Tag: injury prevention

Overall Athleticism & Risk of Injury

Will Improving Your Overall Athleticism Reduce Your Risk of Stress Fractures?

Guest blog by John Davis (RunnersConnect)

Most runners know somebody whose training or racing ambitions have been sidelined because of an injury caused by another sport.  Whether it’s a torn ACL from playing a pick-up game of soccer or a sprained ankle from a rec basketball league, “other sports” have a reputation for causing trouble when runners try their hand at them.

Traditionally, many runners are uncoordinated and unskilled at ball sports, so they tend to avoid them. Moreover, not only do runners perform poorly, they also often get hurt while doing so.

But some fascinating studies published in the past few years are indicating that this might be the wrong way to look at ball sports and general athleticism in relation to running.  Instead of merely causing injuries and soreness, participating in ball sports might confer a protective effect against some injuries because of the adaptability of your body.  We’ll take a look at these studies to figure out exactly what’s going on.

Running, ball sport, and bone strength

The first among these studies was published in 2000 by a group of researchers led by Charles Milgrom in Israel who were evaluating risk factors for military recruits who would develop stress fractures.

In a series of studies, the researchers looked at the effects of pre-boot camp activity levels on stress fracture risk in Israeli military recruits.  The recruits were surveyed on their activity levels, then followed during their basic training.  Surprisingly (and in contrast to some other military studies), being a runner did not confer a significant protective effect against stress fractures during military service. However, recruits who had played ball sports (typically basketball for the recruits in this study) for at least two years before military service suffered significantly fewer stress fractures than those who did not.

In a follow-up study, the same research group measured the strain on the tibia bone during walking, running, and basketball, finding that the peak stress on the bone was up to 50% higher during a basketball game when compared to running.  The researchers surmised that regular exposure to these higher stresses in the years before the ball-sport athletes became military recruits caused them to develop stronger and more robust bones, and hence more resistance to stress fractures.

Another study examining runners, ball-sport players, and bone strength was published in 2007 by Michael Fredericson and others at Stanford University.  Using a sample of 15 elite male soccer players, 15 elite male runners, and 15 sedentary men, Fredericson et al. used an x-ray machine to measure the subjects’ bone density at several locations in their skeleton.

Though the runners hand stronger bones than the sedentary subjects at places which are directly loaded on impact, like the heel bone, they are outclassed by soccer players, who have stronger bones everywhere as measured by bone density: whole-body, hip, leg, spine, and heel bone.   This is probably because of the dynamic nature of playing a ball sport like soccer: unlike the simplicity in running, ball sport athletes make a huge range of different cutting and turning motions on a regular basis, putting a wide variety of stresses on their skeleton.  Compared to ball sports, runners, by contrast, put moderate but repetitive stresses on their bones, which don’t result in as robust of skeletal strength overall.

Do ball sports help protect against stress fractures?

The last question to address is whether experience playing ball sports actually grants a protective effect from stress fractures in runners.  Fortunately, this exact concern was addressed in a large study of elite track and field athletes at the 2003 USATF national track championships, held at Stanford University.

Michael Fredericson, Jessica Ngo, and Kristin Cobb issued a one-page questionnaire to 156 female and 118 male distance runners competing at USATF nationals.  The athletes were asked about their sports histories and any stress fractures they had suffered.  After collecting the surveys, Fredericson, Ngo, and Cobb found that runners who had formerly been ball sport athletes had a significantly lower risk of suffering stress fractures.

For both men and women, each year of playing ball sports resulted in a 13% lower incidence of stress fractures.

Women, however, had one caveat: this protective effect only applied if they had normal menstrual periods; women with amenorrhea, which disturbs bone growth, had no protective effect from playing a ball sport like basketball or soccer.

Like with the two previous studies, the authors hypothesized that the diverse stresses associated with dynamic sports like soccer and basketball led to “greater and more symmetrically distributed bone mass,” which resulted in resistance to stress fractures.

Now, there’s still no research on whether playing ball sports while you’re also doing running training will grant any protective effects against injury, and as mentioned earlier, ball sports are far from innocuous.  Soccer and basketball players suffer a lot more ankle and knee sprains than runners do, for example.  But perhaps it is time to start thinking more seriously about the importance of general athleticism in running.

When you spend an hour a day or more running in mostly a straight line, you’re bound to develop some deficiencies when it comes to lateral or diagonal movement, as well as sharp accelerations and large stresses on your bones. 

Incorporating some agility drills or strength work into your running routine might be one way to address this; indeed, many elite runners already do strength and conditioning work that involves lateral shuffling, hurdle drills, medicine ball work, plyometric jumps, and diagonal running and cutting, all of which are similar to the types of stress involved with playing a ball sport.

Given what we’ve learned above, this type of ancillary training is likely to benefit your body’s overall structural integrity, hopefully leading to protection against stress fractures and possibly other overuse injuries too.

Get more great injury prevention advice from John Davis (plus other great training & maintenance tips from Jeff Gaudette & Co) on the RunnersConnect blog.

Graston & ART: Legitimate Treatment?

Are Graston and Active Release Technique (ART) a Legitimate Treatment For Running Injuries?

Guest blog by John Davis (RunnersConnect)

graston running injuriesSoft tissue injuries are the broadest and most common category of injuries that runners suffer from.  This category encompasses all injuries to the muscles, tendons, and fascia in your lower body.

While they are often easier to treat and less severe than “bony” injuries like stress fractures, soft tissue injuries like Achilles tendonitis, plantar fasciitis, and muscle strains nevertheless cause huge disruptions in the training of many runners.

As such, any progress on treating these injuries is sure to garner a lot of attention.

Two relatively new treatment protocols, Graston Technique and Active Release Technique (ART), have emerged as popular ways to speed the healing process from muscle, tendon, and fascia injuries, especially in the running and triathlon communities.

But what kind of scientific support do these treatments have, and are they grounded on good medical information?

To answer that, we will have to review some of the scientific literature that has been published on Graston and ART.

Graston and ART: An overview

Before doing that, however, we ought to become familiar with both Graston and Active Release Technique.  Both of these treatments are based on the idea of tissue adhesion and scar tissue—according to proponents of ART and Graston, injured tissue develops abnormalities when it heals, which impair normal function.

To get rid of these abnormalities, ART and Graston both use mechanical force to break them down—ART involves the practitioner using his or her hands to apply pressure to the muscles surrounding the injured area, while flexing and extending the joints they are connected to.

Graston involves using curved metal tools to apply pressure and friction across the injured muscle, fascia, or tendon.  Both are “proprietary” techniques, meaning that a practitioner must pay for special classes to become licensed in them.

This naturally attracts some skepticism from the medical and scientific communities, as the nature of the respective businesses, which oversee ART and Graston is somewhat out-of-step with treatments under serious consideration for rehabbing injuries.  Perhaps because of this, most practitioners of ART and Graston are chiropractors, though some physical therapists are licensed as well.

Are Graston and ART based on legitimate principles?

