And the Verdict Is...

... a weak left posterior tibialis, most likely caused by a strain from competing in the Maymont 8 Miler last September.

Or so says my new best friend, Steve-the-physical-therapist-who-specializes-in-running-injuries.

So what the heck is the posterior tibialis muscle?

Yoinked from Wikipedia

It's that one, that goes from your tibia, wraps around the ankle, and attaches at the top of the inner arch. Steve thinks that I strained it during the Maymont 8 Miler last September and then because I never officially treated it it just gets aggravated once in a while. Also not helping matters is the fact that my feet are too flexible (I never knew there was such as thing as too flexible), so the muscles in my lower leg and ankle have to work harder to keep my feet stable.

Usually I'm pretty skeptical of doctors, especially orthopedists and physical therapists. My feeling (which is probably - ok likely - 100% wrong) is that they just take a guess as to what the problem is and hope that they are right, con you into hours of therapy, and then nothing gets better and you are out a lot of time, sleep, and money. But to me this diagnosis makes perfect sense and explains my ankle pain and arch pain. 

The good news: I'm not truly injured, just a little weak in the left ankle.

The hour and a half of questioning, running up and down halls, weird stretches, and attempts to bring me into alignment (fruitless, since I'm naturally crooked) also led Steve to the following:

• My foot strikes per minute are a little on the low side and that I am not a terrible heel striker, but do tend to land there more often than not.
• I did better than most of the runners that he sees on the core strength and flexibility tests (thank you, yoga). In fact, for a few minutes he did additional tests to see if I had hypermobility because I was able to a few of the Beighton Score tasks. I only scored a 3, so I'm not hypermobile. But I could have told you that - the only reason I am reasonably flexible at all is because of 4 years of yoga.
• My basic running mechanics are fine (yay).
• The scoliosis doesn't seem to really be causing that much trouble. It is why my left side is a little out of whack but it's nothing that will really mess me up.

Strangely enough, I kind of enjoyed this battery of tests and had a good time quizzing Steve on what each weird thing he was making me do measured. Despite my dislike of doctors and propensity to faint around needles or at the prospect of medical procedures in general, I have always been highly intrigued by anatomy and physiology. I took biology and anatomy courses in high school and college and delight in learning about various disorders and conditions via WebMD and Wikipedia, so I have a pretty good basic knowledge and am always fascinated by doctor visits and how they reach diagnosis. I'm sure I annoy the hell out of my doctors with my attempts at self-diagnosis and overly-informed-learning-toward-hypochondriac-type-questions.

Anyhow, so what does this mean for my running obsession and marathon dreams?

First, I have to go do physical therapy twice a week for four weeks with Steve... which is why he is my new best friend. Not really. No offense to Steve, but I hate physical therapy and am not looking forward to it. I hate paying the copay (I know I know, I should be thankful that I have good health insurance and don't have to pay that much). I hate having to wake up early to go there first thing in the morning so I don't miss work. I hate the boring strength exercise that I'm supposed to do twice a day.

Basically, this is how I feel about having to spend a bunch of time at the sports medicine office:

Actually, Steve is pretty cool and a runner himself, so I enjoyed "talking shop" with him during the sonogram therapy and ice therapy portions of my visit. And I know that taking care of this weakness now will prevent big problems down the road (hopefully), so it will be worth it.

Second, for the next few weeks I am relegated to maintaining my current mileage (15-20 miles per week); and that mileage has to be flat. Read: no more trail runs or hills. Period. So much for my brief love affair with trail runs.

Third, I have to cut out the heel striking and up my foot strikes per minute to somewhere between 170-180. To achieve this, I got permission from Steve to go shoe shopping and finally pull the trigger on the purchase of a pair of Brooks PureCadence. He's a big fan of the more natural running shoes and when I asked "How do you feel about the Brooks Pure line?" he immediately said, "I love them!"

Well, there's nothing I love more than an excuse to buy some running gear, so I immediately ordered up a pair in the snazzy teal color. Steve claims that the very low Heel-Toe Offset of 4.0 mm on these shoes will help encourage me to start moving my strikes from the heel to mid foot.

To increase my foot strikes per minute, Steve encouraged me to check out Jogtunes and download some songs with at least 180 bpm and then make sure I am running in time to the music. Yay - more medically necessary shopping! And my inner band geek also loves the fact that I've been directed to run in step to music.

Fourth, right now this is nbd (no big deal - I learned that one from BFF. Thanks for keeping me current). By taking preventative measures now, marathon training and running a marathon should be totally fine unless some other muscle, joint, or ligament decides to take a crap on me.

So that's what's up. Yay medical science.