My Peroneal Struggles: Dry Needling

Training Tips

Now, first let me say that I HATE needles. I know most people say that….or they say “I LOVE it”, but I am so far in the hate camp that when I get my bloodwork done for Inside Tracker a few times a year, I have to lie down, look away, and let a lone tear roll out my eye.

Wimp.

So when Sarah told me that dry needling was what saved her hip flexor and allowed her to run Boston marathon (she has finished 2nd American woman before), it really caught my attention.

But at the time, I didn’t have anything that was THAT urgent to be prepared to have lots of needles poked in my leg.

I have told you in the past that I have had peroneal issues. That is why I had the Runners Connect writer research it to see if he could find anything new that I had yet to consider.

My pain had been going on for years now, coinciding almost to the day with my first visit to UVA Speed Clinic. I had also had many chats with the UVA guys about why this was happening. Along with some bad times when I was going down an injury depression spiral that’s why I created the Coming Back From Injury Podcast Series. I wanted to be there for you all and help out as much as I can, especially through this time.

Max simply said that it would eventually balance itself out, and once we fixed the biomechanical issues, it would get better.

So Drew and I went to work on that, and we have come a loooooonnngggggg way, but yet the peroneal pain still comes back to haunt me often.

Some weeks it is bad, other weeks I don’t feel it at all.

Some runs I couldn’t tell you which leg it was, others I considered walking as I get that gut feeling that this is NOT good.

But it just never seemed to be constant to where we could pinpoint it on something.

The only thing we did notice, was that it mostly occurred on easy days.

The days that are critically important to recovery, were the days where it wold bother me most….and not at the start of the run, but would start getting angry around 5 miles into a run.

We came to the conclusion that it must be something about my efficiency. When I run slower, I am less efficient in some way that overloads that peroneal muscle.

Made it very tempting to speed up on recovery runs……but I still kept it easy, even if that meant more treatment after.

Let me just say that the pain I felt has never been more than a 6 or 7 out of 10, and I would say across the last 2 years it has been an average of a 3, so I am not talking serious pain here.

I also found that when I took my time off, it would always come back with a vengeance. Once I start running again, it was pretty sore for the first week, especially after my usual 2 week time of no exercise after a marathon.

Cue freakout; HOW AM I GOING TO MAKE IT THROUGH A SEASON?!?!

But once I got going, gradually the pain subsided, and it would go back to its random pain.

As you know, I am the kind of person who puts my health first.

The pain associated with the peroneal was tolerable.

I could easily keep going as I have been, and in a lot of ways I have been. After two years, I just expect it a lot of the time, and just….well, get on with it.

BUT

There was that voice in my head that said, “hey, uhhh something is WRONG here, so why are you ignoring it? Even if you can run on it, it HURTS….yes, that means you need to LISTEN”

I did not want to be one of those 60 year old runners who hobbles along, barely able to run because of so many years of ignoring a pain that should have been dealt with years ago, and is now going to be there for the rest of my life.

Although of course I realize that mine probably already is chronic.

That being said, we had not stopped searching for treatment to help fix the problem.

Drew and I have continued to work on the biomechanical issues, but as for the pain, I have seen probably 10-12 experts about it, and it leaves all of them scratching their heads.

Most of the time when I see a specialist about it, they do some kind of treatment that they believe will work, it hurts like hell as they get right into the spot that hurts OR they share some kind of AHA! noise with me, to where they believe they have fixed the problem, but then the next day my peroneal is even angrier.

Kind of like when you have a bug bite.

The feeling you get when you first give in to the itch and scratch it feels ahhhmaazing, and you think this relief will last forever, but then soon after, the itch comes back ten times worse.

That is how it always felt after someone got into it.

So I had not really allowed anyone to go near it over the past six months. Karen and Dr Mike Sullivan are the only people I really allow to go near it, and even to them, who I see every week, and trust very much, I dont really let them touch the specific spot, but instead work all around it.

Both of those treatments do actually leave it feeling better the next day, but a few days later, it comes back again.

Sorry, this is turning into a really long story, but basically, steve and I were frustrated.

We knew this wasnt something we could just accept as fact and just ignore that I was in pain, so we kept searching.

