The Importance of Rehabilitation

For any athlete – professionals or just weekend warriors – it can be very difficult to come back from a major injury.  I am learning this firsthand.  While out on a training run back in July, I tripped and broke my left big toe.  You might not think that breaking your big toe is any big deal (pardon the pun).  However, the big toes are among the most important parts of our body for running.  We need to be able to push-off using the big toes in our feet.  I am finding not only did I need to allow my broken toe to heal, I also needed rehabilitation to restore my flexibility, strength, and balance.

My doctor did not prescribe any physical therapy when I was released from wearing my boot.  I was told to start walking and building back up to running.  I wasn’t given any exercises to start limbering up all those joints in my foot that had gone on an unplanned vacation.

Without any guidance from my doctor, I did the best I could.  In Pilates the instructor had me doing various exercises that involved my foot.  I would do exercises on the Reformer where I would be raising up and down on my toes, balls of my feet, and on my heels.  I used the foot pedal on the Chair to push down using different parts of my foot.  The problem was my foot had been totally immobile for eight weeks.  Jumping back into intense foot work ended up causing me more problems.  Over the last several months, I developed a severe pain in my ankle as well as tendonitis in my lower leg.  It was increasingly difficult to run and we all know how much I like to run.  I was getting anxious as to whether I would be ready for my next marathon.  It is a biggie – the Boston Marathon in April.

I went to see my chiropractor.  Yes, my bones were a bit out of alignment but my foot lacked flexibility.  The joints weren’t fluid and moving as they should.  My big toe wasn’t bending as it should.  I needed to address this problem quickly.  After verifying that I didn’t have a stress fracture, my next stop was my physical therapist.

My physical therapist got me going on a set of exercises that are improving the strength in my ankle as well as improving the flexibility of my foot.  She also hooked me up with a personal trainer in the clinic who works with patients on more involved rehabilitation.  Both my physical therapist and personal trainer confirmed something that I already suspected.  My running (and walking) gait had changed as a result of my broken toe.  I wasn’t pushing off of my big toe on my left foot.  I was compensating by using other parts of my foot, resulting in an unnatural gait.  My body was totally out of balance.  I was on the road to more serious problems in my ankle, lower leg, hips and potentially also even in my right leg and foot.

The personal trainer used the GravityFit system with me.  The GravityFit system helps you to understand what muscles should be engaged to do things like stand, sit, and squat.  I put on each of the different pieces of GravityFit equipment that provide feedback on my form.  I understood instantly what correct form felt like, when my core was engaged.  Establishing that understanding (and muscle memory) helped me to identify when my form was right and when it was wrong.  With my new-found knowledge, my balance immediately improved.

Once I understood what correct form was, the personal trainer then worked on my gait.  I was putting my weight into my heels when I walked and ran, possibly from an unconscious fear of putting weight onto my big toe.   She showed me the proper way I should be walking and running.  I focused on shifting my weight onto the balls of my feet.  When I took a few running steps, I was able to push-off from my big toe.  There wasn’t pain in my ankle.  Granted the muscles in my foot, ankle and lower leg need to be strengthened but at least now I feel like I am working on getting back to where I was.  More importantly I will be rehabilitating my foot without causing myself more problems.

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This experience with my broken toe has taught me that I can’t go it alone.  I can’t just do things that I think will help me fully recover.  I don’t know much about recovery and rehabilitation.   I was relying on a disjointed patchwork of self-prescribed strategies – massage, Pilates, and chiropractic adjustments – I thought would help me get back to pre-July shape.  I was doomed to failure.

What I really needed was people with the expert knowledge of injuries and rehabilitation to get back to pre-injury condition.  I have that team in place now.  They are giving me exercises to improve my strength, flexibility and balance.  Massages supplement the work the physical therapist does and remain an important part of my recovery.   Everyone knows what is at stake for me.  They are confident that if I do my part, I will reach my goal.

My foot is responding very well to the physical therapy and personal training.  I can see improvements already.  Today I had no pain when I was running hill repeats.  To me that is a huge improvement.  I know my running form was better because I learned what correct form feels like.

My advice to anyone who gets a significant injury is to work with someone who is certified in rehabilitative fitness.  Don’t do what I did and self-prescribe a rehabilitation program that can backfire, causing more injuries.  If you care enough about training for a big event, don’t short change yourself by not getting the expert help you need for rehabilitation.  In the long run, you will bounce back faster and probably stronger.

How important is the big toe for running?  Here is an article that explains just how critical it is  http://www.kinetic-revolution.com/big-toe-extension-running-gait/

The GravityFit program was extremely informative for helping me find my core and use it to improve my balance and work on my gait.