Structural changes in tissues affected by chronic overuse injuries are well-documented: The collagen fibers of the Achilles tendon, for example, which appear like wavy, parallel lines when healthy, rupture, snarl, and degenerate into a mess that looks like a plate of spaghetti in athletes with chronic Achilles problems.  And the formation of scar tissue in muscle injuries is well-documented, as well.

Additionally, successful treatment of tendon injury through well-vetted rehab programs, such as eccentric heel drops for Achilles tendonitis, is connected with a return to normal tendon structure, at least as measured by ultrasound imaging.

Unfortunately, there’s no good evidence yet that ART or Graston (or any soft-tissue manipulation therapy) can influence the microscopic structure of a healing tendon or muscle in an athlete.

Two studies using different manual techniques found some changes in the structure of rat tendons and ligaments, but this is not nearly enough to declare the theoretical foundations of ART and Graston to be sound.

The best science on these therapies so far is limited to case studies and pilot studies.  A case study is the scientific equivalent of an anecdote—they describe how a doctor or therapist treated one particular patient with an injury.  Pilot studies are generally conducted with only a few subjects and no control group.

In one example, 20 men took a sit-and-reach test for hamstring flexibility, then had ART administered and underwent another sit-and-reach test, which showed an improvement in hamstring flexibility. In another study, five subjects with carpal tunnel syndrome were treated with ART over a period of two weeks and all demonstrated improvement.

Not all pilot studies found success, though—one study of nine athletes with “anterior knee pain” (likely patellofemoral pain syndrome or ‘runner’s knee‘) found that administering one treatment of ART did not result in better knee function.

All peer-reviewed studies on Graston technique to date are limited to case studies, describing individual patients being treated for everything from trigger finger to low back pain.

Breaking the barrier

The biggest barrier to ART and Graston being accepted as legitimate treatments for injury is the lack of well-designed studies on their usefulness.  Control groups, which are administered a fake treatment, are absolutely necessary to establish the scientific worth of any injury rehab protocol.  Otherwise, factors like the placebo effect and simple healing over time make determining the use of a treatment near-impossible.

While having a scientific basis for treatments is important, the old adage that “any medicine that works is good medicine” holds up.

Today, most insurance companies will pay for chiropractic adjustments for low back pain, not because chiropractic is necessarily based on solid science, but because well-designed placebo-controlled studies have demonstrated that it is a legitimately beneficial treatment for back pain.

While popular among athletes, the usefulness of ART and Graston is still questionable from a scientific perspective.  If you think you might benefit from them, feel free to try it out, but do realize that you are taking a gamble on an uncertain treatment.  If you are skeptical, you may want to wait until better-designed studies are published on the benefits of soft-tissue manipulation.

Get more great injury prevention advice from John Davis (plus other great training & maintenance tips from Jeff Gaudette & Co) on the RunnersConnect blog.

Age and Calf Injuries

The Relationship Between Age and Calf Injuries

Guest blog by John Davis (RunnersConnect)

age calf injuries runningIn last week’s article, we saw that some particular injuries that are common among male runners—knee osteoarthritis, meniscus tears and calf strains—are also conspicuously more frequent as runners get older.

Calf strains (or tears) in particular are a very common problem among masters athletes, so today we’ll be looking into why this injury occurs more often as you get older.

Examining calf injuries and age

Calf injuries appear to be unique among muscular sports injuries in that they appear more frequently as you get older.

A study of professional soccer players by Jan Ekstrand, Martin Hägglund, and Markus Waldén at Linköping University in Sweden found that, while hamstring and adductor injuries were more common than calf injuries, the incidence of calf strain increased with age, while the risk of injury to the other muscles of the leg remained unchanged.

The calf actually consists of two muscles: the gastrocnemius and the soleus.  The gastrocnemius has two “heads” which make up the meatier upper part of the calf, while the soleus is the more slender lower part of the muscle.  Both the gastrocnemius and soleus can be strained, but the medial head of the gastrocnemius is the most common location for injuries.

Though calf injuries are a problem for runners, they also occur quite frequently in ball sports like tennis, soccer, basketball, and cricket, so many scientific studies, including the ones we’ll be looking at, involve competitors from these sports.

Research-backed theories

The first step in answering the question of why calf injuries become more common with age is understanding the mechanics at play when a calf strain occurs.

One creative study, published in 2002 by sports injury clinicians at the Australian Cricket Board, examined the exact moment of a calf strain, caught close-up by multiple TV broadcast cameras during an Australia vs. England cricket match.

  • The authors of the study noted that the calf strain—plainly clear to see in the video, when the athlete’s calf appears to slacken on the lateral side—occurred just as the player’s opposite foot left the ground, as the calf transitioned from an eccentric contraction to an isometric “stance phase.” 
  • The authors also cite other work which indicates that calf injury occurs not as you pushoff  the ground (a concentric contraction), but just as you transition from landing to supporting and beginning to drive off the ground (eccentric and isometric muscle contractions).  This is significant because it can help us predict strategies for prevention.
  • Eccentric loads are also known to be more damaging to muscles, though the body is capable of supporting significantly more weight in an eccentric contraction than a concentric one.  Knowing this, we can predict that aging would increase the risk of muscular injury, as muscular strength gradually decreases as you get older.
  • Not only that, but aging selectively weakens the “fast twitch” muscle fibers that are tailored to handle high-power contractions and rapid loading.
  • Less muscle strength overall will also lead to increased fatigue, which has been implicated in muscle strains—at least in one study at Duke University using rabbits.

Unfortunately, this still leaves open the question of why the calf in particular becomes more susceptible to injury with aging, and not the hamstrings, quads, or adductors.

I found no research that could directly explain this phenomenon.  It could simply be that the calf has less muscle mass overall when compared to the other prime movers of the lower leg, like the hamstrings and the quads.  A consistent rate of muscle fiber decline with age would therefore affect it to a greater extent than these other muscles.

On the other hand, there could be something biologically unique about the calf or its function during sport that makes it more susceptible to injury with age—either differences in the muscle itself, or differences in the relative amount of force that it must handle.

Final thoughts

Whatever the reason, older runners, especially men, need to be aware that their calves get more vulnerable to injury as they age. 

Our understanding of the injury process can also help predict some preventative measures; since we know that calf strains occur during the eccentric and isometric phases of the running gait, it is likely that calf strengthening routines that focus on these aspects will be more successful at preventing injury than simply doing traditional calf raises, a primarily concentric exercise. 

Eccentric heel drops,  often used to treat Achilles tendonitis, are a highly effective eccentric strengthening exercise, while “toe walks”—walking forwards or especially backwards keeping your heels off the ground—are a good isometric exercise that even strong runners will find challenging after a few sets of 15 or 20 meters.

Staying healthy is an integral part to success as a masters athlete, so being aware of the causes and possible ways to prevent calf strains will help your training and racing greatly.

Get more great injury prevention advice from John Davis (plus other great training & maintenance tips from Jeff Gaudette & Co) on the RunnersConnect blog.

