Last week I wrote and shared a couple of stories about mystery pain that shows up out of the blue.

It's super common, and it's super frustrating to people because they don't understand why and how a thing is happening.

It happens to younger folks too, but when it happens to those of us who've got a few more miles on our bodies our brains tend to take us directly to the "I'm getting old and my body is falling apart place. " (Not true.)

Today I've got a story about the time I had mystery plantar fascitis. Some morning's I'd wake up with the WORST heel pain - I could barely get down the stairs in the morning. It was a problem hobbling down stairs to get coffee and then back upstairs for a shower and back downstairs with the dirty laundry and back upstairs with the clean laundry. The pain was not as severe once I got going, but I was on my feet all day for work as a physical therapist and the facility I worked in at the time basically had a thin carpet over concrete flooring so my feet were not feeling great by the end of the day. Mostly I travelled for marathons because it's a great way to see places, and although I forget which one I was training for, I was concerned about my trip and my marathon training. Marathon training is a bit like algebra, each next phase building on the last. In the model I followed, you build up to 10-12 mile long runs adding 1 mile per week, then you add two miles to your long run 12, then 14, then 16, and so on. My preference was to go up to 22-26 miles in training. So the plan for how far I was running and when was done at least 3 months in advance with a little wiggle room but not a lot. If I got too far off my training plan I would not be ready to run 26.2 miles in time. I was quite a lot younger - in my thirties or so - so I didn't think my body was falling apart, but it was a mystery nonetheless and I was super frustrated! When mystery pain shows up it's often multifactorial, but a good physical therapist will ask you the right questions and start to sort things out.

Fortunately, figuring things like this out is my job (It can help speed up getting out of pain and getting back to the things we love when we can figure out what the cause is, but we can't always figure it out and it sure isn't mandatory. If you've been in pain for 10 years, it can become kind of like solving a cold case and the clues just aren't there, so we focus on moving forward).

When a new pain or ache shows up, the first thing to do is look for any changes that happened around or shortly before the onset. So I walked myself through the process.

ACTIVITY: It was pre-kids and during a phase of my life when I had the luxury of time to train for and run Marathons (26.2 miles) and nap. (My kids are in middle school and high school now so I have time to nap again!). The running wasn't new, I had done marathon training before so the distance and the frequency wasn't new and I was following a program I had followed before. I'm a little to lazy to run fast or up hill so I hadn't increased my intensity.

FOOTWEAR: I'm SUPER consistent about buying new sneakers every 3-6 months, buying a new pair of the SAME MODEL that I know works for me. Running companies are ALWAYS updating their footwear lines, so if the particular shoe I have been wearing is unavailable I go somewhere like

New England Running Company where the staff measure your feet to confirm your size, take a look at your feet, and ask you a few questions before making a recommendation with their huge and current knowledge on current running shoe makes and models. You can have a great shoe that's really expensive but isn't right for you and it can be the primary cause of pain - I've seen it many times. Unless reading up on the brands, makes, and models of sneakers is your hobby, I highly recommend getting your athletic shoes from a store that will help guide you!

FLEXIBILITY: I'm good about spending time stretching after long runs, not so much short runs - but I sprinkle in some stretching through the day like calf stretches when I'm brushing my teeth. (We are supposed to brush our teeth for two minites twice a day, it's a great time to stretch your gastrocnemius and soleus muscles for 30 seconds each on both sides. There's not much else you can do while brushing your teeth. When these to muscles are inflexible they can contribute to plantar fascitis, achilles tendinitis, knee pain, and a whole host of other issues like even back pain!)

STRENGTH: I'm not great about strengthening cause it can be a little boring, but I did have the strength to do a single leg minisquat on elevated heel which is the bare minimum you need for any running - and then you need endurance to sustain or repeat it for longer distance.

Summary: the usual things checked out.

Activity: running, not new to running. No tissue overload with too much, too fast increase in duration (time or distance), intensity (speed or hills), or frequency (how often).

Footwear - updated shoes, no change in style.

Flexibility - doing the right stretches - correctly

Strength: - able to do a single leg squat on elevated heel with pelvis level, doing the basics.

So I had to dig a little deeper. What else was different around the time my morning heel pain showed up? I did have a new pair of dress shoes for work that I really loved - they were a super comfortable pair of black wedge slip ons with a very soft wedge heel. It took me a couple of weeks to figure it out, but I started to suspect it was my new shoes. I wore the accused wedges to work, but the next morning wasn't too bad. So I wore them to work a second day. And the third morning my feet were killing me! It seemed that only when I wore these shoes two days in a row that my heel pain was severe in the morning. To test my theory I stopped wearing the adorable black wedge and kept doing all of the right things to help my feet get better (did I mention it was BOTH FEET!!) - stretching, self massage, ice, wearing only sneakers for a week. My feet felt a lot better very quickly, I did my long run the next weekend, and it hasn't been an issue since. The adorable black wedge shoes were the primary culprit in this instance. That's not always the case - but it can be.

Now you might ask why I did not stop wearing all dress shoes and wear only sneakers and have those sneakers on first thing when I got out of bed and have shoes on at all times from the start. This is what I recommend (and many other PT's) when folks come in with plantar fascitis - because we know it helps. The answer is that I was young. I didn't want to ruin my work outfits with sneakers.

Have you ever had a mystery ache or pain show up out of the blue?