Calf pain in runners: 9 causes and considerations From footwear to form

One of the most common complaints runners have is calf pain, particularly while running. It might initially come in bouts during just a couple runs, but sometimes it will stick around for weeks and months if left unaddressed. Rest usually improves this discomfort at first, but isn’t typically sufficient for long-term, consistent relief if the person continues to run and doesn’t make any other changes. They’ll complain that their calf muscles feel “tight.” And it’s common for both calf muscle groups to start to feel this way around the same time.

Some runners take the “I give up” approach and assume it’s a necessary part of getting older or running too many miles, so they begin to modify their training around it by planning an additional rest day or cross training instead. They take the “a little running is better than no running” approach, which I think is very reasonable for a true injury, but when something can be improved, why not address it the right way?

For the sake of this article let’s assume we are covering muscle-specific pain in the calf that isn’t too bothersome much outside of running. These are more likely to be muscle overuse syndromes or biomechanical overload syndromes. This cause of pain can be treated while you continue to run, if done correctly.

But there are plenty of other things that can cause calf pain and you will need a medical professional, not an internet article, to rule those out.

Possible (and Potentially Serious) Medical Issues to Rule Out

  • Blood clots/deep vein thrombosis
  • Nerve mobility deficits or irritability of the lumbar, sciatic, and tibial nerves
  • Calf muscle tear/rupture
  • Popliteal artery entrapment

What can you do?

Seek professional medical guidance if you have had a traumatic injury (often accompanied by a sudden “pop” or a feeling of being kicked in the calf). We are also very concerned if there is a more persistent or severe onset of pain, or additional symptoms like sensation changes (pins, needles, tingling, burning), fever, swelling, and redness of the calf. It’s important to consider your overall history because factors such as being older, having a history of a particular problem, recent immobilization, comorbidities, and certain medications can all have a role. These issues are very different than a mild discomfort, tightness, or fatigue that occurs only while running. It isn’t to say that some of these problems can’t be treated conservatively but you will have the best chance at success with proper diagnosis. We need to keep in mind too, if you have attempted treatment that doesn’t seem to be helping.

download.png

Other considerations:

Calf Strength and Endurance Deficits

Logic would tell you that running demands a ton of work from the leg muscles. At some routine level of activity, the muscles adapt to that work and you keep on going from week to week without issues, just as happily as ever. Now what happens if you chronically demand so much from those muscles that they can’t adapt to what you are trying to have them do? They slowly start to...change…like your best friend from junior high school. At first it was cute but two months later you were just annoyed. The muscles don’t have to be painful, at first. Maybe they just feel more tired and tight. But when you keep running on them and don’t make any other changes they become more consistently problematic.

The muscle and fascial connective tissue isn’t able to adapt to your demands in a positive manner when demand outpaces normal repair over a long period of time. Why couldn’t the muscles withstand the demand? Most likely there wasn’t enough strength or endurance (or both) in the muscle group. Given enough time of chronic repetitive stress on under-prepared tissue, the quality of the soft tissue changes.

Running really requires something called “strength endurance” from muscles like the calf. You might even better call it “strength and power endurance,” but I don’t want the top of your head to blow off right now so forget I said that. The point is that the muscles of the calf have to withstand high forces (strength), very rapidly (power), and with high frequency (endurance).

The calf-strength variations that will show up when tested during a single leg calf/heel raise are often interesting. A runner might have tons of gastrocnemius strength during a straight-knee calf raise, but when the calf raise is re-tested while the knee is flexed, they can’t reach the top end of the calf raise anymore. Often this means they have decreased soleus strength, which is a real problem since, while running, we spend a large portion of the running stride with the knee slightly bent. Or maybe they can’t perform the same amount of reps on one side when compared to the other in either position.

Even worse is when the person can’t perform any type of single leg calf raises without relying on their long toe flexing muscles that come from deep in the calf region. My heart hurts when I see this. These people tend to grip with their toes during calf raises and just can’t get their brain to shut those muscles off while completing the raise because the bigger, outer calf muscles are just that weak. It’s not a surprise that people will run with those toe muscles engaged heavily too.

What can you do?

Build the strength of the calf muscles using calf raises, with the knee slightly bent and straight, without gripping with the toes, and with just a single leg at a time. Full ankle range of motion is key. Causing calf muscle fatigue is the goal. That might take five reps or 20. Don’t hammer it to death because you’ll probably become sore for two days. Early strengthening with bodyweight is good but after 2-3 weeks of 3-4x/week, runners should be able to add extra resistance, even beginning with something like 10 pounds. The calf needs to be strong, but...

IMG_3763.jpg

Other Strength Deficits

I am stating the obvious here, but it takes more than the calf muscles to propel a runner. Lacking hip or thigh strength could lead to a trickle-down of abnormal demand into the calf muscles. The calf could actually be super strong but just have to endure too much stress every time you go running because something else stinks at its job. End result: too much work being done by the calf muscles that leads to stress-induced discomfort.

What can you do?

Ensure you have full strength of the hip and thigh muscles (eg. gluteus maximus, gluteus medius, hamstrings, quadriceps). Strengthening exercises for these areas is beyond the scope of this article, but the point is you need to look outside the area of symptoms if you want to actually fix the problem. Remember to emphasize single-leg strengthening to ensure symmetry. If you can only do eight single leg bridges on one side and 20 on the other then you’ve got some extra work to do on the weaker side.

Neuromuscular control

Your awareness of and ability to modify the way your body moves at any given instant is a good indicator of overall athleticism. Remember, our muscles only know how to function based on what they are told by the nervous system, particularly the spinal cord. If your nervous system can’t figure out how much force to generate from the various muscles at any one moment then your movement isn’t refined. Picture a gymnast on a balance beam. It doesn’t take much error to result in falling off the beam. They really have to own their movements with precision and certainty. Kinda, sorta knowing where their feet are isn’t going to cut it. Or imagine an infant learning to crawl. They are constantly on the edge of failure until their nervous system figures out the best way to coordinate muscle contractions to keep their body stable. Your calf muscles must contract with correct amounts of other muscle contractions in that leg with every footstrike.

What can you do?