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Achilles Tendonitis

By Ian Nurse, DC

It all started a few weeks ago. You can distinctly remember one calf just being slightly tighter than the other. “Where did that come from?” you wonder as you don’t miss a step and finish off that medium long run. “That will be gone tomorrow,” you think to yourself as you make your way to the couch to relax, putting off any type of foamrolling, strengthening, or stretching until the next day. Weeks have now passed and that tightness is not only still there, but it’s been joined by its good friends, pain and swelling. Yet those two unwelcomed symptoms have moved down from the original area of concern and settled-in nicely surrounding one of the broadest and strongest tendons in the entire body: the Achilles. Now, each running step is met with a sharp pain that has even started to alter your gait. It even hurts to move your foot up and down, and the pain is accompanied by a strange creaking sensation and noise (a.k.a. crepitus). “How did this happen?” you wonder, and, more importantly, “How am I going to get rid of it?”

Achilles tendonitis is one of the most common and frustrating injuries for runners of all ages and abilities but especially those slightly older. Despite its broad width and strength, it understandably becomes overused and injured as we place a force 7 times our body weight each time our foot pushes off the ground. Additionally, the Achilles dramatically weakens with age which explains why this is a common injury amongst veteran runners, many of whom have never had Achilles issues in the past.

Interestingly, many of the traditional means of prevention and treatment have recently been reconsidered and debunked. As Achilles tendonitis is most often seen in the high-arched runner with excessively tight calf muscles, original thinking was to relieve the Achilles of that tension by adding a heel lift. More recent studies have shown that it is far more important to help lengthen the calf muscles than try to accommodate their inherent tightness with a heel lift. Dr. Tom Michaud, an expert in running related injuries and author of Human Locomotion, suggests a regimen of stretching, strengthening, massage, and Graston treatment as a means of not only treating Achilles tendonitis but also preventing it. A weekly routine including a deep tissue massage utilizing a foam-roller and Graston treatment, if possible, to break-up restrictive scar tissue, followed by stretching and strength exercises can significantly help prevent this injury from occurring in the first place.

achilles tendonitis text box
As this injury seems to affect a particular portion of the tendon, the front side, the type of stretches and exercises performed are important considerations. When stretching, one must apply only a gentle tension and hold for a prolonged period of time, 35-40 seconds. Overly aggressive stretching can actually damage the insertion point and pull it further away from the heel. These mild tension stretches should be repeated every few hours throughout the day with the best results being shown to occur following deep tissue massage. An additional approach is to stand on a slant board several times a day to help lengthen the calf and take pressure off the Achilles.

When it comes to strengthening, the latest studies have shown that eccentric- focused calf raises are the most effective means of combatting this injury. For many of us, calf raises entail a strong contraction up and then returning to a lowered position as quickly as possible. With eccentric calf raises, one focuses on contracting the muscle as it lengthens as opposed to as it shortens. To accomplish this one should raise both heels together and then slowly lower just one heel at a time after reaching the peak elevation. Counting down from 5 is an easy way to ensure that the muscle is working hard throughout the entire motion. As stated earlier, most Achilles issues occur at the front portion of the tendon, and, thus, it is also important to contract the calf muscles to their highest point before initiating the eccentric phase to activate this portion of the muscle.

The Achilles tendon is an incredibly strong player throughout the runner’s gait cycle. While most tendons in the body would rupture with a force of 7 times one’s body weight being applied to it, the Achilles is able to endure thousands of steps in just a single run. Since we ask so much of this small band of tissue, it’s only fair to give it the attention that it needs to stay strong and healthy. By adopting this simple regular routine consisting of massage, stretching, and strengthening one’s calf, a more serious, training-altering injury can easily be avoided.

Ian Nurse gives us his script in every issue of Level Renner. This article was originally published in the July/August issue of Level Renner, which can be downloaded for free (along with all of our back issues). Get your free subscription today, which also will make you eligible for our subscriber only contests.

Dynamic Stretching

A Warm-up Routine to Reduce Injury and Improve Performance

Guest blog by Matt Phillips (RunnersConnect)

stretching warm-up for runnersThe Romans had a neat trick for knowing how far their troops had traveled. They would have a soldier count each time his left foot hit the ground. When he’d reached 1000, they knew they had traveled a mile. Some 2000 years later, researchers at Boise State University confirmed this with data determining the total number of steps to run a 12-minute-mile as 1,951 (compared to 1,064 steps for a 6-minute-mile).

So, why the history lesson?

Well, if I asked you to go and hop 1,951 times you would probably show some initial reservations as to whether your legs are up to the task. And yet, running is pretty much that – an extended series of hopping from one leg to the other whilst trying to minimise ground contact time (with some help from gravity, depending on the efficiency of your running form), and dealing with forces of around 2.5 times your body weight each time your foot hits the ground.

Seeing running as a series of hops can be a useful way to open your mind to the fact that in order to run without suffering injury, you ultimately have a decision to make: either reduce how far you run (i.e. say goodbye to races over a certain distance) or prepare your body for longer distances by adding strength & conditioning exercises to your weekly routine.

Through this new series of weekly articles, my aim will be to help you avoid becoming one of the 30- 70% of runners who get injured every year. We will start by looking at one of the most important and yet commonly overlooked ways of preparing for your run: the warm up.

Is stretching before a run bad for you?

Let’s face it, most runners will welcome any excuse to avoid a 5-10 minute warm-up before a run. We just want to run!

So when research from New South Wales, Australia first suggested over 10 years ago that static stretching (long-hold stretching) did not reduce injury,  traditional warm up routines before running were soon ditched in favour of just jogging the first five minutes.

The case against static stretching before a run was further weakened by recent research that suggests it reduces the natural leg stiffness that is required for running efficiency. As the foot makes contact with the ground, this stiffness is said to absorb energy and use it to spring forwards.

Researchers at Florida State University in 2010 showed that trained distance runners became about 5% less efficient and covered 3% less distance in a time trial if they did static stretching before the run.

However, and this is the crunch, all of the above concerns static stretching, i.e. long-hold stretching (like touching your toes for 40 seconds). It is important to differentiate this from dynamic stretching, which involves controlled, repetitive sports-specific movements that mimic the way your muscles and connective tissues will need to stretch during your chosen activity, e.g. swinging your leg forwards 15 times.

A follow up study by Florida State University stated that there is no evidence that dynamic stretching before a run inhibits performance.

Dynamic stretching as a warm-up

Let’s look at an example: one of the major components of an efficient running stride is having enough range of movement in the hip flexor to allow your leg to travel back behind you before your toe leaves the ground. A dynamic stretch that mimics this hip extension, e.g. a lunge, will reduce internal resistance whilst running and improve the efficiency of your stride.

Given that many of us have tight hip flexors due to sitting down all day, a controlled dynamic stretch that progressively increases range of movement in the hip before we start running can help us run more efficiently with better form.

Although there is no evidence that one particular “running style” will reduce injury rate (no one-size-fits-all remedy), certain biomechanical inefficiencies associated with poor running form can be linked to reoccurring injury (more on that next week).

Preparation for efficient running form cannot be achieved by simply preceding your run with a five minute jog.

