way to the grocery store and back – no pain at all!
Coach Me (thinking this might mean some improvement): How about for the rest of the day?
Client Me: Well, after I’d been home for awhile and was puttering around, it hurt again. Kind of a lot. But then less again in the evening.
Coach Me (still looking for a pattern): So, talk me through your day, and tell me how much it hurts at different times.
Client Me: OK. Let’s take yesterday, for example: I get out of bed and it feels good for a few steps. But while I’m making breakfast, it starts to hurt again. After breakfast, it’s OK, but not great, while I get cleaned up and ready for my day. I work at my desk for awhile, with breaks to get water or lunch, and use the restroom. Sometimes it hurts when I stand, sometimes it doesn’t. I get changed for the gym and put on my supportive sneakers. When I’m wearing those, it doesn’t hurt. I do my workout – Body Pump or Spin, and that’s fine. When I’m done and take my shoes off, sometimes it hurts and sometimes it doesn’t. But that was just yesterday. On other days, it hurts more/less at different times.
Coach Me (interrupting): Does it hurt more after a certain kind of workout?
Client Me: No, not really. For awhile, I thought Spin was pretty good and maybe made it feel better, but last night I spun, and afterward it hurt.
Coach Me: Oooook….
Client Me: Yoga sometimes hurts, because I’m in bare feet.
Coach Me: Do certain poses hurt more than others?
Client Me: No? Sometimes it hurts, and sometimes it doesn’t. *shrug*
Coach Me: How about running? You raced on Sunday. How was that?
Client Me: Well, it didn’t hurt while I was running. For the rest of the day on Sunday, it was OK – like it’s been. Maybe it hurt a little more on Monday, but I’m not sure. I may have been imagining that, and Tuesday was definitely average, like it was before the race.
Coach Me (going for a different approach): Overall, does it hurt more than it did two weeks ago?
Client Me: It’s about the same…I think. I mean, when I’m standing, it still doesn’t hurt a little bit of the time, it sort of hurts/I can feel it most of the time, and it hurts a lot occasionally.
Coach Me (one final attempt): So, on a scale of 0 (none) to 10 (childbirth), how much does it hurt?
Client Me: That’s really hard to say. Right now, I’m sitting down. So, 0. [I can be a bit of a smart aleck sometimes.]
Coach Me: How about…on average.
Client Me: I can’t answer that question. Every step is different.
Three weeks ago, if I had this conversation with a client, I would hang up the phone and let out an exasperated, “ARGGGGHH!!!” I’d also probably figure that she was being evasive: Perhaps she was running when she wasn’t supposed to, or not sticking to her icing/stretching/rolling regimen, or not paying close enough attention to her body to notice trends/patterns. Because, really – most injuries have a pattern. They hurt in certain ways, or at certain times, or in relation to certain activities – not this willy-nilly business that the client above describes.
But what’s humbling is that, in this case, I’m the client. I know that I’m stretching, and icing. I know the workouts I’m doing. I know that I’m not changing my footfall (at least, I’m trying not to). As people go, I’m pretty in tune with my body (at least, I have been for all my other injuries), and I trust my assessments of myself. So this on-again/off-again, apparently pattern-less discomfort is driving me bananas. My Mom innocently asked me if my plantar fasciitis was doing “better” the other day, and I almost threw a frustrated fit. “I think it’s about the same. I don’t think it’s worse. But…*ouch that step just hurt* …I just don’t know.”
This is an important caution and reminder for me as a coach: Sometimes, an injury is fickle, and it’s not necessarily the athlete’s fault. And while I certainly can coach people through injuries/chronice health issues that I’ve never had (thank goodness!), sometimes there really is nothing like experience.
I’m not even talking about knowing a cure or treatment – there are plenty of references for that. I’m mostly talking about understanding a client’s experience. For example, everything I read about plantar fasciitis says, “It usually hurts the most when the individual first wakes up, and after sitting for long periods.” Before PF, I would expect a sufferer’s experience to approximately mimic this. But in reality, I haven’t been able to reliably correlate my discomfort to these times/activities. This doesn’t mean I don’t have PF, and it doesn’t mean I’m lying – it just means that PF and I, and our experience together, are a little weird.
So I am reminded that, when faced with an athlete going through something I’m struggling to understand, I need to use my support network. It’s OK – even good – for me to ask for help. And ultimately, being aware of my own limits makes me a better coach, not a worse one.
Running friends, fill in this blank: I am an expert on (insert injury here).
Anyone recently sucked it up and sought advice, even when you thought you knew ‘the answer’? Did it pay off?
P.S. If you ever need someone to talk to about anything mentioned in that first paragraph, go right ahead and let me know. I can’t promise a miracle cure, but I can promise to share what insight I do have, and provide some reassurance and a sympathetic ear…