Working on drills to improve your balance and proprioception is key. As previously mentioned, single-leg work is a necessity. And I don’t mean sit on a machine to do knee extensions, calf raises or leg presses one leg at a time. When you use machines, there’s no real demand that requires the nervous system to learn how to stabilize your body. Single leg balance that progresses into single leg deadlifts, single leg squats, single leg hops, single leg box jumps, single leg calf raises, the options are many. The point is to emphasize standing on one leg while you move the rest of your body.

men-1245982_1280.jpg

Foot, Ankle Structure

An individual with a more flexible foot or ankle type that allows an inward collapse of the heel bone or inner foot arch could be placing more demand on their calf. These people are generically labeled as “flat-footed.” Though the more superficial calf muscles are mainly producing force for the forward/backward sagittal plane, there are additional forces that this outer calf and much deeper calf must withstand in the side-to-side or frontal plane. And then we must consider that the deeper calf muscles, like the posterior tibialis, that help to control the side-to-side ankle and foot motion, are also notorious for being part of the cause of pain.

What can you do?

Build the strength of the muscles that assist in stabilizing the ankle and foot that also come from the lower leg, like the peroneus longus, peroneus brevis, anterior tibialis, and posterior tibialis. One way of doing this is with resistance bands. This is also why I love single leg strengthening exercises like single leg Russian deadlifts that also require a person to balance and stabilize like a circus elephant on top a ball. As discussed below, you should perform routine soft-tissue maintenance on all of the calf muscles, superficial and deep.

Maintenance Habits

Here’s a big one. So you run for hours at a time or try to run really fast, essentially beating down the calf muscle fibers and their surrounding fascia and tendons, but then you don’t do anything good for those tissues? Resting is supposed to fix it all? It probably would if you weren’t trying to run most days of the week.

What can you do?

Buy and use a massage stick, foam roller, or lacrosse ball to routinely massage the muscles of the legs. Be sure to emphasize routine soft tissue maintenance for every major muscle group. The technique doesn’t matter as much as just doing something positive regularly for the muscles to keep them more supple and loose. Before the pain rules your life. Once the pain is consistently present, I can use techniques to get it to go away quickly and then you need to take over with a maintenance program.

Calf Muscle Length

In many instances, you can think of calf muscle length as an indicator of something besides true structural muscle fiber, fascia, or tendon length. The chronic abuse of running very often leads your nervous system into thinking a higher level of nerve-dependent activity is needed in the calf when it really isn’t. That keeps the fibers holding a greater tension at all times, which makes the calf muscle appear shorter than it really is structurally. So there’s a big difference between your nervous system telling a muscle to behave as if it is tight and a muscle that truly, structurally is short and tight. Weird, I know.

What can you do?

Calf stretching with the runner’s stretch or dropping your heel off a step is typically what runners choose to do if their calves feel tight. But if you want a change in actual muscle structure and length, be prepared for it to take multiple weeks of frequent and prolonged stretching. Like three 60-second stretches at least three days per week. A deep full squat will more likely max out the ankle joint motion and soleus muscle length while a straight leg heel drop on a step is meant to be a gastrocnemius stretch. But I would rather rely on the other soft tissue techniques mentioned above as maintenance, like self-massage, myofascial release, or dry needling to make the muscles relax, which automatically improves their length in many people. Remember, the goal probably doesn’t need to be improving the muscle fiber lengths, it’s convincing your nervous system to let the darn muscle relax.

5744485713_9f1573f0cd_b.jpg

Running Technique

Certain techniques tend to stress certain tissues more over time - that is neither bad nor good. If there were ever a predictable running method to stress the calf muscles, it would be a forefoot initial contact style, particularly if the runner doesn’t allow the heel to reach the ground after making contact. With about 2.5x to 3x your bodyweight coming through the limb while running, there are huge lengthening or eccentric forces coming through the calf tissue when the forefoot touches the ground before any other part of the foot. This could be the case with midfoot striking too. Depending on the runner’s individual style though, midfoot contact can decrease calf stress. Heel striking itself doesn’t necessarily tend to load the calf the same way a forefoot contact might, but rest assured those people have their own set of problems at the knees, thighs, and hips. Overstriding, which commonly accompanies heel striking, can be more stressful though.

What can you do?

By choosing to use a forefoot contact you should know the calf area is at risk for injury and perform your due diligence with the maintenance just mentioned to keep the calf muscles loose, relaxed, and happy! You may not immediately need to modify your technique to a heel or midfoot strike but could do so temporarily to maintain running fitness until the calf muscle status has been improved. Overstriding needs addressed in any instance. This is where we often need to address hip strength and control, hip flexor length, and other possible issues throughout the entire leg.

Paces, Distances, Training Program Design

What type of running have you been doing lately? Fast, slow, mixed speed, uphill, downhill, shorter distance, longer distance? Are these methods what you have always done or has your training changed recently to incorporate more speedwork, racing, or hills?

What can you do?

If you changed your distance, terrain, or speeds, and the changes contributed to the symptoms, temporarily remove or decrease those stressors for a week or two. Uphills and running faster are the most potent instigators of calf pain. Know the threshold of when the pain would begin while running and then try to stay just beneath that point for a couple weeks while the strengthening and other soft tissue treatment take hold. Be sure to have a full recovery day without sports or running that doesn’t stress the calf muscles.

my-red-shoe-1197221-639x424.jpg

Footwear

So you thought the zero drop or minimal shoes were great choice? Well, they are, but not if all this other stuff is off and you suddenly change the shoes too. They cause at least a 10% increase in calf load compared to a traditional shoe. Add that onto your already lackluster muscle tissue quality and we have a recipe for trouble. This is also an issue for runners when they switch suddenly from their base training shoes into their racing flats or spikes for competition.

What can you do?

Work your way into minimal or zero drop shoes gradually if you haven’t used them before. Two or three runs per week of 5-10 minutes is plenty in the first month. Run your warm up with them and then switch into your old training shoes. Gradually add faster workouts with spikes and flats into your training instead of just competing in those shoes. Spend more time barefoot at home and be sure to do the maintenance piece mentioned above to get the muscle tone to decrease. Here’s a nice article on transitioning to minimal footwear.


If you enjoyed this article, please take a moment to like us on Facebook and please share it with your running friends!

7 Takeaways from the Healthy Running WV Conference

healthy running.png

Recently, I had the opportunity to attend the Healthy Running WV Conference held in Ranson, WV on November 3rd and 4th. There were about 50 attendees from a variety of backgrounds: running coach, MD, PT, DPM, and general runners. I doubt many of them left without having their preconceptions of training, nutrition, or health challenged. And that’s because the two primary presenters, Drs. Mark Cucuzzella and Phil Maffetone, are well known for challenging the status quo. Although both have a long history in exercise performance, lately they are more interested in public health. And for good reason. I wanted to share just a little taste of the information presented.