In being active and challenging, dynamic stretching will also promote the other well documented physical and mental benefits associated with a warm up.

What dynamic stretching should I do?

Which and how much dynamic stretching you do in your warm up will depend on your fitness level and the type of running you plan to do.

You will find many examples online but as always we suggest you consult a professional before embarking on a new exercise routine. The main message I want you to get from this article is that you do something!

I personally am a huge fan of progressive lunges before embarking on a run. Elite running coach Jay Johnson demonstrates physical therapist Gary Gray’s “Lunge Matrix” in the link below, describing it as “quintessential, elemental and fundamental to staying healthy as a runner.” He stresses that “you do this the FIRST thing when you get out of the car.”

Here is a summary of the “Lunge Matrix” seen on the video. You can also purchase the Lunge Matrix as part of Jay’s excellent Building a Better Runner DVD series.

For each version, Coach Jay recommends five lunges are performed on each leg (10 in total).

1. Front Lunge

stretching for runners_front lunge

In this lunge, you are preparing for forwards & backwards movement (the sagittal plane). The front knee needs to stay in alignment with the front foot (same goes for back knee & back foot), but there is often debate as to whether the front knee should pass the toes. Personally, I see stopping the front knee from passing the toes as a way of helping quad dominant runners from using the posterior muscles more, discouraging excessive arching of the lower back and getting a better stretch in the all too often tight hip flexors.

2. Front lunge with a twist

stretching for runners_lunge with twist

The action of twisting over the front leg (moving your body through the transverse plane) increases the stretch in the hip flexor of the back leg. By challenging your balance it engages the core (including the glutes) and increases proprioception (your body’s ability to sense movement within joints and joint position). It will take some practice so break it down into stages.

3. Side lunge

stretching for runners_lateral lunge

This lunge moves your body through the frontal plane and in doing so targets the abductors and hip-stabilizing muscles. Aim to keep the fixed leg straight. Personally, I recommend rotating the lifted foot out to 45 degrees so that the knee moves in line with the foot.

4. Back and to the side Lunge

stretching for runners_side lunge

With this lunge, the traveling back foot turns 90 degrees to the side, again allowing the knee to move in alignment. By traveling in a combination of the frontal plane and sagittal plane, you are preparing for the often forgotten rotational demands of running.

5. Backward lunge

stretching for runners_backward lunge

The backwards lunge is more challenging than the others but in essence involves the same muscle movement sequencing that is needed in running. It demands more core stability, hip extension and glute recruitment than the other lunges, decreasing hip and ankle stiffness. Or as Coach Jay says “…a great way to explain to your butt that you’re about to use it.”

Where do we go from here?

Like I say, there are plenty of sources for dynamic stretching on the internet: ankle rolls, toe pumps, leg swings, single leg deadlifts, etc. Sourcing is not the issue.

The issue is ensuring you avoid the massive temptation to miss it out before you run. You will come up with every excuse under the sun: “It’s too cold,” “I don’t have time,” “I’ll do extra tomorrow to make up for it.” It’s just five minutes people!  Believe me, it will create focus, readiness, and mark the beginning of fewer injuries & improved running performance.

I look forward to hearing which dynamic stretching exercises you add to your warm up. If you are struggling to source links, ask in the comments section and either I or another reader will be happy to help. Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. For more great training, injury prevention and nutrition advice, be sure to check out the RunnersConnect blog. If you’re in the market for a personal coach then it’d be worth checking out their coaching service as well.

Plantar Fasciitis

By Ian Nurse, D.C.

Tough to pronounce but impossible to ignore, plantar fasciitis is one of the most common foot injuries of both novice and veteran runners. For those who have suffered through it, the symptoms and chronology are unmistakable: insidious at first, then becoming a chronic, sharp and burning sensation on the inside base of the heel with the first few steps in the morning. While the pain seems to get better with activity, it returns with full force by the end of the day. One of the slower healing injuries of the body, it’s not uncommon to hear of people enduring anywhere from months to years.

So what exactly is plantar fasciitis? How does one treat it, or, better yet, avoid it in the first place?

Screen Shot 2013-06-06 at 10.19.19 AMFirst, let’s start with the anatomy and the role it plays in the proper functioning of the body. The plantar fascia is a fibrous sheath consisting of the connective tissue protein, collagen. This sheath is lined in parallel to the direction of pull over the muscles on the bottom of the foot. This super structure is critical in arch support carrying as much as 25% of the load. As one can imagine, it also plays a significant role in the gate cycle as it acts as a tie beam transferring force from the calf to the forefoot. Running from the inside portion of the heel to the base of the big toe, one can experience symptoms along any portion of the arch; however, the pain typically centralizes where it originates at the base of the heel.

While previous thinking had correlated arch height as a predisposing factor to developing plantar fasciitis, new research refutes this claim. The most accurate kinetic predictor is not the size of your arch but rather the working relationship between the plantar fascia and the intrinsic muscles that lie beneath. As the plantar fascia itself is a passive structure that stores and returns energy, it relies on the intrinsic muscles to create the energy needed to support the arch. If the intrinsic muscles are not firing correctly due to adhesion, scar tissue or muscle imbalance, the plantar fascia has to adopt a more dynamic role that can lead to problems. Tissues tighten up and restrict blood flow to the area, leading to scar tissue formation. This in itself is enough to produce pain, but if untreated can progress into an even more difficult problem: tendon degeneration. In this case, the point on the heel bone where all those muscles and the plantar fascia attach begins to degenerate or die.

How does one avoid ever getting plantar fasciitis?

First and foremost, wearing the proper footwear is crucial. Think of putting a train on the wrong set of tracks. Wearing shoes that are either too supportive, or not supportive enough can be the leading factor to someone developing this condition. The second tool in prevention is strengthening the muscles of the foot. Exercises such as toe scrunches and calf raises a few times a week can help develop a better balanced arch that will rely less on the plantar fascia and more on the muscles.

What can I do if I have been suffering from plantar fasciitis?

As mentioned earlier, plantar fasciitis can be an extremely slow healer. Anatomically, the foot is already in a position of decreased blood flow that also has to work against gravity. As a result, the degenerating tissue is unable to get the nutrients and blood that it needs. It’s important to treat this early so that it does not become a chronic condition. Start with assessing all of your training variables that might have led to it developing in the first place—improper shoes, training surfaces, and intensity. It’s also very important to both help break up the scar tissue that has formed and reduce the inflammation. Rolling your foot over a golf ball can be a helpful form of self massage. Make sure that you then follow that treatment with icing to reduce the swelling. Freezing a Nalgene bottle filled with water makes for a great ice massage tool. As our body heals itself at night, it’s also vital that the foot is held at 90 degree angle to ensure that the fibers heal in a lengthened position. A night splint or the Strassburg sock are useful tools to facilitate this important healing step.

For those cases that are not healing on their own, consulting a professional could be a necessary step. Massage therapists, PT’s, and chiropractors all treat plantar fasciitis on a regular basis and could be the final step needed.

