A Year of plantar fasciitis: 12 months of pain and recovery

I've had plantar fasciitis for about a year now. If you have plantar fasciitis and this is your first time, just know this: this running injury can take a very long time to heal. It can take "10 months" (as my orthopedic surgeon foot specialist told me) to two years to heal. Below is a review of the past year of my plantar fasciits pain and my slow road to recovery. I'm not back running yet, but at least the pain is gone--most days anyway.

December 2008:
I first got that nagging heel pain in my left foot just before Christmas last year but being me, ignored it and kept on running. Each day the pain in my heel was more acute when I stepped out of bed. Gradually, through the weeks, it did not disappear after my foot muscles loosened up after a morning run. The pain continued after Christmas during our annual "week in the snow" in Mt. Shasta. My beloved mountains runs combined the physical exultation of striving up hills in the thin cold mountain air with the gorgeous visual of mountain roads blanked in white snow lined by contrastingly dark trunks and snow covered bows of evergreens. the sky varied from gray clouds with misty white snow fall and fog to blindingly bright blue skies and fresh snow glistening in the sunlight. So ignoring the heel pain, I savored the mountain scenery and kept running.

January 2009:
The heel pain was joined by a partner in January from me favoring my "good" right foot: hip bursitis in January. I self-diagnosed the searing to aching pain on the top of my right hip bone. It made sense to me since I knew I was favoring my right side to keep pressure off my left foot with plantar fascia pain. Being stubborn I kept on running because (1) if I didn't get a good run in every day I got cranky and (2) See number one.

April 2009:
The pain got worse each week of running that by April I was limping and down to running only two to three times a week with a long run on Saturday's with a fun local running club. I resisted getting off my feet because I would miss my morning chats with fellow runners at the Inside Track Running Club. Running was more than just a work out for me--it was also the only way I could spend time with my busy running friends. To lesson the tenderness I was applying ice to the painful foot and hip and taking lot's of ibuprofen.

May 2009:
I started buying stuff to lesson the pain. I got over-the-counter arch supports, a heel sock that kept my foot in a dorsoflexed (toes pulled towards the knee) position while I slept at night and bought a great book on Amazon.com Injury Afoot: 30 things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Faciitis by Patrick Hafner. I did every exercise in the book and found it helpful. However, I think my injury was too far gone. Also, I kept walking barefoot on the beach each week when I did my open water swims with my new swimming friends. The "ice pick in the heel" pain of the plantar fasciitis in my left foot persisted.

June 2009:
Finally, after six months of increasing heel and hip pain joined with lower back pain (!), I stopped running. I replaced my 4-6 day a week running habit with road cycling and doing more open water swims. I started seeing a Rolfer once a month who came highly recommended. The Rolfer helped me walk normally. I was pain free after each session which was great. But the plantar fasciits and hip pain returned a day or two after each session. By this time I was wearing a night splint (which keeps my arch stretched while sleeping) every night.

August 2009:
I bought arch supports such as SuperFeet and wore them all the time. I got a special bicycle shoe version for my road cleats. My workouts consisted of road biking 2-3 times a week and swimming 2-3 times a week. No running or long walks. I saw a doctor for the first time in August and my x-ray showed that at least my foot bones were normal. I stopped running totally per the doc's advice and stretched my calf muscles every day, several times a day. According the doctor, I had to loosen up my tight calves as they were pulling on my foot tendons and exacerbating my symptoms.

September 2009:
I didn't run at all this month until a test jog a few days before the Carpinteria Triathlon. This month I just swam and road biked. I did the Carpinteria Triathlon and think I did my fastest swim and bike ever. I ran the 5K run portion slowly in the triathlon and had a realy fun race and saw lot's of old tri-geek friends. Was it worth it? I don't know now. I think that 5K really messed up my plantar fascia. I got a cast put on my throbbing left foot the day after the triathlon.

October 2009:
The day after the Carpinteria Triathlon I got a cast put on my foot. I wore the cast for four weeks. The week before the cast was to be removed, I had no heel or hip bursitis pain at all. Then I did a fast hike, hop and jog up Romero Canyon with some ultra runner friends. I think I re-injured my left foot then. The next day my left heel was painful to the touch again when I got the cast removed. I got a prescription for physical therapy (PT). The cast did cure that nagging right hip pain from hip bursitis, though.

November 2009:
After I got the cast off my left foot it was still sore. The doctor gave me felt heel lifts for my shoes but my heel was too sore to use them. My left ankle and foot felt very weak and fragile after being in a cast for four weeks so the physical therapists started me with some gentile strength and stability exercises that still challenged me at the time. On my first PT session I was pessimistic about the treatment and not in a good mood with my left heal throbbing in pain. It felt about the same that it did a month earlier after the triathlon and before the cast. The heel pain on the diagnostic pain scale was about a 5 or 6. It just ached the first two weeks. I did two PT sessions each week through the month of November. Each 1 1/2 hour session went something like this (from my PT notes from the November 10th):

• Stretch calves (2x 30 seconds each side)
• Stretch hamstrings (2x 30 seconds each side)
• BAPS aka the "Biomechanical Ankle Platform System" (this is an egg-shaped disk about the size of a large pizza with a screw-in half plastic sphere under it so I can rotate my foot 360 degrees)
• Straight leg extensions, four directions by pulling surgical tubing (2x 30times each direction, each foot)
• Foot/ankle stretches with a TheraBand #3
• "Monster walk" (walk about 20 feet with a giant rubber band around my ankles and legs shoulder width a part: forwards, backwards, left and right-2x)
• Ultrasound
• Deep tissue massage
• ice (1o minutes)

After a week the PT's added these exercises:

• Stand on one foot on the squishy top of Bosa ball and try not to fall off (30 seconds, 2x)
• Step up on top of a Bosa ball: forward and back, then side-to-side (2x)
• "Horses Head" (stand on one foot and at the same time pull on the light green stretchy surgical tubing with my opposite side hand towards my hip while lifting my right knee to a 90 degree position; then bend forward, letting foot down and straightening arm so the surgical tubing slakens; Repeat 15 times, each leg 2x)
• Stand on the flat bottom of a Bosa ball that is flipped upside down & do knee bends without falling off (about 30 seconds)

December 2009:
By December my heel hurt at about a 2 on the pain scale. This month, now that I'm officially "high functioning" according the PT staff they have me doing more strength and plyometric exercises in addition to the stability and core work. After each PT session I was sweating and my legs felt fatigued and shaky-- like Jell-O. Here is a typical routine of PT exercises after 6 weeks of treatment (from my PT notes from December 15 & 17):

• Treadmill walk (10 minutes, 2.0 incline, 4 mph)
• Stretch calves (2x 30 seconds each side)
• Stretch hamstrings (2x 30 seconds each side)
• Foot/ankle stretches with a TheraBand #3 (2x dorsal, medial, lateral for each foot)
• "Horses Head" (stand on my left foot on a trampoline and at the same time pull on the stiff dark gray surgical tubing with my right hand towards my right hip while lifting my right knee to a 90 degree position; then bend forward, letting foot down and straightening arm so the surgical tubing slakens; Repeat 15 times, each leg 2x)
  
• "Monster walk" (walk about 20 feet with a stiffer rubber band around my ankles and legs shoulder width a part: forwards, backwards, left and right-2x)
• "False Starts" get into a track starting position with each foot on a furniture slider (flat thing with a slick plastic bottom that slides on the carpet and sticky rubber top surface where you put your foot) and go back and forth until "fatigue"--for me that's 50x--each side, 2x)
• "Triple Threat" ( This is tough for me & I just look ridiculous so I try to get out of doing this exercise each session). Here is how it goes: lay flat on the ground with a giant beach ball (aka "balance ball") under your legs and lift up your pelvis so your legs are straight like a board. (That #1 of the "Triple Threat.") Bring the beach ball close to your butt by bending your knees and keeping your pelvis up (That is #2). With ball at your butt, lift your pelvis higher (That is #3). If I can get through 5 repetitions of these without shooting the ball across the room and hitting the ground with a thunk, it's been a good session for me. (2x5 repetitions)
• "Wooden Steps" First I step forwards one leg at a time on the step like I'm doing some sort of traditional hat dance, Then I side-step up on the step and down the other side, both feet on top and on the floor for "two-beat" version, then I step side-to-side up and over the thing with only one foot on the step and the floor at a time for the "one-beat" version.
• "The Matrix" This exercise is sick: As fast as you can do (1) 30 squats (butt out so as to not overload the knees); (2) 30 lunges (knee almost touching the ground); (3) 30 squat-jumps; (4) 30 lunge-jumps switching feet mid-air. Twice.
• Leg press (30x 80 lbs--but now I do 2x 100 lbs, twice)
• ice (1o minutes)

I have have been generally pain free from my left foot plantar fasciitis for two weeks now. I had a relapse earlier this week for two days after I had the amnesiatic and stupid idea to stroll around barefoot in the sunshine for about an hour on Saturday on a friend's deck-- but other than that, I'm recovering from this affliction. I still can't run. I can't walk barefoot. But, at least (for today anyway) my plantar fasciitis pain is gone.