  1. Attempting to peak for endurance events can be unnecessary, injury causing, and downright unhealthy. Dr. Maffetone suggested that we may really only need 2-4 weeks of speedwork in the final preparation for a competition, and we can perform quite well with no speedwork at all if the aerobic metabolism has been well trained over time. This is quite a bit shorter than the 6-8 weeks recommended by coaches like Arthur Lydiard.

  2. Runners unnecessarily run too fast most of the time. I tell runners this all the time (some believe me, some don’t), but let’s revisit it. Exercise does not have to be uncomfortable to result in health and fitness gains. Dr. Maffetone recounted working with multiple elite and Olympic level athletes that had measurably deficient levels of aerobic fitness who continued to make significant performance gains when he took away their anaerobic training and ultimately trained them at slower speeds.

  3. Food quality is more important to overall health than a specific caloric intake. For everyone, athlete or not, poor quality carbohydrates do an extremely bad job of creating satiety. So guess what? You eat more of them. I’ve hammered my fair share of Oreos and still didn’t feel satisfied. The carbs lead to a dramatic insulin response that can change in magnitude over time. High-quality proteins and fats do a great job of making us feel full sooner and longer after a meal without the dramatic insulin spike. Unprocessed vegetables can even provide a worthy source of carbohydrate. This is not new information to me or many others, but it’s worth repeating for those that are unaware of how prepackaged food, which emphasizes carbs, have made so many things easier to prepare but far less nutritionally valuable.

  4. There are performance and health benefits to emphasizing greater protein and fat macronutrient intake over carbohydrate. Commonly accepted information encourages 60-70% daily carbohydrate intake for endurance athletes. We could get away with 30-40% or even less. Routinely de-emphasizing carbohydrate reliance in training forces the body to rely more on stored fat, which is pretty awesome if you want to run in a marathon or ultramarathon. Then you won’t require as much additional fueling during these longer events, delaying or ultimately preventing the dreaded bonk. Dr. Cucuzzella, who recently maintains a low carb intake, but has run for decades, has the physiology lab data to prove his increase of peak fat burning efficiency from 1.18 grams/minute to 1.9 grams/minute in just a year. These same kinds of beneficial metabolic changes were suspected many years ago by Dr. Tim Noakes in his famous text “Lore of Running.” I’m anxious to see where the research is on this in another 5-10 years.

  5. Sprinting hard at the end of a long event, like a marathon, is more likely to trigger a cardiac event (heart attack) in someone predisposed to having such a cardiac issue. Don’t know if you are at risk? Talk to your physician about finding out your coronary artery calcium score.

  6. A simple glucometer can be an excellent, affordable self-monitoring tool for detecting carbohydrate intolerance and the early onset of insulin resistance that leads to type 2 diabetes. Cucuzzella and Maffetone suggest that people don’t just wake up one day with type 2 diabetes. The changes occur over time because of poor nutritional quality. By the way, a few years back we called type 2 diabetes “adult onset” to differentiate it from the type 1 diabetes that people can have at birth. Unfortunately, that has become a misnomer because young children have begun to acquire type 2 diabetes as the American diet has emphasized low-quality processed carbohydrates since the 1980s.

  7. Insulin resistance is a common factor to a variety of diseases. There is growing evidence that issues such as cardiovascular disease follow long term metabolic changes associated with a high carbohydrate diet. Older research focused on cholesterol but the tide is shifting.

If you are interested in attending a future Healthy Running Conference, check out www.healthyrunning.org for more information. 

You can read more about each of this particular conference's primary presenters at the following sites:

  • Mark: https://www.drmarksdesk.com
  • Phil: https://www.philmaffetone.com

How to keep muscle cramps from ruining your workouts and competitions

A CASE STUDY

The scene: It’s a hot, 75 degree Saturday in June, humidity 85%, birds singing. Maybe the most hot and humid day so far this month.

The athlete: Is 6 miles into what is expected to be a 15-mile long run. Last night they enjoyed a couple beers with dinner after completing a 4-mile easy run. Work was pretty hectic, so they drank coffee all day to keep focused. They didn’t consume much water or other fluids.

The cramp: Comes quickly into one calf during the long run, rendering the leg nearly useless and painful, despite the individual believing they weren’t putting out much effort. This has happened before. The runner stretches the muscle for 10 seconds, decreasing the pain and begins to run again. Four minutes later it happens again so they repeat the process until 8 miles, when they finally quit the run out of frustration.

Talk about a wasted training day. Did this runner do something wrong in their preparation for this run? Yes. No. Maybe. Perhaps I’m trying to trick you a little because the truth is we don’t have enough information about the entire situation. What is their maintenance routine like outside of running? Do they strength train? Have they eaten during the initial part of the run?

SO MUCH TO THINK ABOUT

You should see that there are a variety of factors to consider regarding the onset of muscle cramps. Here are some you’ve heard of and maybe some you haven’t:

  • Prior training experience regarding intensities and durations
  • History of muscle cramping
  • Current hydration status, particularly related to level of sweat loss
  • Electrolyte levels of magnesium, calcium, sodium, and potassium in the blood and muscles
  • Muscle tone, which is controlled by the nervous system and reinforced by day-to-day use patterns (and also changed with routine soft-tissue maintenance)
  • Central nervous system status, as in higher anxiety and stress levels
  • Peripheral nervous system status
  • Stimulant intake, such as caffeine, which impacts nervous system function
  • Recent physical activity and fatigue levels
  • Environmental conditions regarding temperature, humidity, and terrain
  • Muscular demands at that moment, as in the force of muscle contraction required
  • Direct muscle trauma

There is likely an interplay of these factors and you therefore need to consider them all in muscle cramp prevention. How are you going to do that? Partly with good regular maintenance and training habits. Partly with a little trial-and-error testing.

Muscle cramps have been a thorn in the side of many athletes for decades, and what fixes them in one athlete may not work for another. Some athletes just seem more prone to cramping while others have minimal issues. I would be surprised if the crowd that is prone to cramping didn’t have at least one or two of these areas to address though.

Available research indicates three main theories exist in the cause of exercise-induced muscle cramping:

  1. “Skeletal muscle overload and fatigue from overuse or insufficient conditioning can prompt muscle cramping locally in the overworked muscle fibers.” (Bergeron, 2008)
  2. “Extensive sweating and a consequent significant whole-body exchangeable sodium deficit can lead to more widespread muscle cramping, even when there is minimal or no muscle overload and fatigue.” (Bergeron, 2008)
  3. “Either neural activity in the spinal cord or in the peripheral could be the cause of the cramps.” (Nakagawa, 2013)

WHAT WE'VE GOT HERE IS A FAILURE TO COMMUNICATE

Lately, the neurological cause has been winning research arguments, so it would make sense to try the solutions that have the most bearing in that area. I frequently tell athletes that the muscles only know what they are told by the nervous system. Without a motor nerve supply, muscles are useless masses of floppy meat. Which means that if the communication between the motor nerves and the muscles goes wrong, you will have a failure of the muscle’s normal function.