This was originally published in the March/April 2013 issue of Level Renner. Want to get this material as it’s released? Sign up for your free subscription in the box on the right side of the screen. As always, if you have any questions regarding this injury or would like to have your own condition assessed, please do not hesitate to contact Ian: [email protected]

Choosing the Right Running Shoes

A Look at How Trainers Affect Training and Running Performance

Guest blog by Matt PhillipsRunnersConnect

running shoesFollowing last week’s article “Foot Types & Foot Wear,” I have had quite a few runners ask me the same question, with words to the effect of: “Ok, if the whole overpronation shoe model thing has no evidence, what the hell do I run in!?”

A very good question! But first things first…

Why do we need running shoes at all?

Relax, I’m not going to start preaching about barefoot running (although I’m not going to dismiss it either). But in order to discuss how we decide which trainers are suitable for us, it is useful to re-evaluate exactly what we are buying them for.

With that in mind, over the last couple of days I have been asking the runners I meet what they are looking for when they buy trainers. Collectively, the majority of them produced the following three reasons: protection,supportcushioning.

Protection

If by protection we are referring to avoiding glass & syringes, then wearing something on our feet obviously makes sense. This may well be the main contributing factor as to why, at least in my experience, it is rare to see runners training or racing in no shoes on at all.

Many of us could probably find less hazardous routes on which to entertain the theoretical benefits of barefoot running, but until clearer evidence supports such theories, most of us will probably pass.  However, if we’re talking about protection from running on hard surfaces then we are essentially looking at cushioning (more on that shortly).

Support

By support, most people are referring to stopping the medial arch of the foot “collapsing,” which brings us back to the whole supination/neutral/pronation paradigm used by most running shops to prescribe you a “suitable” trainer after watching you walk or run for a couple of minutes (or in some cases just standing you on a pressure pad, which in itself has no connection to how your foot acts whilst running). I am sure you are already familiar with the process:

  • If the arch of your supporting foot drops “too much” you are labelled an “overpronator” and assigned a motion-control shoe that will in theory reduce the “overpronation”.
  • If your arch does not drop “enough”, you are said to be an underpronator (or supinator), and assigned a flexible, cushioned shoe to absorb some of the shock that underpronator is said to cause.
  • If you are somewhere in the middle, you are said to have normal pronation and are recommended a “neutral” shoe that in theory provides just the right amount of stability and cushioning.

As we saw last week, this model is heavily flawed and unsupported to date by any evidence. It is important not to let fear of injury or promises of recovery persuade you to be herded into one of the three pens (motion control, stability or neutral) however persuasive the sheepdog/sales person may be!

Cushioning

If you regularly run on hard surfaces like pavements, tracks and treadmills, you would think cushioning makes sense. Running shops can be very quick to stress this point if they “see” you as a heel striker. And yet, studies show (Scott, 1990) that peak loads at typical sites of injury for runners (Achilles, knees, etc.) actually occur during midstance (when your bodyweight passes over the supporting leg) and toe off (when your back leg pushes away from the ground).

These studies suggest that impact force at heel contact has no effect on the peak force seen at typical injury sites.

There is also growing evidence that when faced with higher impact forces from a harder running surface, your body makes natural adjustments to deal with the change in impact force – changes in joint stiffness, changes in the way the foot strikes the ground, and also via a concept called “muscle tuning” (pre-activation of muscles prior to impact).

Based on information received visually and from the previous foot strike, the body adjusts how strongly the muscles in your leg contract before the foot hits the ground again. Imagine jumping on a trampoline – your legs naturally stiffen in preparation for the soft landing.

Now imagine yourself jumping onto concrete – your legs naturally become less stiff in preparation for the hard landing. This natural adjustment is the result of sensory feedback from not only the eyes but also from the feet. In other words, the theory is that sensory feedback from the feet following one foot strike helps prepares the body for the next foot strike. If this is indeed the case, could excessive cushioning at the bottom of a trainer inhibit this natural sensory feedback?

Cushioning & injury prevention

The role that impact actually plays in running injuries is not at all clear. Studies by two highly respected biomechanics researchers, Dr. Irene Davis (Director of the Running Injury Lab, University of Delaware) and Dr. Benno Nigg (Co-Director of the Human Performance Laboratory, University of Calgary) have produced contrasting results.

Whilst Dr. Davis’ research links high impact loading rates with plantar fasciitis and tibia stress fractures, Dr. Nigg has found that overall injury rates are slightly lower among runners with high impact loading rates.

One possible interpretation of the above is that leg stiffness, as we considered earlier, is an important factor with certain injuries. Dr. Davis’ research linked runners who had suffered tibia stress fractures with higher impact forces and higher leg stiffness.

If tibia stress fractures are a consequence of high leg stiffness (for which I hasten to add there is as yet no evidence) then maybe runners susceptible to them should try wearing a less cushioned shoe and run on harder surfaces.

Just as we saw in our “landing on concrete” example earlier, in preparation for the harder surface, the body will reduce leg stiffness, which if the theory is correct could reduce susceptibility to tibia stress fractures.

At this stage it is all theory, and I draw particular attention to the words “maybe” and “try”. Always introduce changes slowly and gradually! Give your body a chance to tell you how it feels about the change before you do any harm to yourself!

So what trainers should I buy?

For those of you still clinging onto the hope that I or indeed anyone is going to be able to give you a structured model for trainer selection, I should probably put you out of your misery. There is no model. But do not despair. See it as liberation as opposed to a hindrance.

Yes, some people are recommended trainers and their injury disappears, but plenty are given the same advice and the injury continues. The journey to injury free running is best started with acceptance & application of the following mantra, as used by running coach James Dunne of Kinetic RevolutionForm Before Footwear.

As far as trainer selection goes, Pete Larson, anatomy professor, writer & runner with self diagnosed shoe obsession sums it up nicely: “I can run in just about anything as long as I’m careful to take things slowly and listen to my body.”

This is what I mean by “liberation.

Part of Pete’s Running Shoe Collection, 2010. (Photo Courtesy of P. Larson)

Part of Pete’s Running Shoe Collection, 2010. (Photo Courtesy of P. Larson)

In my opinion, one of the best things to so far emerge from the barefoot debate is the much larger variety of designs of shoe you can now choose from.

Having seen that heavy cushioning is not necessarily helpful to everybody, you should now hopefully be more confident to test, for example, some lighter trainers. Again, the secret is experimenting to see what feels comfortable for you. Bear in mind that a trainer that suits you for one distance, terrain or speed may not work as well for another.

You could also try trainers with a slightly lower Heel-Toe Drop than you are used to (the difference in height between the heel and the forefoot).

Traditional running shoes have a heel-toe drop of about 12mm. Vibram Fivefingers have pretty much a drop of 0mm. Going straight from 12mm to 0mm is not taking things slowly or listening to your body! There are plenty of 6-10mm transitional trainers on the market which will allow you to experiment more gently.

Though there is as yet no direct evidence for benefits of a lower drop, I personally see much logic in the argument that exposing your feet and legs to varying forces (in a controlled, sensible manner) could potentially make you a stronger runner and reduce injury.

