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Expand your running knowledge, identify running misconceptions and become a faster, healthier, SMARTER runner. Let Brodie Sharpe become your new running guide as he teaches you powerful injury insights from his many years as a physiotherapist while also interviewing the best running gurus in the world. This is ideal for injured runners & runners looking for injury prevention and elevated performance. So, take full advantage by starting at season 1 where Brodie teaches you THE TOP PRINCIPLES TO OVERCOME ANY RUNNING INJURY and let’s begin your run smarter journey.
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On today's episode, Moira's chronic injury success story. Welcome to the only podcast delivering and deciphering the latest running research to help you run smarter. My name is Brodie. I'm an online physiotherapist treating runners all over the world, but I'm also an advert runner who just like you have been through vicious injury cycles and when searching for answers, struggled to decipher between common myths and real evidence-based guidance. But this podcast is changing that. So join me as a run smarter scholar and raise your running IQ so we can break through the injury cycles and achieve running feats you never thought possible. conversation with Moira was originally going to just go out on to the run smarter podcast, but about halfway through this conversation, I'm like, this needs to go out onto my second podcast, the overcoming proximal hamstring tendinopathy podcast, because the bits and pieces of Moira's recovery can relate to anyone who's been injured, whether you're currently managing an injury or whether you've been injured in the past, pay close attention to all these little elements and see if any resonate with you in terms of your thoughts, your feelings, your emotions, what the health professionals may tell you about this injury, the scans, and their interpretation about your injury, all of that stuff. Moira has had a tough battle for a very long time with this particular injury, which you'll go on to talk about. And I encourage you to self-reflect, self-reflect on not only what has happened to you in your past and current injuries, but how you've approached it both You know, psychologically, emotionally, and physically, have a very keen interest in pain science. And as you know, from several episodes and other success stories discussing chronic pain, this is just another one that I am glad I'm sharing with the world. And I'm glad Moira agreed to come on. Well, she didn't actually agree. She actually offered to come onto the podcast. So I'm glad that she did. And let's hear a story now. Moira, thank you very much for joining me on the podcast today. Thank you, Brody. Glad to be here. We're to start with your history. So can you just introduce yourself and in particular, fitness background prior to this injury that we're about to talk about? Yep. Yep. So, so yeah, my name is Maura. I'm 32 years old and I have been running ever since I was a kid. I started running local road races with my dad and brothers. probably around age seven, eight, and absolutely loved running. So ran cross country and middle school. By seventh grade, I was running all three seasons with the high school. Ran all through high school and D1 in college all three seasons. And then out of college, I got into triathlons and really started just loving like endurance sports. So I did two Ironman triathlons. Lots of half Ironmans, lots of half marathons, six marathons, and it's just been one of my favorite parts of every day is going out and running and biking and exploring the world. So that's kind of my running history, my endurance sport history. Something else I want to note that I'm kind of embarrassed to admit seeing as once we hear my story, but I am a physical therapist as well. even though I made a lot of mistakes in this injury. A lot of my experience is in pediatric setting, but I am a physical therapist. And then something else that I would like to kind of mention that I think plays a big part into my story is that I did have history of an eating disorder in college that I considered myself to be recovered from, but definitely used exercise a lot as kind of a way to cope with. And I think that kind of plays into a lot of what led into my injury as well. Excellent. Thank you very much for sharing that because it does help paint a nice picture. Let's talk about the onset of the injury. Like how long ago was it and talk us through that experience? Yeah. So my injury started July 2023. I was actually, I remember the exact run. It was a week before I was getting married. I went out for a run and I took a step and kind of was like, oh no, I think I just gave myself a stress fracture. I just felt pain in my right foot, of on that, felt like the fifth metatarsal, so that outside bone. And I think, know, kind of going back to my story leading up to the wedding, was... falling into some bad habits. So I kind of wasn't super surprised that I may have given myself a stress fracture. I was talking like bad eating habits. So when that happened, I've kind of was like, oh no, this is, I did this to myself. So for the next week, I kind of modified my activity and was doing pretty okay. I don't really remember having much foot pain, you know, got married. was a day, I was able to walk down the aisle because I was a little nervous that wasn't going to be able to happen. And then, you know, a couple days later decided, ah, I think I must have just that just was probably a little niggle, like I'm probably fine to go out and run. And it went for about five miles and was limping at the end of that just because of pain in my foot. So I thought, OK, I definitely have a stress fracture. I did not go to get an x-ray for a little bit, you know, kind of insurance wise, I didn't really want to pay the money to go get an x-ray that was probably not going to show a stress fracture. So I figured, let me just try to manage this. I did a lot of swimming for the next few weeks, a little bit of biking, but did not run at all. And symptoms were kind of starting to get worse. I was starting to have foot pain with just walking around. I put myself in a boot. and went and got an x-ray done. And this was about, this was six weeks after the initial injury. And I had that x-ray done and the doctor said, no, you're fine. There's no stress fracture. He said, you know, did you sprain your ankle recently? And I had told them that I did sprain it really badly about eight months prior to that. And he said, oh, you have a little loose body in your ankle. It's probably just causing some radiating pain down into your foot, a little bit of nerve irritation. I think that's all it is. think you're fine. So that was great news for me. I just decided, okay, that's just a little bit of, know, that sprained ankle is bothering me, but I'm fine. Let me go back to running. So I did, and I had pain. He had given me an ankle brace. So I tried that for a few runs and that really did not, it was very painful in my foot. So I just stopped using that. And I had pain, but it wasn't really. very bad and I kind of just thought, okay, well, if it's not a stress fracture, like, it's not that dangerous to keep running. So I just kept running. Just to backtrack a little bit leading up to that happening, I, for about 10 months up to that, prior to July, I had decided I was wanting to qualify for the Boston Marathon. So I ran a marathon in November of 2022. Right after that, I sprained my ankle really badly. Kind of took some downtime for a few weeks, not as long as I should have, and then decided I was going to train for another marathon. So tried again in spring of 2023. That race did not go so well. Ended up having to kind of pull out of that a little bit. So two weeks later, tried again. And I did qualify for it. But at this point, I had now run three marathons in about a six month time span. So that was. Not a great move. And so I think that was kind of partially what led to this injury happening. So that's kind of where that initial injury happened. you just clarify like