Respecting the Problem: Steps to Recover from an Injury

By Jae Gruenke | Injury Recovery

Sep 20

After injury are you uncertain what to do to get back to running? Do you wonder how much discomfort is okay, what kinds of exercises help you heal, and how can you tell when you’re overdoing it? And ultimately what can you do to keep the knock-on effects of the injury–the changes in your movement habits to compensate for pain, take the stress off your injured part, and allow yourself to heal—from predisposing you to another injury down the line?

I had plenty of injuries in my years as a professional dancer, and thus ample opportunity to develop techniques for dealing with them. In recent years I’ve mostly just used this knowledge to help my clients, but now I have an opportunity to use it on myself again; as I mentioned in August, I had a cycling accident at the end of July and fractured the 5th metatarsal of my right foot.

I have not done everything perfectly but I’ve done a bunch of things that have really helped. Here’s the rundown.

In August I did what the physio at the hospital said: I wore my aircast and used crutches as needed to protect my foot. Luckily the accident was just days before I left on a three-week holiday in the US, where we were mostly staying with my mother. Perfect recipe for a real rest so I could heal. I focused on giving my body the building blocks to do that, using this extremely helpful guide to nutrition for bone healing, though instead of supplements I looked for foods that gave me the nutrition I needed. Lots of oysters, sardines, brazil nuts, cultured dairy… and plenty of gorgeous meat, fish, fruit and veg. I also took collagen powder and devoted myself to sunbathing sans sunscreen, using the D Minder app to keep track of my vitamin D levels. This kind of injury rehab is not exactly hardship!

I used my earthing mat as much as possible, keeping it on the sorest parts of my foot. I use it a lot anyway, but I never fail to be amazed at what a difference it makes in relieving pain and inflammation and promoting healing.

Exercise-wise I continued doing whole-body floor-based exercises I’ve done for a long time: some yoga-type stuff and my favorite stretches. The stretches in particular helped me keep my back from going out as a consequence of wearing that darn aircast. I also made sure to gently move all the muscles of my right foot at least once a day to generate the forces that would heal my foot bones and tissues correctly.

And finally, I did something really therapeutic that I call “respecting the problem.” Every night before bed I gently moved my hands over my right foot, feeling where all the bones were, seeing if I could trace the length of each of the metatarsal bones, feel the shapes of the metatarsal heads, gently touch the sore areas, make very small movements in all of the joints, and generally relax and comfort my foot. I wasn’t trying to fix anything, but just to feel what was there. It’s very soothing and increases circulation, helps organize the tissues, reassures my brain that there’s less to be anxious about than it might seem so I don’t have an exaggerated pain response, and quite possibly does a host of other things I couldn’t even name.

It also helped me be aware of the progress I was making in healing, and I was amazed over the course of the holiday at how distinctly my foot improved every single day.

Then I came back home to Edinburgh, back to work and family responsibilities and a surprise calamity or two–long story for another time–and was no longer able to focus on my healing. My foot suffered.

In the nearly four weeks since our return, I’ve gradually ditched the aircast and then the crutches, and currently limp around in a comfy pair of cushioned Altra Zero-Drop shoes Colin McPhail of Footworks in Edinburgh kindly set me up with.

But wow am I limping.

I’ve had to get around one way or another on foot, since we don’t have a car in Edinburgh and the buses don’t always get me quite where I need to be. The priority has been on getting where I need to be rather than on doing what felt right for my foot, and that means I’ve regularly overdone it, and also not started doing more systematic foot strengthening exercises and some Feldenkrais lessons when I should have.

I’d expected not only to be walking normally by now, but also to be starting back on a teeny tiny bit of gentle running. But alas I’m quite far from that.

Really I should have known better than to expect it. Not only has the second phase of my healing happened under sub-optimal circumstances, it’s also naturally the tougher phase, and the surprises it brings are generally not so pleasant.

My good friend Jon Simon, acupuncturist extraordinare in NYC, calls this phase the “pain in the ass” phase of healing. It is when you’re getting closer and closer to being back to normal, but you stop being able to see your progress and only see the frustrating gap that still exists between yourself and health. This phase seems to go on forever and it’s hard to notice progress. You tend to struggle with pain due to compensatory movement patterns and have a lot of problems you think you shouldn’t.

That has seriously been the case with me. My fifth metatarsal really feels fine but my fourth hurts so much I sometimes expect to see its glowing outline through the skin of my foot when I look down. I suspect I injured that one too, but on the bottom rather than the top so it didn’t show on the x-ray. No matter, it’s healing too, but it hurts like a motherf*cker. (Foul language is also therapeutic. Sometimes you need to vent.)

It will hurt less if I start working on how I’m moving at this point—that is the nature of the “pain in the ass” stage of healing– and thankfully since some of the life and family stress has ebbed I can finally focus on it.

