Thursday, September 8, 2011

Achilles' heal

At last, I've turned the corner with my Achilles' tendinosis injury. Or at least I think I've turned the corner. Though at first it seemed minor, this injury surprised me with a continual nagging that has left me less active than during those two months I suffered, half bedridden, through Valley Fever three years ago. But persistence is a common characteristic of tendon injuries.

Generally, when sick or injured, I try to adopt as a mindset the Stockdale Paradox: to continue believing in the happy ending without putting any deadlines on its arrival. For me, this is tough to do. Weeks ago, just after I admitted I was hurt and needed to take time off, I did what impatient analytical types are apt to do and I scrutinized my heel for change and extrapolated. It's feeling better three days straight, I would say. I might be running again by next weekend, only for that weekend to come and go and for my heel to have regressed. It's as though the brunt of healing doesn't happen until I've submitted to the injury and become prepared to do whatever it tells me—which of course means sitting out longer than expected, another reference to Hofstadter's Law.

Also, as far as tendinosis goes, Medicine is in the dark about diagnosis and treatment. Two years ago I hurt my knees during my California bike trip. It wasn't a serious injury—just a little pain and tenderness while riding, no doubt from overuse. The next day after returning to Phoenix I began taking ibuprofen for anti-inflammation. That week I resumed my normal level of activity, including commuting to work sixteen miles round-trip each day. I took the ibuprofen for about a week, and my knees healed fine, no problem.

Compare that to my current injury. While in New York, after a run, my Achilles' tendon began to hurt. It wasn't a serious injury—just a little pain and tenderness while running, no doubt from overuse. A few days later, after having returned to Phoenix, I began taking ibuprofen, and I resumed my normal level of activity. After nearly two weeks, my heel was much worse. I could no longer run or ride with my usual intensity.

I'm about 80% confident both injuries are tendinosis: both entailed isolated pain near joints following strenuous bouts of activity. Websites about tendinosis tend to agree that tendinosis is degeneration, not inflammation, and that anti-inflammatory medicine likely has an adverse effect on the tendons' ability to heal. But my (admittedly non-scientific) experience has been that anti-inflammatory medicine does help, though only when the injury is minor. (When the injury is major, the medicine only masks the pain and allows the sufferer to continue inflicting further damage.) I stopped taking ibuprofen for my heel after those two weeks, and along with resting my heel it began improving immediately. But recently that progress stalled, so I took ibuprofen again, for two days, after which my heel felt noticeably better. Small sample size, anecdotal evidence, no controls…am I refusing to admit I know nothing about these injuries?

2 comments:

Unknown said...

Honestly, Craig, I think Ib, Ice, elevation, they are like the steering wheel on a child's driving toy. They give you some knobs to turn that make you feel like you're doing good. But that's all they do.
Glad to hear you're on the mend, though. Someone needs to race Becca in January.

Craig Brandenburg said...

Chad— I suspect you're right. There's no substitute for rest. As for racing Becca…we'll see.