when you were running and you were getting symptoms, where the location of the symptoms were? So this is funny, I think about this a lot because it just kept feeling like it was in my foot. at like the fifth metatarsal where, you know, ultimately things changed a lot from there. And then I think after I had seen this doctor who kind of said, you know, I think this is coming from that ankle sprain, started noticing quite a bit more ankle pain as well and just kind of pain within that, you know, ATFL ligament. that front ligament that tends is kind of where the majority of sprains happen. And that's, so I was just kind of. saying like in my head, like he told me that and I was like, yep, that's where the pain is. So when I would run, it would kind of just be in the front, that four foot area. And it would not necessarily get worse throughout the run. It would just kind of be there and it would be pretty sore after. But then as I continued running, it almost seemed like the symptoms started to let up like, you know, over the next few months of running. It was there, but it just. there would be some days where it was really bad and other days where it was kind of just like, this is my new normal, but I'm happy to be running. So for people who aren't familiar where the fifth met is, we're looking at like the outside sort of like where your little toe is and just following your little toe down until like you sort of get to the mid foot. So that sort of area, but you're saying after you had the scans and the Dr. Meyer said, okay, maybe it was a result of the ankle sprain sort of stayed on the outside of the ankle, but more towards the ankle joint itself. So, um, closer to the heel, guess you could say. Uh, okay. So you mentioned runs were symptomatic, but not that bad still continue to run and over the months, maybe got a little bit better. Is that right? I guess I'll backtrack a little bit. mean, with it, when those first few runs back, kind of when I came out of the boot and was kind of cleared to go back running, those were pretty painful. Um, The next few weeks from there, things seemed to get a little bit better. Um, but then over the next probably three or four months, things were kind of getting worse progressively. Um, and that it was, you know, symptoms were changing. It was kind of more of like a soreness that was lingering a little bit. Um, but yeah, that's kind of where we were there. Um, any other changes in characteristics apart from the soreness maybe lingering a bit longer after the runs is that. Anything else you can ask about? Trying to think. The biggest thing that I kind of remember was if I did anything where it really required me to kind of stabilize on that foot, like I went and did a pickup game of basketball one day, or I did a gym workout where I was doing some kind of like skiers where I was jumping side to side, like my ankle would be very sore after that. But I kind of just thought Yeah, I mean, that makes sense. And then as long as I'm kind of forward, straight and back, you know, things are okay. I was able to bike. was trying, I was doing more cross training than I would have been otherwise. So, you know, where I may have run a couple of days in a row, I was trying to bike a little bit more, use the elliptical a bit more and those things seem to be okay. But there was a general soreness at all times. Okay. Yep. And Any other attempts at treatment? Any other attempts of, uh, apart from running and sort of load management, anything else? I'm ashamed to say no. I was just, I, another piece that kind of falls into the story for later on is a lot of, I was going through a lot of changes in my life at this time too. So I had gotten married, which was great. Um, you know, but I, that happened. I got a new job, um, right. Pretty much two weeks after I got married and that. kind of changed my schedule and my just everything in my life in a lot of ways. I had a lot more free time which resulted in you know some of those exercise pieces coming back in again where I had more free time so now I was doing a lot more just going out for longer runs longer bike rides. I was coming off of a year and a half of having a really structured training plan with a coach where you know I had rest days built in and I was you know. was preventing me from doing too much. And now I had all this free time and I was just kind of doing way too much. So that was kind of something I forgot why you asked me I'm sorry. That's okay. was gonna talk about like, you mentioned bad habits leading up to the wedding as well. Would that be like eating related as well? Yeah, I mean, I was stressed. And I think that kind of just my appetite kind of decreased a lot from that. But yes, I mean, there was definitely you know, for whatever reason, just some of those bad habits came in of just kind of feeling like I wanted to look my best. And so because of that, I was just falling into some restrictive habits, where I definitely was not, you know, consuming enough. And I was exercising quite a bit. So it was just wasn't it was just kind of a bad recipe. Yeah. It seems like there's a lot of factors that have sort of fit the pattern to increase the likelihood of injury. know, okay, we're looking at the training load side of things. Okay. Yeah. More availability to train more, but less of a training plan structured for the required rest days and required deload weeks and those sorts of things weren't in. You have the, I guess the psychological stresses of the wedding coming up and, uh, that sort of things. We've got the input of your nutrients and your building blocks and that might be inadequate at that time. So a lot of things, a of things happening prior to that. Yes. The marathon's always like three marathons in three months building up maybe a bit of pressure around the qualifying for Boston and excitement. Maybe like a lot of those things would be at play around that time. Um, okay. So we're several months down the track now where symptoms are starting to get worse. with running, there's no other treatments that you're currently exploring. When were the symptoms at their worst? Like, you paint a picture as to what distances were you running? What was the pain symptoms like? Talk us through that moment. so by January, I was kind of at my baseline of running about 30 miles a week and biking two times a week for about an hour and a half, two hours. I was just, things were not feeling good. And at this point I decided I needed to get an MRI. So that's kind of, I did that. We can jump back to that. Symptoms were probably their worst this past summer. So about a year after things, after this all started. So it was pretty much about six months of me ignoring things for a while. And then another six months of things just going rapidly downhill, which kind of was a lot to do with what the findings of those MRIs were and kind of the snowball effect of that. And trying a million different treatments and stuff before kind of falling in finding your podcast and learning a lot of about other aspects of it. I guess I'll jump into what that MRI showed. So January, 2024, I went and got the MRI. And that same doctor who told me that there was just a little loose body in my ankle, walked into the room, looked at the MRI and said, you have to get surgery. Your ankle is extremely unstable. You have significant tearing of the ATFL and... you know, named a bunch of these other things that I think I understood, but were still very scary for me to hear. And he just, he verbatim said, if you don't deal with this, it's just going to get worse. And, you know, you just are going to need to get stabilization surgery. So on one end that to me, I was like, you know, I've never had an injury this long. I've really never, I've had one stress fracture prior. So to me dealing with this for six months, I was like, there needs to be some explanation for what's going on. So surgery was kind of like, well, that's extreme, but maybe that is what's going on, like at this point. but I also that didn't sit right with me. I decided I just, first of all, I was like, there, I don't think we need to jump to surgery. I don't think