Last night I resumed “respecting the problem” and this morning I took a barefoot walk that felt completely normal for at least 10 minutes before my foot started to ache. Massive progress.

Today I started up my yoga practice again. Doing yoga or any structured exercise when you’re injured is a delicate business, and the keys are finding ways to do the movements that don’t hurt and making sure not to force anything. For instance, I wanted to try some single-leg balancing poses, but since my fourth metatarsal was aching my brain would not let me balance on my right foot. I tried them holding on to a nearby tree, and suddenly my foot didn’t hurt and I could balance without any excess tension or force. Exploring ways around your pain is the approach that ensures you feel better afterwards rather than worse and your exercise doesn’t cause setbacks. I feel quite good now.

Yoga won’t be sufficient to get back to using my foot properly in a way that decreases pain, though, so tonight I’ll do a wee Feldenkrais lesson before bed and that’ll be my nightly routine all week.

I’ll report back to you next week on my progress. Meanwhile, if you’re currently rehabbing an injury, try “respecting the problem” and gently working on the movement of your whole body and let me know how it goes.

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About the Author

Jae Gruenke, GCFP, is a running technique expert and Feldenkrais Practitioner. Known as a “running form guru,” she is the Founder and CEO of The Balanced Runner™ in New York City and The Balanced Runner UK. She has helped runners from beginner to Olympian improve their form to become pain-free, economical, and fast.

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(5) comments

Sue September 20, 2015

Golly Jae, I can see by your xray that it was quite the break.I understand the fifth metatarsal is the foot propeller and it is so easy to compensate with this injury as it is so painful. Luckily you are totally aware of possible compensations so you should be able to avoid these.
I suffered a severe foot crush and broke bones in many places and it was actually your Feldenkrais video’s that helped me to recover my gait when running and to undo the compensations further up the chain. Your foot movements using the tripod and later your hip rotation awareness tutorials enabled me to run again with confidence and Joy. I still do foot exercises on a daily basis but your help is what has made all the difference over the last few years!
Looking forward to seeing you back out there soon with ease.

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Mauricio Herrador September 20, 2015

This is a great share! by the way, foul language gets more oxygen in your system whether you express it verbally or in writting!
What I see my PT clients go thru in their rehab also is that as their tissues start to heal and become less painful in function they want to inmediately increase the intensity of their activity, not realizing, like you have, that there is a limp or change/adaptation in the mechanics that will probably not serve them well in the longer run.
I really appreciate you sharing your eagerness derived mistakes as it gives you a human genuineness uncommon in rehab providers I know personally.

I never knew what an earthing mat is. Now I’m very curious!

Love your work!

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Becky September 20, 2015

Jae, that’s quite the fracture. All good wishes for an uneventful and complete recovery!
Becky

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SCOTT FORRESTER September 20, 2015

Thanks Jae, great post. Thanks for sharing your actual experience. I have written several articles on injuries and recently had one myself. In some of my articles I came up with the acronym St.O.P. for Stop and acknowledge the problem, Observe and learn, and proceed differently. Many people try to proceed without going through these steps.

I think we all have injuries from time to time. It is my impression that Moshe Feldenkrais said that if we lived life fully these things would happen from time to time. I recently finished a one hour run/walk and found that my right knee was quite upset. this was unusal and not expected, however I could trace the problem to particulary poor running that day.

I first recognized the need for rest and was able to do that over a weekend. Then I began to explore the ways that I could move more easily and did a number of Feldenkrais lessons. I was actually amazed at how quickly I healed from what had been a little bit of a scary situation. I really had very little trouble being on my feet all day at work even though I could barely walk the friday night after the problem. I am thankful. I often find that things like holding onto a tree to help balance are ways of reassuring the nervous system and incrementally redeveloping the ability to stand on one leg. I find that people often say I can’t do something in an all or nothing attitude when they in fact can do it if they do it incrementally. Movement starts in the physical imagination and we do not cease to be runners because of a set back. All of our movement is still accessable in the imagination. I have used the idea of touching the injured part and using touch to re-integrate the part into the whole but that was as much an instinctive thing for me to do as something I was taught.

I am writing a book to introduce Awareness to the fitness community. Listening to the body is often talked about but not taught in detail.

Thanks for sharing this post. It was particularly clear, concise and helpful. Good writing -Scott

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Elaine September 25, 2015

Great article Jae! Thanks for sharing the process you are going through, and I appreciate your insights. When I fractured my toe (much more minor injury than yours!) five years ago, I did not respect the problem, and did not take time in the pain in the ass phase and rushed way too quickly into trying to run and resume normal things again… problems ensued! Anyway, I wish you speedy healing from here on out, and commend you for taking the time to respect the problem even when it feels like you just can’t spare it! 🙂

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