Achilles Tendinopathy: The First Step to Recovery Is Likely NOT Your Go-To

Dorsiflexion- Calf StretchDorsiflexion- Calf StretchAchilles tendinopathy is a frustrating injury for many athletes, particularly runners. It is oftentimes a lingering nuisance because some of the “go-to” treatment methods are likely impeding recovery instead of effectively returning the injured athlete to training.  Achilles tendinopathy is an insertional tendinopathy, and it is important to reduce the irritating compression of the tendon in the initial stages of any insertional tendinopathy.

When a runner has pain, the common initial reaction is to stretch the tender area. Stretching of the calf involves dorsiflexion (see images), the movement or position that further aggravates a sensitive Achilles tendon by compressing the tendon against its insertion (where the tendon connects to the bone).  Although this movement or position is not inherently bad for the Achilles tendon, limiting it for a brief period of time is necessary to facilitate recovery of an Achilles tendinopathy. Moral of the story…if you suspect you have this injury, resist the urge to stretch!

 

Running Technique 101: Part 1

There are a few running basics that every runner should be familiar with:

Shoes- There is nothing better than finding the perfect running shoe, but how do you determine what the right shoe is for you? As much as I would love to give you specific guidelines to lead you directly to your perfect pair, it is not that simple. In fact, matching  foot type to a particular type of shoe has shown over and over again to be an oversimplified and ineffective way to determine what running shoes are best for each individual. The key to running shoe shopping is comfort! To learn more read “Shoes: A Runners Best Friend” .

Sound- You can learn a lot about your running gait by listening to the sound of your feet hit the ground. Do you hear a consistent rhythmic pattern? Are you landing loudly for all to hear? Is one foot strike more audible than the other? Take the earbuds out the next time you run and listen. The goal is to hear symmetrical, consistent, rhythmic and quiet landing.

Step Rate (aka cadence)- One of the the most important factors to reducing pain during running and your risk for injury is adjusting your cadence. The goal is to land under your center of gravity to allow joints and muscles to most effectively accept load.  To learn more read “The Foot Strike Debate: Does It Matter?”

Strike- Foot strike is a hot topic for many runners. No one seems to want the dreaded heel strike and are in favor of the midfoot and forefoot strike (flatfooted and on your toes). There are dangers of quickly trying to adapt your foot strike. Does having a midfoot or forefoot strike make long distance runners faster, more efficient, and less prone to injury, and is making the switch worth the risk? The short answer would be no. To learn more read “The Foot Strike Debate: Does It Matter?”

Loading and Natural Tendencies

At least 9 times out of 10 I can determine a runners injured side (right versus left) by observing them standing, sitting, or even laying down. Many running injuries are not painful in those positions; therefore you cannot infer that the runner is simply favoring the injured side. People often develop “natural tendencies” such as always standing or sitting with weight shifted to the same side or with one foot pointing consistently more outward. In people who do NOT run, these natural tendencies are unlikely to play a large roll in developing an injury. Endurance runners, on the other hand, are very unique. Running involves loading each leg with 3-4 times their body weight roughly 90 times per minute.
If you consistently unload one leg, point one foot out greater than the other, or bring your knees together in sitting, then you can expect these movement patterns to show up in your running gait. You cannot move your body one way all day, then turn your “running switch” on to symmetrically and properly accept load.Tips:
  1. Be aware throughout the day.
  2. Correct and load evenly.
  3. If you are currently injured and having trouble correcting your natural tendencies while running then ask me for help!

Brain Training-Running Psychology

What are the first 5 things that come to mind when you think of race training? Long runs, tempo runs, speed and hill intervals, strength training, and proper nutrition…Preparing our bodies to run a race is a no brainer. Most runners would also agree that the mind can determine how successful you are on race day, but they do not know how to train it. The brain is a very complicated and powerful part of our body that can negatively or positively affect our performance.

The Pixar movie “Inside Out” provided a fun picture of what goes on inside our brains. Like Joy trying to keep Sadness away on the first day of school, there are thoughts and feelings that we should keep in a small circle deep in our minds while running. Allowing anxiety, fear, dwelling on fatigue, and decreased confidence to creep in is a surefire way to slow you down. How do we train our brain to filter thoughts? Many may say that the music they listen to has a huge affect on how fatigued they feel during a run. I personally had to delete “Let The Bodies Hit The Floor” (Drowning Pool), “I Need A Doctor” (Eminem, Dr. Dre), and an oldie but goody “Lean On Me” (Bill Withers) from my running playlists.

What may come as a surprise to runners is that continuously checking your watch and monitoring rate of perceived exertion (RPE) can decrease pace. Recent research published in the Journal of Medicine and Science in Sports and Exercise showed that runners actually ran 10% slower and felt like they were working harder when they could visually monitor their pace and had increased internal focus. Improving your external focus and concentration on running technique to improve efficiency will make you run faster with a lower perceived effort. Training using the following tips can help you use your brain to run faster!

  • Focus on the skill of running and running most efficiently.
  • Check the watch and “feelings” only at each 1 mile lap.
  • Train with friends & race in a pack.

