Tuesday, 28 June 2011

First tentative steps

More Ronnie Corbett than Paul Bunyan, but on the back of yesterday's advice (on and off line) I took the first steps to getting back on track yesterday:

  1. I weighed myself (13st 7.4lb as opposed to 11st 9lb at the start of April)
  2. I entered all my food/drink onto WLR
  3. I maintained the appropriate deficit
  4. I didn't eat any crap
  5. Sue got me some new shorts (thirty frickin' four waist and thirty frickin' two quid)
  6. I made sure I had lots to drink through the day
  7. I sent an email to the physio asking for an appointment
On the last point I'm 99% certain of what I have, what the treatment is and what the possible prognosis is but I want some advice on the when and what to do running wise. For example, based on the severity I think I have/had Noakes says achillies tendonosis needs an initial 3 weeks rest but I've had 2 weeks and in the last week there's been little improvement so do I still run at 3 weeks? If so how far? In what conditions should I bail out? Am I really rating the severity accurately? I suppose I'm after a framework for the what and when of treatment and hopefully recovery.

Saturday, 18 June 2011

Not so much wallowing as drowning

Thanks for all the responses to my last post - really appreciated the thought behind them and flattered that my ramblings were of interest.

I haven't posted since, partly as I've been really busy and partly because I've had little to post about. I've also hardly commented on other people's blogs since either - apologies for that too.

I did start a post entitled 'Injuries Don't Negotiate' but it didn't get past draft stage and I've cannibalised it for this entry, which is part update and part (hopefully) cathartic heart pouring.

I got Tim Noakes's excellent book 'Lore of Running' a couple of years ago. Its a mighty tome of close to 1000 pages and can be pretty scientific and heavy going too but as a reference source to dip in and out of it really is excellent. I wish I'd referred to it a few weeks ago.

Based on Noakes's comprehensive guidance on achilles injury and the other research I have done on line I'm certain that I have a mild case of plantar fasciitis that resulted from sudden weight gain along with with achilles tendonisis on the left. The former has settled down almost completely (at least when not running) but the latter is a fairly big problem; with recuperation still very much a work in progress.

Taking Noakes's description on board it looks like the causes were:

  1. Age - Its a degenerative condition not uncommon in middle aged male runners. There's a cheery thought.
  2. Wearing stiff soled shoes with very low heels - My post marathon running was done almost exclusively in new Saucony minimalist shoes. The heel height is extremely low and there's not much flexibility in the soles. Might be coincidence but the injury came on after switching to these shoes. Might have been wise to have transitioned to them as the pre marathon running was done in far more built up Nike Lunar Eclipse and (for tempo and speed work) Newton Sir Isaacs.
  3. Sudden single long run - Noakes states this as a common trigger and I can only remember the pain being notable after the 16.5 mile run I did a few weeks ago. That run was notably longer than anything I'd done since Paris so, again, sems quite a coincidence if it wasn't the trigger.
In summary: looks like the underlying problem is age related degeneration (cue more cheery thoughts), with possible aggravation from switching too quickly to radically different footwear and an immediate trigger/breakdown point from suddenly trying to do a long hilly run off the back of very little training.

According to Noakes recovery is measured in months and years rather than weeks, though in most cases a good recovery can be made eventually.

In terms of treatment he advocated immediate complete rest (i.e. avoid standing and walking as well as running) for 1 - 3 weeks minimum at the first sign of symptoms. Oops. That's where the negotiating came in as I tried to cut back and run through discomfort and it didn't play ball. He also suggested regular icing, which I did belatedly do and found it surprisingly effective.

He classes all injuries through 4 levels of severity and for this injury I'd summarise his ideas as:

  1. Soreness each morning - complete rest for a week, change footwear, stretch calves.
  2. Discomfort during running but doesn't interfere with run - treatment as above but drop intensity and distances upon starting again.
  3. Pain during running that interferes with performance - 3 weeks complete rest, treatments as above, re-start with light jogging only until symptoms become Level 1.
  4. Pain prevents running - try approaches above and if no joy consult a surgeon.
I'd say I definitely got to Level 3. Arguably I got to 4 as on several attempts I had to abandon runs at the first stride but (I hope) that may have been a hint of caution on my part and I was actually only at L3.

