Monday, April 23, 2012

Recovering from AR50M - Trigger Point therapy

Recovering from the American River 50 Mile Run on April 7 has been a great experience for the most part.  I experienced little fatigue, no exhaustion and very little soreness EXCEPT for the front of my right ankle.  In a nutshell, I began having pain on the top of my foot in front of my ankle at about mile 12 of the run. I managed to deal with the sharp pain for the remaining 38 miles with max doses of Ibuprofen and some serious focusing on ankle lift and relaxation. I’d never had this pain before so really didn’t know what to think except that I had some serious dorsiflexion issues exacerbated by my right foot splay.
Right foot splay as seen from the rear - the foot is relaxed, but does not hang straight down
My experience dealing with this pain for the last two weeks has been an interesting journey for me providing me with some valueable thought I would write about it. 

I iced the front of my foot for 4 days after the race with little relief. I was seriously jonesing to run, had normal energy and felt great within a few days after the AR50M except for my foot.  I was getting desparate to recover from the pain. I had been talking with Mary Lindahl, ChiRunning Master Instructor and one of my bestest friends, about my recovery and she encouraged me to consider that trigger points may be the problem and not necessarily injury.

Trigger Point Therapy Book
I knew Mary had had a great deal of success with trigger points and she was the one who referred me to the book a while back.  I found the chapter that applied to my pain area and discovered the obvious dorsiflexion muscle to be the source of the problem… Trigger points in the muscle belly of Anterior Tibialis are the number one culprit for referred pain to the front of the ankle.  So I started massaging the belly of the Anterior Tibialis, found an excruciatingly tender point (trigger point by definition) and followed the guidelines to massage it.  As I massaged the area, the referred pain on the front of my foot flared!  It was like an electrical current traveled directly from the muscle belly to my foot.  The Trigger Point Therapy Book described this to be exactly the sensation I would feel if the pain was a result of a trigger point.  In general, trigger points are usually in a muscle above the point of pain.  The key is to find which one radiates to the painful area.  Clearly, I had found it.

Within 24 hours the pain in the front of my foot had lessened significantly.  Enough so that I was able to do a hilly 13 mile training run with little, if any pain only 36 hours after I began massaging the trigger points.  I haven’t iced since.  I have continued to massage the trigger points which I’ve discovered to be in the entire length of the Anterior Tibialis muscle.  I’ve also discovered the same ones on the left side so I’m massaging them, too as preventive maintenance/therapy.

Trigger points in Anterior Tibialis Muscle of right leg (that's trail dirt tan)
As a Registered Nurse and believer in traditional medical cures, the use of trigger point therapy is a big shift to believing in something that could work that is not part of that paradigm.  I'm intrigued with the possibilities for me and for others who might be willing to be open to them.   Wow, ice didn't work, but massaging a muscle above the point of pain did.

I know that we’re supposed to be pain free with ChiRunning, and I'm a ChiRunning Certified Instructor.  What could admitting that I have pain or am possibly injured do to my reputation as a credible Instructor?  But I think it would be disingenuous to say that ChiRunning has solved all my problems for someone who wants to run long miles for many hours per week.  I also think that anatomical dissymmetry can contribute to biomechanical problems that eventually lead to pain and injury despite good technique especially if someone is running long distances every week.  I don't know anyone who is anatomically perfect on one side let alone both sides.  As a result of the “tibial torsion” (thank you David Stretanski, CR Certified Instructor, for identifying the problem and assisting me with some corrective exercises), my body is now showing the effects of dorsiflexion after putting in many miles.

ChiRunning has given me the gift of running.  Learning about Trigger Points is keeping me running while I sort out the anatomical problems and focus on the Chirunning focuses that can keep me injury free.

This pain has a message for me and that is to:
  • focus on rotating my pelvis more on the left side so it's equal to the right,
  • focus on a full foot landing directly underneath me and my center of mass,
  • don't over stride by doing the above,
  • relax the lower legs more, and allow ankle lift to happen consistently especially on hills
  • focus on movement from my center
I'll be running the Escape from Prison Hill Half Marathon on April 28, in 4 days.  It has about 2500 feet of climb.  Most of the uphills and downhills are barely runnable, so it will be challenging to keep relaxed lower legs.  The following weekend on May 5 is the Lone Pine 50K, another hilly trail race. 

So, I'll keep massaging and focusing.  The process and learning is fascinating.  And I get to run and be grateful for concepts like ChiRunning (for focuses), Trigger Point Therapy (for resolving pain) and western medicine (for ibuprofen). 

On my short trail run today, I once again thanked God that I am able to run. 


  1. Cheryl ~

    Thanks for sharing and I hope that Escape from Prison Hill goes well for you this weekend.

    There are some fabulous tools that you can use to help with self-massaging trigger points here: I highly recommend the lower leg kit. It is expensive if you just consider the physical products included, but the real value comes in the included DVD, which has a 20-minute massage sequence (they call it a "class") that is excellent. That being said, it is still less than one visit to a PT.

    Good luck this weekend and with your busy race schedule!
    Helen in Truckee

    1. Thank you, Helen. I will check out the kit you referred to.

  2. I agree with Helen Re: triggerpoint technology's tools! And the workbook that Mary shared is my go-to guide. As a age-grouper triathlete...I refer to that guide ALL THE TIME!

    I'm so glad you posted about this. A a fellow instructor, I think it's awesome that we share openly. The reality is that Chirunning is a lifelong practice. Our bodies come in all shapes and sizes...and our biomechanics do too! We can get trigger points from sleeping on a bad we should have tools beyond ibuprophin!

    Anyway...I'm proud of your results on your race...and glad you shared this great recovery method!!!


    1. Thanks Patrick! I love your comment, "The reality is that ChiRunning is a lifelong practice." So true and isn't that what makes it so engaging. Even tho we're age-groupers we can still get better!

  3. Great blog Cheryl. It's crucial that as instructors we share our stories, students can learn a lot from our experiences. I don't think any of us are anatomically symmetrical and this indeed leads to biomechanical problems. I've been there myself and still am but to a much lesser extent then when I started out with Chi Running. For some of us the path is not so straight and takes us to lots of different places along the way. Good places though and a lifelong journey of learning.


    1. Thanks Michelle, I agree that being open about our own challenges with our students and each other will lend more reality to the challenge of learning about our bodies and our ability to create the mind - chi - body connection!