Kept asking other experts we knew, who would give me advice, and they were fantastic! Most recently, Dr Pribut (who I had on the podcast), has been SO helpful, and has given a lot of recommendations that have eased the pain, and made me consider things I never had before after he looked at some videos of the way I run. I also have compiled a list of running rehab specialists and experts  as a great reference from ALL over the world.

The most important part of this was using this wobble board to do exercises.

“That can help with muscle strength, balance and joint position sense. And it is especially good for the peroneal tendons. It may work a bit better for more distal tendon problems but is worth a go.

I usually recommend starting with a side to side movement for 30 seconds to a minute. Then adding one more exercise about every 5 days: side to side movement, then circles touching the edge clockwise, then circles counter-clockwise. After 3.5 weeks or so, you’ll be doing these four exercises. You may add in one leg balance and front back exercises if you like after that. “

I asked him if I could get one of the cheaper boards, this is what he said:

“Just think – would you like to run the marathon in $19.95 shoes or Keds or Chuck Ts :-)”

I did purchase that one purely because he recommended it, that’s how much I trust his opinion, but he lives a long way away, so I could not see him for treatment.

If you are struggling with peroneal tendinitis, that would be where I would start.

However, with CIM growing closer, Steve and I decided it was also time for something a little more drastic.

Dry needling.

I was VERY nervous about this. Not just the idea of the needles, but about having someone else poke around in the very area that hurts, which could set me in for another few weeks of pain every day if he made it angry.

But Dr Kyle Bowling came very well recommended.

I drove to Louisville to see him one afternoon, and he spent 90 minutes (!!) diagnosing me and giving treatment.

Once again, we concluded it was peroneal tendonitis, and Kyle made it VERY clear that this was never going to stop coming back until I fixed my hip drop, as that was the real source of the problem here.

So once again, Drew and I are hitting my glute muscles hard to work on that.

But yes, so Dr Kyle said he would like to try dry needling on the area, and that I probably would be angry at him for a few days, but it should help.

I braced for the pain of the treatment, and to be honest, it was every bit as bad as I expected.

But not in the traditional pain way. I had experienced runs with this pain more than what I had in this treatment (although keep in mind that I have had a lot of intense physio treatment in my life, so be prepared for it to HURT).

For me though, it was more just getting the needles in.

Tina dry needling

I was dripping sweat the entire time. I was biting down on my shirt. I was trying not to cry.

I really freakin hate needles.

It feels like he flicks them into your leg (one at a time), and then twists them, kind of as if you had a cut, and then someone puts their nail into that cut.

It is a strange sensation, as the sharp pain is on the very inside of your body.

After 29 needles (!!),he used E-stim to make the muscle contract to make the treatment even more effective.

tina dry needle

That was a pretty uncomfortable 15 minutes, but Kyle and I just chatted away about running as he is training for a sub 2:40 at Indy Monumental at the time.

But I survived, and it really wasnt THAT bad.

Before I left for the day, Kyle reminded me once again, that it would probably be pretty sore tomorrow and that this was not going to go away for good until I fixed my form.

I sheepishly asked him if I could still do my hill + tempo workout I had planned for the next day, and my mouth dropped to the floor when he said, “yeah, sure!”

I was fully expecting him (like most experts) to tell me to take it very easy for the next few days, and to give me a lecture about it.

But no, that is one of the best things about Kyle.

Not only is he a fantastic doctor, who just makes you feel so comfortable and in good hands, but he understands running, he KNOWS how it feels to miss a training run (as he is going through it too!), and he is not going to tell you not to run unless he really thinks you are making it worse.

So the next day, I braced for pain, but it never came.

My peroneal felt the best it had in a long time!

And it continued to for the rest of the week.

It was only towards the end of the week that the pain started to come back, but that makes sense as the miles had gradually tightened the area back up again, and it was time for another treatment.

So back I went on Tuesday after my workout this time, relieved that it had helped, and we went a little more aggressive with the treatment.

He noted that it did not feel as bad as last week, but was definitely still worse than the other side.

I felt in very good hands, and trusted him to know how to treat it.

The next day, I was in a lot of pain on my run.

But this time, it was a different spot. It was on the inside of my leg, towards my heel.

The pain was more than I had experienced in a long time, to the point where I nearly considered cutting my run as it scared me.

I got home, texting Kyle, once again freaking out.

But he said with the aggressive treatment, he was not surprised, and that the pain in this different spot was probably because the peroneals had let go a little, and it was from those medial muscles working harder than they are used to.