This nerve-muscle communication is as much about sending signals to a muscle as much as it is about stopping those signals. It is possible that, with repetitive use and fatigue, the signal from the motor nerve to the muscle isn’t stopped as efficiently as it should be and then the muscle insists on maintaining a contracted state, otherwise known as a cramp.

If cramps occur intermittently for you during exercise, the most likely scenario is one or a combination of these factors:

  1. Poor self-maintenance habits of the muscles
  2. Poor nutritional choices
  3. Subpar preparation of the muscles and nervous system for the task at hand
  4. Neglecting to account for environmental demands

YOUR HOMEWORK

Prevent the cramp with proper preparation and regular maintenance:

  • First and foremost, if you always cramp in the same muscles, I would not be surprised to find that the resting tension in that muscle was elevated compared to muscles where you don’t ever cramp. Cramping muscles are likely to be more tender to firm pressure. Plus, you may be able to tell that those muscles are physically more taut than your other muscles. Your focus needs to be on getting that resting activity to decrease at all times. For that, you are going to routinely and specifically massage that muscle 1-2 minutes every other day with a massage stick, lacrosse ball, or your hands. It should be uncomfortable to work on the irritable tissue. And it’s going to take a month or two of consistent work to keep that muscle more relaxed. If you want it quicker, then my suggestion is to have dry needling to “reset” the nerve-muscle communication.
  • Strength train the muscles that routinely cramp to increase their fatigue resistance while simultaneously strengthening any other muscles that can assist with the same motion. For example, the calf muscles are effective pushing muscles so be sure to address any strength loss in the other rearward pushing muscles like the gluteus maximus and hamstrings.
  • Consider the psychological aspect. Cramping has a lot to do with nervous system function. You aren’t going to make the situation any better by increasing anxiety and stress levels. Athletes that struggle with this need to practice techniques that can lower their stress through deep breathing, meditation, yoga, or sports psychology. It’s no surprise that you could train for weeks without cramps but on race day the anxiety increases at your main event, contributing to the mystery cramps.
  • Expose yourself consistently to any triggering environmental stimuli, like higher heat and increased humidity.
  • If you are expecting to be in a competition that requires minimal or significant terrain changes then try to duplicate those changes or lack of changes in your training.
  • Progress gradually and consistently in durations and intensities of prolonged exercise.
  • It’s easy to suggest staying hydrated. Typical advice. Just keep your urine on the clearer side consistently. Not just the day of or day before longer exercise bouts. Don’t overhydrate because that can carry health consequences as well.
  • Consistently eat a well-rounded diet. If you start restricting specific foods that carry important nutrients, then you need to ensure you are obtaining a suitable replacement. For instance, by restricting meat you may cut out a large magnesium source. Do your research on what micronutrient requirements frequent exercisers have and adjust accordingly.

Prevent the cramp during activity:

  • Vary the range of motion and demand on the muscle as much as you can before you have any sense of cramping. For instance, to change the motion and demands of the calf while running switch from your usual forefoot strike to a heel strike for 20-30 seconds every 1-2 miles. Research indicates that the muscle fibers must achieve a shortened state in order to cramp (Bertolasi, 1993). For instance, if you are constantly running on your forefoot, the calf muscle fibers don’t get a chance to elongate, keeping them in a shorter, and riskier, position at all times.
  • Eat something containing carbohydrates during the exercise. It stands to reason that if muscle fatigue is delayed by eating to supplement energy stores, then you may not cramp as soon or maybe even at all if a few calories are always coming in (Jung, 2005). Nerves must have a supply of energy to function, too. They like glucose. It never ceases to amaze me how many people think they can go harder and faster in an event than they do in training with fewer or worse yet, no calories. Multiple systems change function without normal blood sugar levels.
  • Stick to a reasonable plan. Just because you feel good physically and mentally from resting a couple extra days prior to competition doesn’t mean you should suddenly decide to pursue higher intensities than you have trained for. Even if you don’t cramp, you will probably bonk in a long event, or blow up in a short event.

If the cramp happens:

  • Attempt to stretch the muscle. Do not stretch it rapidly and do not stretch it as hard as you can. A gentle but prolonged stretch is the best option at this point. Hold the stretch for at least 30 seconds. Now is not the time to bounce to the end point of the stretch because you have special structures in place to cause muscle contraction when that bounce hits its end point.
  • Massage the muscle with firm pressure. Even a single, prolonged pressure of 30-60 seconds to the muscle may break its cycle of cramping.   
  • Eat. Didn’t I just go over this?
  • Try my personal favorite solution, dill pickle juice, as the muscle threatens to cramp. It’s not the salt that is effective but the noxious stimuli from the vinegar. A new sports drink named Hot Shot relies on a similar mechanism but it has more of a spicy flavor. Either way, the potent oral stimulation effects nervous system input.
  • Try a couple electrolyte tablets or maybe a sports drink containing electrolytes. This isn’t supported by research, but a placebo effect is still a possible effect. But will you still have the placebo effect now that I’ve told you it shouldn’t work? Please let me know how that goes. I personally stopped using them.
  • Overall, you must adjust according to the variety of factors at hand. If you know you are under-hydrated, aren’t eating enough, haven’t maintained your frequently cramping muscles, undertrained, stressed out, and it’s really humid outside, then your best option is to slow down a little, learn a lesson, and work on the flaws before your next event.

There are instances where cramping with great frequency can be a sign of diseases and serious neurological issues so do not hesitate to contact a medical professional if muscle cramping is occurring outside the realm of exercise. Even a history of sciatic nerve problems can predispose a person to cramping during exercise.

Take care of the muscles and the nervous system with planning and preparation and they will take care of you.

Please let me know if you have any questions at derek@mountainridgept.com. And definitely let me know if you find some of these ideas helpful in muscle cramp management by liking the Mountain Ridge Physical Therapy Facebook page. Or buy me some dill pickles. 

