A Tale of Two Injuries: Treating ITBS and Achilles Tendonitis with Dry-Needling.
By: Will Briggs
“It was the best of times, it was the worst of times...” The opening line of Dickens’ famous novel A Tale of Two Cities captures the essence of the injury dilemma for all of us runners in just a few short words. Well, at least in the worst-of-times part. Injury stinks. Two at the same time are even worse. Maybe my story will encourage my fellow runners in some way.
About fourteen months ago, in mile 9.5 of a long run, my achilles started hurting pretty sharply. I hadn’t twisted anything, no stumbling, nothing. Just pain suddenly. I stopped immediately and walked it in. I jumped on the internet to learn more and discovered loads of people’s stories of tendonitis. I did a bit of research and discovered some exercises people recommended and took a couple of days off to rest, ice, compress, and elevate. After all that’s the right thing to do.
I got back to running after a few days, and the pain would largely go away after about a half mile, but came back right after the run. The next morning, rolling out of bed, it would be really tight, sometimes quite painful. I moved into a phase where I decided to just manage it. I did some trail running, ran a couple of mountains in Tennessee on vacation. But it kept hurting and never got much better, maybe got slightly worse. Eventually, I decided to take the dreaded 8 weeks off everyone seemed to advise online. I stated my layoff, and, for good measure, visited an orthopedic surgeon for a consult. He affirmed the diagnosis, recommended 8 weeks off, suggested I go to a physical therapist.
Well, after the famous opening words above, Dickens goes on to say, “...it was the age of wisdom, it was the age of foolishness...” I had been given wisdom and responded foolishly. I took the 8 weeks off. Mostly. I rode the bike and everyone seems to think that’s great. But I decided my YouTube physical therapy exercises would be fine to help me heal. Hindsight tells me how silly that decision was. Eventually I did get back to running, but it never really healed.
I had learned to manage my achilles pain, along with a small dose of denial. And I kept running. I trained through the summer at Red River Gorge with an eye on running the Hot Hot Hundred 100K relay (HH100) and was able to enjoy running three 10K legs of the relay with my two awesome teammates, Jesse Chula and Laura Cox, that fine, surprisingly cool August day.
Now, I had in my mind that I was going to take a serious break to let my body completely heal after the HH100. But my buddy Jesse was still training for Cloudsplitter, Rugged Red Half Marathon, and The Rough Trail Ultra. I couldn’t say no and just kept getting out there to run. Here I was, piling on 40+ miles a week in three runs, never running two days in a row because that ALWAYS sidelined me for a week or more.
Fast forward a few months to November. Jesse and I connected for a short 10 mile door to trail on Thanksgiving Day. Sure enough, at mile 9.5 my knee started hurting sharply this time. I tried to run a bit but realized this wasn’t one where I could just-run-through-it. Later that day, I couldn’t walk down stairs without extreme pain. The next day it was even worse. But it eased up after about four days. I did a stair running workout for 1000 feet of gain. No problem. Ha! I had bested this injury with some ice and a few days rest. Then I took a short four mile run on a lunch break two days later. Pain. Back. Full force. AND, it had crept into my other knee as well. My internet research pointed to IT Band Syndrome. You guessed it: take 8 weeks off. Do hip and glute strengthening exercises. Which I found online.
I took the plunge, took time off with no bike riding, ate as cleanly as possible, grew a beard, and did my exercises every other day while adding yoga in the off-days. After 8 patient weeks, I took my first tentative running strides. There was tightness and tension in the knee but no pain. Three milers, three times a week. Add no more than 10% additional distance weekly. After four months, I was getting back up to a couple of 6-8 mile runs a week with a long run of 10-12 miles on the weekend. The pain returned at mile 8.5 of a ten miler. I ran it in easy. Finished. Took a week off running and biked.
The next weekend I set out for a 12 miler. The pain returned at mile 3 this time. I gutted it out and finished 11 of my planned miles for the day. It was like I had returned to Thanksgiving Day. Same pain. Same problem. Dickens again: “...it was the winter of despair, we had everything before us, we had nothing before us...”
I went back to my orthopedic surgeon. He confirmed my IT Band Syndrome self-diagnosis. And, further, broke the news to me that my tendonitis had become chronic. I could have almost told him that, due to the nodule I was still trying to deny existed even though the bump on my tendon could now be seen on the surface. “Go to the freaking Physical Therapist.” No, my doctor didn’t say that. It was me telling myself to stop trying to self diagnose and treat. Go get some help, dummy.
The moment the PT heard about the location of my knee pain, he felt along the side of my quadricep and put his finger right on a spot that I’d noticed being particularly sore whenever I foam rolled. The spot was a good 12 inches away from the pain in my knee. But when he manipulated that spot, the pain referred... right down to my knee, to the exact spot I’d been having pain when running.
He moved to the achilles tendon next. Again, he began feeling about a foot away from the location of the nodule. And again, when he pressed his finger into a tight spot deep in my calf, the pain referred down into my achilles. He prescribed a number of strengthening exercises and suggested that dry-needling would likely bring relief and resolve my problem.
Inside I was like, “Dry needling?!” But I was ready to be well. So at the next PT session, we finished with needling. A “dry” needle is one containing no medicine. They are very fine acupuncture-style needles. The early use of needling used anti-inflammatories and other meds injected directly into the tight muscles. When they used needles with no meds as controls for the experimentation, the results were the same with or without the medication, indicating it was the needles that brought about the results, rather than the medication.
What does it feel like? Well, after several treatments, I can say the insertion of the needle doesn’t hurt at all. It kind of feels like someone tapping their finger once, firmly, on your skin. When the needle is manipulated in the tense muscle, it feels like a dull ache. The closest thing I can compare it to is the feeling you have about five hours after getting your flu shot - that slightly tender, sore muscle where the inoculation had been given. You know there’s something going on there, but it’s not a sharp pain.
Well, the needling experience resulted in instant relaxation for the tight spots in my lateral quadricep, my gastrocnemius, and my actual achilles tendon. To my complete amazement, the nodule in my achilles tendon went away completely in one treatment after being there for over a year. Relief of the pain has been a huge blessing.
Injuries are always tough to navigate. We often initially respond with denial. Anger. Bargaining. All the classic stages of grief. Because it feels like such a loss to not be able to do what we love so deeply. Now, I’m still in the recovery phase, but the early signs are all extremely encouraging. Time will tell. I’ll keep you all posted.