I believe in Kyle, and so I let it go, and eagerly awaited to see how it felt the next day.

The next day there was nothing.

It felt great, no pain in any of the spots, and my calf felt noticeably different.

It has felt pretty good all week, which was a huge relief.

Now, I know this has been a monster post, especially about something so personal.

This is something that is going to “help” very few of you, and for those of you nodding your head with peroneal pain too, you HAVE to get the diagnosis that it is in fact peroneal tendinitis, NOT a fibula stress fracture or Achilles tendonitis.

Those can sometimes come across as peroneal pain and match the symptoms, but they are completely different treatments to what I am talking about today.

If you are definitely sure you have peroneal tendinitis, I would start with the exercises I recommended above from Dr Pribut, and then see if you can seek out dry needling treatment too. I am not saying it will work for everyone, but for me, this has been a game changer.

I also wanted to share my relief, my trust, my good gut feeling about Dr Kyle and the treatment he is giving me.

Rather than looking at the next few months training for CIM hoping that my peroneal will make it through, instead I look forward with confidence, that even if I see him just once a week, that will be enough to calm it down and maybe even help it go away for good.

I realize that I will have to ultimately fix this at the source, and we are working on it, but I can’t tell you how good it feels to have this respond positively to a treatment, and therefore, Dr Kyle, this is to you, THANK YOU!

I am so lucky to have such a wonderful support network around me, and people like Dr Pribut and Dr Kyle make it possible for me to keep chasing my dreams.

So, I would like to welcome Cotton Candy and Cookie Dough to Team Ice Cream!

Have you ever had dry needling? Fan?

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17 Comments.

  • That’s interesting. I’ve always wondered about dry needling. I might need to check it out. Thanks for sharing Tina, like you I’m terrified of needles. They are not for me at all.

  • Wow! That is a VERY different experience from what I had with dry needling and I’m so glad this seems to work for you!!! I don’t mind needles at all but this was super painful for me and I could only take one needle and only for about 1 minute. You have once again proven why you are my she-ro 🙂

  • You Instagram post had me intrigued. I’ve thought about doing Dry Needling for my Posterior Tib Tendonitis. I’ve heard from others that it can really help. Of course, it’s not the cure all, like you mentioned, but it can help with the flare ups.

  • Tina, you are very brave! Hats off to you for going through (subjectively scary) treatment and painful training.

    I can just say that ACUPUNCTURE was what allowed me to follow my London marathon training earlier this year halfways to plan (have been suffering from piriformis syndrome/ nerve affliction since 2013, sometimes more, sometimes less, rambling etc.). Running always felt better after the needle treatment, yet pain was creeping back up slightly a few days later. But at least I could keep going!
    Ankle problems was another plague (irritated tendon), when I found that ARNICA gel and SILICA supplements go a long way.

    For both problems, NOENE insoles came with a massive release. I can’t recommend them highly enough and really don’t want to miss them any more (I can feel the difference when I have to be on high heels for a few hours..).
    Swiss NOENE insoles are made of a special material (used to absorb all the tiny little and bigger shocks on tunnel and bridge construction in the Alps). They make the trainers slightly heavier, but it’s not too much and it’s all worth it during training (they are thin, you can even put them underneath the advanced Saucony insoles if you like).
    I never want to go without any more (running NYC in Nov might be an exception when I run on super light adizero, when every second counts and I can rest a full week or two afterwards if I need to).
    https://www.youtube.com/watch?v=jk1kzFqrYm0
    https://www.youtube.com/watch?v=SY7878F5ZcE
    https://www.youtube.com/watch?v=ZYr4CgmqmTU (French/Geman, but the images tell it all).

    From a pain level that knocked me out entirely/ forced limping, I could manage it quite well after a while,
    and now I don’t feel it while walking any more, and hardly on my runs either, both easy and intense ones
    (I also sometimes felt it was actually better when I pushed hard, which was surprising)

    Keep up the good work, Tina!

  • I am a dry needling believer! I actually love it so much that I go in once or twice a month as a preventative measure as well. Nothing loosens up my hips like it does and I always leave feeling much better. Glad you were able to overcome your fears and had a good experience!!