For those who would like to geek out on some related material:

  1. http://journals.lww.com/acsm-csmr/Abstract/2008/07001/Muscle_Cramps_during_Exercise_Is_It_Fatigue_or.9.aspx
  2. http://link.springer.com/article/10.2165/00007256-199621060-00003#page-1
  3. https://www.researchgate.net/publication/299960193_Neural_Mechanisms_of_Muscle_Cramp
  4. http://home.trainingpeaks.com/blog/article/controlling-neuromuscular-performance-to-prevent-muscle-cramps?utm_source=tpr&utm_medium=email&utm_campaign=07-16-anl

Three common overuse injury mistakes you are making and how to avoid them

Using the “wait and see” method:

There are two ways to go wrong with the “wait and see” method. In the first, an athlete, believing “rest” is the critical factor in injury recovery, takes a large amount of time off after the initial onset of pain. When they do finally return to activity, having had no pain for a day or two, they often start out with way too much intensity or time. If you haven’t run in 2 weeks, then the first run back should not be a 5-mile excursion. In fact, it should be quite brief. And of course, instead of running an easy 10-minute mile pace, your legs are fresh, so 7- or 8-minute miles seem suddenly more comfortable than ever.

Few people ever follow this advice because there is a misconception that rest fixes all. (Same assumption goes for surgery fixing everything, but that’s another story.) And then the athlete can’t figure out why the injury came back a couple weeks later. Of course that recurrence is followed by yet another solid block of rest and the cycle of inconsistency continues. The body WANTS to heal. I find that to be pretty amazing. The key is providing consistent exercise loading to not only maintain fitness but to improve tissue integrity.

Don’t get me wrong. Rest is extremely important in recovery from training and from injury. But it should all be administered in appropriate doses. If you know, deep down, that rest is powerful then you should be doing a better job of resting prior to any symptom onset, not waiting until something hurts. Rest should never be considered as the primary method to address injury.

In the second scenario, the athlete ignores their initial injury symptoms and continues to exercise, waiting for the injury to spontaneously resolve. This can stack too much stress onto an already injured area. It’s often easy to do with running, because so many muscle and tendon injuries actually feel better once the tissues have warmed up a bit. That’s why overuse injuries are so deceiving. If the pain is gone while exercising, you must be doing okay, right? Well, no, it’s not that easy.

If we were to classify the onset of pain from overuse injury, there’s typically a progression:

  1. Pain only after exercise.
  2. Pain during exercise, though not at a high enough level to stop.
  3. Pain during exercise that does limit time or performance.
  4. Pain so severe you absolutely cannot exercise.

Athletes often become stuck at the second phase. Sometimes for months at a time. When they approach the third phase, they suddenly become desperate and finally begin addressing the things they knew were problems in the first place. Don’t be “that guy.”

Consider yourself only as good as your last successful, pain free run. Best not to worry about progressing when injured if you want a long career. Best to worry about preventing regression and working on your known problem areas, like hip strength or ankle range of motion. If you don’t know where your problem areas are, seek guidance from a movement expert.

Relying on pills and injections:

Everybody loves a “quick fix.” Some like it because it requires no real effort or time to take a pill. Others like it because it might reliably take pain away and they are unaware of any other treatment option. For some people, they feel they don’t have time for proper injury treatment. In any case, once the pain decreases you expect to go on about your training as soon as possible without any other care.

But think about this for a moment. If a mechanical stress led to your painful tissue damage, then there’s good reason to focus on a mechanical solution when there is one available. Medicines aren’t typically designed to alter mechanical stress. Let’s say the medication did stop the pain. Just because the pain stopped doesn’t mean the underlying problem went away.

Unfortunately, rarely is the proper solution a quick one. Pills and injections are not a reasonable long-term solution. Just like appropriate doses of rest, NSAIDs and corticosteroid injections certainly have a place in treatment. But they are not a valid long-term option for relief of overuse damage.  

Blaming the shoes:

I am guessing the shoe industry is at fault for this perception. It’s not about the shoes. Overuse injuries are likely to be caused by a variety of factors but most frequently by training errors. This means your intensity was too high, distance too long, or the rest was insufficient. (This is the third time I have mentioned rest!)

Even the biomechanical flaws that I might address in the clinic take a back seat to poor program design. We are highly adaptable. Each running technique is known to stress specific tissues.

What might be considered horrible running technique can be safely performed if you progressed slowly enough and were strong in all the right muscles, tendons, and ligaments.

Summary:

Like the cause of the injury, resolution should be a multifactorial approach. The trick is going to be exercising within the tolerances that the injured area allows while also working on any related deficits. Back the distance and pace down.

It’s unreasonable to believe that you don’t have mechanical deficits somewhere that contribute to the injury. Training errors in speed and time just make those flaws more prominent. You must look outside the area of injury. The body relies on an integration of systems for movement so if just one system fails at its job then you have a problem. And that problem probably isn’t where your pain is occurring. Is your balance perfect? Movement awareness stellar? Posture perfect? Strength out of this world? Have the joint motion of a 10 year old? Unlikely. Bring home those new shoes and get to work on the right things.

 

Strength Training for Runners, Part 5: Exercises

To finish up this series of posts on strength training, let’s cover a few examples of exercises that you can incorporate into your routine. Most of the videos focus on the lower body and trunk, though you should certainly work the upper body. With several of the lower body exercises, you can integrate in an upper body component to add an additional challenge. The Mountain Ridge Physical Therapy YouTube page contains several variations of these exercises, from basic to advanced versions. 

Quadriceps

Lunges, Bulgarian split squats, Squats, Step ups, Step downs, Plyometrics

Hamstrings

Squats, Hamstring curl with swiss ball, Hamstrings heel slide, Deadlift, Single leg deadlift, Plyometrics

Lateral gluteals

Side lying leg lift, Single leg pelvic drops, Airplane, Clamshell

Gluteus maximus

Lunges, Squats, Step ups, Single leg bridges, Double leg bridges, Glute thrusts, Plyometrics

Gastrocnemius/soleus

Calf raises, Plyometrics

Hip rotators

Single leg hip rotation

Abdominals

Front plank, Side plank, Anti-rotation walkout

Low and mid back extensors

Prone trunk extensions (Superman), Thoracic rotations, Front planks, Side planks

 

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying the information to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

 

Strength Training for Runners, Part 3: How?

So hopefully I’m persuading a few runners to try adding strength training to their regimen. Let’s go over some general strength training tips and the primary objectives to consider for the various muscle groups.

Strength training tips and objectives

1. Your primary goal is to place a stress on the body that it isn’t accustomed to and that, in some ways, exceeds the stress that running places on the body. This demand is what leads to positive adaptations.

