Plantar Fasciitis - An Uncomfortable Reality

     I met my friend Kathryn a little over a year ago.  In the course of our early conversations, she shared with me that she had been struggling with Plantar Fasciitis (severe pain in her foot).  It had come on slowly and she had tried to manage things the best she could - not knowing what to do to aleviate the problem.  After dealing with it for months, she had turned to expert advice to try and help her, but to little effect.  At night she was sleeping with a boot on her foot to try and manage the pain.  Going forward she was facing the prospect of either dealing with the problem for years to come or surgery.  

     Correcting a problem like Plantar Fasciitis involves looking at all the contributing factors and then doing the work that is necessary to make things better.  This is where most people struggle, because looking at problems can reveal certain uncomfortable truths.  On top of that, the work that is necessary to correct things is often brutally painful.  Moving forward can be difficult because it means letting go of ego, being honest about the cause of the problems, and being committed to the process.   
     Talking with Kathryn about her foot, I told her I could fix the problem, but that she had to be aware of what was involved.  I would pull no punches, either in what I saw the problem was or in the work that was necessary to correct it.  It would be a painful process.  This is where a lot of people are stopped cold.  They don't want to hear the truth of what's wrong or they think that they shouldn't have to do the work needed to move forward.  Often times, the only way they will finally address the problem is when the daily pain and hassle of dealing with it outweighs doing what is necessary to correct it.  

      Digging into things, I identified several factors that needed to be addressed.  The fascia in her foot needed to be worked on.  The calf needed to be loosened with heavy bodywork.  Her diet needed to be changed with a higher emphasis on protein and good fat for recovery.  Her spine needed to be aligned and her posture worked on.  Addressing these factors is difficult because it touches on sensitive issues of personal choices, body image, accountability and the like.  At one point or another every athlete I've ever worked with has expressed frustration with what I am telling them.  It's uncomfortable to be confronted with things that need to be worked through.  
       We started with heavy bodywork on the foot and calf.  This is an incredibly painful process.  It can feel like knives digging into the muscle.  Several people have commented to me that body work is the worst pain they've ever experienced.  After a session, there is a feeling of having been beaten up.  But, with rest and a good diet, the muscle can rebuild without the knots and tightness.  
     Everything is connected in the body, which is why it's important to address all the components of a problem.  In Kathryn's case that involved looking at the tightness in the calf, hip alignment, posture and weight in terms of how it affected her foot.  After months of working through the problem we were able to largely eliminate her Plantar Fasciitis.  I've explained to her that long term it's critical for her health to maintain good behaviors and continue improving her health habits.  That means rolling out her calves after working out and keeping them loose, keeping her spine aligned and her core strong, eating high quality food, and the like.   

 

     The truth of addressing serious problems or making fundamental changes in health is that you have to be committed to the process. Doing things only half way will only result in marginal outcomes. As the saying goes, "You can’t cross a chasm in two small jumps." That doesn't mean trying to change everything all at once - it's okay to do things little by little.  What's important is to do them all the way.  Every day focus on getting better.  

     The thing that is so damaging about dealing with chronic pain or body issues is that it has a debilitating effect on every aspect of life.  It limits what a person is capable of.  More than that, it affects beliefs about what is possible.  For example, it's hard to imagine doing something like running a marathon when it's painful just to walk to the kitchen.  As Kathryn's foot has healed and the constant pain has subsided she has been able to consider new possibilities.  She started riding her bike more regularly and completed her first 100 mile ride a month ago.  A few weeks ago she went for her first run in over a year.  With the understanding of how to deal with Plantar Fasciitis and avoid similar problems in the future, she can focus on moving forward and finding new goals and pursuits. Semper Porro.

Pride

     We live in an entitlement culture.  Everyone is great, everyone is fantastic.   Always be positive, don't be negative.  Gold stars all around.  In my years of teaching and coaching, I have come to learn that this attitude - the belief that every student or athlete is somehow special - is the main impediment to moving forward.  If you already think you know better or that you are indeed special, then you won't be prepared to do what needs to be done to move forward.  As an instructor there have been many times that a student has informed me that they know better and don't need to hear what I am telling them.  Or, they agree with me - and then carry on exactly as they were.  After all, if you are special and amazing and awesome, you are already doing everything you need to be doing.  