Remember to listen to your body

If you run too far, too often, or too fast in a new pair of trainers, your body will let you know. Many of the running injuries we see in clinic are linked to a runner buying a new pair of trainers and thinking they can pick up their training program from where they left off. It’s more than that. Most runners actually run faster or further the first time they put on their new trainers (we all love new toys!).

  • It is vital to respect the fact that your body will often need time to adjust to a new style of trainer. Put on a minimalistic shoe for the first time and run too far and your calves will soon let you know about it! It’s all about taking it slowly and listening to your body.
  • If you experience a slight discomfort, treat it as a thoughtful message from your body that you need to break the new trainers in a little more gently. Put them away for a while. Go back to your favourite trainers then re-test the new ones with reduced time or intensity.
  • Obviously, if the pain is persistent and affects your running whilst wearing other footwear then get it checked out by a professional, but in my experience most running injuries are the result of either ignoring a warning sign (not listening to the body) or too quick an escalation in frequency, intensity or time.

It may be the shoes, but it’s more likely to be you pushing yourself too much, too soon. Which brings me to my next point…

Use more than one pair of trainers

In order to break in new trainers, you will need to have your all time favorites at hand to wear in between. Your body will warn you if you are doing too much in your new trainers. Listen to it. Put them away for a week, continue with your regular trainers, then go back to the new ones.

Many runners I work with report that exposing their legs & feet to different forces via rotating the trainers they run in leads to (or at least coincides with) less injury. Given that the majority of running injuries are the result of repetitive strain, mixing it up kind of makes sense (and that goes for running surfaces as well). Invest in a few pairs of different style trainers – the chances are you will get your money back by less need for injury treatment!

Have you experienced success by changing to a new style of trainer? Maybe you already rotate different style trainers as part of your running program? We are always keen to hear from you and look forward to reading your comments.

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on TwitterAnd for more great training, nutrition, maintenance info, check out the RunnersConnect blog.

Injury Prevention: Footwear & Foot Type

The Impact of Footwear and Foot Type on Injury Prevention

Guest blog by Matt Phillips, RunnersConnect

footwearAlways Evolve” – one of my favourite valedictions used by esteemed physical therapist and blogger Mike Scott, DPT at the end of posts in his weekly series “Educainment.

Running has certainly seen some evolution of thought over the last few years, much of it following the publication in May 2009 of Christopher McDougal’s best seller Born To Run, bringing with it bold claims that running barefoot (or wearing something as close as possible to barefoot while protecting you from environmental elements) can strengthen your feet, reduce running injuries, encourage proper running form, and improve performance.

Until then, the only experience many of us had of barefoot running was seeing the South African teenager Zola Budd on our television sets, running barefoot in the women’s 3000 meter race at the 1984 Los Angeles Olympics.

Barefoot running

Whilst some runners have praised a transition to barefoot running (along with the typical shift to forefoot striking that barefoot running encourages) as a cure for an injury they were suffering, others have not been so fortunate and have seen it bring the onset of new injury, despite religiously following a slow, progressive transition period.

Clinical tests to date have also produced conflicting results. Barefoot running has been seen to reduce the risk of certain running related injuries, but increase the risk of others. It’s as if what works for some does not necessarily work for others. Sound familiar?

Regardless of personal experience, production of conclusive evidence for the benefits of barefoot running is still an ongoing project.

Minimalistic footwear

The increased profile and interest in barefoot running brought with it demand for less restrictive, less cushioned footwear, with the idea of allowing the foot to move and work in a more natural fashion whilst still providing a certain amount of protection.

As a result, today there is a wide spectrum of minimalistic footwear that, though not as extreme as barefoot style shoes like the Vibram FiveFingers, typically aim to provide less drop (difference between heel height and toe height), less cushioning, a wider toe box (more room for the toes) and more flexibility.

Like barefoot running, conclusive evidence for the benefits of minimalistic footwear is still a work in practice. A 2012 review in the Journal of Strength & Conditioning titled: “Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?” concluded:

Running barefoot or in minimalist footwear has become a popular trend. Whether this trend is supported by the evidence or conjecture has yet to be determined.

Traditional footwear

Before any of you take “lack of conclusive evidence” as a reason to dismiss the possible benefits of barefoot running or minimalist shoes, I should point out – and this may come as a shock to you – that there is no evidence either that traditional running shoes can reduce injury or improve running performance.

Yes, you read that right. Though you were maybe told in the sports shop that your cushioned, stability or motion control trainer will help prevent injury, there is no evidence to support it. The problem is, the model that has been used for the last sixty years and more often than not is still used to help you select which trainers suit you is based on, well… not a lot.

Foot types

If you have ever been to a sports shop to buy a pair of running shoes (or have received an “ankle-down” gait analysis), chances are you are familiar with the diagram below, or something very similar. It links three “foot types” (based on the height of the medial arch) with three corresponding types of recommended running shoe:

RC6_FootTypes

The origin of the idea to group feet according to the height of the medial arch is not clear. Ian Griffiths, Director of Sports Podiatry Info Ltd suggests it may stem from a method of assessing footprints devised in 1947 by Colonel Harris and Major Beath as part of an Army foot survey. The first time an image associating medial arch height with shoe type actually appeared in print could have been the 1980 “The Running Shoe Book” by Peter R Cavanagh.

RC6_RunningShoeBook

What we do know is that since 1980, running shoes all over the world have been recommended and sold using the Foot Type model. Selection typically follows an “assessment” (often involving the subject stepping onto a pressure pad or being filmed from the ankle down whilst running) of how much the medial arch drops (referred to in the diagram as “pronation”) or doesn’t drop (“supination”), along with the idea that somewhere in the middle (“neutral”) is normal, healthy and necessary for injury prevention (more on that later).

  • If the arch of your supporting leg drops “too much”, you are labelled an “overpronator” and assigned a motion-control shoe that will in theory reduce the “overpronation”. If your arch does not drop “enough”, you are said to be an underpronator (or supinator), and assigned a flexible, cushioned shoe to absorb some of the shock thatunderpronator is said to cause.
  • If you are somewhere in the middle, you are said to have normal pronation and are recommended a “neutral” shoe that in theory provides just the right amount of stability and cushioning. Leaving aside the question of who decides “how much” dropping is normal, it is important at this stage to remind ourselves that both pronation and supination are naturalintegral parts of foot biomechanics.

Dr Shawn Allen, Diplomate of American Board of Chiropractic Orthopaedists explains:

The foot is a biomechanical marvel. 26 bones and 31 joints, working together in concert to provide balance, stability, and locomotion. As we walk or run, the foot is supposed to go through a series of biomechanical changes, so that it can either adapt to the environment or become a rigid lever for propulsion. When these mechanisms fail, problems usually arise. When the heel hits the ground, the arch of the foot is supposed to partially collapse (pronation), so that the foot can adapt to the ground; in this position, it is flexible and “unlocked”. After the weight of the body passes over the foot, the arch is supposed to retract, and the foot becomes more rigid or “locked” (supination), so that you can use it to propel yourself forward. If the foot remains in pronation for too long, or does not supinate correctly, problems will develop over time.