I need stabilization surgery. I'm not. rolling my ankle every time I go out for a run, I'm just in a lot of pain and something seems like something is really wrong in my foot, but I don't know what's going on. So I proceeded to get several more opinions and each of those other opinions I went to agreed with me that surgery was not necessary and that that was probably a little bit excessive. But also, just kind of said, there's swelling in your foot, but there's not really much else going on besides some scarring of that ligament that kind of makes sense with having had multiple dad sprains. And they kind of just said, one doctor said you might have a tear of your peroneal tendon, but that's probably nothing to worry about. at this point, my stress level around this was pretty high. And any time somebody told me something, I was that. kind of my little bit, the fact that I had some more knowledge in this department was just not good for me because now I was imagining everything that was going on and the next time and then I would start feeling those symptoms. So, you know, up until this point, I kind of hadn't really noticed my peroneal tendon being very painful. And after this one doctor said you might have a tear of it, all I could feel was that that tendon was painful, it would get really tight. And I was like, Oh my goodness, I have, I have a really bad tear in this. And I've just been running through this. And it's probably gonna like, I don't know what's gonna happen. But this is really bad. And so, you know, everyone kind of just each of these doctors said, take some time off. Like, have you tried not running? I was like, well, I mean, not really. Like, yes, I did way back. But since then, I haven't and they kind of just said take some time off. And so I I that. I did a lot of swimming, but at this point even kicking while swimming would really bother my foot and my ankle. So I was using a pull buoy and I was just swimming with my arms and I wouldn't even push off of the wall with my foot. And for about two months, that's all I did. That and aqua jogging. I would try to go for bike rides, but now my even biking was really bothering it. I was just getting numbness and tingling in my foot and I was getting... more and more anxious about just kind of what the heck is going on here. Like last year I was training for a marathon and trying to qualify for Boston and now I'm don't know what's going on. And I just felt like I just didn't know where to turn to. So that's kind of that aspect of it. Can I ask like, think the having the PT knowledge. has its hindrances has its positives of gathering in the story because one, the suggestion for surgery, like a lot of people without PT knowledge would suggest is what the doctor suggests like MRI shows what's going on. And that's the answer. Okay, it's extreme, but let's move forward with that. the fact that you've, it didn't sit right with you is probably because you've had your PT training. And if people aren't familiar, like your ATFL ligament is the one that you stretch when you roll your ankle. And if the MRI itself shows that that is unstable, then or whatever they decided to use might clinically present as a quite an unstable ankle that rolls really easily. But reconstructive surgery would tighten up that ATFL, you know, that that's probably the approach they're going to go with, but doesn't really correlate with your symptoms. Like you say, you're not you're just in pain, you're not you don't have a unstable ankle that's rolling when you walk and run and that sort of thing. So glad that you had the knowledge on board to seek a second opinion. And we constantly on this podcast, the success stories and that sort of stuff ponder over the relevance of MRIs and the dangers with MRIs showing everything and all these, you know, insignificant findings. However, the PT stuff also, like you say, with the added knowledge probably creates a little bit more fear and anxiety when suggesting about certain structures. And interesting that it's yet happened again, that you had pain around like the mid foot, then someone suggests, maybe it's at the ankle. Then you start getting paid the ankle, then someone suggests, maybe it's a peroneal tendons. And then you start getting pain there just purely on suggestion and an authority figure telling you that maybe it's this. happened a couple on a couple of occasions now. So maybe it's starting to illuminate a few reasons behind that. But just thought I'd touch on those points. Just just talking through where my mind's going into telling the story, which is a great story so far. Unfortunately, for you, but entertaining and sort of curiosity provoking for me. Yeah. Where are at now? So you're a bit in the dark in terms of direction moving forward to getting all these other opinions and symptoms are starting to change, where to from here? So at this point, you know, I've decided that we were, it was probably time to go see, you know, outpatient PT. hadn't, I hadn't given that a go yet. I kind of thought I could rehab myself, but it didn't really seem like I was getting very far with that. So I, I did. I started going to a physical therapist and I'm going to be honest, going into that, I was already not trusting them because I just thought, I don't know what's going on, so why are you going to know what's going on? I shouldn't have thought like that, but that's how it was. I went to an outpatient therapist for a while, didn't really feel like I was getting much of anywhere there because they were just saying, Can you run? And I said, yes, I can run, but it doesn't feel right. I've run my entire life. I know what feels right. Something's wrong. This doesn't feel right. And they would kind of say, well, jump on the treadmill. And so I'd run for 10 minutes and I'd get off. And they'd be like, well, you can run. It was just kind of like, yeah. So I just didn't have any trust there. I kind of started getting really desperate. and just doing anything that I could possibly think of. I was trying different shoes. was trying to wear, I was using KT tape because I just thought, you know, maybe my peroneal is just really overactive for some reason and I have to just kind of use some KT tape to get it to calm down. I don't know. One of the doctors said, have you tried using just, have you been using NSAIDs very much, you know, just popping some anti-inflammatories? And I thought, no, okay, we could try that. One doctor said, you have sinus tarsi syndrome. And I really didn't want a cortisone injection at all. But at this point, I was like, maybe that's what's going on. So I got a cortisone injection in my foot. That didn't help at all. I kind of went back and forth with using the ankle brace because everyone kept saying, you know, your ankle's unstable. So I thought maybe I should try that. But it just was never working. I tried dry needling. I was trying to just, I was spending. all of my downtime looking at exercises and just pathologies of like what could be going on right now. So was trying a million different exercises. was trying, I went and got acupressure done and I just wasn't really getting anywhere. I was trying stretching the tendon because one PTI1-2 said that your tendon is just really super tight and you need to stretch it. So I was stretching it a lot. And then another one. This was kind of the rabbit hole of just going way too far. I went to this very expensive cash-based PT who kind of, I thought, okay, he'll figure it out. And he told me, which maybe there's truth to this, it did not work for me, that, you know, 90 % of orthopedic issues are caused by visceral malalignments. so he, visceral meaning organ. So he did some manipulations where we were kind of, he was doing some movements of my organs just externally and I went to two of those sessions and spent so much money on it and I just, I was like, this is not, this is not right. So that was kind of treatments that I attempted during this time. I ended up eventually going for a second MRI. because I just was like something, know, maybe at this, you know, four months ago, we said nothing was going on, but at this point, I'm