  • Efficient running is stressful for the muscles, tendons, bones, joints, and other tissues in the body.
  • Inefficient running is even more stressful on many of these structures, which means you want to either get rid of the inefficiency (ideal) or make your body more tolerant of it (not ideal).

2. The progression should go as follows: mobility → skill → stability → endurance → strength → power

  • This means you need to master the basic movement pattern with a full range of motion far before you attempt to move heavy amounts of weight or move explosively.
  • Running requires tons of repetitions of a powerful movement yet many people don’t have the basic mobility and strength down to safely use that power.

3. Circuit train, especially if you aren’t accustomed to strength training yet.

  • Runners love to stay moving, so your earliest forays into strengthening can emphasize circuit training of the entire body. Circuit training allows you to move right from one exercise into another, bringing the heart rate up and providing a similar feel to the constant work of running that we crave.
  • Circuit training is more reasonable from a time-management perspective.
  • If you are new to strength work, alternate upper body, lower body, and core exercises to let each muscle region recover effectively in between exercises.
  • More experienced athletes can stack a single set of two or three similar exercises together to increase the muscle demand. For example, lunges followed by single leg squats and then on to step-ups.
  • You can add plyometric and agility drills throughout the strength session to keep the heart rate up and integrate running with speed, which is discussed next.

4. Integrate strengthening into your run workouts to improve your awareness of how to use those muscles while running.

  • Going back to circuit training, here’s one of my favorite winter activities when the weather is horrible and I must run inside:
    • Treadmill run 5 minutes
    • Hip strengthening and stability 1-2 minutes
    • Core strengthening and stability 1-2 minutes
    • Leg strengthening 1-2 minutes
    • Wash, rinse, and repeat for 45 to 90 minutes total
  • Perform a couple of bodyweight resisted exercises like leg raises or planks during your warm up to emphasize core and hip stability, strengthening, posture correction, and muscle awareness.

5. The abdominals (and actually some hip muscles) are primarily stabilizers when you run so learn to use them in that way.

  • Instead of crunches or sit-ups, use variations of planks and bridges.
  • Emphasize single leg activities with the pelvis held in a level position. I reviewed the pelvic position last week with the Trendelenburg's sign.

6. Work one side of the body at a time.

  • Symmetry in muscle strength is a key point. Working both sides of the body at the same time is less challenging and less productive because you will inevitably use a more dominant side without even realizing it.

7. Work multiple muscle groups simultaneously by emphasizing “closed chain” movements.

  • Closed chain implies the end of the leg or arm will be in contact with the ground or fixed object. Examples include squats, lunges, push-ups, step-ups, power cleans, planks, pull-ups, and most plyometrics like jumping and hopping.
  • Closed chain movements mimic running and normal daily activity. Open chain exercises, like leg extensions, do not often duplicate our day-to-day movement.

8. Think about performing exercises by the plane of movement that you move each joint through and then do a little work for each plane.

  • Squats and lunges emphasize a forward/backward plane at the knees and hips.
  • Single leg hip rotations emphasize a horizontal plane at the hips.
  • Pelvic drops emphasize a side-to-side plane at the hips and trunk.

9. When an exercise has become too easy, add an element to decrease stability and see if that doesn’t increase the difficulty.

  • For example, a standard front plank is easily advanced by lifting one leg, one arm, or both at the same time. The idea is to increase the wobble factor.
  • Some equipment options to increase instability include swiss balls, BOSU balls, and wobble boards.
  • Many standing exercises can be performed on a single leg to challenge the stability but you need to be proficient with their double-legged versions first.

10. Avoid using machines, emphasize free weights.

  • The limited range of motion keeps you from working in the positions that you actually need to gain usable strength.
  • Machines do not challenge the stabilizing muscles and nervous system components that can be beneficial for injury prevention and optimal performance.
  • Free weights are more likely to mimic the tasks that we perform in daily life because we commonly lift and move heavy objects.

11. Reduce strength training loads primarily in the week before your “A” races but not before “B” or “C” races.

  • Strengthening is part of the constant stimulus that you are trying to adapt to, so you don’t want to recover excessively before your low priority events. Train on through.
  • While training just before a low priority event you can decrease the number of repetitions in a set by 3-5 but keep the weight the same.
  • Before an “A” race, decrease both the sets, resistance, and repetitions if you have been working with resistances that cause failure at higher repetitions (i.e., do only 1-2 sets of 15-30 repetitions instead of 2-3 sets of 15-40 repetitions). If you have been gearing up with really high loads and performing more powerful, explosive moves, then back the sets down and the resistance only slightly (ie. do 2-5 sets of 3-8 repetitions instead of 5-6 sets of 3-8 repetitions).

12. Once your priority event has passed, back off of the rapid power and agility movements and encourage basic strength and strength endurance again for 2-4 weeks.

13. Perform strength training on shorter or less intense running days, especially if you have never strength trained before.

  • We don’t need too much of a good thing. Too much exercise stimuli in a day or series of days is a recipe for injury.
  • I often still use running as a brief warm-up before strengthening and, as mentioned, incorporate running drills throughout the strength workout.
  • Strength days are a great time to do other cross training on a bike, elliptical, rower, rock wall, or anything that allows you to experiment and break up the monotony of running.

14. A general initial strengthening structure could consider spending:

  • 50% of the time on the large primary movement muscle groups that undergo heavy use in running to improve overall movement strength and strength endurance.
    • These muscles, like the quadriceps, gluteus maximus, and hamstrings, can be pushed harder with higher resistances.
  • 25% of your time focusing on the muscle groups that are not dominant and become neglected in the running motion to prevent injury.
    • These muscles, like the deep gluteals, usually require very little resistance because they are not large or power producing.
  • 25% of the time integrating plyometric drills to increase power output, speed, and agility.

15. Allow at least 6-8 weeks of working at least 1x/week for noticeable performance changes.

In next week's blog I'll go over more application specifics and exercises. 

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying them to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

Strength Training for Runners, Part 2: Why?

Why strength and plyometric train?

Why not strength and plyometric train? That’s a better question. My personal excuse is that it’s not as fun as running, partly because it’s not done outside and nowhere near the woods. I’d rather move me, not a dumbbell. Although I’m sure some would say by moving myself I am indeed moving a dumbbell. *Sigh*

For myself and many other runners, strengthening is a necessity if you want to run long, hard, or into old age. I will gladly give up 3-6 junk miles every week to take the time for this type of cross training. Strength training gets me to a point that makes the other runs more enjoyable. How does it improve my running enjoyment? Largely because I stay less injured overall, my back doesn’t hurt during long runs anymore, I recover quicker, and my legs never get that completely destroyed feeling in long races that they once did.