My plan for January is to start running again. Slow-ly.

Triathlon Training Tips for First Time Triathletes

Now that we are entering the triathlon racing off-season, it's a great time for people considering on doing their first triathlon to start building a fitness base and getting familiar with their new sport. This posting is an abbreviated version of one I posted last summer and it's better suited to winter and spring off season training here in Southern California.

My personal philosophy for triathlon success is less "purchase" and more "practice". It's based on a daily practice of training one's body within the rhythms of one's daily life that includes work and family. During the late spring and summer racing season I call this the "Daily Practice of Triathlon Training". By "daily" I mean that each day during the racing season has a fitness purpose. It is either a training day (making me stronger/faster) for a particular sport or a recovery (non-training) day (making me stronger/faster by letting my body re-build). During the Spring and Summer I train in one of the three sports six days a week. The seventh day is a recovery day for all three of the triathlon sports.

These tips are geared towards those who live in Ojai and Ventura, California but if you replace the triathlon store name and local triathlon club or running club name with one in your town, I think this list can be helpful for most people. Also, there are many excellent online resources for information and athletic inspiration for beginners, too.

If you are interested in more details on training and sports nutrition, please checkout RunnersWorld.com or Active.com/triathlon. Both of those sites have links to training schedules and performance tips for running road or trail races and racing triathlons.

Here is my advice for training for one's first triathlon in 2010:

1. Research the sport.

• Talk to Triathletes The best information I ever got about doing triathlons was from people I met while training, buying gear and racing. You generally get un-biased information when speaking with people who don't have anything to gain by you purchasing something.
  
  
• Go online
  
  Social Media Sites Twitter.com and search "#triathletes" is a good way to find triathlon information from triathletes. Most are regular people just like you, online. It's neat to pose a question (in 140 characters or less) on Twitter and have triathletes from all over reply back with a tip. I found online training schedules on these training social media web sites: dailymile.com, endurancejunkies.com , and buckeyeoutdoors.com (you can embed your training schedule in your blog--I haven't tried this yet) and MapMyRun.com. I use dailymile.com.
  
  Websites Websites such as Active.com/triathlon and Multisports.com feature free tips and triathlon training schedules (some must be purchased).
  
  
• Books Get a good triathlon training book to get an overview of the basics the sport and time managing the multi-sport workouts. Here's a good one that a friend found for me at a garage sale: Triathlete's Training Bible. but, I'm sure there are others, too.
  
  
• Magazines Checkout Triathlete Magazine. There’s great training and nutrition articles and the race and athlete profiles inspire. Be aware that this magazine is product advertising-supported.
  
  
• Learn by doing. Now is the time to experiment with new shoes, try a friends bicycle and to have fun with triathlon training. During the off-season your goal is to buildup your base and find out what gear works best for you.
  
  Training for a triathlon is a daily practice and you will learn how to do it best by trial and error. There are core principals about physiology and nutrition but every body is unique. What works for the Dude at the Triathlon Shop Who Has Done Ironman 18 times ;) may not work for you. It’s necessary to get to know what YOUR body needs and how it performs by doing it and listening to it. Do your first Brick Workout (bike ride followed immediately by a short run) and find out what you can ingest to keep your energy consistent that doesn't make you feel sick. Go for a bike ride on borrowed bike to test it out. Do a mini-triathlon on your own from your local pool. Just do it. The cool thing with triathlon training is that it is cross-training so as your individual running or swimming mileage may be less, you will have the additional benefit of training and getting stronger from the other two sports.
  

3. Daily Practice of Triathlon Training.

• Consistency is key. The off season is a good time to get used to training once a day, six days a week. Now is a good time to experiment with new gear. It's also the time to build up one's endurance base. Triathlon training is a Daily Practice that will take some getting used to.
  
  
• During the spring and summer each day will be a workout day. By Spring you should be used to training six days a week and fitting it into your work, school or family schedules if you can. The Daily Practice includes: your daily work out, your pre-workout food/beverage that is mostly carbs and easy to digest, your post-workout recovery food/beverage and sleeping more.
  

4. Become a member of a local triathlon, running or athletic club.

• This is a good and socially fun way find out about local road rides/open water swims and have better access to find other tri newbies. Plus, according to scientific research, you will get faster and stronger training with others than if training alone.* Being a member of a training club may translate into other benefits such as club discounts on gear and race entries. Some of the more experienced or long distance triathlon club members may seem a little arrogant or hardcore to a beginner. Just don't take it personally. It takes a lot of mental and physical focus to be competitive in the Ironman triathlon distance these days and that can take a toll on one's social skills. The qualifying times Ironman and Nationals has gotten a lot tougher than when I started doing triathlons in the free-wheeling late Eighties. It seemed more fun in those days. Though training was just as tough (and in some ways more difficult without all the energy supplements they have these days) there were less people to race against and the triathlon community was smaller and friendlier to each other as crazy kindred spirits. We were considered nuts by non-triathletes in the early days of the sport.
  
  *See the article "Get Fitter with Friends”, The Economist Magazine, September 19, 2009, P. 92.

5. Swimming

• Swim Training If you are new-ish to swimming, try to get in the water (lap pool, lake or ocean) at least 2-3x/week (30 minutes each) to build up your form & confidence. Do intervals if you can when in the pool. (I have some beginner swim workouts you can do to break up the monotony, too] Check out Active.com and look up swim stroke technique web videos and tips there or on youtube.com. Sometimes having a few pointers & practicing some swim drills can really make a difference in swim efficiency.
• Swim Suit For women, the two-piece swim suites with the draw string bottoms are good and one-piece suites are fine, too but can get hot when your running.
• Swimming Wet Suit If you don't have a swim wetsuit, a surf wet suit can still work but won't have the range of motion in it's fit nor the sleeker less-resistant material for is best for swimming. Great quality swim suits are at Inside Track Multisports in Ventura and Hazard Cycle Sports in Santa Barbara for new ones. Inside Track Multisports and GoForItSports.com offer used wetsuit rentals for sale for a fraction of their new retail price if you are on a budget. I've heard that retailer Play It Again Sports in Ventura has had swimming wetsuits, too. Craig's List and Ebay have been used successfully by friends for getting good quality used wet suits and gear, also. Wetsuits are not cheap but a good one that fits can transform non-tropical open water swimming from cold misery to comfortable fun. Swim wetsuites add buoyancy and speed, too. That is always a plus for me. There are a lot of quality brands with slightly different fits for different body shapes such as 2xu, Blue Seventy, Quintana Roo and others. I wear a Woman's Blue Seventy. When I open water swim in the ocean during the winter with my Blue Seventy wetsuit and matching swim booties and neoprene cap I may look ridiculous, but I am never cold. If you are new to open water swimming or swimming with faster people, it's a good idea to invest in a pair of swim fins. I swim with TYR Crossblades in the ocean sometimes. One more point about swimming open water: wear a swim cap. Sports Chalet and several online retailers such as Goforitsports.com sell them.
  
