Following the heart

I've identified as a runner since returning home from college in 2005. Growing up, I was a baseball player but, for one reason or another, didn't have the drive to pursue the sport in college. After my freshman year of college, I took up running, inspired by a 7-mile road race held every summer in Litchfield, CT. My then-girlfriend had run it a few times, and we trained together in the nation's capital. I'll never forget my very first "fun" run on the trails behind my alma mater. It was just as miserable I had remembered running to be in high school for baseball. Something in me, however, craved more, and I continued to run--albeit only 5K, give or take, at a time--every other day. At the time, I had no knowledge, whatsoever, of the sport, mechanics, etc. I just ran, and it felt good.

When I returned home from college, I got serious. I started reading Runner's World, learned my foot type, and decided that it was time to invest in a better, more suitable pair of shoes; although, in hindsight, the New Balance 993 was a good pair of shoes. I decided on a motion control shoe. Within only a few weeks, I was injured. In reality, though, my foot had probably been injured long before I began experiencing pain that late-fall day 2005. I remember the pain like it was yesterday. It began on a 7-mile, out-and-back run on Winsted Road in Torrington. The run out felt great; the run back felt like shit. I pushed through it, nonetheless. It was the same pain that I feel today, nearly a decade later. At the time, I didn't think much of it and continued to run on it until I wound up in my first doctor's office. Diagnosis: posterior tibialis tendinitis. It would not be until another two years and about a half-dozen more doctors before I learned the real diagnosis: a spring ligament rupture and an osteochondral lesion of the talus. I still have the business card on which Dr. Reach scrawled the diagnosis. Despite the bad news, seemingly out of thin air, I found a long-lost freedom. A freedom from not knowing. When the body feels good, unlike when the body hurts, it doesn't matter why. It's easy to take for granted.

Dr. Reach performed surgery on my foot in 2008. Obviously, he did a good job and my foot healed, because I went on to run several thousand miles over the course of the next few years. There's now some question as to whether he succeeded in treating the cause of the injury, as opposed to just the injury itself. Dr. Johnson, here in Ashland, seems to think that an equinus contracture is not only the cause of my latest injury--most likely just posterior tibialis tendinitis and not a recurrent ligament rupture, per an MRI--but the first injury in 2005. Equinus contracture is simply the inability of the foot to dorsiflex. Few of us runners--probably doctors, too, given their track record--realize this, but sufficient dorsiflexion is part and parcel of the running gait cycle. Without it, the whole body gets thrown. It's a miracle to me that I've gotten this far in my running career without more serious injury to my body. To treat equinus contracture, the doctor must first determine whether it's the gastrocnemius muscle or achilles tendon at fault and lengthen the appropriate structure, accordingly. Dr. Johnson thinks it's the gastrocnemius muscle in me and has proposed a procedure named after the doctor who developed it (of course)--the Strayer Procedure. It involves cutting tendon to provide more slack in the muscle and, in turn, more dorsiflexion. It's fundamental biomechanics, but I'm apprehensive.

As it stands, I can barely get my foot past neutral--i.e., 90 degrees--without compensating by stressing the medial aspect of the foot. It's well settled that undue stress over time leads to injury. To run safely, one needs 115 degrees, at a minimum. Everything I've read has stated that stretching will get you only a few degrees. Strayer promises at least 15. At the suggestion of a friend, I began practicing Bikram yoga in early November 2013. I have found not a scintilla on the efficacy of Bikram yoga--or any yoga, for that matter--in treating equinus contracture, and I'm willing to bet that I've read every Bikram yoga success story on the Internet. While a success story or two might be nice, faith and trust in the yoga and the ability of the body to heal is all you really need.

Thus, I have two choices: 1) give my body more time to heal or 2) have surgery. Whether I've been active or not, I've felt injured for the good majority of the year. I hardly feel like a runner anymore. I feel more like I did before I became a runner, except now with an elusive yearning. It manifests in a different, more intense kind of pain that I don't wish on anyone. When I see someone running now, I want to run up to him/her and say, "if only you knew how lucky you are." I know I have my very own set of luck, injured or not, but it boils down to perspective. I think I'd be more willing to choose the former if I knew it would work, even if it took half of the rest of my life. The latter is the quicker path to becoming a runner again but not without risk, hence my apprehension. I've read that patients have reported permanent weakness and nerve damage post-op. And I'm not sold that it's my gastrocnemius muscle, as opposed to my achilles tendon, that needs lengthening.

My passion to be outside and moving will forever burn. My heart knows that. What it doesn't know, though, is how to realize that passion in the face of an injury. In time, I'll figure it out, as I always do. I just need to go to that place where it's just quiet you. Things are easier there.