feeling all these different things now. I'm having horrible pain, numbness and tingling, like really crazy things. And so we went and actually back up for a second, we thought maybe this is coming from your back now. So we and got a back MRI, which actually showed like a little herniation of my level S1, which... refers to the foot. So we thought, okay, maybe this is what's going on. And so debated doing like spinal injections, which is not really something that you want to just toy around with. Luckily, that doctor ended up saying that he didn't think that that was the place what we needed to do. So we kind of let the bat go. And at this point, I had booked a free injury chat with you, thank goodness, because we were in a bad place. So luckily, we kind of jumped on with you right around the time that I was at my Wits End. Just to read off some overall this time, some diagnoses that kind of came about and things that suggestions were, you know, we kind of said initially ankle instability. a split tear of the peroneal tendon, sinus tarsus syndrome, peripheral nerve entrapment. Oh, back up for a second. We thought maybe you have nerve damage from that really bad ankle sprain. So I had a nerve conduction velocity test done on my leg, my lower limb, and that came back fine. Is it referred pain from your back? Could it be compartment syndrome? Could it be chronic regional pain syndrome? Yeah, so. Goodness, that's a lot. Those were things we were talking about. And I was recommended maybe trying PRP, but that was, no, we couldn't say for sure that that would work. it was just, I was so far down a rabbit hole of I have no idea what's going on here. When did the numbness tingling sensations, when did that come about? So ironically, that pretty much came on right around the time I was told I needed surgery. I drive a lot for my job. I drive an hour to work and then from work each day. I started noticing a lot while I was driving. My foot just kind of being on the floor of the car. The vibration was just really bothering my foot. And if I went to go push on the gas pedal, like that tendon would just feel super tight. The gas pedal would bother my foot. And that's kind of when that started. So that's that was kind of January, February. 2024. Yeah. Okay. So we jump on a call and we start working together. You, um, give me some details about your history. You talk about all these different diagnoses, your symptoms, all these symptoms that are going on. Second opinions, scans, all these different treatments that you've tried. What, what might've in terms of like the direction of us starting to work together and sort of start to lay out a plan. Did anything surprise you? Was there any like. find shocking about the direction or approach that we took? mean, straight off the bat, just you are you breaking up the pain science aspect of it, the chronic pain. It really was something I never considered. Like I was so far down. You know, there were a lot of times where I was like, is this in my head? You know, all these doctors have her saying something's really bad, have her saying there's the MRI is not showing anything. We don't know what's going on. I was kind of just like, don't know what to do. And when you brought up, and you can probably speak about this much more eloquently, but when you just kind of brought up in general, the nerve, like hypersensitivity and just the pain science and the thought process of being told all of these things and just having no, and all of the stress related to the fact that I... Absolutely love running and running is my life and I have not been able to run for the last six months without like significant pain it was just all-encompassing and You brought that up and I I remember thinking when you first brought it up that we were going down the line of like chronic regional pain syndrome and I was absolutely terrified of that thought because it had been brought up to me and I was like I I don't know what to do with that because that's it. That's a complicated very complicated thing. And I thought that's where you're going. And then you brought it wasn't it was more of like, you know, at this point, this is just this could very much be chronic pain of your body just being so hyper aware of what's going on in your foot. And it just made so much sense to me. And I felt like it was the first time that somebody gave me an answer that made sense. And I think that immediately, like, I just had a trust with you that I did not have with anybody else. And I think, you know, a huge piece was I've been listening to your podcast for quite a while at that point, and was just really impressed with everything. It all made sense. I just felt like it was everything that I knew. And I just kind of wasn't dealing with the right way. But I kind of was. And a large piece that you had kind of brought up. and within episodes that I listened was how important it is for somebody who's active to stay active. And when I had a majority of practitioners tell me to just take time off, that was, that was very, very different than and so I felt like I could trust you with that. So that's kind of where we are with that. I can't remember exactly what was said on our initial calls, but how, how I like to see clients these days, or when I jump on free injury chats, there can be certain data points where someone would describe their injury or describe the history of their injury where I'm like, Oh, that's a data point where there's something that's psychosocial that's going on something that's like non-mechanical, something that is more to do with the nervous system rather than a mechanical acute injury. And in your history and everything that you explaining, they were just things in my mind that were just going off one after the other. And there was like several things about your story that were showing, okay, this isn't responding how a normal like, even if it was a stress fracture, like stress fractures don't respond this way. Swelling doesn't respond this way. But talking about how emotional all this experience was and how the symptoms have changed and slowly emerged over years. slightly evolved into more numbness, more tingling, more sensations, more pain and those sorts of things already the history of scans, second opinion, surgery, all that sort of stuff ramps up a lot of fear. Um, I think I might've mentioned, okay, so we've got all pain is like just the evaluation of pain is all from the brain, just prioritizing things. Where's the threat? How much of a threat is it? How much does it mean to us? and then distributing a certain amount of pain. And the fact that you had in this initial onset, one step and straight away you're like, whoops, stress fracture, I've really overdone now. The fact that you thought about that would create a high urgency, a high relevance, high threat level in the brain to then respond accordingly. Not a lot of people have one step, show up and then think stress fracture, but I guess that's where your PT side of things might've come into it. But then just going through the history, everything is just like, signs of the brain really being worked up, being highly emotional, constantly seeking answers, constantly in a stressful state, and creating a really sensitive nervous system, we are looking at a really sensitive nervous system that is just looking for all these little pieces of looking for pain. So I might have asked some questions about how often do you think about your pain? And like you mentioned, all encompassing think about it, like every hour of my waking day, it's consuming me. is like changing my identity. Like I see myself as an endurance athlete and that is a stripped away from me. All of these pieces are like, Hey, let's just strip everything back. And let's just try to address this as a nervous system issue, a really sensitive nervous system issue. Let's get back to things that you enjoy. Let's get back to, um, things that bring you joy, bring you exercise and let's try to calm down this nervous system. And I'm glad that you were receptive to that idea. I'm glad that you were on board with it from the get go. Because sometimes it can