Its been a couple of weeks since my last visit with Jeremy. So today was the follow-up and the last in our series of appointments. We sat down for most of it and talked through how things were going. 2 issues with totally different outcomes so I will break them up.
Basically, its back. But just when I run. I can run virtually pain free on it now. The tibialis posterior tendinitis in under control. If I would have just kept on going without this intervention, I could have done some real damage. Its by no means 100% yet. I still have the small wedge in the shoe and will continue to wear it for about 6 months. I am working on my mechanics daily which is the source of the evil. The pain is shifting upwards along the tendon and I mainly feel it when at rest. Like while sitting at work when I can be quiet and listen to it. I will continue a variety of the exercises that were prescribed as well. Now that I believe I have stopped injuring it, its healing. By summer, it should be 100% and stronger than ever.
However, over the past few weeks, I have lost serious dorsiflexion in my ankle on the right side. Feels like its all tight with scar tissue and wants to pop. Jeremy measured me down at 10-15 degrees of flexibility on it today. 15 is like the bare minimum. He did a few chiropractic manipulations on it that loosened it up. When he remeasured, I was up to 20-25 degrees. Good news. So I likely need to build that treatment into my monthly battery of maintenance. This will likely move me to seeing Jeremy for all my chiropractic needs in the future because he can better deal with the overuse injuries I have.
The hip flexor has remained about the same but slightly better. Its not a very vascular tendon (not a lot of blood flow) so its a slow beast to repair. We believe much of it stemmed from the ankle so as that unwinds itself, the hip will have less burden and can heal itself. The bad news is that its taking a long time. I am doing the exercises and icing but its a tough tendon to do much more for. Given I struggled with this for all of last fall and it continues to be present, we are going to step things up. Now, I can run pain free in the hip for up to about 2 hours right now but that’s at slow/steady paces and not on hills. Any interesting divergence from that and that hip will flare up. I feel it. Plus, it just aches during the day at work while I sit.
So we strategized based on training and race schedules and I am going to pursue the cortisone injection. Its going to be done via a procedure involving ultrasound. This will allow the doctor to get a good look at the area and inject the shot right into the bursa directly. The rate of success is higher in this case but its a more expensive procedure. If insurance deals, I should be covered for it all. Prior to the injection, he will be able to visually inspect the area and be sure that the diagnosis matches the visualization.
What’s the downside? Well, the tendon will atrophy from the shot by about 10%. Given I have lost some unknown percentage of strength in it, this will further decrease its functioning. However, without the inflammation and pain, it will be able to happily participate in rebuilding its function and will likely come back stronger than the 10% I lose in the procedure plus the damage incurred prior.
This procedure needs to be done prior to my training ramp up so I will be scheduling this shortly.