In the last 3 weeks I've ran twice: 0.7 miles and 2 miles the week before last. Both were 'testers' pre-Noakes and both went OK but brought on some soreness afterwards. On Thursday I had to run about 150m as I was late picking Charlotte up and that also left some tenderness if the achillies was pinched in the next 24 hours.

It seems like everything got 80% better in the first week but since then the rate of improvement has slowed to a crawl. I'm a bit sore on a morning and during the day may feel occasional stiffness/creakiness in the achillies but generally feel its OK, but I'm not convinced its good for running (from Thursday's experience). I'm probably a bit scared of trying too. At the moment I'm thinking of leaving it another 6 days until next Saturday then trying again - back in the old trainers.

I did try going to the gym a couple of weeks ago but found that the cross trainer and rower both aggravated things immediately. I haven't been back since. I feel a bit ashamed to go due to my change in size and whilst the exercise bike is OK injury wise its still less than inspiring. Besides, as you'll see below' I haven't really had the time.

My weight and size remain unchanged at best and at worst a further couple of pounds on. I've managed a couple of days of good diet but that's about it. I haven't had a day off work in 3 weeks and my weekdays in the last 10 days have been 13-14 hours a day. I'm absolutely shattered and living off generally appalling convenience foods plus sweets/biscuits and chocolate.

Last year when I was at 11st 7lbs I got rid of all my bigger clothes. Now, at somewhere between 13st and 13st 7lb, I honestly have virtually nothing I can wear:

  • One pair previously baggy jeans are just about OK
  • One pair jogging pants with forgiving waist
  • 2 t-shirts that just about fit
  • One pair of hugely baggy gym shorts now just fit but my arse looks like the back end of a bus in them
  • One running/gym shirt still fits
  • One suit (just) fits though I had to buy 2 bigger shirts to wear with it
Sue and the kids have gone strawberry picking but I've stayed at home as the only clean clothes I have that fit are some jogging pants and an old stripey polo shirt. I don't want to wear that and leave the house - I look like a participant from the Jeremy Kyle show.

Sometimes I feel very pragmatic about things and accept that until my achillies is fixed there's little I can do. Other times I actually feel really down about it. Not so much wallowing in self pity as drowning in it.

The clothes thing falls into the latter despite my JK jibe, and even the fact of feeling down about that depresses me further - it doesn't seem a very manly thing to feel let alone admit too. On top of that there's an underlying fear that the injury just wont get better or will take many months before it becomes tolerable from a running perspective. Lastly there's the fact of the injury being largely down to age related degeneration. I can't begin to say how depressing a reality that is.

Happy days.

Friday, 17 June 2011

The Great WLR Debate

With little to report on the running front (but more on that later), I thought I better boost my tawdry post count for June by summing up my thoughts on a big debate that seems to be very prominent on the www.weightlossresources.co.uk message boards.

I don't use the boards very much as they don't seem to offer anything very new and, if I'm quite honest, I don't think I have anything very new to offer the boards either. For as long as I can remember though there has been what Alistair Campbell might describe as 'rigourous debate' on the fundamental question of how to approach weight loss and weight management.

There seem to be two rival, and often outspoken, camps: those that advocate a very basic calorie counting approach (epitomised by WLR itself), and those that believe dramatic results can be achieved through adopting the latest trends in the field.

Proponents of traditional calorie counting say its very simple: as long as your 'calories out' figure exceeds your 'calories in' one then you lose weight. What these calories are made up of is neither here nor there, though a passing nod is sometimes given to the idea that the food intake should be 'balanced'.

They believe that anything beyond this is, at best, over complicating the issue and at worst is an attempt to prey on the gullible and desperate by suggesting false benefits, backed up only by pseudo-science, in order to make someone in America very rich. In other words unsustainable fad diets.

On the other hand there are plenty of people who feel that calorie counting misses the point: it over simplifies complex issues and is flawed in that it tries to accommodate the many failings of a modern western diet, a diet that we're not evolved to cope with.