  I recommend wearing a brightly colored swim cap when open water swimming for two reasons:

1. You will feel significantly warmer when swimming with a swim cap
   
2. You will have a better chance of being seen and not run over by boater or surfer when wearing a bright colored swim cap

6. Cycling

• Bike The bike, for non-road cyclists, can be tough hurdle for a beginner or cash-strapped first time triathlete. My best advice is to go to your local multisport or bike shop. A triathlon racing bike is not necessary to race in a triathlon. The tri-bike geometry has more severe angles for time trial efficiency on flat courses and with a proper fitting is slightly faster than a conventional road bike, but is not as comfortable to ride for long rides. A "traditional" road bike shop may not have the expertise in tri-bikes and their accessories. I ride 12-year old conventional road bike with "cross-country" geometry. To get faster, I train more. If you just need a bike, almost any bike that is safe to ride can help you achieve your goal of doing a short or Sprint triathlon this summer. You can even ride your mountain bike or a cross-bike. I don't recommend riding a single-speed cruiser bike, though as they weigh a ton and you may need hand-brakes on the handlebars to compete in a triathlon. As long as you bought your bicycle from a reputable source and it has been safety checked by an established bike dealer such as Inside Track Multisports, Avery's Open Air Bike Shop, or Trek Bicycles in Ventura or Hazard Cycle Shop in Santa Barbara, it should be fine. If you want to go fast on a bike, my best advise is to spend more time in the saddle, than buying expensive gear in a shop.
• Bike Helmet You need a certified-for-safety bicyle helmet or you can't participate in an organized triathlon race. Check out your local bike dealer or multisport shop for this. Your brain is the only one you got, so protect it with the best helmet you can afford. I've been in a bike crash before and my helmet (which hit the pavement--hard) probably saved my life.
• Bike accessories to carry your food & water, etc. If you buy a new road bike you will need two water bottle cages, a seat pack with spare tube, allen tool & patch kit, frame pump, clipless pedals and shoes. You can wait on the clipless pedals and shoes but they allow you to make a more efficient (e.g. faster/more power) pedal stroke when riding. You can buy water bottles or re-use Gatorade bottles or small water bottles in an earth-friendly fashion.

7. Running

• Races are "won" on the run Triathlons, at the elite level, are won and lost during the run. It’s during the last portion of the race, during the run, that the hours of daily training and preparation comes together. many triathlon pros believe that the last segment of the race, the run, is when real race begins. The cardiovascular conditioning benefits you get from running will transfer to swimming and cycling. However, your swimming and cycling muscular training won't transfer to running. If your training time is limited (whose isn't?), I recommend focusing on your running and swimming. You can’t "fake" either of these in a triathlon.
• Local Running Clubs: Inside Track Running Club has daily groups running workouts for all levels of runners in Ventura and Santa Barbara Athletic Club is resource for local workouts in Santa Barbara.
  

8. Training for your first Sprint Triathlon

• Plan ahead--at least six months before your first triathlon. Most Sprint distance triathlons also fill up so it's a good idea to register for a race you are interested in as soon as you can. I usually register about six months before race day for the short races. For of the more popular and longer races (such as the Wild Flower Triathlon) you may have to register up to a year before. I think the Carpinteria Triathlon Sprint Course filled up about two months before the race this year (I registered for the September 27th race the first week of July).
  
  
• If you are doing a Sprint Triathlon with a 5K run distance, I recommend going online to checkout a few 5K race training plans and modify them to your triathlon schedule. There’s a cardio-crossover benefit from cycling and swimming, so your running workouts should focus on building speed and endurance by doing intervals—but only after building up your base. Your “base” in reference to running, is how far you can run or jog comfortably for your longest run and run each week in total. Rule of thumb: do at least one speed or interval workout for running each week.

9. Weekly Triathlon Training Schedule for Sprint Triathlon

• You can train for a triathlon in as little as 1 to 1 1/2 hours per day. Just make each day’s workout a quality workout and abide by the periodization principal (hard days followed by easy days, hard weeks followed by easy weeks, etc.)
  
  
• Sample Training Week Here's a sample week from my own standard training schedule from when I was racing regularly BC (“Before Children”).

• Monday (Swim or Nothing--Recovery Day)
• Tuesday (Run & Bike)
• Wednesday (Swim)
• Thursday (Run & Bike)
• Friday (Swim or Run)
• Saturday (Swim & Long Bike)
• Sunday (Swim and Long Run, a triathlon or running race or Brick Workout (bike followed immediately after with a run, usually 10-24-mile bike/3-6-mile run)

• Do not do a tough workout of the same type of activity two days in a row. When racing, I take Mondays off if I raced or did a tough Brick on Sunday. If I raced Saturday, I planned for Sunday being a recovery day, etc.
  
  
• Brick Workout A Brick Workout (or just Brick for short) is when you combine a bike ride with a run afterwards in one long continuous work out with a few minute break just to change your shoes. Basically, you go for a bike ride, stop to change into your your running shoes (and drink water) and then start running down the road like you got rocks in your quadriceps. This sadistic workout prepares your body for race day both physically and mentally. It's a tough workout and I recommend doing a recovery day/rest day after you do a Brick Workout.

10. Train with others if you can

• It's safer and you will usually be able to get a better workout when you train with others. This is especially true when open water swimming, trail running or road riding. And, it makes the workout time go by more quickly. In my experience, triathletes are usually just busier people in general (many run their businesses, have families, etc.) and training is their way of socializing, too. I've learned more over the years about training and racing from other triathletes while chatting in between workouts, than I ever have from a book, video, or web site. Word of mouth is best. And, it's more fun, anyway.

11. Keep a Training Log or Schedule

• Keep a training log. It keeps you on track when training towards a goal and it also gives one a sense of achievement. Even if it’s just jotting down “Run, 3 miles, hilly” or "Tuesday: Run- 5 miles, hilly, felt tired." on your calendar, planner or Facebook profile or it’s worth the trouble. (You can also refer to your old training logs to track improvement progression or to help you remember how to train for a certain distance or weight loss or PR years later.) Good stuff.

12. Food & Beverages

• Nutrition & fluid/electrolyte replacement: Don't forget to drink enough water & always bring some source of carbohydrate for workouts longer than an hour (banana, bar, energy gel, cookies, orange, gummy bears, etc.). When it's hot, make sure you replace electrolytes lost during perspiration (banana, a few saltines, Gatorade, PowerFul, enduro caps, Hammer HEED, etc) during rides or runs over an hour, too.
• Sports nutrition is a practice: What and when you eat really does affect your training and can help or hinder your improvement. Triathlon is an endurance sport that requires a specific type of energy replenishment for your muscles while working out and for recovering from a workout. The most efficient form of energy for your body to process is carbohydrates. Triathletes, like runners, are known to eat lots of carbohydrate rich foods & food supplements that digest quickly: energy drinks, bagels, pasta, rice, energy gels, bananas, fig newtons, potatoes, etc. Monique Ryan and Liz Applegate are excellent sources of information of performance optimizing sports nutrition for endurance athletes. Check out Amazon.com for their books.
• Before training/racing: Try to eat a easily digestible source of carbohydrate, about 200 calories for most folks, about 1-2 hours before working out. Give yourself about 16 oz. of water with your food to aid hydration and digestion. For long slow workouts, I can eat a banana or PowerBar while I'm running or riding. However, some people can't eat when they run or bike. Trial and error is helpful here. Get to know what works for you.
• After training/racing: You will recover faster and feel better if you get eat or drink a source of carbohydrates 30-45" after a long (1 hour plus) workout or race. Just remember you have a 30"-45" window after a tough workout to replenish with carbohydrates. Research shows that long distance (over 1 1/2 hours) training should be followed by carbohydrates and some protein) Even a food as simple as a peanut butter and jelly sandwich is a great recovery food to have after a long bike ride or run or swim. Cold pizza is good, too. Especially on hot days when you need to replace electrolytes lost through perspiration.
• • Avoid drinking any alcoholic beverages right after you work out. Consuming alcoholic beverages after working out retards your body’s ability to rehydrate and recover from the workout. Replenish with water and nutritious foods first. Be kind to your body. It needs to recover from the stresses of training and racing with good stuff. Not beer.

13. Sleep more

• You will need more sleep if you train every day (six workout days + one recovery day). Your body will require more of sleep for new tissue growth to deal with the physical stresses of training and the mental stresses of managing workouts and racing. If you don't get enough sleep your immune system will weaken and you will be more likely to catch something and get sick. You won't recover as well from your workouts, either. And, you will be tired and grumpy which messes up relationships. So, try to get to bed at least an hour earlier this summer while you are training for your first triathlon. That means usually 8 hours of beautiful, healing sleep. (Maybe more if you can get away with it.) Naps are good, too.