be, people can dismiss it and interpret it. Oh, bro. He's just saying it's all in my head. He's saying I'm making this up, but I am in pain. I feel pain and then would dismiss it, which is why I try very delicately to, you know, communicate in a sort of a different direction, but glad you were on board with that. Anything you want to touch on before we talk about like, practically what we ended up implementing? Yeah, I guess just to kind of backtrack a tiny bit, one of the, guess just because I've listened to a lot of success stories, and I felt like this aspect was something I really resonated with when people spoke was just kind of how bad of a place I was in mentally for a little bit there. It was, you know, the idea of not me, of me not exercising was just not, not even really something I could ever fathom. So I was forcing myself to drive really far to go to a pool multiple times a week to, you know, just swim with a pool buoy. But I just couldn't believe how far I had fallen. It was... I was having trouble sleeping. was waking up just in the middle of the night, in a just with so much anxiety over the fact that like, I can't believe I'm this is where I am right now. I was it was the first thing I was thinking about every morning. I honestly it sounds crazy, but I was dreading weekends and vacations because I just normally would love to wake up and go do my run or my bike ride and then just enjoy the rest of the The weekend with my friends, family, husband, and not having that peace, like I just didn't know what to do with myself anymore. I was asking everybody for their opinion. And unfortunately, unfortunately, unfortunately, I have a lot of access to a lot of my friends are PTs, a lot of just, you my coworkers are PTs. I was asking everybody for their input. So that definitely wasn't helping. And a huge, huge thing was that I was becoming terrified of movement, which was just like, crazy to me. I love exercise and I love being active. there were days where I was just laying on the couch and my foot was just killing me. And I was just like, I can't believe this is where I am. I'm 32 years old. Like this is not where we're supposed to be. You know, it's my one year, my first year of being married and like my poor husband has to deal with a lot of tearful me's. And it just felt like I felt in And I just hated, I hated it so much. So that was kind of where we were. And I just think that's important to touch on just because I am out of that now. So that's very exciting. Thanks for sharing that. This sort of like big three players that I consider in the relation of the developing chronic pain or really sensitive nervous system. One I would say is hypervigilance, which would be How often do you think about your pain? How much do you pay attention to this area? How, like, do you think about it every single step or every, every time you put your foot on the gas pedal, every time you do a walk, like how often is your attention focused on that area? If it's very, if it's excessive, we call that hypervigilance. Uh, the other one be like catastrophisation, fancy word to be like, you just have diet consequences or you think about diet consequences. That is just. over amplification of like the outcomes. It's like, would say probably one step foot pain, stress fracture might be a mild case of catastrophization, but you know, this can balloon out over years, more and more pain, more and more catastrophizing. But the other one that you just elicited was like kinesiophobia, fear of movement. And that can have a huge, huge hindrance on your recovery. and really ramps up the nervous system. If you have a fear of moving, your nervous system and your brain has a fear of moving as well. And therefore every time you move, I think about it, your brain kind of freaking out and being like, let's deliver so much pain because we don't want to move and we want to keep this person as safe as possible. We want to get out of, we want to get towards safety. What better way than for me just to deliver as much pain as possible whenever you move that. And you're just creating these beliefs and they, it's sort of, it's sort of, has this cycle where it leads to more pain, which leads to more fear, which leads to more kinesiophobia, leads to more stress, which leads to more pain, which leads to a more sensitive nervous system, which leads to more fear, which leads to more, you know, hyper vigilance, like all these things just compound, compound, compound. And it's kind of like, it confirms your belief, it confirms those sorts of things, it can be really hard to untangle. And so when we started on this journey, this healing journey, can you recall like in the first couple of weeks, what we ended up doing, what you found helpful, what you found unhelpful? Yeah, so one of the first things you kind of asked me is, okay, what are you comfortable doing? And at this point, you know, to kind of piggyback off what you said a bit, another really frustrating thing for me is that My symptoms were inconsistent, where there were times where I felt like I could maybe go for like a shorter run and it would be okay. And then other times where I could maybe go for a bike ride because I was just so frustrated where I was like, I'm just going for it and I'm going to suffer the consequences and it would be okay. And then there were other times where it really was not okay. And so those things were kind of really frustrating because I couldn't figure out a pattern. I couldn't figure it was so inconsistent that I was just kind of at a loss of where to be. Luckily, by the time we started working together, for whatever reason, I think it was because I had really at that point dialed back the running because I think I would go for runs and then those would go poorly and then I would think, I'm going to go for a bike. But now my tendon was really annoyed and tight from the run. And so when the bike would bother it, think it was confusing which thing was aggravating it, because I was never really sticking to a strict schedule. So by the time we started working together, I kind of really pulled back from the running for a bit. And I'd gotten to a spot where I could tolerate going for a bike ride. I think I could do like an hour and a half, just a few times a week and be OK. And I kind of thought you weren't what... surprising thing I didn't think you were gonna say like okay that's great let's do that but you were all about like any sort of movement that you're not fearful of and that fits into program of load management and what we're gonna create is great so we started with biking I can't remember it was two or three times a week but kind of going out for 90 minutes was which was just beautiful because I felt like I was finally getting back to the slightest piece of me. And then we were just kind of doing, you know, we had, okay, there were three exercises we were going to do. So we added in one a day. And we kind of just like, all right, how did we respond to that? Great. Now, like, let's try this other exercise. Pretty quickly from there, started stacking the exercises where Okay, we can do all of our strength on this day and you can Aqua Jog on this day and you can bike on this day. And now we're getting to a spot where, okay, I'm being active four or five days a week. Like this is, this is incredible. So that was kind of, I would say the first probably three or so weeks was there. And I was really chomping at the bit to try running, but I was also absolutely terrified to try running. Um, and I was a little bit surprised by how soon you said, okay, we're going to try our run walk. Um, and so we tried that probably three weeks and this was the beginning of September. I remember being so excited and I knew it was going to be a run walk. I knew the schedule and I knew it was going to be two minutes of walking and 10 seconds of running, um, for a whopping five reps. I. was so excited to do that run. I was terrified too, but I was really excited. And I remember actually being a little let down afterwards, because I was like, wait, that was my run that I was so excited for? it just, you know, I thought it was gonna be