Instead of calorie counting they believe we should concentrate more on the composition of our diet. Typically this involves limiting, or even excluding, simple carbohydrates and putting a far greater emphasis on protein. In doing so they are supported by research that shows that protein promotes satiety and, as it is more difficult for the body to process, promotes a greater calorific expenditure.

Sometimes I see the debate as conservatives versus radicals. Equally, I think the debate could be seen as between those that favour a macro management approach (concentrating on the big numbers) versus those prefer micro management (looking at the detailed composition of food intake).

The debate seems to extend, less passionately, to exercise. Traditionalists seem to favour cardiovascular exercise to burn more calories and directly effect the daily calories in vs calories out calculation; modernists favour muscle building from resistance training to slowly raise the metabolic rate. Again, I see this very much as macro management versus micro management.

Both groups claim that their way is proven and scientific, while the other route is unsustainable and here's where my own opinions start to emerge:

They're both right and they're both wrong!

The fiercest proponents of each camp are often living proof of their own beliefs: people who have lost a lot of weight through an approach. I suspect that their success leads to understandable frustration with those that countenance the existence of an alternative view, and this leads to the debate sometimes having a pretty intolerant, smug tone from the alpha (fe)males of the WLR message boards.

Leaving the tone aside, take two examples of success from the two camps. There's a chap (whose name escapes me) posted this week that he'd lost something like 7.5 stones by following a very basic calorie counting approach. Incredible result and bravo. Take a look at Jo's blog (linked to on the right) and you'll see she's had some incredible results through a mix of resistance training, intermittent fasting and a paleo diet.

What these two individuals show though, isn't so much that their approach does work more that it can work. I think there's an important distinction.

Building on the theme of using my two examples (and without asking either first!) I'd question the sustainability of both.

I very much doubt that Jo is going to be intermittently fasting and eating a paleo diet for the rest of her days. At some stage she'll want/need (for want of a better word) to 'normalise' her diet. That's a risky point. I just don't see a full on radical approach like this as being something truly sustainable 'for life' even if it may feel like it for a while.

Its not plain sailing for the calorie counter either, despite the claims that calorie counting benefits from not excluding any food. I'd hazard a guess that 99% of WLR members 'fail' in the sense that they wont reach the target they set by the expected date and the vast majority that join will never reach their goal. I'd also guess that even a great many of the site's success stories wont have stayed at their goal weight. Calorie counting is too rigid and doesn't make allowance for differences physiology and psychology. It isn't really sustainable either, not least because few of us would like to be spending £10 a month and 20 minutes a day in order to log our food intake until the day we die.

I suppose I see it that 'new diets' can offer an exciting opportunity to reinvigorate your approach to healthy eating and weight management, as well as the opportunity for dramatic short term results, but each will ultimately prove to be the next in a long line of approaches that come into, and then fade out of, fashion. Calorie counting, on the other hand, will always be there and its long standing reputation for no nonsense success allows companies like WLR and Weight Watchers to come into being, but its the reality of its widespread failure that allows them to make a profit.

We're all very different. Our bodies are different, our lifestyles are different, our relationships with food are different, our psychologies are different. That means that different approaches have more appeal (and will work better) for different people. More than that we change and what we find easy to follow and successful today may not work for us tomorrow.

To claim there's a one size fits all approach is ill informed and, in the context of a weight loss message board, distinctly unhelpful.

I feel there are definite merits to both approaches, and in my view the ideal would be to work to the loose framework of calorie counting whilst accommodating gradual changes to dietary composition that will make the results more meaningful and lasting, but thats a deliberately broad statement.

The precise diet any of us follow should be what works best for us, not for anyone else, and not because it makes a few bob for someone else either, but above all it should be flexible, designed with the long term in mind and allows for the evolution of habits.

Sunday, 5 June 2011


Having decided to take it easy on all fronts (well, diet and running anyway), I seem to be in a better place mentally and more in control of eating.

Yesterday I was happily active, got lots done and whilst my diet included the rare treat of a Chinese takeaway, two of the overhyped Oreo biscuits and two pain au chocolat, there was no binge and far more controlled choices.

Result eh?