14. Triathlon Terms:

• PR: "Personal Record" (Your fastest race time.)
• WR: "World Record" (I'm glad they invented the term PR for the rest of us!)
• PW: "Personal Worst" (Your slowest race time.)
• Bonk: to run out of energy while exercising; to have an over whelming desire to stop moving and lay on the couch. Symptoms include feeling exhausted, dizziness, confusion, sleepiness, an over-whelming desire to sit under a tree and take a nap, grumpiness and sometimes, even tears. This is what happens when your body runs out of accessible blood sugar called glycogen that it needs to powers your muscles and to think clearly. You can avoid this awful state by making sure you have a source of easily digestible energy and water handy when working out such as bananas, energy gels and water or an energy drink. A good pre-race practice that helps me is to consume a banana or energy gel with a 16-oz. bottle of water about 30 minutes before race start.
• Carbo Load: This is a pre-race rite of commensality (ritual meal sharing) that features a large meal of mostly carbohydrate-rich foods such as pasta, potatos or rice. It is generally shared with family members, loved ones or with other triathletes. It’s stated purpose is to increase your body’s glycogen stores so you don’t bonk in the following day’s race. It also reinforces the social solidarity and specialness of the triathlete as he or she prepares to athletically test his or herself at publicly during the race the following day.
• Trigeek: a triathlete or wannabe triathlete who takes their athletic training and race performances bit too seriously for his friends and believes that upgrading to newer and more expensive triathlon gear and racing is more important than anything else.

15: Triathlon Race Distances (USA):

• Sprint: 0.5k-swim/15k-bike/5k-run
• Olympic: 1.5k-swim/40k-bike/10k-run
• Long Course Santa Barbara Triathlon: 1mi-swim, 34mi-bike, 10mi-run
• 70.3 or Half Ironman: 1.2mi-swim,/56mi-bike/13.1mi-run
• 140.6 or Full Ironman: 2.4mi-swim/112-bike/26.2mi-run
• Double Ironman (a multi-day stage race of double the Ironman triathlon distances): 5.4-m swim, 224-m bike, 52.4-m run

16: Upcoming Local Triathlons and Multiport Races

The best way to find local races online is Active.com which has an online database of just about every "all comers" triathlon, road race and other sports competitions in the United States. Printed race entries and flyers can be found on the "race table" at Inside Track Multisports in Ventura, CA.

You can find my daily workouts & multisport musings at: Twitter.com/multisportmama and Dailymile.com/people/multisportmama .

:) A

Plantar Fasciitis update: I got my cast off but I can't run...yet

I got my cast off today. I posted a photo of my cast-freed atrophied leg on my Facebook page with the caption, "Yikes! The horror! The hair!" The leg is cleanly shaven and sterilized with antibacterial soap now. Thank goodness.

Here is a summary of what my orthopedic surgeon told me that I need to do in order to get back to running long. If you are suffering from plantar fasciitis, I will tell you right now, I don't have the answer on how to get you back to running again. After months of self-treating it, reading about it in both consumer and fry peer-reviewed articles in scientific journals, I only know this: what treatments didn't work for me, mistakes I've made that made it worse, and that there is no single cure or treatment that works for everyone.

This is the second time I've had plantar fasciitis so bad where I had to completely stop running for over three months. The first time was a flare up that happened a few months after I got Achilles Tendonitis in the last mile of the Chardonnay 10 mile race in 1995. (I think the micro-tears in my Achilles was from under-training in my running, not stretching before the race and having tight hamstrings from my long road rides and from wearing racing flats for the first time in a long time.) It took about four years and two non-running periods of third-trimester pregnancy to get rid of the plantar fasciitis the last time I had it. The Achilles tendinitis only lasted about six months.

"You still have plantar fasciitis," said the doctor.

So, that means to me that I still need to sleep in an awkward putty-colored scratchy night splint at night. And, I still need to wear my store-bought orthotics (Superfeet and Spenco), and I can't wear flip-flops or cute sandles, and I can't walk around barefoot--even to the bathroom or to the pool. *Sigh* My foot doctor wrote me a prescription for physical therapy, 3 times a week for 4 weeks. The doctor wanted me to wear the felt heal lift I got from his office, too. Unfortunately, it doesn't fit in my shoes with the arch supporting orthotics and my husband cut a hole in it. I asked him to cut a hole in it because the pressure of it was hurting the inflamed area on the front of my heal in September--before I got cast. So "no go" on the $58 felt heal lift thingy. Hopefully, that is crucial.

"It takes about 10 months to get rid of it."

Okay, so does that mean I count 10 months from my first blog posting about my plantar fasciitis injury? Or, when I stopped training with Inside Track Running Club, the day after a painful 8 mile run along the coast on a beautiful sunny Saturday morning on June 27th? Or does it mean I count from the day I finally stopped running all together, the day after the Carpinteria Triathlon on September 28th? The next day I could hardly put my left food down without a sharp ice pick-like stabbing pain in my left heal. It was also on that Monday I got the cast put on. If so...

Crap! That means I won't be back running at 100% until May 2010.

I'm going with the first blog posting date, August 6th, minus one month. That way, I will be back at 100% in March. That's not scientific but I'm an optimist. (That's me at the Carpinteria Triathlon in the photo above. Not in the photo is my son waving and my daughter yelling, "Mom! What the heck?! I thought you weren't going to run!" The ambulance in the photo is symbolic of the damage that I did to my foot that day. Next time I will listen to my kids. Photo by Christine Paone)


"Before you can run, you need to walk."

Here's my walk-to-run training regime per my doctor -- as I remembered it (I was still in shock at the time after he said, "it takes 10 months to heal...":

• 1st month: I need to walk up to a 1/4 mile the this week, then the 1/2 mile the second week and by 4 weeks be able to walk 2 miles.
• 2nd month: I need to then add 1/4 of slow jogging (8-10 mpm) then walk 1/4 mile and so on the second month. By 8 weeks, I should be able to jog 2 miles--pain free.

"This will get you running again but you won't be able to go back to doing 10 mile runs until March."

:(

"You need to strengthen your left leg."

But before that I need to do the calf/Achilles tendon stretching exercise several times a day. Here's how:

Stand facing the wall with feel comfortabley apart (8-10 inces) Put your left foot about one foot length away from the wall (about 10 inches), toes pointing straight towards the wall. Put your hands on the wall and push back so your weight goes on the left foot. Keeping your back straight, slowly bend your knees, keeping your weight on your left foot. Hold this position 30 seconds before slowly rising to a standing position. Switch to the other foot and repeat. (The image above is from the American Academy of Orthopedic Surgeons web site. The position shown is slightly different from my doctor's instructions. In his version, the feet need to be closer together with the back foot's toe just behind the front foot's heal. This web site has other helpful stretches to treat or prevent plantar facsiitis and a good description of the injury.)

Strengthening exercises:

• Calf raises; You do this by standing facing a wall, about 24 inches away from it, and raising on your toes; do this while standing on one leg at a time and continue this exercise until you can do as many calf raises on your weak (injured) foot as you can on your strong foot
  
• Wall hamstring strengthening exercise; We called this doing "The Torture Chair" when I was in Track and Cross-Country in High School. It involves leaning against a wall in the sitting position with your legs at a 90° angle and then sliding up the wall and back down to 90°. Try it. It's fun. ;)
  
• Calf raises over steps; This exercise sounded a bit too similar to the Negative Calf Raises that aggravated my plantar fasciitis for two months last summer. I may do this exercise later when my foot gets stronger
• Do leg extensions to strengthen the quads and hamstrings in the gym
  

"Your range of motion is much better after four weeks in a cast."

Apparently, my left Achilles tendon and calf muscles were so tight before he casted my foot into a 90° angle, that he could not dorseflex my foot (push my toes towards my knee) more than a few degrees. Now I can flex my foot up 10-15°. The cast apparently immobilized the injured tissue and helped helped to loosen a tight Achilles tendon that was causing me to repeatedly strain the plantar fascia. The night splint wasn't enough.

"You will be able to run again and do ultras and race triathlons again. No problem. Just stay positive. "

Actually, he didn't say that. But I wish he did.

