[pct-l] tendonitis (was Getting Back on Trail,

Thu Jun 3 19:41:34 CDT 2010

Well, I might as well chime in also.  I sustained the same injury to my leg
as Dan did and the same way.  I came down Mt. San Jacinto from Fuller Ridge
camp last year and pushed it without stopping.  At the faucet it was hot and
after getting water I got about 100 yards down the road before I had the
sudden onset of pain in my right shin.

Instead of doing the smart thing, stopping, I kept hiking with a couple of
hiker friends seeing if I could gut it out.   I made it another 8 miles to
the Mesa Wind Farm, for a 24 mile day, and called it quits when my buds kept
going climbing into the white water river canyon and a 30+ mile day.  The
next day reaching the canyon wasn't bad, but then traversing the next range
of hills to Mission Creek was excruciatingly painful.  I knew I was in
trouble and used my spot to message my wife so that she'd come down to Big
Bear.  I didn't push the rescue button, but she remembered that she wouldn't
be copied with a 911 message so she called the Riverside Sheriffs office to
see if they had received one.

This part is kind of interesting as the sheriff's office apparently looks
for occasions to fly their bird.  I'd just finished bathing and was cooking
dinner when I saw the helicopter circle in and land (How the pilot
accomplished that by the creek was amazing)  He got out and chatted and
asked if I had any message for my wife and asked if I wanted a ride.  He was
a tremendously nice guy; we really got along well.  I turned him down as I
wasn't ready to quit.  It turned out I probably should have gone with him.

The next morning I used athletic tape to bind and compress my calf and shin
and hiked up out of the basin, about a 5000' climb.  With the compression I
felt fine.  I got up to the camp with an access road and called it quits for
the day.  I went to take off the tape and the first turn off resulted in
literally a spurt of body fluids.  I was an army medic back in the day and
worked my way through school in Emergency Rooms. I had taped my leg from the
ankle to just below the knee and knew the tape had to come off and I'd
rather do it myself than someone in an ER.  I took off the tape and it took
off the skin underneath resulting in  a lot of body fluid and, ultimately,
bleeding and I prevailed on a nearby car camper to take me in to the
hospital.  I was in Big Bear for 10 days and two hospital visits and got
back on the trail at the highway outside of town and hiked to Van Dusen
Road, a distance of only 9 miles.  The pain at the end let me know I had to
get off the trail and the leg helped my decision along by becoming infected.
 I have a wonderful pattern of scars to this day.  (Trail angeling later
that year up north one of my hiking friends wanted to rename me 'Stripe'.)

I believe I was predisposed to this injury as I had previously sustained a
training accident to my right knee.  I had been training for eight months,
running four miles of hills and alternating the next day with an hour on
the Stair-master with a 30 # pack. In early March of that year I felt as if
I'd peaked and kicked the mileage up to 5 miles of hills.  As soon as I
finished that extra mile I had the onset of pain in the medial portion of
the joint line and it wouldn't go away even though immobilized the knee.  I
ultimately got in to a sports doc , but it was 7 weeks on inactivity, and
some atrophy, later. I got a cortisone shot and after three days for it to
take effect, hit the trail on April 27th of 2009.

With this said, the cortisone was wonderful.  It stopped the inflammation in
it's tracks.  I couldn't understand why none of the 3 sports docs I saw
later for the leg would give me a shot.  What I was told was that sometimes
inflammation is good thing.  I went through a lot of attempts at
rehabilitation with PT's and an athletic trainer, none of which was
successful.  I had planned on hiking this year but could only attend the
Kick Off.  I had a final diagnostic test in early May, an ultrasound which
finally demonstrated the problem...The top of the anterior tibialis muscle
in the front of the shin which is used to lift the foot while walking
downhill was now 20% scar tissue in it's posterior portion.  I'm now able to
have treatment specifically directed at this problem.

It appears that the cortisone was felt to be likely to hinder the healing
process.  Before I retired (I just turned 58) I worked with a lot of
physicians and know a little.  I read a 60 page medical journal article that
specifically details what inflammation actually does.  In my case I
destroyed a significant portion of the muscle and the inflammatory process
clears that away, including dissolving old tissue and blood vessels and then
builds new vessels.  It is part of the process of breaking down the scar
tissue which is an intermediate step but one which I believe was arrested
because of the chemical burns from the tape and the resulting skin loss and
infection incapacitated me for awhile.

On Thu, Jun 3, 2010 at 4:05 PM, Tom Holz <tom.holz at gmail.com> wrote:

> Thank you for that brief info on inflamation.  I suspect I lost proper
> range of motion (eg dorsiflexion of the foot) due in part to a
> combination of my gait and continually taking NSAIDs for months.
>
> Bigfoot
>
> On Jun 3, 2010, at 3:37 PM, Yoshihiro Murakami
> <completewalker at gmail.com> wrote:
>
> > Brief answer is simple.
> >
> > According to the medical dictionary, inflammation is defined as a
> > protective tissue response to injury or destruction of tissues, which
> > serves to destroy, dilute, or wall off both the injurious agent and
> > the injured tissues. So the inflammation is a normal response of the
> > body, it  rises in the temperature of the injured parts, and
> > facilitate the biochemical reactions. As a result, it facilitates the
> > recovery of injury. But, extreme inflammation is harmful, because it
> > destroy the normal tissues. So, we need icing. When the degree of
> > inflammation became tolerance range, we should keep warm the injured
> > parts to facilitate the recovery. I don't know the long term effect of
> > suppressing inflammation. but I think the long term use of medical
> > substance will prevent  the recovery process.
> >
> > Detailed answer is difficult. It is for medical specialist.
> >
> >
> >
> >
> >
> >
> >> PS - one area I stilll want to understand more is how the body reacts
> >> and adapts to stress, especially the role of inflamation.  I hiked
> >> the
> >> whole AT thanks to ibuprofen, and I'm still using it intermittently
> >> on
> >> the PCT when I get close to injury, but I don't really understand the
> >> long term impact of supressing inflammtion with NSAIDs.
> >>
> >> On Jun 2, 2010, at 11:18 PM, kylie skidmore <kyliepete at gmail.com>
> >> wrote:
> >>
> >>> thanks dan & tom - this is very helpful. where did you get your info
> >>> on gait and stride length - did you just figure it out or did
> >>> someone recommend changes?
> >>>
> >>> On 3 June 2010 06:11, Tom Holz <tom.holz at gmail.com> wrote:
> >>> Ive been loosly following this discussion from the trail, but wanted
> >>> to add that my hike this year was entirely made possible by changing
> >>> my old hiking gait (heel strike, wide stride, shin splints, foot
> >>> pain)
> >>> to a short relaxed "barefoot" type stride.  I now believe gait and
> >>> form are as or more important that packweight, shoes, or insoles in
> >>> reducing hiking injuries
> >>>
> >>>  From Agua Dulce,
> >>> Bigfoot
> >>>
> >>> On Jun 2, 2010, at 7:31 AM, Dan Ransom <danransom at gmail.com> wrote:
> >>>
> >>>> I'm happy to explain my situation...  Though there will probably be
> >>>> people who offer differing opinions.  For a week or more I was
> >>> calling
> >>>> this "shin splints" for lack of a better understanding.  It is not
> >>>> traditional shin splints, however.  It is (was?) severe tendonitis
> >>> in
> >>>> the muscle that lifts your toes off the ground, 2 inches above the
> >>>> ankle, right on the outside of the shin bone.
> >>>>
> >>>> My problem was probably three-fold.
> >>>>
> >>>> 1 - I have poor walking form.  I take very long heel-strike strides
> >>>> and walk relatively fast.   The heel strike motion, instead of a
> >>> more
> >>>> neutral strike, forces the foot to flex with every step, and
> >>>> muscles
> >>>> get strained.  In my shorter walks the last week, I've spent
> >>>> considerable time relearning a shorter stride with less impact.  So
> >>>> far pain free.
> >>>>
> >>>> 2- Footwear was not supportive enough, no torsional rigidity.  The
> >>>> rolling motion induced by sidehilling on snow probably contributed
> >>> to
> >>>> the muscle fatigue.  These have been changed from new balance trail
> >>>> runners to Salomon XT wings.  Arch support has also been
> >>>> recommended
> >>>> to me, as well as different lacing patterns that allow the foot to
> >>>> swell and expand within the shoe.
> >>>>
> >>>> 3 - The snow on Fuller Ridge I believe caused lots of little
> >>>> micro-slips, and again, I wasn't deliberate enough with foot
> >>>> placement.  Just figured I'd walk through it.  Walk through it I
> >>> did,
> >>>> but when I got to I-10, it felt like I shot my right leg at point
> >>>> blank with a shotgun, and it was pretty obvious there was
> >>> significant
> >>>> damage.
> >>>>
> >>>> Pack weight certainly can compound any of the issues here, and at
> >>> the
> >>>> time I was carrying about 13 pounds base, plus 14-ish pounds in
> >>>> food
> >>>> and water.  Not a really heavy load, but for my return I will be
> >>>> coming back lighter, ridding myself of some of the 3 pound camera
> >>> kit
> >>>> I was carrying.
> >>>>
> >>>> I've never had an injury in this location before, and I've done a
> >>> fair
> >>>> share of backpacking previous.  But never such big days so
> >>>> consistently.  I suppose the lesson for me is to go slow, take it
> >>>> easy, and listen to your body, and focus on walking stress
> >>> free...  I
> >>>> was too confident I could walk through it, and it blew up.
> >>> Hopefully
> >>>> a very humbling 3 weeks, a ton of ice massage and a course of
> >>>> cortisone will resolve the issue for me.
> >>>>
> >>>> Thanks to some help from this list, I think I'll be back out this
> >>>> weekend...
> >>>>
> >>>> - Dan
> >>>> _______________________________________________
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> >
> >
> >
> > --
> > Sincerely
> > --------------- --------------------------------------
> > Hiro    ( Yoshihiro Murakami )
> > HP:http://psycho01.edu.u-toyama.ac.jp
> > http://picasaweb.google.co.jp/CompleteWalker/
> > Backpacking for 30 years in Japan
> > 2009 JMT, the first America.
> > ------------------------------------------------------
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