Interestingly though, my achillies still felt sore from just walking and carrying yesterday and both heels felt sore. In the past a physio had said I had a touch of plantar fasciitis (which I'll shorten to PF from now) but it didn't really cause a problem and faded away again, but I decided to look it up last night.

Digressing slightly, Googling that sort of thing isn't too reliable. A number of (generally American) websites purport to give information but are essentially barely disguised marketing tools for specific insoles and are a little misleading as a result. The information from universities (also generally US) seems far more even handed and gives a different 'weighting' to both causes and treatment.

Not sure if the achillies is related but I suspect it might well be.

You see, I've been trying to work out what might have triggered the injury. Its chronic rather than acute and there was no 'incident' to set things off but neither was there a sudden increase in training mileage; sudden change in terrain, sudden increase in length of runs, or change of footwear. There were none of the triggers that explain a chronic injury's onset.

Or so I thought.

I'd recognised that the recent hefty weight gain would make runs feel harder and that it could make a small contribution to tiredness and knotting of muscles but last night's research suggests rather more than that.

It seems weight is a major factor for PF. This is particularly true for the obese (which I'm obviously not) but several sites list a common cause as 'sudden weight gain'. The fascia operates to raise the arch with every step and is loaded each time with a pressure of double our body weight, so a sudden gain of 20lb means every step adds an extra 40lb of pressure on the fascia - effectively a sudden ramping up of training workload.

Bingo! There's the trigger.

I still don't know if the achillies is linked or not - not directly as its not a PF symptom - but I now suspect the trigger is the same. Its not the weight I'm at, its the speed at which I got here.

Bad news is that it can last for months or even years. Good news is that losing weight and appropriate stretching, allied with NSAIDs, ice and rest in the early stages can help speed things up.

Good news, is that when I think back to last year there were two times when I had heel and/or achillies pain and both matched to periods of weight gain. Whilst neither seemed as prolonged or painful as this, they both were brought back under control.

I won't even try to run until at least next weekend, and as and when I do it will be a very short very slow run. In the meantime I'm popping the drugs and doing the stretches. At the gym may stick to the bike in order to keep weight off my feet.

What I'm not doing is hurtling straight into a knee jerk, super fast weight loss regime. For today at least I'm happy just to feel control. In the coming days I'll go with trying for some form of defecit as this is evidently a big part of the cure but it wont be pressured or dramatic.

Thursday, 2 June 2011

All bets are off

Next week Chester marathon training (was due to) start. That required me to run 54 miles in the first week.

I haven't ran 54 miles over the last 5 weeks.

At the moment I'm not able to run much more than 6 miles and I can't do hills or speedwork as to do so would cause my achillies injury to flare up again. Similarly I can only manage these short slow runs with a good 4 days rest between. Anything more than this and I'm limited to hobbling round the house. In the last 10 days I've aborted three runs where I felt just about ok but the moment I took the first running step I had to stop.

Not sure what I have done to it - though achillies tendinitis is common in middle aged men according to net research. A fact which cheered me up no end. Presumably my prostate will be next to go?

Realistically there is not the slightest chance I could get up to the required mileage next week. If the achillies healed quickly I might just manage to take 2-3 weeks to ramp up to a lower mileage training plan but that would be pretty unlikely to succeed as tendons are so slow to heal. I'd be odds on to make the injury worse. Besides which that wouldn't be the training (or therefore race) that I planned.

Add to that my weight. I'd need to be dieting carefully at the same time as marathon training. That's the equivalent of Hitler fighting the war on two fronts: sure I'd defeat France and send the British running back across the channel but on the other side there would be an inevitable Stalingrad. You can't successfully do both. Plus that would put me in the guise of Hitler and I don't like that.

So, I've accepted now that Chester isn't happening, and now I'm giving myself another week away from running at least. I'm not going to try and diet during this time either.

Hopefully in a week, or however long it takes I can begin to slowly reduce weight while slowly increasing running; do some runs simply for fun and maybe by the autumn be in a position to run some really good shorter races.

If I do that there's no pressure to chase impossible weight targets and no need to push my running too hard. In both cases there's then less to get stressed about.

For this course of action do I deserve a medal or are you sending me a white feather?