Altering Pace Control and Pace Regulation: Attentional Focus Effects during Running. Noel E. Brick, Mark J. Campbell, Richard S. Metcalfe, Jacqueline L. Mair, Tadhg E. MacIntyre Med Sci Sports Exerc. 2015 December 15 Published online 2015 December 15. doi: 10.1249/MSS.0000000000000843

 

Early Season Troubleshooting

The birds are chirping, the temps are rising and the running season is off to a start! The inaugural race, the 2016 Glass City Marathon, is quickly approaching. How are you feeling about your training? There are a couple problems that runners may face around this early season stage that can lead to panicking and frustration. Below are a couple easy tips on how to deal with some of those potential issues.

  1. “I cannot go the distance.”
  • Slow it down. What pace are you setting for your long runs? Your greatest distance run for the week should be your slowest. Pace yourself 45 seconds to 1 minute per mile slower than your race pace goal or stay in heart rate zone 2.
  • Get the right fuel. See “Fueling the Endurance Machine” by Ryan Leone, MEd, MFN, RD.
  • Cross Train. Incorporate at least one long and slow cross training day per week. This allows you to build cardiovascular and muscular endurance without adding extra running mileage to your schedule.
  1. “I cannot get my speed up.”
  •  Hills and speed intervals. Use one or two of your lower distance runs to incorporate hills and speed intervals.
  • Become more efficient. Hone your running skills so you don’t waste energy with excessive vertical movement.
  • Strength Train. In season strength training is recommended 2 days per week.
  1. “I hurt.”
  • Allow yourself to recover. Are you giving yourself 1 day off or appropriately actively resting?
  • Check your cadence. Running significantly less than 180 steps per minute indicates that there are likely several factors that are linked to running injuries present. Increasing your cadence to around 180 steps per minute can significantly reduce those factors and pain with running. See “The Foot Strike Debate: Does it Matter?”
  • Check your training. Are you appropriately running long runs and only doing 1-2 days per week of speed or hill intervals?
  • Get help. If you are hurting enough during runs that it alters your gait OR you are hurting when you are not running (at rest or with normal daily activities), STOP. Those are red flags that indicate you should get medical advice. You can come directly to see a physical therapist. Call 419-318-7019 or go towww.toledophysicaltherapy.com to receive specialized care and return to running ASAP!

*A lot of this content will be described in greater detail in upcoming blog posts. Follow the Elite PT Facebook page to stay current when new blogs are posted!

Shoes: A Runner’s Best Friend

When I see runners for their first visit, they typically cannot wait to show me their shoes.  Running shoes come in all different brands, shapes, lengths, widths, colors, weights, materials, degrees of stability, etc., etc. The options are endless. Unless they are of the barefoot variety and count gadgets like watches and heart rate monitors, shoes are runners only equipment. So there is no mystery as to why there is a shoe fetish among runners.

If you ask a group of runners what causes running injuries, “wearing the wrong shoes” always tops their list. Is this response incorrect? Depends on your definition of “wrong” and how you determine what is the “right” shoe for you. Should your degree of supination and pronation point to the type of shoe you wear? How about your foot strike? There are multiple studies that show that wearing a shoe matched to your “foot type” does not reduce your risk for injury. How are runners supposed to find their one perfect pair of shoes out of a million if “foot type” is not the answer?

I recently had a runner tentatively show me her shoes and say, “they are just Nikes…” After I reassured her that I was not opposed to Nike, she went on to tell me that she was shoe shamed for not wearing Saucony or Brooks by her fellow running friends. I went on to find out why she stood her ground and stuck with her particular pair of shoes. She stated that they were simply the most comfortable pair of running shoes that she has ever had. BINGO!

As much as we may want some easy to follow diagram with specific criteria to determine the perfect running shoe for you, there isn’t one! There are too many shoe options to count and an even greater variety of people with different combinations of “foot type”, injury history, training history, running gait, strength, mobility etc., etc. Do not allow yourself to continue wearing an uncomfortable shoe because it is the latest trend, coolest brand, or what your go to medical professional, shoe store, or running buddy recommends. Every runner is unique. The only  complete answer is to keep shopping and running until you find YOUR most comfortable running shoe.

If you are at a loss of where to start or have tried many different options and still cannot find a shoe that works for you, check out our Running Assessment! With a comprehensive individual assessment, Elite PT can give you guidance to get you headed in the right direction.

Off Season Training

Many residents of Northwest Ohio hunker down and hibernate while packing on a few pounds during the long winter months. There are many great excuses to not train through the winter.

  1. Treadmills and bike trainers can be almost as boring as waiting in line at the DMV.
  2. The ice and snow are serious safety hazards…not to leave out the wind chill.
  3. A single thought of going from cold air to cold water to cold air again can be enough to miss open swim time.
  4. When is the first race of the season?

Although those 4 excuses may seem like valid reasons to skip out on winter workouts, training in the off season is very rewarding and can be enjoyable! The winter is a great time to focus on areas of training that may get put to wayside in the heart of racing season.

