Plantar Fasciitis and Strength Training

First, an overdue update and summary about the whole plantar fasciitis (PF) thing:

I have been doing triathlons (all distances) throughout the last 6 years, injury-free (apart from MCL tears that were just bad luck).

Then this summer, I got plantar fasciitis.
So, I'm asking myself - what could be the cause(s) and what can I do to treat it?
There is the whole range of advices and experiences out there, both online and amongst physical therapists (and people suffering from PF).

For me, after a break from running between january-march this year (due to a MCL-I sprain) I focused on speed runs and interval training, while at the same time starting heavy weight training (5x5 program), and preparing for a halfironman in july.
I also hiked/trained with a backpack between 20-25lbs in the woods (wearing running shoes).

I had to drop the halfironman due to poor mental health (mental overload).
And I recognized I had to reduce my training accordingly.
I focused more on unstructured activities like hiking and running up my favorite mountain top.

I got on a group hiking trip/pilegrimage in august, with a backpack around 20lbs, doing appr 10miles a day in rough mountain terrain.
My boots were well used, but I forgot to use my soft innsoles, so my feet started to hurt.
They didn't stop hurting during those five days.

Well back home, esp.my right heel hurt, but I'm kind of use to an aching body, so I just took it easy, no running.
Soft shoes - no more boots!
Hiking in running shoes with a super light backpack.
But on the last mountain trip I almost didn't make it down the mountain due to the sharp pain in my right foot.
To compensate, I put most of my bodyweight on my left foot/knee more, resulting in pain in my left lateral meniscus.

I got home in the end by walking backwards through the woods.
That's when I called a friend who is a physical therapist (after I got so many results by googling "heel pain" which I thought sounded innocent).

PF confirmed at my GP, and by ultrasound.

---> so, what now?


There are probably thousands of advices out there, millions of people (literally, yes) are suffering from plantar fasciitis, and some of them blog about it.

It's not always encouraging reading.

And I kind of miss the "scientific" approach of it.
I mean, the plantar fascia is more like a ligament, joining bones in the foot together to form the foot arch and support it.

There is almost no flexibility in the fascia, and there shouldn't be, so why would I try to stretch it, why are there so many recommendations about stretching the fascia?

There has been good results from stretching the fascia compared to stretching the achilles tendon (sorry I forgot what article that was), but there was no controll group, so who knows what the cause of improvement was?
The stretching, or the enhanced blood flow to the fascia caused by stretching and handling the foot, thus helping tissue healing?

Anyway, I stumbled upon an article published this fall (2014) about weight training in the treatment of PF.
While there is no clear evidence (I guess there never will be anyway, for PF is way too complicated and individual to make sense out of structured studies) there was at least a positive outcome at some point of the course.

I like the approach of strengthening, I can hardly understand how a structure in the body should heal merely by stretching, without strengthening or any other treatment enhancing his function.

This is just a rather long note, mostly written to remind myself of the topic, and that I want to do more reseach on the topic.
And, implement some strengthening routines so my feet get stronger, my calves get stronger, and my fascia thus maybe get more support from the surrounded muscles so it can heel properly without being overloaded every time my feet hit the ground.


If you're really interested and want to do some further reading on the topic, I can strongly recommend Chad's Physical Therapy Blog:

Screenshot from Chad's Physical Therapy Blog. Worth a visit!

You will find the article I was refering to here: "Strength Better Than Stretch for Plantar Fasciitis".

So much for now.
Have a great weekend and get well soon, you PF sufferers out there!

I love weight training!

I think it's about time to admit it:
I love weight training!

That is, I love lifting weights.
Resistance training, that is, replacing dumbbells and bars with other types of resistance provided by tubes or cables or simply ones own bodyweight is fun, too.
But I really enjoy lifting heavy weights.

 A memory to my "first" and unexpected PB in deadlift: 75kg (165 lbs)

It hasn't always been like this.

Frustration Friday

I cannot not blog just because I don't feel good.
Isn't the ups and downs of life what makes life what it is?

Anyway, I had a little episode that made me frustrated.
And even more, beyond frustration there was sadness, disbelief, mental exhaustion and finally, even dispair.
Yes, dispair.

Speed Skills.

I'm still doing base work.
That is, triathlon base training, in order to get my endurance as good as possible, and improve my basic skills.
I'm also  trying to work on my weaknesses, although it's not that easy to find out what those are.

Joe Friel suggests to compare oneself with the other participants in an age group to see where you are fastest and slowest.
I think my weakness is definitely the bike part.
My strong side is the swim.
And I'm doing ok on the run, at least on the run part in triathlons.