     Often times, the only way for a person to move forward is to be humbled.  Pride is the impediment to success.  The problem is, in our entitlement culture, we have mistaken true pride and actual accomplishment for false pride and misplaced praise.  True pride is the satisfaction that comes in accomplishing something.  It's real and tangible.  It's the reward for actual achievements.  False pride is the fake projection that people create for themselves as a way to boost their confidence or make themselves feel better.  They tell themselves that they are more exceptional than they actually are to mask the reality of where they are at.  The truth of the matter is though, nobody is special.  Some people just do special things.  

      When all is said and done, what matters is what a person does.  As the saying goes, talk is cheap.  Actions speak louder than words.  For people raised with a sense of misplaced entitlement or self belief, the only way to connect with reality and move forward is to be humbled.  The false pride and unrealistic projections must be broken down.  For people who have lived with an inflated sense of where they are, that can be a bitter pill to swallow.  It's especially hard for people who are smart and for who success has come easily at first.  Everyone must face reality at a certain point though, whether it's because they didn't get into the school they wanted, or they were turned down for a job, or they got dropped in a race they were targeting.  

     The fact of the matter is, reality is hard.  Success does not come easily.  A lot of the time, even when you work and work at something, you still will fail.  And there will be no gold stars.  Just mild words of sympathy - better luck next time.  And so a lot of people try to make the best of things.  They put a positive spin on where they are at.  They say they tried.  Others try to deny reality.  They make excuses.  They point out the obstacles that were against them.  They give up because things are hard.  Successful people stay the course and find a way to get the things that they want.  They have no false pride. They are committed to reality and do what is necessary to move forward.  

     The question of whether a person has the right process is simple.  Do they get the things they want?  A person rooted in reality sees what is needed to achieve what they want and then does what is necessary to accomplish their goal.  They accept critical feedback and make changes to keep moving forward.  They have no false sense of accomplishment.  The pride that they do have is in a job well done.  Semper Porro.

A Little Dissatisfied

     Whenever things slow down, and I can pause to catch my breath, I feel a creeping melancholy seep over me.  Truth be told, I sometimes feel as if depression and anxiety is my natural state.  And, I only manage to keep it at bay by going full speed ahead all the time.  As soon as I have nothing to push against I can't help feeling a bit useless - like an unused tool collecting dust in a shed.  

Anytime someone says I can't do something, my first instinct is to want to do it anyway.  

     Everyone is so focused on the positive and avoiding the negative that sometimes I feel people forget that there is a counterbalance to everything.  You need contrast in your life.  Pretending everything is perfect makes things seem a little hollow - like a savory dish that has no salt or chocolate without a little bitterness. The truth is, for me at least, there are a lot of things I struggle with.  There are a lot of things I don't know.  My marriage isn't perfect, I struggle with being a dad at times, working my athletes leaves me feeling a bit lost at times, and the list goes on and on.  I think it's important to recognize and be real about these things though.  I'm not afraid of acknowledging my problems and weaknesses.  I want to see things for what they are so I can constantly make adjustments and move forward.  

Practice, practice, practice.  You have to teach the mind that winning is normal.  

     There are so many things I want that I am striving for.  At the same time I have constant doubt and worry about how things will turn out moving forward.  At certain times I've tried to push those thoughts aside.  Tried to ignore everything that stood against me.  Over the years though, I've come to realize it's okay to feel a little dissatisfied, a little worried, a little anxious.  I even value it.  Those things keep me fired up.  Being depressed when things are easy keeps me motivated to keep moving forward.  Because, I don't want to feel that way.  I'm happiest when I have something to push against. When things are hard, I know I am going in the right direction.  

Steven Davis drilling it on the front.  

Faster or Farther

     My friend Cameron recently completed the Half Marathon she was training for.  She went eight minutes faster than her previous best, on an off-road course no less (which is slower than running on pavement).  The thing that was most exciting though is that she did it with no shin pain.  Amazing what a few small changes to the process can yield.   

     After the race we started talking about what she wanted to set her sights on next.  The question was whether to keep training for Half Marathons or to stretch it out a bit more and train for a Full Marathon.  Going forward it's a question of whether she wants to go faster or farther.  What's excellent is she can train confident in the knowledge that there is a process for either goal.  A good process will carry you forward.  Semper Porro.