Problems with assigning shoes according to degree of pronation

So, the running shoe recommendation model is based on the idea that at midstance, just before the full weight of the body passes over the foot, the best position of the subtalar jointis “neutral”, i.e. the foot perpendicular to the horizontal ground.

The argument is that this “neutral” position signifies optimum functioning of the foot, optimum pronation and supination. One problem with this is the fact that the subtalar joint has variable anatomy. In other words, function will vary from person to person, so the ‘optimum’ position to be in will also vary. Ian Griffiths explains:

Studies have shown that the structural anatomy of the human subtalar joint varies from person to person and it has also been shown that the location of the axis of the joint can and does vary from person to person; this will of course directly influence the magnitude of pronation and supination seen.  In light of this sort of evidence it seems odd that there would be an expectation that all individuals could or should function similarly or identically.”

Taking the above into consideration, it should come as no surprise that there is no data or evidence that suggests “neutral” STJ alignment is linked with injury and/or pain free running. One study examined 120 healthy individuals both non weight-bearing and weight-bearing. Not one subject conformed to the criteria of “neutral” alignment.

Is there any evidence that “over-pronation” increases injury?

Almost all studies to date on “over-pronation” have found no evidence that it increases the risk of injury. A 2010 study concluded that the prescription of shoes with elevated cushioned heels and pronation control systems tailored to an individual’s foot type was not evidence based.

Another piece of research suggested the running shoe model was overly simplistic and potentially injurious. In fact, in this research, every ‘overpronated’ runner put into a motion control shoe during a 13 week half marathon training programme reported an injury.

Craig Payne, DipPod MPH, University lecturer and famed Running Research Junkie points out that lack of evidence for linking overpronation to injury may well be down to the methods used to measure pronation:

The weakness of many of those studies is how they measured “pronation”; for example, some measure calcaneal eversion; some measure navicular drop; some do a footprint analysis; and some use a dynamic 3D kinematic analysis. The problem with that is that someone may be ‘overpronated’ on the measurement of one parameter and not ‘overpronated’ on another parameter.”

A study published this month by Teyhen DS. titled “Impact of Foot Type on Cost of Lower Extremity Injury” set out to determine the relationship between foot type and medical costs associated with lower extremity musculoskeletal injury, using a population of 668 healthy U.S. military healthcare beneficiaries in active military service for at least 18 months of the 31 month study.

It quantified level of pronation using the Foot Posture Index, a measurement of static foot posture that takes into account not one but multiple components that go into “overpronation”, devised by Dr Anthony Redmond, Arthritis Research Campaign Lecturer at the University of Leeds.

Whether static foot posture has much to do with foot posture whilst moving (e.g. running) is a discussion for another day. What the study did show is that of the 336 participants (out of the total 668) who sought medical care for lower extremity musculoskeletal injuries, a high percentage (no exact value available at this time) were those who had been listed as “extreme pronated feet” via the Foot Posture Index.

Future research will be needed to help see if degree of pronation via multiple component assessment (e.g. the Foot Posture Index) can be linked to injury. In the meantime, using just one component of “over-pronation” (e.g. medial arch height) to assign suitable footwear will continue to be a game of hit and miss.

Concluding considerations

  • Is the whole running shoe recommendation model based on misconception?
  • If it is, what model should be used, if any?
  • There are certifications out there teaching shop staff how to sell running shoes. What are they based on?
  • As a result of this debate, some are suggesting that runners should buy trainers based on “comfort” alone. Hard to imagine?

As I see it, just because an injury is present on someone with an “excessive” level of pronation (whatever that is…), it does necessarily mean that the level of pronation is the cause of the injury (correlation vs. causation).

It is imperative to consider and understand the biomechanics of the rest of the body (as well as foot posture) before reaching any conclusions. And even with all of that knowledge, it will still be a daunting task to be able to say “this is the running shoe you need!”

So, what should we base trainer recommendation on? A tricky question that we will consider next week. In the meantime, I am keen to know of your personal experience. What you are currently running in? What made you buy them? Have you managed to reduce injury via a change in footwear? Maybe a change in your footwear has led to an increase in injury? As always, I look forward to your comments!

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. And for more great training, nutrition, maintenance info, check out the RunnersConnect blog.

****UPDATE****

As luck would have it, Colbert interviewed Daniel Lieberman on the subject of barefoot running on last night’s show:

Piriformis Syndrome

A Real Pain In The Butt

By Ian Nurse, DC

This past month, as the Boston Marathon training cycle came to a close, more and more runners started coming into my office complaining of the same thing: “So I have this dull ache in my butt! I think it’s my piriformis.” With this sudden spike of a particular injury in mind, I will attempt to answer the following questions: why is everybody talking about the piriformis and where the heck is it?

For such a small muscle, the piriformis seems to get a lot of attention. It does play an important role as a hip stabilizer and an external rotator (bringing your leg out and back), but it doesn’t act alone. There are three other external rotators and stabilizers of the hip that play an equally significant role.

Screen Shot 2013-05-15 at 3.43.51 PM

Ian Nurse (BAA, backwards hat) cruises along in the Boston Marathon, courtesy of Scott Mason.

So why does this one little muscle get a whole syndrome named after it? The answer revolves around the piriformis’ proximity to another extremely important structure, the sciatic nerve. The piriformis muscle and sciatic nerve are close neighbors that even demonstrate various positioning throughout the population. For the majority of the population, the sciatic nerve lies directly beneath the lower edge of the piriformis; others demonstrate a split sciatic nerve lying above and below the piriformis; another small group actually have their sciatic nerves bisect the muscle itself. That said, all four deep external rotators, as well as the gluteus medius muscle, are positioned close enough to the sciatic to cause irritation. Perhaps a more appropriate name might be “deep external rotator syndrome?”

Traditionally, piriformis syndrome is used to describe a condition in which tension within only the piriformis muscle produces entrapment and irritation of sciatic nerve. This entrapment can be caused by numerous soft tissue factors including an excess of scar tissue surrounding the nerve or a muscle imbalance. As the sciatic nerve is one of the largest nerves in the body, comprised of nerve roots from L4-S3, if it becomes entrapped, one can feel a variety of symptoms. Typically, a patient complains of a deep ache in the hip with pain and/or paresthesia (abnormal tingling or sensation) traveling down the back of the thigh and into the calf and foot. Symptoms are often exacerbated when the patient performs squats or stands from a seated position. Clinically, patients notice symptoms more with sitting and during car rides. Repetitive activities such as walking, running, and cycling can become quite uncomfortable as tension over the sciatic builds.

While the positioning of the anatomy plays an important role, there are many avoidable risk factors that contribute to developing this syndrome. As the main hip external rotators are the gluteus maximus and gluteus medius, weakness and imbalance within these muscles impede on proper function of the deep hip rotators, thus, causing tension. Wearing improper footwear, running on banked surfaces or slippery surfaces (think of all the snow this past winter) and sitting all day (especially if you have a wallet in your back pocket) are also common causes. Pregnancy, and the resulting relaxation of the pelvic bowl ligaments, is a potential cause, as the deep rotators must now pick up the slack for the ligaments.