I would argue that running itself is a series of plyometrics. (The Merriam-Webster definition of a plyometric activity is “exercise involving repeated rapid stretching and contracting of muscles”). Plyometrics are just high speed strengthening.

Here are a few reasons runners should consider strength training:

1. Strength training improves performance. Every runner can benefit from strength training. Competitive trail runners, marathoners, and speed demons who compete at any distance could reap very significant gains. At the same time, the less competitive folks running just for fun could benefit too.

The mechanisms of improved performance can be attributed to any one or a combination of the following factors:

  • Increased hip and core stability
  • Increased force production of the muscle fibers (aka strength)
  • Increased fatigue resistance of the larger leg muscle groups (aka endurance)
  • Increased endurance of the core, hip, and leg muscle groups while producing greater force (aka strength endurance)

Increased hip and core stability

Having a strong core and hips takes unnecessary trunk motions out of the equation. You can then move the arms and legs more quickly and with greater force without disrupting the stable base. I noticed this in the 2016 women’s 10,000 meter U.S. Olympic trials. Molly Huddle maintains a very stable trunk posture. As a result, there is less energy wasted during the early and middle part of the run and that energy can be put to use in the closing laps. And at that point many of the competitors are flailing anyway.

 

Increased force production

As far as the prime movers of the legs go, if you want to move faster while running, your options are to:

  • increase turnover while maintaining the same muscle force output,
  • increase force from the muscles while maintaining the same turnover, or
  • increase both muscle force and rate of turnover.

Strength (and plyometric) training is a great way to teach your larger leg muscles to generate that force in an efficient manner. Many of the changes that we would refer to as increased strength are actually the result of the nervous system’s ability to refine how the muscle fibers fire. It’s definitely not all about making the muscles bigger. By increasing the ease and efficiency of force production, you can become faster.

Increased fatigue resistance of the larger leg muscle groups and increased endurance of the core, hip, and leg muscle groups while producing greater force

Greater total muscle strength can lead to greater strength endurance capacity. Strength endurance is concerned with the ability to generate a certain force for a prolonged period. In other words, after strength training for a few weeks I can make a muscle produce the same or greater force for a longer period of time before it begins to fail. This is a huge benefit if you have reached the limits of what your fast-twitch muscle fibers are willing to perform with standard running interval training techniques.

Racing and hard efforts can rely heavily on the fast-twitch muscle fibers, and slow endurance training does very little to train these muscle fibers because slow training is primarily using slow-twitch muscle fibers. You can only perform so much high intensity interval work while running so strength training is another way to stimulate these muscle fibers. By regularly training the fast-twitch muscle fibers, you can improve movement economy and improve fatigue tolerance. Better fast-twitch muscle fiber use will help you when bridging a gap in a race, moving at faster speeds, and climbing hills.

2. Strength training can help you prevent injury. There is research citing decreased injury incidence in athletes with consistent strength training routines (http://bjsm.bmj.com/content/early/2013/10/07/bjsports-2013-092538.abstract). Stretching, on the other hand, has no consistent research support in injury prevention. For one, as mentioned, proper strength training helps to increase hip and core stability so that the legs and arms are moving on a stable base. My theory would be that it’s mostly the strength, stability, and muscular endurance of the hips and core that help to keep a runner away from injury though it's certainly important to train the rest of the leg as well. This is where many runners have the wrong idea of what strengthening should really be about. The primary objective is to take the unnecessary motion out of the system in order to reduce the injury causing “slop.”

3. Strength training can help you recover from injury. Often, strengthening of specific muscles is a vital component of any patient’s injury recovery in my clinic. In the case of both injured and uninjured tissues, the intention is to rely on these primary concepts:

  • Improved structural integrity of muscle, tendon, ligament, and bone, and
  • Improved strength and neurological activity in weak muscles

4. Strength training changes your perspective on higher training intensities. If you can perform enough repetitions with a high resistance that you reach a point of true muscle failure, you begin to understand what it’s like to really push that extra bit of effort from yourself. That can make a finish line sprint or track workout feel a little easier, for the muscles at least.

5. Strength training helps decrease age-related strength loss. Aging causes a loss of the fast-twitch types of muscles fibers and their associated nerves. Frequently demanding work from those muscle fibers slows the rate of loss. Nobody wants to lose the strength necessary to do daily tasks but I assure you that it will happen if you let it. I didn’t think about this until I started approaching 40 years of age (and the girls stopped whistling at me.)

6. Increasing strength makes you a generally healthier individual and a well-rounded athlete. There’s nothing better than being able to confidently lift a 50-pound bag of potting soil from the ground without fear of hurting your back. And being able to randomly and confidently play a pickup game of {insert any sport here} is pretty awesome too.

7. Variety and changes in your training program prevent burnout and staleness. The same old, same old becomes dull and demotivating for most people. There is so much variety possible with strength and plyometric training that it can really freshen up your outlook.

8. Strength training can boost you through a performance plateau. The repetition associated with some endurance training programs will inevitably lead to a plateau in many athletes. In order to bust through the plateau you need a new type of training stimulus. Resistance training can be that stimulus if delivered correctly over a 4-8 week period of time, especially if you add the plyometrics and change up your running interval program.

Please let me know if you have any questions by emailing me at derek@mountainridgept.com.

 

Strength Training for Runners, Part 1: Myths

Middle and long distance runners have a long history of neglecting proper strength training, partly because they don’t enjoy it as much as running and partly because of the myths surrounding the concept. Those myths need to be broken.

Myth #1: Strength training will make my muscles bigger and then I'll be heavier.

You will not automatically gain weight and become huge because you start strength training. In the strength training world this increase of muscle size is referred to as “hypertrophy.” Many runners don’t want to gain size because that’s extra weight to carry in every step. The reality is your body will best adapt to the stresses you place on it most often. If you run once per week but lift weights on 3-4 days then yes, you might bulk up. But if you run 3-4 days each week and strength train during just one day then you aren’t going to add muscle mass. Age, sex, and genetics each play a role in gaining muscle size as well. And the type of strengthening stimulus matters. Larger muscle size tends to come from an emphasis on multiple sets of an exercise using a weight that is 50-75% of your one repetition maximum.


Myth #2: Strength training requires weight equipment.