Dealing with Plantar Faciitis: Trying a cast to heal the cursed thing

I have had more kind words of advice to help me recover from plantar faciitis these past few months than I can count from friends, family, Twitter, Facebook and blog followers and even complete strangers.

I've been battling this affliction off and on since 1995 when it first reared it's evil head after I finished the Santa Barbara Chardonnay 10 mile race and got micro-tears in my Achilles tendon. (I still remember that awful popping sensation in my right Achilles tendon just above my heal in the last mile of the race.) I PR'd that day but I paid a terrible price. After limping into the finishers area my running would never be the same. The Achilles tendinitis forced me to drop out of Canadian Ironman and eventually, I developed a case of plantar faciitis on my left foot--my "good" foot--while trying to recover from it. The Achilles tendinitis healed completely after a few months or so of no running. However, the plantar faciitis wouldn't go away until I got pregnant with my first child and stopped running completely for about 5 months.

But then the plantar faciitis came back again after I did the Catalina Marathon in March 2000. To combat it I wore my own homemade arch supports, eschewed wearing flip-flops, got deep tissue sports massage and cross-trained for a few months. It really didn't go away for another year. Later, I was able to train for and completed several more marathons, including the heinously fun Big Sur Trail Marathon in 2003, and later qualified for Boston. My last long, 15+ miles, run was the Boston Marathon in 2004.

To date, my current case of plantar faciitis began after I increased my running mileage too quickly in Dec'08 after joining a local running club. I was working, being mom and juggling writing a difficult research paper then, so I had very little time to train. I was doing the long running club road runs on the weekends (10-14 miles) while only running 2-3x during the week (5 miles). In hindsight this was stupid and I knew better. The pain got worse and by six months later I couldn't run a step without pain. I also had two secondary injuries: hip bursitis (right side) and lower back pain. I tried changing running shoes: first buying a new pair of my usual cushioned and structured New Balance running shoes, the NB 1224, then when my heal still hurt, I went for less structure and switched to Brooks Cascadia trail shoes. I also bought a running video of a running technique developed by Ken Mierke called Evolution Running that was mentioned by Christopher McDougal as one of the curatives for his own case of chronic plantar faciitis and Achilles tendonitis in the recent published best selling book, Born to Run. Nothing worked.

What I have tried

This past summer, to treat my plantar faciitis, I've did just about "everything but the kitchen sink". Beginning in June:

• I stopped running
• Cross-trained in swimming, bicycling and weight training.
• I bought a pair of last year's racing flats on sale, Brooks T5s, and used those to walk around in with Superfeet orthotics (the green high arch model) most of the time and as soon as I got out of bed in the morning.
• I got the book Injury Afoot by Patrick Hafner on how to treat my plantar faciitis iinjury and tried everything in the book. (Sponsorship disclosure: After I reviewed Injury Afoot, the author kindly sent me a free copy as well as some advise on good stretches for plantar faciitis sufferers on his blog "Heal Your Heel Pain".) In hindsight, I was was doing some of the stretching exercises too early, re-injuring the facia. I also wasn't diligent in obeying the book's advise to never walk barefoot. I was re-injuring the facia as soon as I got out of bed in the morning when I walked barefoot into the bathroom and three times a week when I walked barefoot from my car to the beach for my open water swims or from the locker room to the pool at our local fitness club.
• I actively treated the the plantar faciitis stiffness and pain in my left foot with monthly Rolfing sessions (if you try this, bring a piece of wood to chew on, it's deep tissue work and can get uncomfortable)
• Iced my heal and arch 1-2x/day (10-15 min each time)
• Took Advil (2-4x/day, 400mg each time, as needed for pain
• Slept with a night splint (so sexy...not!)
• My husband administered deep tissue work on the injured foot once a week during the last month
• I saw an orthopedic surgeon foot specialist finally
• After the doctors visit, I wore Superfeet orthotics or the over-priced ($58 but $8 to me with insurance) heal lift given to me by my orthopedic surgeon in my shoes

During my summer of plantar faciitis, at about every 3 or 4 weeks, I would do something stupid and re-injure it. In desperation, one beautiful dawn morning while visiting Leucadia, a north county San Diego Meca for old school triathletes, I tried jogging barefoot on the hard packed sand of Moonlight beach for 30 minutes while my husband coached me on my gait for less heal striking. Another morning, I tried jogging in my socks on a treadmill (only 1 mile) after being inspired by the barefoot running tweets and articles I have been reading. Both times had disappointing and painful results. (At least the beach run was pretty.)

Nothing I have done has worked for longer than a day or so. Even the deep tissue massage and Rolfing didn't work for longer than two days. Sure, my foot felt great afterward (my whole body felt great), but the classic symptoms of tendon tightness in my arch, a hard swelling from the adhesion at the front of my heal and sharp pain (like an ice pick jabbing violently in my heal) returned after a day or so of tentative painfree bliss.

What I have not tried

I had not tried aqua-jogging, acupuncture, cortisone shots, surgery, seeing a shaman, praying to the Virgin Mary, taking supplements, meditation or wearing a cast. For now, I am trying the cast method. And, to I'm eating mostly fruits and vegetables to boost my antioxidant intake and to maintain my weight. I hope that by immobilizing my foot in a cast for 4 weeks and keeping all pressure off my plantar facia, it will be able to finally get better.

Someday I hope to be able walk and eventually run long distances again without that ice-pick-stabbing-in-the-heal debilitating pain.

If those Tarahumara that Chris McDougal wrote about in his book Born to Run can kick ass in their forties, fifties and sixties running twenty, fifty or hundred miles on mountainous trails wearing nothing but homemade tire sandals, there must be some way to recover from this affliction. I'm open to just about any suggestions people may have who have recovered from plantar faciitis.

For now, I just hope the cast and the diet of mostly fruits and veggies work.

Climate Change Talks in Bangkok for COP15, inspired by green Copenhagen

While clicking around looking for inexpensive travel options for my husband to attend the COP15 Climate Change Treaty talks in Copenhagen this December I found an inspiring web video about the amazingly sustainable and healthful features of living in Copenhagen. See below.

"Amazingly" is not a bit of hyperbole compared to my own town and nearby ecological disaster area called Los Angeles. Nearly everyone seems to be riding bicycles in the main city of Copenhagen. Over 40% of Copenhageners ride to work and there are over 300 kilometers (186 miles) of bike lanes according to the video. The water ways running through the city are clean enough to swim in and water sports in it seem to be encouraged from the scenes of people frolicking in the water. Also, twenty-three percent of food consumed in Copenhagen is organic with a civic goal of 90% by 2015. Why can't we do that here in Southern California? Heck, we got much better weather for year round biking, water sports and a much longer growing season for organic veggies...How cool would it be if we could safely swim or kayak in the LA river and bike to work breathing fresh air and riding safely in a designated bicycle lane? Check out Denmark's green efforts in Copenhagen--it's possible:



The COP15 and follow-up United Nations climate treaty negotiations are trying to make more Copenhagens possible through financial incentives to go green. My husband may attend the COP15 United Nations Climate Control Treaty meeting Dec. 7-18 in Copenhagen. He would be going as a volunteer mediator representative of Mediators Beyond Borders. Since he is volunteering and paying his own, as you can imagine, he is pretty committed to the environment and facilitating peace globally through encouraging mediation as a dispute resolution tool. Right now hubby is at the UNFCCC Climate Change Talks in Bangkok, Thailand as a volunteer with Mediators Beyond Borders. To read Mark Kirwin's field reports from Bangkok go to the 11th Hour Mediation blog.

An organization of journalists have even created a web site to track the climate control treaty negotiators called Adoptanegotiator.org. Some of these UNFCCC observers feel that the United States isn't taking enough responsibility for reducing carbon emissions and if the US keeps blaming China and India for polluting, that the US will end up stalling substantive progress on the talks in Bangkok. It's good to remember that the US did not sign the last climate control treaty, the Kyoto Protocol. And, after eight years of the Bush Administration, our reputation abroad on environmental and "play-well-with-others" matters has been seriously tarnished.