a little bit more, but it's okay. But we very quick, I saw, you know, at this point, I was really hopeful. I was like, you know, there's no world that this isn't gonna work in. Like this is just so... like so systematic, so gradual, just like this is going to work. So I printed out the run walk schedule. I put it on my fridge. I put it on my desk at work so that I could kind of just see, you know, this is probably not exactly the best thing because that is a little bit of my being a little bit over zealous and compulsive, I guess. But for me, it was just rather than sitting there and thinking. negatively about things. was like, look, this is my plan and this is what we're going to do. And if I do this, I know we're going to get back to where I want to be. Um, so that's kind of what those first few weeks looked like. Can I chime in there? Um, because very rarely would I get someone to do a run walk program and have them starting off 10 seconds, 10 second intervals. It's usually like 30 seconds minimum. most often one or two minute intervals. However, it wasn't a case of, uh, physical load for you. That wasn't the issue. The issue was like, how are you emotionally in this moment? Because the bike sort of less anxious about compared to the running. So yep, let's just free up. And like you said, 90 minutes on the bike felt amazing. That's like an emotional state that we want to lean towards, which is why we sort of delved into that. But you I can't remember specifically, but you probably might've mentioned that you were fearful about returning to running. And so that was my indication of, okay, we can't have you run. If you're in fear, that is not, we're going to, your brain's going to be linking the two very consistently. If that continues to happen, we're not, you're not going to see any improvement. So I think we had the discussion around like, are you in fear of jogging for 10 seconds? And you're probably like, okay, I think I could do that. I don't have a lot of. anxiety about that. And so the decision purely to do that was from an emotional standpoint. Let's just find a really minuscule dosage that doesn't put your brain into overdrive. That doesn't really ramp up a sympathetic overactive nervous system. It gets you into not only a calm state, but an excited state. Like you said, you're excited. That's exactly the direction we want to head towards. Put you there, put you in that emotional state, do that thing successful. gives you a bit more reassurance, gives you a bit more encouragement, gives you a bit more excitement to then go do something a little bit more next time and just making those gradual improvements. Cause it requires a lot of gradual steps to not freak out. It's like, if I did 10 seconds, if I could tolerate 10 second runs five times, I could definitely do 15 seconds five times. That's not, it's not a big jump that I am, my brain's going to overdrive. So, um, a lot of people are probably listening being like, really, do I have to do that? It depends. It depends where your emotional state is in that moment. And that would be the justification for assigning those things. Um, so I just thought I'd just chime in there and sort of just, no, and it's funny that you say that because I, I, I knew that. And I think that I, I can't remember if you said it for sure. Or if I kind of just in the back of my head knew like, this is purely this first few runs back are just confidence. Like it's just about proving to myself that I'm going to be okay with this. And I remember. telling people, like I was so excited that I was going to run and I told people and they kind of were like, you're running for 10 seconds? And to me, I was like, yes, and it's fine. Like I'm excited for this. yeah, no, totally, again, trusted you and I knew that like that was kind of, there was a reason. So I was very excited to do that. And I knew that we were going to, and you said to me, when someone is presenting like this, where I'm thinking it's a lot more of. this chronic pain, nerve sensitivity, we tend to progress pretty quickly. like, just, knew like, okay, we're just gonna, we're gonna ride this out for these two weeks. And then like, I saw like, okay, if this goes well, two weeks from now, I'm gonna be running for, you know, not continuously, but I'm gonna be running for 15 minutes, like, you know, at three minute intervals. So that was like, it was huge. I was, I was excited. Very good. I do like to have a silver lining there with people because a lot of people like I've been in pain for two years, it's gonna take two years for me to, you know, build this back up. But what I like to explain to people is if a lot of their pain presentation is this nervous system, just a buildup of the nervous system, you can make a significant improvement very, very quickly, because all we need to do is settle down your nervous system. That might be hard to do, but if you manage to do it, it's instantaneous. Like how long does it take you to settle down your nervous system? If you know what to do, it can take seconds. And then, you know, pain significantly diminishes. I've just had a client last week who said, doing this in a very similar position that you're in, all I need to do now is take a slow, deep breath out and my pain significantly reduces. Cause what happens when you breathe out, you activate your parasympathetic nervous system, which reduces that hypersensitivity of the nervous system. And that's instantaneous. And so it is hard to do for a lot of people. is like shifting beliefs. is trying to, when you say, don't think about your pain, it's hard to not think about pain because you're in pain. And so it can be hard to unravel at times, but when it clicks into place, it can be quite a big change. And it's my followup question. How long before you started to notice some improvements or some encouragement that this actually was working? I mean, I would try to think, I think mentally it was immediately because I just felt so hopeful. I felt like we finally were going to get somewhere. So I think, you know, with that, I was just less stressed about everything. I had more hope. And so my overall baseline symptoms improved. I'm trying to think, I mean, for the most part, I'm kind of jumping ahead a little bit, but for the most part, you know, I never really had a flare up of the actual peroneal tendon throughout our entire progression with everything. I was having some other weird symptoms come about. I was getting some... shin splints, really stressed me out at the time because I had never experienced those before. And I remember I felt like I was driving you crazy because I was like, what's going on Brody? Like, this doesn't make sense. I was having some tendon pain on the inside of my ankles now. And I think it was all just kind of coming from the idea of, you know, at this point, my body, which was so used to moving so much all the time, really lost. a lot of just muscle everything. And so it was just kind of like, okay, this is gonna be like I'm going and running again for the first time in a really long time. So we're gonna have some new things come about. But you kind of kept reassuring that we have not done anything crazy. Like we have stuck to this very gradual progression. you're, you know. We don't need to worry about new injuries arising because that was my biggest fear was, my gosh, what if I get this other pain, like what if I get shin splints now that turn into like stress fractures in my, like, it's just going crazy. And so I think, I forgot what you said again, but I think, oh, when did I start to kind of, yeah, I mean, I was, for the most part, we kind of were just able to follow the plan. You know, it was like, what we kind of said was, all right, this is our phases. We'll up this phase each week. And if we need to, if we get to a spot where things are flared up, then we'll kind of be able to just hang out at that phase for a little bit until you feel confident, like we can keep progressing. And I think that was huge for me too, because my biggest fear was building up and then having to go back again and start from square one. I was like, please don't tell me we need