Monday, March 12, 2018

Recovering from a sesamoid stress fracture

I've continued ramping up mileage and intensity, moving from 4h to now 6h30, including sprint intervals and hills - and the foot is still "holding", meaning that while I can still feel the occasional tension and weird soreness, there is nothing that prevents me from running and, most importantly, it is all decreasing in duration and intensity, even as I ramp up my running. So while I certainly won't cry victory yet, I think I can put down what I've been doing in the past months to help recover from the sesamoid injury, in case someone else finds themself in the same situation:

- specifically designed orthopedic sole: if nothing else, definitely this! I waited too long.
- rest: it is definitely worth waiting more than less before resuming running; at least six weeks, probably two months, with even minimal walking - and always with the special soles.
- cross-training: to keep up fitness, definitely get into doing 10-20mn of high-intensity aqua-jogging intervals - obviously keeps the heart pumping but also surprising trains the leg muscles; high-intensity rowing; low-intensity bike for endurance to replace long runs (if you do too high intensity, you risk putting pressure on the sesamoid); and strength training (watch out for lunges though!)
- nutrition: magnesium, calcium with vitamin D, vitamin K, and natural acerola vitamin C/ascobic acid; omega 3; and prefer alkaline foods as less inflammatory
- anti-inflammatories, occasionally: for several weeks as i eased back into running, i would take one tablet 2-3 times a week in the evening after a higher intensity session that made me feel the foot.
ice:  definitely try and ice in the evening on every day that you run when you first ease back into it, and of course as necessary.
- return to training: very gradually; go at an easy pace at first - 30mn then adding about 10mn each time, but allowing two full days rest between sessions (i.e. monday, then thursday); if and when you add intensity, make it first longer tempo sessions, then long intervals (1 mile, 1k, 800m) then shorter (400m) and only then go for hills and 30-45" sprints. Even if you are used to high mileage, I found it best to follow the 10-15% rule and back off after 3 weeks. It goes slowly at first, but once you hit 4 hours, it starts to increase noticeably. Just better to really take the time. First time around, i increased too quickly and had to stop for 10 days.
- what pain is ok pain: obviously that's a personal one, so again I can only give the guidelines i've followed, based on what the podiatrist told me after examining me:
    * if i could press on the big toe bone and just behind it, and there was no sharp pain, and it didn't really feel that much different from the other, healthy foot, then it's probably just tension in the tendons and muscles that are being newly sollicited.
    * if it didn't hurt during the run, or only as a distant bother, and in any case didn't get worse, then I would soldier on, perhaps shortening the planned run a little - or avoiding any interval work.

Hope this helps...

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