It has been fascinating to hear, second hand, about the daily negotiations over the text of the different elements of the treaty's specifications for reducing carbon emissions. The competing national, economic, humanitarian and environmental concerns and perspectives are interesting and, to me, sometimes, disheartening. The volunteer mediators at Mediators Beyond Borders certainly have their work cut out for them.

Read about Day 2 of the UNFCCC climate change treaty text negotiations in Bangkok >

Future graduate students take note:

The Danish gov't is awarding about $700,000 in 2-year climate masters degree scholarships at Danish Universities--in honor of the COP15 summit's green agenda and practices. Here's the link: http://en.cop15.dk/news/view+news?newsid=641

PS: Now the trick is, how does one get paid to do this good work????

You can get fitter faster with friends

Well, leave it to science to explain what most runners and triathletes already know: that you can get fitter faster if you train with your friends. "Exercising in a group can be more effective by making things easier" declared the subheading in in an article titled Fitter with friends in the September 19, 2009 issue of The Economist Magazine.

That's not news to me but it's nice to feel that my experiences training with friends has been validated by science as the best method! What was interesting in the article to me was the physiological process that causes a person to get fitter by training with others. According to the research of anthropologists Emma Cohen of Oxford University, and Robin Ejsmond-Frey there is a heightened tolerance for pain in athletes working out in a synchronized group. In their studies of competitive rowers they found that the usual production of endorphins that are released during extreme physical exertion (and which serve to numb the pain from lactic acid buildup in muscles) are increased. From their studies, they found that endorphin levels of athletes working out in a group are significantly higher than when the same athletes are working out alone. Working out with others is less painful. Sign me up.

Swimming with others

When I'm not joining my friends for our group open water swims at "dawn-thirty" on the weekday mornings (see photo above), my swim speed declines down to my slow baseline "yawn" pace of about 50 meters at 50 seconds. Too slow! Plus, I usually get bored after several weeks of solitary pool swims (no matter how creative I try to get with intervals, etc.) and usually climb out of the pool after 30 minutes with a lame self-promise that I will make it up later. If you are new to swimming and are looking for swim pals the best bet would be to ask about a Masters Swim group at your local public, university or club pool. Another option, if you have a background in swimming, is to see if there is a local swim or triathlon club. You can also take a swim class at a local community pool or university through a continuing ed or extension program. I improved my swim technique last summer at a month long group swim Stroke Refinement class at our lcoa Ventura Aquatics Center. It was fun; and I got faster.

Here are few online resources for group pool and open water swimming:

• U.S Swim Masters (National)
• Rincon Triathlon Club (Ventura County pool and open water swimming)
• Santa Barbara Swim Club (Santa Barbara-based, pool & open water swimming)
• Channel Island YMCA (Santa Barbara & Ventura County pools)
• Buenaventura Aquatics Center (Ventura)
  

Running with others

Running with others has always made me faster. It has also brought me countless hours of communal fun, has given me new friends and has strengthened friendships. ("Friends who play together, stay together..."). There are military studies that show that coordinated physical exercise can strengthen social bonds.

The best way to find running friends via word-of-mouth. If work for a large organization, generally there is another runner to partner up with. Another way to find running friends is at a local running club. Most clubs are based around either a geographic location or non-profit fund raising organization such as the Leukemia Society's Team In Training (TNT). Another group running source would be enrolling in a running class at a local university of college or finding a coach (which is sort of the same as joining a running club).

Finally, you can sign up for a race. I recommend this especially when traveling as it's a fun way to get the know the local geography and culture. As a race participant at races far away from home, I've been happily surprised how inclusive the local runners were to myself, a stranger to the area. For example, I'll never forget the friendly invitation I got from a few local runners when I did the Boston Marathon. Unfortunately, I was too exhausted after the race to accept the party invitation. But it was really nice to be invited. If you are visiting for a while check online for a local running group. One of my favorite places away from home to run is Washington, DC. It's a really wonderful experience to cruise through the The Mall at dawn on foot and see so many historical places and enjoy the serene vistas along the Potomac.

Here are a few online resources of group running opportunities:

• Road Runners Club of America (National)
• Leukemia Society's Team In Training (TNT) (National)
• Inside Track Running Club (Ventura County)
• DC Road Runners Club (Washington, DC)
• Active.com (National list of nearly every major road and trail race)
• Trail Runner Magazine (National)
• Runner's World Magazine (National)
  

Bicycling

Well, since I'm still nursing a running injury (the dreaded plantar faciitis) I've been riding my road bike a lot. And, frankly it gets boring. By accident (serendipity really) I hooked up with the some local riders of the Channel Island Bicycle Club the other day on a group ride. By far, these are the friendly folks on two wheels that I have ever meant. No "Freds" or "Big Head Todds". They were inclusive, fun and they had some inspiring hill climbers in their group, too. Another way to find people to ride with is to check out a local bike shop. If they don't have shop rides they will certainly know about club rides, popular riding routes (road and/or trail) and should be a good resource for all things bike-related. I bolded "local bike shop" because the local bike shops can be a terrific resource. (Full disclosure: I used to be a sales representative for Diamondback Bicycles. There will always be a place in my heart for the local bike shop..:))

Here are a few online resources of group bicycling opportunities:

• Channel Islands Bicycle Club (Ventura County)
• Santa Barbara Bicycling Coalition (Santa Barbara County)
• Goleta Valley Cycling Club (Santa Barbara County)
• Inside Track Multisport (Ventura, mostly triathlon bikes)
• Avery's Open Air Bicycles (Ventura, mostly road, mountain, cruiser bikes)
• Hazard's Cyclesport (Santa Barbara)
• Active.com (National list of major bicycle fun rides, races, century rides)
• International Mountain Biking Association (National)
  

Well, that is it for now. There are so many great group workout resources that I haven't mentioned and I apologize. I haven't worked out yet today and I've been itching for a hilly road ride since before work. And, that was nine hours ago! Ugh....must get outside and workout now...

'Bye!

Diet, Health and Teeth from an Anthropological Perspective

And, now for something completely different: the interaction between one's diet and one's teeth from an anthropological perspective.

I became interested in the paleoarcheology of dental remains when my open water swim pal and dentist, who in addition to being an excellent open water swimmer, has an insatiable curiosity about almost anything and a particular talent for making just about anything seem interesting. In this case the topic on one pre-dawn swim morning at the beach was about why 3,000 year old Egyptian dental remains found in a commoners grave in Amarna, Egypt had such beautiful teeth. (He also teaches dentistry at UCLA and when fully awake I'm sure his lectures and funny stories must be even more engaging.) A few days later my open-water-swim-and-dental surgeon friend gave me a back issue of a dental magazine called Compendium with very anthropologically interesting headline on it's June 2009 cover: "Anthropology: Origins of Dental Crowding and Malocclusions"

According to the article dental anthropologists believe that there is a correlation between a modern or industrial diet of highly processed foods and malocclusions. (Malocclusion means "dental crowding with teeth out of alignment.") Consumption of a diet of processed high-calorie and low-fiber foods occurs with the transition from indigenous or non-industrial culture to an industrialized culture and diet. What is not so clear is why this is so: is it genetics or is it diet or is it a combination of both? Nearly two-thirds of American’s have some degree of dental crowding while indigenous peoples subsisting on their native diets seem to have nearly perfectly aligned teeth with almost no crowding (Rose 2009:292). The trend seems to hold for the majority of societies that consume an industrialized diet of mostly soft processed foods.

Traditional orthodontic textbooks attributed dental crowding to teratogens (agents causing birth defects), malnutrition, genetic disturbances or a genetic admixture of inherited genes and behaviors such as thumb sucking (Rose 2009: 294). But the hereditary cause of malocclusion proponed by the National Institute of Health doesn’t seem to be true (NIH 2009) according to the latest studies. The photos above are from IslandBraces.com via Google Images.

Compendium cites dental anthropological and archeological studies in its June 2009 issue that supports a connection between an industrial diet and dental crowding or malocclusion. The most common reason why people in the United States need orthodontic treatment seems to be a insufficient alveolar bone mass of the upper and lower jaw bones in order to hold thirty-two teeth in alignment. The latest research seems to indicate that this is due to insufficient chewing stress during childhood rather than to genetic causes as originally believed. The Masticatory Function Hypothesis promoted by Carlson and Van Gernven maintained that dietary changes initiated by the adoption of agriculture and food processing technology in the Nile Valley over the past 10,000 years have resulted in changes in the skull such as reduced jaw sizes (Rose 2009:296). “Carlson and Van Gerven argued most of the facial changes were not the result of genetic changes but caused by reduced chewing stress during development (Rose 2009: 296).”