  • I have had dry needling done, and while it is super weird, I found it extremely helpful for reaching some deep down ligaments and tendons that we just could help manually. It is REALLY weird to get in you bum, let me tell you. I had peroneal issues way back when–wish I had know about dry needling then!

  • Thanks for sharing. My coach has been nudging me to get dry needling. I have had acupuncture and found that super relaxing. I guess I’ve just been putting it off. I’ve had a nagging medial gastrocnemius issue for about a month now. Even after cutting back mileage, it’s still there, like you said, not horrible pain– maybe at worst a 4 – but it’s there. But this post gives me hope that dry needling might help my gastroc, because so far, nothing else has! Guess I need to get my #$%@ together and make an appointment 😉

  • Dry needling kept this 60yr old body on ‘track’ for this past racing season. Quad & calf issues were helped immensely. But it was an unnerving feeling directly after my first quad treatment. Thought I had been hit by a Mack truck. However, the second day, it seemed as if the pain had miraculously disappeared. Acupuncture helped my plantar fasciitis. Hate the initial anticipation of the tingling pain of dry needling but love the feeling of release.
    Tina… good luck with the rest of your training. Hope the peroneal continues to improve.

  • Morgan Daulton
    October 5, 2016 10:48 am

    This is a very timely post. I have had a nagging heel pain for a couple of months now and asked my PT friend who is trained in dry needling if it would help. She assured me it would, but I haven’t gotten up the nerve to go see her. I guess I was afraid that it would make the muscle MORE inflamed if you’re sticking a needle into it! But I don’t understand the science. These comments are really interesting to read. If so many people have benefitted from dry needling, I really need to get my butt in gear and go see her.

  • I’m excited to give the board and the needling a try. It’s so crazy that your story is pretty much my story in this regard. I wish I would have known about Kyle when I was spending 10 days in Louisville! 🙂

  • My peroneals are also angry off and on. I actually found when I was swimming in Hawaii they were super angry, likely to do with the turn out of my feet. I also have weak glutes and drop my hips, so that’ll be a focus area for me as well.

    While dry needling sucks when I have it done, I’ve found it to be extremely effective, though my PT only used one at a time and manipulated the needle itself to get the muscle to release.

  • I’m so glad that dry needling helped you! I don’t doubt it’s benefits, but that many needles terrifies me. Even your description of how it feels makes me cringe. But when it comes to running injuries, I think a little temporary pain is well worth avoid a long term injury or time off from running.

  • Kaitlyn Kiernan
    October 6, 2016 4:07 pm

    I am exactly like you when it comes to acupuncture (for Achilles’ tendinitis…). I spend the entire session sweating and trying not to think about the fact that I have a bunch of needles sticking out of me. I always leave the table a disgusting mess. While acupuncture is hard, I can’t imagine dry needling with the e-stim while the needles are in ! But I’m so glad to hear this is helping to resolve such a long-running issue for you!

  • I’m a recent adorer of dry needling. I have had a chronically tight right hip involving the glutes, tfl, it band, and peroneals for a few years. I finally broke down and got a steroid injection for the piriformis, but something still wasn’t right with the rest and I needed to isolate the source. Long story short I traced my issue to be Morton’s Foot – if you have a longer second toe look it up. The mechanics with this structure are pretty wild. My gait with it had taken a toll. I had a hell of a heel whip and developed a functionally short leg, and thus hip drop. Eureka! I bought specialized orthotics for Morton’s structure and saw immediate improvement and continue to. The trigger points needed, and still do, periodic visits to my therapist for needling, but it has been a lifesaver. Thanks to the muscle release I haven’t felt this great in years. I urge anyone with myofacial pain to give it a shot.

  • I love Dr. Pribut!!!!! He’s my doctor here in DC, and even though I only ever go to him when something has gone wrong, I love seeing him and genuinely enjoy talking to him. So glad that he was featured here!

  • Dry needling really helped my bout with Plantar Fasciitis a LOT. I totally believe in it and will keep going every now and then just for good measure and to stay on top of things. The needles can be a bear, but so worth it. I’m glad the pain subsided for you!!! 🙂

  • Really interesting. As a future OT I’m intrigued by dry needling. I’ve been having foot pain for over a week and am not sure if it’s my peroneal tendon or something else (X rays came back fine) but bottom of my foot and outside edge of foot below my ankle bother me with walking/running (weight bearing). I am hoping it gets better if I take it easy still this week!

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