But what I think is one of my abilities that need most improvement is force and muscular endurance, both on the bike and on the run.

I love my bike, I'm just not that fast on it :D

At the same time as I'm trying to improve those two, I'm also trying not to stress my feet to much, and take my plantar fasciitis into account. That is, the PF is almost gone. I'm actually synptom-free, at least really pain-free!

But I have to be careful not to do too much running, not to increase weekly mileage too fast, and do lots of variation in my running training.
What I want to do, is increase my running workout frequency, that is, three times a week running really short distances (below 6-7km) or low duration (less then an hour), on variable surfaces (trail is more forgiving then the road), maybe even do only running skills instead of pure running, or do just two workouts of slightly longer duration.

But I still think that I'd benefit from running more often, at least if I can keep the intensity and duration low, and the quality high.

So - Joe Friel also tells us to avoid "big gaps with days of no training for any of the three sports".

Well - as for swimming I'm not concerned, I can swim fast enough and still have a good race experience with only a swim workout a week.
As for cycling, I have those frequent short bouts of hill training almost each day, when biking home. Even though the hill back home lasts for "only" 10min or so, it is quite steep, and when I have been shopping, my bike is quite heavy, so there is almost never two days in a row where I haven't been on a bike seat!

But - running is a totally different story.
When I trained for long-distance triathlons and marathons before that, my ideal workout frequency was three times a week.
A short run, a medium short run at a slightly faster pace, and long rather slow run.

Now, having had plantar fasciitis I kind of fear running more than twice a week, but that might actually be exactly what I need: small bouts of running, or running skill sessions, running-related strength training or drills, or short-lasting trail runs around 4-5km together with Lukas, with plenty of stops to breathe out, stretch, monitor my feet, and enjoy.

Today I was kind of wondering what to do.
I definitely want to do strength training in the late afternoon, but I haven't been running since sunday, meaning I haven't been running for wole three days.

After hiking/running 14km on sunday (that is, walking most of the distance with short jogs of maybe 5km together) I felt the need to stay off my feet on monday.
Strength training was great to do, and walking Lukas in the woods while finding blueberries was great recovery as well.

Tuesday I had an hour's appointment at my doctor, which wore me out mentally, and since I had a slight touch of strange sensation in my left thigh muscle, I skipped the run that day. Although I was motivated, and the weather was great.
After my deadlift PB the day before I definitely felt my legs could need an extra day of recovery.

Wednesday came with beautiful weather and trouble with decision-making - I felt both like cycling and swimming and running altogether.
But - I haven't been swimming much this year, and since my new wetsuit makes swimming so much more fun, I definitely wanted to swim.

My Zoot 3.0 - inside out - ready for swimming!

So I packed my wetsuit and swim stuff and took my bike and cycled to Telnes to swim. Since I also felt for a bike workout, it was the perfect distance of 15km, a great warm-up for the swim and some small but steep hills to work a bit on my force skills (big gear up the hill, and easy pedaling the rest of it).

A bit tired after the bike, but still ready to swim.

The swim was great, and it was interesting to have measured my swim pace with the GPS on my cell phone tucked into the back inside my wetsuit. Luckily it didn't drown since I had done a good job of covering it in plastic and tape. But the GPS reading was rather weird... although I of course would loved to have pace of 12min/1km for sure. But believe me, I don't, and I didn't downstream in a river either, so the readings were really far off!

About half an hour of swimming pluss the one hour of biking made a fun and solid bike&swim workout.
I must admit I felt tired when I woke up today, but then I had woken up and laid awake from a nightmare, so I guess it wasn't what I'd call a good night's sleep.

So...what today?
The plan suggests strength training and running.
But we have such great warm weather and sunshine today, that I rather want to do anything else thana training inside. I could have taken an "early" morning run together with Lukas (my early morning runs start at 10am) and then go lifting weights at 4pm, but I really was drained when I woke up.

And I don't want to skip strength training since this is what I benefit from the most these days. I need more strength, to work both on my muscular endurance and sports-specific force.

So - strength training it is.
And - before that - running skills, since it is already three days since my last running workout.
I asked Joe Friel's advice again, finding a suggestion on page 86 in "Your Best Triathlon":
Strides drill.

Strides.

That is something I can do on the treadmill before lifting weights.
I could also do that outside, I'm really not sure yet what to choose.
I guess the treadmill is more time-efficient, since I'm going to the gym anyway today.