The implications for orthodontic treatment is to treat dental crowding not with tooth extraction and orthodontics but rather with dentofacial orthopedics and orthodontics in order to increase alveolar bone growth during growth and development (Rose 2009: 297).

A prescription for straighter teeth may also be a diet of more tough and fibrous foods for young children while their jaws are still developing. The reason is that foods that require more mastication seem to stimulate more alveolar bone growth in the maxilliary and mandibular dental bridges in both cross-cultural cross-generation studies and in animal studies, too (Rose 2009:296).

Dental anthropologist Robert Corruccini gathered 20 years of research on the cross-cultural and generational differences in occlusial (alignment) anomalies and concluded that reduced chewing stress in childhood produced jaws that were too small for the teeth despite the ubiquitous trend in dental size and reduction since the advent of agriculture (Rose 2009:296). Corrucini reviewed several previously unpublished cross-cultural studies that showed a significant increase in malocclusion in younger generations who consumed a more refined commercial diet than that of their grandparents who consumed a traditional diet of coarser and more fibrous foods (Rose 2009: 296).

Diet has long been associated with dental health. Weston Price’s 1939 cross-cultural study of 11 human diets titled Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects were one of several early cross-cultural studies that pointed to traditional indigenous diets rather than inherited characteristics to be a greater contributing factor to general and dental health.

Robert Corrucini, a dental anthropologist, labeled malocclusion as a “disease of civilization (Rose 2009:299).” Once again, it seems that a Western or industrialized diet characterized by processed, low fiber, high fat, and high sugar foods may be to blame for another modern health malady besides diabetes, heart disease, cancer, obesity and so on: crooked teeth.

….

Resources

National Institute of Health
2009, “Malocclusion of Teeth”, United States National Institute of Health, retrieved on September 7, 2009, from http://www.nlm.nih.gov/medlineplus/ency/article/001058.htm#Causes,%20incidence,%20and%20risk%20factors

Price, Weston A.
1939 Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects, La Mesa, CA: Price-Pottenger Nutrition Foundation, Pp. 524.

Rose, Jerome C. and Richard D. Roblee
2009 “Origins of Dental Crowding and Malocclusions: An Anthropological Perspective,” Compendium of Continuing Education in Dentistry, June 2009, vol. 30., No.5., Pp. 292-300.

Wellsphere
2009, “Nutrition and physical Degeneration,” WellSphere, retrieved on September 7, 2009, from http://www.wellsphere.com/general-medicine-article/nutrition-and-physical-degeneration/22844

Dealing with plantar faciitis: an update--Post Doctor Visit

After six weeks of not running and following several recommendations to the "T" and still no progress on regaining a pain-free left foot, I finally went to a medical specialist this morning for my nagging case of plantar faciitis-- a common running injury that is hard to treat successfully. The graphic to the left that I got from the AAOS web site shows it's location.

I've been suffering from a worsening case of plantar faciitis on my left foot and a secondary injury of hip bursitas on my right side (which since has subsided since I stopped running about 2 months ago) and intermittent lower-back pain (sacrum area), since December 2008.

The injuries seemed to correlate with a sudden-I'm-so-dumb-to-do-this jump in running miles (more than 10% increase each week) and writing a research paper on the foodways of triathletes and runners for an anthropology class. My days in December were sleep-deprived generally and usually involved long hours of sitting at my computer, sitting in my car on the 101 Freeway or in class followed by a long Saturday road run with the gazelle-like Inside Track Running Club ultra and marathon runners. ("Who needs to gradually increase their mileage to train for a marathon? Not me!") Nine months is long time for me to be nursing an injury. Lately, I've been doing more mileage writing and reading about running, than actually doing it. I've been a runner who can't run.

Since I forgot to ask the good doctor's permission to blab about his advice to me online, his identity won't be revealed. However, I'm confident he knows what he is talking about. He's an orthopedic surgeon who specializes in the foot and ankle, is athletic himself (runs and surfs) and has been treating foot injuries for twenty-five years. Finally, two of my doctor-swimmer friends recommended him.

After the doctor reviewed my gait and stance, an x-ray of my foot, and the wear pattern on my old NB 1224 running shoes, according to him, I had no obvious mechanical problems with my gait. Both feet have good flexibility and perform well. I just have a very painful heal (pain located at the mid-point/center and front area on the sole). And, I have tight soleus muscles. Apparently tight calves strain the plantar facia & Achilles tendons by deprecating my gait efficiency which puts additional weight and pressure on the arch/heal area with each step.

Here are his recommendations (as I understood them) to treat my plantar faciitis:

1. Wear a foam heal-lift in my shoes to remove the constant strain on my plantar facia & Achilles tendon's attachment on the calcaneous (heal bone)

2. Stretch my soleus muscle (muscle below the gastronemius that is just above the heal) with a wall stretching technique three times a day; Web pages that show how to do the stretches properly are at SportsInjuryClinic.net and at the AAOS web site.

3. Use ice on my heal/arch for pain management within 30 minutes after an activity inflames it; massage with ice is okay if done gently

4. Lay off strength training for a while: it's too soon for me to engage in heal lifts or heal dips or walking around barefoot if the heal hurts or hurts afterwards; As the doctor said, "If it hurts, don't do it!"

5. No running of any kind until the pain/inflammation subsides; That means no barefoot walking or running and no up hill, forefoot, or beach walking or running for a few weeks

6. Go for a walk on flat ground with supportive shoes (Brooks T5 with Superfeet insoles & foam heal lifts or NB 1225 with Superfeet insoles and foam heal lift) for a mile; then progress to a 1/2 mile walk, 1/2 mile jog (no faster than 8 or 9mpm for jogging intervals); and work up the mileage if there is no pain (If there is pain, back off and go back to walking)

7. When I can run again, practice a mid-foot running style with a shorter stride and feet landing underneath my center of gravity--not in front of me, landing lightly on my mid-foot before rolling off. For more information about improving one's efficiency through running mechanics check out RunningTimes.com for a mid-foot running article that covers the many current running biomechanic trends and philosophies such as Chi Running, Evolution Running, Dr. Ramanov's Pose Technique, barefoot running, etc. I got this from Clynton at Running Quest.net. He posts informative articles on running and diet with cited sources, too.

8. Continue using the night splint; stretch the calf muscles before getting out of bed each morning

9. Cross-train (continue swimming, weight training & riding my bike to keep up my cardio)

10. Gentle self-massage of heal and facia of arch on the foot every day followed by ice only if needed for pain and inflammation; As the doctor told me, "Ice doesn't help this injury."

Even though I wasn't running earlier this summer my heal pain kept hurting while I was doing my six-week Born to Run- and Advice-from-Friends- inspired "Everything But the Kitchen Sink" and two-week "Kitchen Sink" Plantar Faciitis Treatment Program. According to the doctor, I kept straining my arch/heal facia by strength training too early (calf raises and dips, lunges and walking barefoot around the house and beach). These failed treatment programs culminated with two desperate (but enjoyable) barefoot jogs on the beach. Severe pain was the result of the final beach runs. It was only nagging pain before.

If this new treatment plan doesn't help then the doctor will consider putting my injured foot in a cast for 4 weeks to take the pressure off my Achilles/heal or plantar facia. That means I can't do my dawn open water swims, though. And the thought of riding a stationary bike to keep up my cardio really isn't appealing. I hope it doesn't come to that.

My doctor didn't talk about the barefoot running nor of the forefoot running discourse in the running community. That may be because either he was unfamiliar with the trend of training this way with barefoot-in-the-grass running drills and strength training. Or, it may have been because he ran out of time for my appointment. He emphasized only that the calf muscles of one's leg drives and supports one's foot. This is a paradigm shift for me: my calves are a part of of my feet. To fix my feet I must first fix my calves by frequent (at least 2x/day) stretching of my soleus muscles done with correct form.