to go back to 10 seconds of running. I just felt like I just couldn't handle that. And so we pretty much were always able to keep progressing. And I think another thing that you kind of said was that with the nerve sensitivity, this is going to take a little bit of time. But for the most part, symptoms should be improving week to week. And I kind of felt. like they were, which was crazy because it's like, okay, each week I'm doing a little bit more, but my symptoms are getting a little bit better. And that was just so like, it was like an oxymoron to me at this point because I just was so confused about everything and all of my symptoms and no pattern and all this stuff. So I think just little by little, I had these big goals, which I think I kind of started to, as we went, I think We started working together at the end of August and I said to you, I would absolutely love to be able to do the Turkey Trot with my family on Thanksgiving, because that's just something I've done literally every year of my, you know, since I was eight. And you said, okay. And I think as it got closer, I started to realize like, yeah, I could go out there and do it in a run walk, but I'm not going be able to race it. And for me, like it was almost like, I just, I was like, I don't know if it's worth that. Putting myself out there, like mentally it might be harder for me to be out there on the race and doing a run walk where I might be just rather kind of keep working on my own and just kind of getting stronger and stronger until I can get to a place where I can go out there and do like a full run. So I guess I just little by, mean, little, it was very. I want to, it was quick and slow at the same time. Like I think it was the progression was kind of like, okay, we're getting there. We're getting where they're getting there. And then I, I felt like I kind of was getting much more competent as we went and I'd come to you each week and kind of say, okay, I want to do more. Like I want to, like, I felt like I was pushing the envelope, which was something that I was very grateful to have you there for. Cause I think that was something that was always fighting me in the butt previously was I was always doing too much. Like I was always. just felt good on a run, great. Then I can try and I can do like two more miles the next time, which was always just way too much. So yeah, direction we tried to go with is like, in terms of like, we try to avoid big fluctuations in your training load, like as soon as there's a little increase in pain, don't like start from scratch, let's just have a little dial down and just calm calm yourself down, then let's just dial it back up when things are feeling okay. Um, the Turkey trot was a good illustration of, should we do this thing? It would mean a lot to me, but if it's a run walk, I won't be okay with it. won't be off field. I won't be in a good place that that was a good decision to be like, let's forego it because emotionally we want to gravitate towards where that excitement is, where that joy is, where the appreciation and optimism is. And we want to avoid the, the other side. Um, I've been working with clients at the moment who are like, In the same scenario where it's like, if I do a run walk, I feel injured. I feel like I'm an injured person and I'm constantly thinking about my injury because I am doing a run walk. You've assigned me a very reduced amount of running that I know I'm capable of more. However, when I run continuously, I feel great. I feel free. I feel like I'm getting back into my regular training routine and we test it out. Okay. Let's see how you go with a run walk. They feel worse. Let's see how you go with a continuous run. They feel better purely cause they're two very different emotional states and two very different nervous system sensitivities. And one thing I want to highlight was yes, we want to have those subtle fluctuations if there is a dial up of pain or dial down of pain, rather than big, you know, disruptions to your training plan. And yes, I do agree like week per week, symptom wise, it was a very slow turn very slow of just like reassurance, reassurance. you're doing okay, this is just a mild increase in pain. You're building up your mileage every time. You know, keep a pray, keep being appreciative of the mileage that you have. And I think you've slowly started to turn around being week by week, we were getting on calls and you're like, I had a little bit of pain, but I calmed myself down. And it's okay. It's okay that I have a bit of pain. I think the the reassurance will was less from me and more from yourself convincing yourself that it was okay over the over the weeks and over the months. Because I want to ask, were there any particular strategies that you had to try to calm down your nervous system? I do think self talk was a big one in there, like trying to reassure yourself and be like, you know what, that's okay, I have these new symptoms, but that's okay. Can you think of anything else that might have been useful? I'm trying to think. I think one of the biggest things, I guess, was just a huge piece that I didn't mention earlier was that for a while there I was convinced that I was doing irreversible damage and that I was just setting myself up for an absolute a lifetime of just not being able to be active. And I think that in educating myself and just kind of like doing more research, listening to some of your podcasts that you had a lot of people come on and talk about tendon specific rehab and everything. I learned that that's not the case. That, you know, a lot of the times if you're just listening to your symptoms that you are that it's safe, that the movement isn't causing damage. And I think that was huge. So I think that just within that I would kind of remind myself of if I started getting symptoms it was like, okay, well you know what? And I kept like a notes page in my phone of anytime I did something that I thought was going to aggravate me that didn't, I wrote it down. And it was like, okay, times that I was really fearful that this was gonna bother me and then I was okay after. So that if there was a time where things were flared up or bothering me, I would kind of be like. Okay, but remember when you did this, like you're okay, like it's gonna be okay. I can't take all the credit, but I leaned on friends, family, my husband a lot and they really helped. So I think, know, those, I guess that was the majority of it. And then I think I just kind of, would relisten to your podcast a lot. Like I had some favorites on the pain science. I think there were three ones. I would listen to those a lot because they just resonated every time that I listened to it where I was like, okay, like that makes so much sense. I'm okay. And just different things like that. Just the mindset of overcoming an injury sort of thing. I guess that, and then I had at my desk, I had a lot of paperwork that I would have to do during that time. for a while would be when I would just find myself like stewing and just doing research and everything. so I kind of, I wrote out a schedule of our plan and I wrote out a list of just kind of like mantras to myself. And then I would kind of just read them over and then I'd be like, okay, we're shutting it down. We're not thinking about this anymore. Like we're doing my work. And I guess those were kind of some of my biggest things. Can you remember one of those mantras that might've resonated? I some of them down. I think one of the, hold on one second, one of the biggest things, oh no, was just to... Let think for a second. It's just, you know, that the body is meant to heal and it's going to heal if you kind of, if you just progressively, you know, manage your load and progress it. Things like that. Things like you're still an athlete, recovery is just your sport now. That this is just kind of a blip in time and that, you know, we're gonna... I know you're gonna get back to running and it's, it's gonna be okay. Um, things like that. had some more written down and I can't find them. I think what we're talking about with this spiral of pain equals anxiety or fear, which equals a