Friel is mentioning that he has his triathletes do this drill called "strides" almost every week in the Base period, so I guess it's the kind of workout I could do more frequently as well.

The workout set-up is as following:
Warm-up 10-15min, and then the SS set: 6-8 x 20 sec at a fairly fast pace, but not as fast as possible. Focus is on landing flat-footed with the knee slightly bent if doing on a slight downhill (as suggested), and counting and increasing the cadence.
The goal for cadence is 90-96, that is, 30-32 right-foot strikes pr interval (20secs).

I'm going to do that.
Actually the workout should be done on  a slightly downhill, and the distance covered be marked and tried to increase. But  - we'll see about that.
Since it's been a long time I've worked on my running cadence, I'll just focus on the cadence and not the length of the stride.

So - plan is made for today. At last!

Strides.

I'm still doing base work.
That is, triathlon base training, in order to get my endurance as good as possible, and improve my basic skills.
I'm also  trying to work on my weaknesses, although it's not that easy to find out what those are.

Joe Friel suggests to compare oneself with the other participants in an age group to see where you are fastest and slowest.
I think my weakness is definitely the bike part.
My strong side is the swim.
And I'm doing ok on the run, at least on the run part in triathlons.

But what I think is one of my abilities that need most improvement is force and muscular endurance, both on the bike and on the run.

I love my bike, I'm just not that fast on it :D

At the same time as I'm trying to improve those two, I'm also trying not to stress my feet to much, and take my plantar fasciitis into account. That is, the PF is almost gone. I'm actually synptom-free, at least really pain-free!

On the road again.

Dry roads. Blue sky. Sunshine. Very little trafic. Only a slight breeze.
Perfect conditions for a bike ride.
The month?
March.
The temperature? 5C or so?
Motivation to go outside and ride? B-I-G!

It's all about dressing right when out on the bike in the winter.
Which I did. Not too fancy maybe, with my super warm Keen boots and skiing mittens, but they kept me warm.

Our lake is so beautiful and I never get tired of the view.

Well it's only early march, not much green yet, but lots of blue!
At Sanden Camping, I had to take a stop.
There is that little beach with those round, smooth stones and the water with the color like honey.

The weather was so beautiful that I even got out of the house at 10.00 a.m., and that is early for me!!
But I really enjoyed it.
I would never gotten out for a run that "early", I'm definitively more of an evening athlete.
But to go on a bike ride in the sunshine in the morning is not too bad.

I might not look as happy as I was, but I really enjoyed it! 

I tried to keep my heartrate low, which is not east since it's a really rolling or even hilly bike ride along the lake. But that's ok. Just took it easy on the way up the hills, and enoyed the ride down!

This spring my focus is on long low intensity bike rides and speed skills.
Since this bike ride was supposed to be easy, I allowed myself to stop at the camping and relax for a few minutes. Skorve mountain with the fresh white snow was a beautiful view.Very soothing!

I can take a break if I want! 

I was glad I chose my Keen winter boots instead of bike shoes. Even with overshoes, I find proper bike shoes way too cold to ride in the winter.
My Keen boots on the other hands are both warm and comfy, and they have plenty of space for two pair of wool socks, and place to wiggle my toes.
They are long, going up on my legs, but are soft around the ancles and don't impair proper ancle movement - important for a round leg turnover on the bike.
I wasn't really aerodynamic that day, clothing-wise:

• my good old SWIX skiing pants (wind-proof in front, and more flexible and breathable in the back)
• alpine mittens
• Hi-viz vest for extra windproofing on the upper body and extra visibility 
• my KEEN boots
• cycling jacket from Gore Bikewear (ok, one piece of slightly aerodynamic and proper bike clothing, I just love that jacket)

And, of course, wool underwear because there is nothing better than merino wool underwear in the winter (or any season really).
And a bandana - a real a super garment. A piece of clothing that I can hardly do without.

I love the lake and the view! 

The roads were dry and almost free from stones, but terribly dusty so I chose my mountainbike. My tribike is still really hard to get outside unless it's summertime - it's a bit spoiled so it'll stay on the indoor trainer for a few more weeks.

My Hardrocx has become a true friend.

Mountain biking is a lot of fun, so I've decided that since I won't be able to do triathlons this year due to plantar fasciitis, I'll do a mountain bike race!
I actually have never done one before!
I have participated in two or three sprint triathlons with my former mountainbike, but never in a proper bike ride.
So that's exciting!
And I love my Hardrocx bike. Just love it.

So let's hope for more sunshiny days so I can get my bike outside and ride! :)