For now I'm wearing my $8 foam heal lifts from Ventura Orthopedic in my lightweight and flexible Brooks T5 running shoes, $70-ish (it was last year's model on sale), I bought at Inside Track with my $35 Superfeet insoles (green ones for high arches) that I also picked up at Inside Track. My left foot aches a bit today. But is probably from yesterday's painful one mile forefoot running experiment on the treadmill. And, playing with the kids in the water at the beach yesterday--barefoot of course.

Thank you so much to those who have left me informative comments & encouragement!

Dealing with plantar faciitis: an update

After six weeks of following my Everything-but-the-kitchen sink Plantar Faciitis Treatment Plan my foot still hurts.

This is a real bummer.

Briefly, my six week Everything-but-the-kitchen sink Plantar Faciitis Treatment Plan was:

• Ice pack treatment 2x/day (no longer than 10 minutes each per my doctor friend)
• Ibuprofen when there's arch/heel pain/inflammation (per my retired PT friend)
• Wearing shoes with arch supports such as SuperFeet all the time--even at the beach
• Calf strengthening exercises: positive heal rises 3 sets of 20 and negative (off a step) to exhaustion, for each leg every other day
• Stretching my calves, hamstrings, glutes--everyday
• Cross-training everyday by either swimming, road cycling, or 30 minutes on the elliptical machine with weight training of my upper body everyday
• Survive a pain and straight-talk session once a month with my gifted and no-nonsense Rolfer who keeps repeating "Don't run for two months!"
• Wearing a night splint (which keeps my arch stretched while sleeping), etc.
• Complain about it and my inability to do my favorite athlete past time ever: run

So, six weeks later, my heal wasn't hurting at all and I found myself with an hour to myself on Santa Cruz Island at the bottom of my very favorite running trail that meandered to the top of the bluffs. This beautiful trail gives a 360 degree view of the island's windswept hills, sea lion and seabird nesting areas on the rocks below, it's still native chapparel-covered peaks, and a soaring view of the mainland across the Santa Barbara Channel and open ocean with seagulls and pelicans flying by.

I jogged up the hill.

Thirty-five minutes later back at the bottom of the trail, my heal hurt. A lot. Damn.

The soreness went away a few days later so when I found myself at Moonlight Beach, site of my very first full triathlon (Bud Light Series, Olympic Distance, 1988) I thought that a barefoot run on the hard packed sand might be good for it.

I was wrong. After thirty minutes of trying to jog like a Kenyan or Tarahumara (landing on the forefoot, heals flicking up and faster turnover), my heal hurt. A lot. Again.

Damn.

Okay, so here's my new Kitchen Sink Plantar Faciitis Treatment Plan:

• See an orthopedic surgeon who specializes in feet, has been recommended by a former patient or medical doctor and who is athletic; the appointment is tomorrow and I'm anticipating it with both hope and fear (What if he can't do anything for me or recommends expensive options such as custom-made insoles that don't work?)
• Ice pack treatment 2x/day (longer than 10 minutes each per myself)
• Take two Advil when there's arch/heel pain/inflammation
• Wear my new Brooks T5 Racing Flats (last year's model to this year's "T6" that I got on sale) with the disco shoelaces with a pair of SuperFeet high arch (green) insoles when I'm not icing my feet, showering, swimming, riding my bike or dreaming.
• Do calf strengthening exercises every other day (positive heal rises 3 sets of 20 and negative (off a step) to exhaustion, for each leg)
• Stretch everyday (calves, hamstrings, quads, glutes, lowerback)
• Cross-train everyday (Swim, bike or do 30 minutes on the elliptical machine with some free weight training of my upper body)
• Wear a night splint (which keeps my arch stretched while sleeping)
• Avoid wearing flip-flops, shoes with no arch support or walking barefoot whenever possible
• Tweet about my Plantar Faciitis woes on Twitter in hopes that some one can offer me some good advice, encouragement or at the very least, commiserate (misery loves company)
  

Since I've been complaining about my running injury on Twitter, a lot of people have kindly shared advise or words of encouragement. So many people have tweeted me that I am really feeling good right now. My heal still hurts but everything feels great. Especially my heart.

Here's some of the Tweets I've received about treating Plantar Faciitis or offering encouragement:

"@Superfeet@multisportmama Hoping you get some relief – if we can be of any help, please let us know! 1.888.355.3338"

"@RaceSpeed@multisportmama Let me know what you find with your PF. Swimming seems to be good. Enjoy."

"@trijd@multisportmama Hope you get rid of it soon."

"How is the foot? Been able to do any BF running? Would love your thoughts on new post http://bit.ly/HPlxg" (Direct Message)

"@RaceSpeed@multisportmama Be careful with this type of injury. Here is a link to wikipedia write-up http://bit.ly/UnMD They say time is best cure."

"@RaceSpeed@multisportmama At bottom of this article is more links to exercises that help RT @faceurfears: Top 10 Sports Injuries - http://shar.es/qxtU"

"Thanks for the follow. Have you tried Active Release Therapy on your calves for your Plantar Faciitis? Worked instant wonders for my wife." (Direct Message)

"@kchealy@multisportmama you're welcome. I hope your PF resolves soon...it's a pesky injury!"

"@RaceSpeed@multisportmama Two points, bear with me. 1) If going on for 6 weeks without running, I worry and definitely worth Drs visit."

"@RaceSpeed@multisportmama 2nd point, I found video claims good for all foot related weakness injuries. http://bit.ly/15Srde Worth a look at."

"@kchealy@multisportmama the thing that helped me with PF was massage. Very painful but effective."

"@boulderrunner@multisportmama in my experience it [visit to a podiatrist] can be [a waste of money]. They love custom footbeds. Don't underestimate rolling on a golf ball and rest"

"@michaelsally@multisportmama well, depends on the dr. Most traditional drs like drugs or the cut & burn approach. Neither solve the cause."

"@runnrgrl@multisportmama pf sucks. Are you getting orthotics. After 3 mths of finetuning, mine helped! Still no more pf since-2 yrs of relief so far"

"@donna_de@multisportmama I'm reading Chi Running on the same topic [barefoot running]!"

"@ajrizza@multisportmama I see runners all time with PF we do foot and ankle exercises, EPAT (check out link) and Orthotics from Foot Management ..."

"@wildcelticrose@multisportmama the story of the accident-shows that an athlete can overcome anything http://wildcelticrose.net/l..."

"@the17thman@multisportmama @FootPursuita You should try Aqua Aerobics http://bit.ly/eldVE"

"@behindtherabbit@multisportmama thinking a lot about adopting 'less shoe is better' - slowly, to avoid injury. starting with light trainers, then mayB VFFs?"

"@dnorton@multisportmama I will go out on a limb to say a little barefoot running may actually help your PT. It has with mine... YMMV."

"@bmolloy@multisportmama I had PF last year for the first time and it took 3 months to be gone completely. heat moldable orthotics were my cure."

"@RunningQuest@multisportmama That's great! Remember to take it slow, to give yr muscles time to awaken. Good news is they do so pretty quickly."

"@healthyashley@multisportmama I'm sorry about the news (and pain!)... Good luck with your alternative exercises! Can you bike?"

"@turtlescanrun@multisportmama I guess you are with us on that list...It is so hard sometimes..I'm always injured or recovering lately :S"

"@ultrarunnergirl@multisportmama best advice 4 PF i know: keep supportive shoes on all the time, never go barefoot, esp getting up in a.m. or @ nite 2 pee."

"@DCrunnergrrl@multisportmama I know how you feel! Contemplating one of my 1st runs "back" tonite, and trying to make sure I don't jump the gun. So hard!"

"@ncjack@multisportmama awesome! How's the PF??"

"@misb@multisportmama how's the PF? Hope it's settling down! Orthotics, ART, & the night splint cured my chronic case."

"@misb@multisportmama it's Active Release Technique http://bit.ly/7xB4V & http://bit.ly/ZVzis ; really helps with soft tissue/fascia issues"

"@chicrunner@multisportmama gosh! get better soon. I am stretching as I type ha ha :)"

"@IronmanLongRunr@multisportmama I say tape it strong and give her a go"

Thank you everyone. Just knowing that there are people out there (fellow runners, parents, triathletes, non-athletes--people) who care enough to take a minute to Tweet me a word of encouragement or healing advice for my plantar faciitis really rocks.

It makes me feel better.

:) A