As runners, we need to pay attention to the little things within our training that can cause these muscles to get irritated. Replacing your shoes before they become too worn out, avoiding banked surfaces, and strengthening of the hip girdle muscles can make a big difference in avoiding this condition in the first place.

As one can see, while small, these muscles can cause big problems. Thankfully, the most effective form of treatment is a conservative one that involves muscle therapy, stretching, and strengthening. The Myrtle Routine created by Coach Jay Johnson is an important supplement to training that can be performed a few times a week to help avoid any muscle imbalance. In addition, a tennis or lacrosse ball can be a simple and inexpensive means of trigger point therapy helping to break up scar tissue deep in the glute and relax the musculature releasing tension on the sciatic.

While “external rotator syndrome” is, both literally and figuratively, a pain in the butt, when treated correctly, it is not an injury that has to stop you from doing the activities that you love.

This is an excerpt from the latest issue of Level Renner (Issue 14, May/Jun 2013). As always, it’s free, so download it here. Sign up for your free subscription (in the sidebar) and you’ll be alerted each time we publish. Ian Nurse is not only a chiropractor but also a real fast runner. See our Boston Marathon coverage to see how he did.

2 Simple Ways To Survive Calf Soreness After Racing

Guest blog by John Davis (RunnersConnect)

As spring begins to peek its head out in many parts of the country (and as many others busily dig out of snowbanks), runners are starting to think about how to open up their springtime 5k and 10k racing season.

One issue that can hound you after your first springtime race is a searing calf soreness that lasts for days.  It’s always worst after your first race, then gradually becomes less severe as you get into your racing season.

In this article, we’ll look at some of the research on why this happens and then provide two simple and effective ways to prevent this first-race calf soreness.

How Muscles Contract: What All Runners Should Know

To understand the science behind why calves get so sore, especially after the first race of the season, it’s important to first understand the different type of contractions a muscle can produce. There are three types of muscular contractions: concentric, isometric, and eccentric.

  • A concentric contraction is when a muscle is moving against resistance in the direction it is contracting, like the “up” part of a bicep curl or the bench press.
  • An isometric contraction is when the muscles are statically resisting a load, like when doing a “plank” exercise or a wall-sit.
  • Finally, an eccentric contraction happens when a muscle is slowing down a stronger load in the opposite direction of the way it contracts—the “down” phase of a bicep curl or bench press, for example.

Research on Contraction Type and Soreness

As early as the 1980s, physiologists were discovering that not all muscular activities are equal when it comes to the damage they do to the muscle fibers and the resultant soreness.

Research was beginning to show that eccentric muscular contractions were significantly more stressful on the body and were more likely to result in soreness.

A 1991 study by Kroon and Naeije is a good example—in their study, five men performed concentric, eccentric, and isometric bicep exercises to exhaustion on three separate occasions. For several days after each muscle-fatiguing task, the researchers used an EMG machine to analyze the effects of the exercises on the muscles.1  While the EMG signals to the biceps muscles recovered in a day or two after the concentric and isometric exercises, the eccentric contractions could affect muscular strength and coordination for up to a week.  Additionally, the subjects reported that soreness was most frequent and severe following the eccentric exercises.

How Does Gait, Speed, and Shoe Selection Impact Calf Soreness

Fortunately, doing some amount of eccentric training can guard against the soreness that often results after large bouts of it.

It is hypothesized that eccentric exercise causes more severe soreness because it results in more damage to the muscle fibers.  By gradually introducing eccentric loads on the muscles, soreness from eccentric activities can be reduced or eliminated, as reported by Karoline Cheung, Patria Hume, and Linda Maxwell in a 2003 review article.2

How is this relevant to first-race calf soreness?

We can discover the root of the calf-soreness issue with a bit of biomechanics.  Given that muscular soreness is most often the result of large eccentric muscular contractions that your body is unaccustomed to, it becomes apparent that high eccentric loading in the calf is to blame for the soreness following your first races of the year.

During the gait cycle, the calf works eccentrically to absorb the energy of impact, storing some of it to be released when you push off the ground.  The degree to which your calf is loaded is dependent on the speed you are running, the shoes you are wearing, and the surface you are running on.

Obviously, a faster pace will cause increased calf loading.  But faster paces also tend to be associated with a footstrike that’s more forward on the foot, which itself increases calf loading—a true forefoot striker loads his or her calf more than a heel striker, for example.  Additionally, the heel height of your shoes can modulate the degree of loading on your calf.

In a standard running shoe with about a 12 mm “drop” from heel to toe, your ankle won’t be able to dorsiflex more than about 4° of plantarflexion when standing on flat ground if you’ve got a size 9 foot.  But in a racing flat with a 4mm drop, your ankle go through a larger range of motion, and the deeper your heel sinks down towards the level of your toes, the greater the loading on your calf.  In track spikes, the effective heel drop is negative, meaning your heel can sink to below the level of your forefoot!

At the same time, the softer the surface you are running on, the deeper your heel will sink into it.  A mushy springtime race on grass or dirt will make your heel sink further into the ground than a paved road, increasing calf loading.  Compound this with high speeds and a low-heeled racing shoe and you can see where the calf soreness comes from!

2 Simple Solutions to Post-Race Calf Soreness

Barefoot Running

Fortunately, the remedy for preventing this soreness is fairly basic: by gradually introducing faster running in lower-heeled shoes (or none at all), you can dodge the painful soreness that follows your early-season races.

If you’re not a minimalist runner or you find that transitioning to a minimalist shoe hasn’t worked for you in the past, you can implement a suggestion from Jason Fitzgerald, which is to run your post-run strides barefoot in the grass. One of the benefits of doing a bit of barefoot running on grass every week is that your calves gradually accustom to the type of eccentric loading you’ll be taking while racing and working out in lightweight shoes, so you won’t get incredibly sore all at once.

Calf Muscle Exercises

Rather than choose between racing flats and running barefoot, doing some eccentric calf exercises off of a stair can also bolster your calf strength during wintertime when you can’t get outside to do some strides or jogging in spikes.  The “eccentric heel drop” exercise that is helpful when you’ve got Achilles tendonitis is also a good all-around strength exercise for your calves.

Exercise 1: The straight-knee eccentric heel drop.

eccentric heel drops achilles tendonitis

Exercise 2: The bent knee eccentric heel drop.

eccentric heel drops bent leg achilles tendonitis

If you’ve purchased our Strength Training for Runners program, you can also incorporate the Achilles Lower Leg Routine into your weekly training two or three times per week. By performing these exercises during the weeks leading up to your racing debut, plus some easy running and light, quick repeats or “strides” either barefoot or in your racing shoes, will hopefully let you dodge the calf soreness that often accompanies your early-season races.

Get more great injury prevention advice from John Davis (plus other great training & maintenance tips from Jeff Gaudette & Co) on the RunnersConnect blog.

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