ramped up nervous system, which equals more pain. And then that just goes on a spiral for years. I think it's very hard to untangle with you, but started like As the months went on, we started to slowly work our way up. were doing more exercise, which led to more reassurance, which led to less of a sensitive nervous system, less fear of movement. That kinesiophobia was slowly starting to calm down, the catastrophizing, the hypervigilance, all of that was slowly starting to unwind. It took time, but... Like as we were jumping on calls, you're starting to be more and more appreciative of the more and more things that you were doing. You're like, Hey, it was a one walk, but I did that for 60 minutes. I did my first 60 minute run and that was like big moments for you. And you started to get your identity back. think you're like, I can actually see myself being an endurance athlete again, doing half marathons, marathons, ironmans, cause we're working out like during these walk runs, like the amount of mileage you actually building up and it was getting considerable. And so the same way that that spiral can really get you into trouble, slowly we can unravel that because the more exercise you do, you feel better about yourself, brings on more reassurance, more encouragement, less pain, which means more encouragement, less of a nervous system, less worry, less fear, less pain. And we're just working our way out of that. And I think it's pretty good timing right now to work out or tell the audience, what's your current mileage? What's your current fitness routine? What does that look like? Yeah. Um, so currently I am, um, active six days a week. I'm running, um, a little over 30 miles continuously a week. Um, I did an 11 mile long run, um, last weekend. Um, and I've been consistently doing, um, you know, long runs a little bit longer and longer, um, throwing in some speed with that, which is feeling amazing. I strain training two times a week and kind of working to I have a goal of not racing but doing a hard effort half marathon in about a month and a half and I feel really confident that I'm going to be able to do that which is humongous because I really never thought I'd be able to get back to that again. And beyond all of that I'm able to kind of do those things and then go along the rest of my day without being in pain or having these really uncomfortable symptoms, which for a while, if I went out and ran, I was hobbling around for the rest of the day and just in a lot of discomfort. So to be able to feel like I could do those things and then not be stressed about, I was planning to go to the mall or the park with some so-and-so later on and like being stressed about having walk around, like that's, that's not happening anymore, which is really huge. Excellent. Cause you maybe give us a summary of what symptoms are like, say in the past two weeks. Yeah. Um, so the kind of something that started up a little bit while we were, um, working together was a little bit more Achilles discomfort than anything. Um, which, know, we bring back to the scans and everything that we chatted about already. One of the last ankle scan I got did show a little bit of tendinopathy within my Achilles, which I had never noticed before. And since then, that's kind of been what's bothering me the most. So but we all know that now that's how to deal with that. So for the most part, I did my long run this past weekend and really wasn't in much discomfort afterwards, which was huge. I get some numbness and tingling in my foot throughout the day, but it's never very bad. like, yeah, right now I'm feeling like a little bit of discomfort just kind of in my heel. But that's, it's almost to the point now where I, for a long time, I felt like I don't know how I can live with this for the rest of my life. It's so uncomfortable. And this, it's kind of like, I could live with this, but I also don't think I'm going to because I think it's... going to continue to get better. So that's kind of where we're at. I'm glad to share that because this is pretty much your story for the whole likes last several months as we've been building up this endurance is you've had, you know, we've been constantly like keeping an eye on all of these symptoms that are going on. And obviously not getting worse, if anything getting better, less frequent, less severe yet. building up your mileage considerably. so, um, tons of successes to go along with this. And I think while your story does have a lot of components, all combined with stress and worry and fear and scans and like second opinions, like there's a lot that encapsulates this whole pain experience. I think anyone who is injured can takeaway, just a little bit of this, might be fear of getting a scan or fear of getting a second opinion or worry or any little piece can really impact someone's nervous system can really impact someone's hyper vigilance can really share that. so even if just like one 10th of your story resonates with someone who's just going through an acute injury can at least help them explain that A certain percentage of their pain experience is going to be the brain's threat, the nervous system's building up and coming up with strategies to settle that down can be really profound. so thanks for coming on and sharing your story. Is there any other final takeaways or touch points that we haven't yet discussed or like I say, final takeaways that might be helpful? Yeah. I think one of the biggest things is to find somebody that you trust. because that was a game changer for me. That piece helped me mentally be in a much better spot. And as soon as I changed my mental just viewpoint on everything, that was groundbreaking for me. I think there are a lot of episodes on your podcast that really helped. So I would just say to anybody that may be struggling to... go listen to the pain science one, listen to the principles to overcome any running injury because I think, you you said you treat every single running injury the same way. So even if you don't know exactly what's going on, you know, we learned in PT school, you don't need to know the exact diagnosis of somebody. If somebody walks in the door and says, these are my symptoms and this is what happens, like you can help them still without knowing exactly what's going on. Those aspects are huge. know, I think there's the book Rebound that just the mindset, that shift in the mindset is humongous. So those are kind of the biggest recommendations I could say. And it's hard. It's really hard. It takes a lot of patience and runners are not patient people. Tend to be very type A perfectionist. We want answers. We want to get there right now and everything. But it's... if you just stick to a progressive systematic plan, like you will get there. And it'll be, and then you can get, can set those goals and watch yourself slowly get closer and closer to them. I don't think people realize that they have an option to seek a second opinion, to try to find someone that they trust. And it's hard to just book in with a doctor and then, you know, just take their word for it and just go along with that. you, if you're feeling a bit off about them, um, because that creates doubt that creates maybe anxieties that creates, you know, all those emotions that aren't helpful for recovery. so, yeah, keep looking, look at recommendations, ask friends and family if they have a health professional that they trust and use that as guidance. So I think that's a great tip. Um, we'll finish up there. It's been a lengthy one, but a very, very important one. So I appreciate you taking the time and thanks for coming onto the podcast. Thank you so much, Brody. If you are looking for more resources to run Smarter or you'd like to jump on a free 20 minute injury chat with me, then click on the resources link in the show notes. There you'll find a link to schedule a call plus free resources like my very popular Injury Prevention 5 Day Course. You'll also find the Run Smarter book and ways you can access my ever-growing treasure trove of running research papers. Thanks once again for joining me and well done on prioritising your running wisdom.