  1. Strength training.  Strength training for endurance athletes has been found to be very beneficial in reducing risk for injury and improving performance; however, during racing season, it is challenging to work in 1-2 strength training sessions per week. In the off season, 3-4 days per week is recommended and much easier to fit into a schedule. If you have not started a strength training regimen, the winter is the perfect time to get to a gym and build a routine.
  2. Speed work.  You can perform more speed workouts while your weekly mileage is down in the off season. Working in faster paced intervals break the monotony of running on the treadmill or biking on a trainer.
  3. Hills. There are not many hills in Northwest Ohio and fewer that you want to brave with ice and snow. The treadmill, yes, has downfalls; however, it is easy to manipulate and monitor incline, pace, and time in order to easily perform hill repeats. Hill training can improve several factors such as anaerobic endurance, muscular endurance and power depending on the grade, speed and duration of the hill intervals.
  4. Technique. Good swimming, biking and running mechanics help with efficiency. In other words, you can go faster requiring less energy! While following a specific training protocol leading up to a race, you are fairly continuously ramping up mileage and/or pace. During that time, it is more challenging to alter swim, bike, and run mechanics because it is important to gradually introduce the new techniques in order to minimize injury risk. The off season is a great time to hone your skills!

If you have been working on strength training, speed work, hills and refining your technique during the off season you will be well prepared for specific race training. You will not feel the need to accelerate your training to be ready for race day reducing your risk for injury.

Bike Back

On average, Americans spend 10+ hours per day sitting which is associated with a large percentage of people with low back pain (LBP). But what about YOU, the active population, the avid cyclist? Are YOU immune to LBP? Bicyclists are very dedicated to their sport even in the winter months when others tend to hibernate; however, LBP is one of the most common non-traumatic cycling injuries. Bicycling is known to be a relatively safe, low impact option for endurance athletes, but it is the sustained “flexed” position that can contribute to the onset of LBP. There is a simple yet very effective exercise that can help fend off this problem.
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Press-ups work to maintain pain free trunk motion in all directions when we spend most of our work day and recreational time in a seated position. To perform a press-up, place your hands directly under your shoulders then use your arms to elevate your chest while trying to relax your back, abdomen, and leg muscles. When you are at the end of your available motion, as pictured above, exhale allowing your belly to sag. Following a brief 2-3 second hold, return to a resting position laying flat. Especially if you are new to this exercise, it is normal to feel pressure or tightness in the center of your low back initially; however, the discomfort should begin to dissipate after only a few repetitions. To help prevent LBP, perform 10 press-ups immediately before and after a ride. If your rides are typically greater than 2 hours, perform additional repetitions throughout the day. Consult your physical therapist if you are currently experiencing LBP or have a history of back surgery before trying this exercise.

The “Foot Strike” Debate: Does it Matter?

 

ELITE_Newsletter_SLYou may be the fastest runner but quickly slowed down or not even make it to the starting line if you land an injury. Does foot strike play a role in injury prevention? If you follow any running blogs or magazines, you have seen a litany of articles on rearfoot (heel) striking versus midfoot or forefoot striking. Some articles have been written that attribute many running injuries to heel striking while other articles have bee entitled “Is Heel Striking Really Bad?” The stark contrast in ideas can be confusing, but hopefully my explanation can bring some clarity.

The known benefit of midfoot and forefoot striking is that you are less likely to over stride. Researchers have consistently agreed that over striding increases your risk for injury. Over striding= foot strike or initial contact in front of the body beyond your center of    gravity. On the contrary, many people who over stride are heel strikers. Hence, the negative vibes towards heel striking.

Does that mean everyone should be a midfoot or forefoot striker? No! Heel striking is not necessarily bad as long as you are not over striding, and converting your foot strike when it is not right for you to do so can increase your risk for injury. A few important factors that should be considered before altering your foot strike are your injury history, years of running experience with your current foot strike, strength and flexibility. These factors are all unique to YOU so there is NOT a one size fits all for running gait. Adjusting your cadence is a safer and more effective way to decrease your risk for running injuries than adopting a new foot strike.

Cadence= # of steps per minute. The optimal cadence is said to be at least 180 steps/minute. If you are stepping at a higher rate, you will limit over striding. You can also maintain your heel strike or naturally adjust to a midfoot or forefoot strike. Whenever you make any adjustments to your running gait, do it in increments of 5-10% allowing your body time to adapt to the new pattern.

 

 

 

Not Another “Overuse Injury”

“Overuse injury” is a term that is oftentimes too near and dear to endurance athletes.  It is also a term that shutterstock_106892909irks me like nails on chalkboard.  Before you think I am going to hop onto a soap box of semantics, allow me to explain why the label “overuse injury” can actually be detrimental to an endurance athlete.  If you had an “overuse injury” what do think you should do?  If you thought rest, ice, and take anti-inflammatory medications, you would only be partially correct. Doing those things are often very helpful in reducing the pain and swelling of a fresh injury; however, if your Read more