Success Comes From Execution

Correcting problems

     One of my favorite aspects of coaching is helping people move past things that hold them back.  I enjoy problem solving and applying what I know to help people move forward.  That's how I started coaching.  A friend of mine started asking questions about how to move forward in cycling.  He had a series of systemic problems that were undermining his ability to move forward.  So, we worked on resolving the biomechanical issues, the overuse of the endocrine system, and in general sharpened and refocused his efforts in a new direction.  Along the way, I found I really enjoyed the process of guiding my friend through his various issues so that he could escape the cycle of one step forward and one step back and make real progress in a positive direction.

Icing the shins.  

      Up till now I have focused exclusively on cycling.  It's my passion and my dream to coach at the highest level.  A few months ago though, my friend Cameron who is a runner started asking me questions about various issues she was dealing with.  I know very little about running, but I have extensive knowledge about the functional aspects of how the body works.  And, like I said, I enjoy problem solving.
      It amazes me how often people push through and live with functional problems (back pain, shin splints, plantar fasciitis, asthma, etc.) when, in most cases, there are solutions to correct these things without surgery or drugs. It just takes the right process coupled with focused work to overcome the problem.  

Anytime you have pain in the body it's almost always because of problems (tightness, muscle trauma, weakness, etc.) on the antagonistic muscle group.  Foam rollers are nice.  But, when the problems are serious you need something harder - like a beer bottle.

     After discussing the various issues that Cameron was dealing with, we had her start using compression sleeves during and after her runs.  We also had her ice her shins and roll out her calves post workout.  On top of that I made some dietary recommendations that included more protein and Omega fatty acids.  A few simple changes in her routine has allowed her to recover faster and begin to eliminate her shin splints. She can look forward to pain free running before too long.  That's going to be pretty dang cool. She's training for a Half Marathon in November.  It will be a good test to see what sort of difference the changes in her routine have made.  Stay tuned... Semper Porro.

Post workout protein shake.  

   

Bike Fit

Inno on a ride before we made any adjustments to his fit.  

      A proper bike fit is one the most critical aspects of performance in cycling and yet it is often overlooked in terms of its importance.  For starters, people often approach it from a static perspective.  They get a bike fit and then leave it at that, assuming they are set up "correctly".   The truth is though, the body is a dynamic system of moving parts that are constantly changing and adapting.  A good bike fit should develop along with the demands and goals of the rider.

Pre fit.  Note the upturned stem, the upright position, the locked elbows, the hunch in his lower back, the awkward cleat placement, and the lack of powerful Glute muscles.  

     My approach to bike fitting is to treat it as an evolving process.  I closely integrate it into the training plan of the athletes I coach.  We start with a basic bike fit and then train on it for a month.  As the body adapts and strengthens, the angles and leverage points change.  Different muscles get called into play and stress is put on different ligaments and joints.     

The first adjustment.  

     Every month we make adjustments to the fit.  There are general goals in terms of building muscle and maximizing leverage that we aim for.  Power, aerodynamics and comfort have to be carefully considered and balanced against each other.   We also make specific adjustments to the fit based on the athlete's goals. A sprinter has different needs compared with a time trialist.

Road testing after a fit.

     Part of the process of fitting is working around injuries, functional imbalances, and latent deficiencies.  Using an evolving model of fitting we can work around problems and correct issues over the course of months.  The process goes hand in hand with body work and doing specific exercises to strengthen and balance the body.  

This is after the second bike fit.  Pelvis is rotated better, cleat placement is under the ball of the foot, and arms are relaxed.  Still seeing an arch in his lower back and Glutes need more development.

     I am just getting started with my newest athlete, Innokenty.  He is dealing with lower back and hip pain that is the result of a weak core.  He also needs more Glute strength to be able to ride with power and strength in an aero position.  We've already made good progress.  His position will continue to evolve in the coming months.  I am excited to see where he'll be at come racing season.  

Bryan Larsen is a good example of a rider who is highly evolved in terms of fit.  His head and back are low for optimum aerodynamics.  His pelvis is rotated and he has a stable core.   We have worked on strengthening and adapting specific muscles over months and years to allow him to drive the gear when he is this low.