Fortunately, resistance training does not always require equipment. It is possible to use your bodyweight to provide a decent stimulus for many of your muscle groups. For instance, it is critical to emphasize hip strength and core stability in any runner’s program. This type of strengthening requires nothing more than challenging positions that start with a basic plank. Advancements of difficulty can be made by isolating the muscles you are trying to work, working only one side of the body at a time, or adding stability challenges (i.e. balance).


Myth #3: Strength training requires special machines.

It definitely does not require special machines. In fact, I am a huge proponent of avoiding machines altogether. Machines are inferior to free weights in so many ways. They do not challenge the parts of your nervous system that monitor your body’s stability and positional awareness. Machines also restrict your range of movements. Freeweights can moved through any available range. And for those that like to workout at home, free weights can be cheaper and take up less space than machines.


Myth #4: Strength training means I have to workout inside a gym.

Strength work doesn’t always have to involve an indoor gym. For running, steep hill repeats with an intentionally slow, bounding cadence can engage a large number of fast-twitch muscle fibers in the hips and legs. It’s those fast-twitch muscle fibers that can improve your sprint speed, surge speed, and overall pace in races like a 5K. The scenario is the same with plyometric training as you don’t need equipment or a special location to bust out a few quick jumps or hops.


Myth #5: Strength training will slow me down.

If done correctly, strength work will not slow you down and actually has the potential to make you faster. In one recent study, even when very heavy amounts of weight were used (3-4 sets of 4-10 repetitions to failure), female runners maintained their race speeds after 11 weeks of training. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783109/) In application, I would never expect a competitive or recreational runner to train with that heavy of a resistance for such a tremendous amount of time. However, it is good to know that even after several weeks of heavy weight training these women sustained their speed. I would expect runners of any ability level to spend their time performing supplemental work to gain hip and core stability and fatigue resistance of their primary movers (hamstrings, quadriceps, calf group).


Myth #6: I won’t gain anything from strength training only one or two days a week.

As little as one day per week is sufficient to have a positive impact on strength and strength endurance. Some athletes think that strength training has to occur at a high frequency to result in a change. That’s simply not true. Working hard on your weakest areas just one to two days each week can have a tremendous impact. If those muscles were minimally challenged beforehand, then any stimulus greater than their normal level of activity is going to cause a positive change. Even if you prevented just one injury, it would be worth the extra effort of as little as 30 minutes each week. 


Next week I’ll dive into the benefits of adding strength training to your running program. In the meantime, if you have any questions, email me at derek@mountainridgept.com.

Knee pain at the iliotibial band: What can you do about it?

Description: Iliotibial band syndrome, or ITBS, is one of the more common injuries affecting runners. And why is that? Probably because the same faulty motor patterns and muscle weaknesses tend to run rampant amongst many runners. ITBS tends to come on gradually, causing a lateral knee pain, though some runners are able to bring on the pain in a single run of greater distance or intensity than their typical. It is often another story of too much, too fast.

Anatomy: The muscles that attach to the ITB are from the hip and thigh region: gluteus maximus, vastus lateralis and tensor fascia latae. The far end of the ITB splits into several sections, which indicates it has a role in the function of many areas. Most commonly athletes will complain of pain where the ITB interacts closely with the lateral femoral condyle.

Cause: The primary function of the ITB is to stabilize the knee during walking and running gait. When some of the hip muscles are weak, the ITB can be relied upon too heavily for knee stability, thus stressing its lower attachment excessively.

Signs and symptoms: The far end of the ITB can flare up like a tendonitis does when initially becoming inflamed. There can be inflammation at the bursa that sits beneath the ITB as well. As a result, you might notice swelling and tenderness to touch at the outer knee where the ITB crosses. There can be a snapping or popping sensation at the lateral knee. The pain tends to take on a sharp and stabbing quality when there is demand placed on the leg but the general area may be achy after use. 

A common finding in many instances of ITB syndrome is hip muscle weakness, particularly of the gluteus medius and gluteus maximus muscles. There may be a decreased ability of the nervous system to activate and control those hip muscles while running, even if they are strong in testing.

This demonstrates poor engagement of the right hip abductors

This demonstrates poor engagement of the right hip abductors

An indicator of poor gluteus medius activation is an excessive dropping of the opposite side of the pelvis when the affected leg is in stance. One way you can check this is to stand in front of a mirror, hands on your hips, and then shifting yourself onto one leg. For instance, if you move onto the left leg and the right side of the pelvis clearly drops then you have a positive Trendelenburg's sign. Check both sides as it is common to have an asymmetry. In the video below I demonstrate both the active position and inactive position. The same excess of pelvic motion can occur in walking and running. 

Solutions: As with many of these injuries, there is no magic pill and no quick fix. Consistent but brief supplemental work is the reliable solution.

1. Some physicians may promote injecting the bursa region that lies between the femur and the end of the ITB. Corticosteroid injection should be a last resort as recurrence is very likely if the mechanical control of the hip and knee are not addressed. I have had patients where injection was used as a first line treatment. Guess what? The pain came back. At least this is a lower risk area to inject with corticosteroid as the risk of ITB rupture is minimal compared to an area like the Achilles tendon or posterior tibialis tendon. The side of the quadriceps is probably more likely to rupture. Remember, injections do not address the mechanical reasons the injury occurred in the first place.

2. The very first and simplest issue to address is the presence of any weak muscles at the lateral side and back of the hip. These muscles need to be activated easily and consistently by the nervous system. So many people have weak muscles around their hips, trunk, and pelvis so don't assume you are an exception. It is a daily occurrence for me to see these issues in the clinic. 

Athletes need a baseline level of strength and the ability to effectively recruit these muscles while running to prevent the pelvis and hips from destabilizing. Poor strength or activation may allow the thigh to collapse inward or rotate inward along with an unleveling of the pelvis. It’s also important to consider the endurance of these muscles because the strength will undoubtedly be decreased a few miles into a run or fatiguing workout.

As a side note, I have seen so many patients that were correctly told to perform exercises like a side lying straight leg raise only to discover they are doing it in a manner that works the wrong muscles because no one checked their technique. Their form was incorrect and doing these exercises incorrectly can actually contribute to the problem. Not only are the wrong muscles used (eg. tensor fascia latae), they are creating a dominance in areas that further inhibit the function of the correct muscles (eg. gluteus maximus).

Here's the routine that I do on a weekly basis. 

3. As the awareness, endurance, and strength are all starting to increase, it is necessary to challenge the nervous system’s ability to stabilize the hips and pelvis. Single leg balancing activities are a great program component to do this. The individual must recognize where the pelvis achieves a stable position in order for this to be effective. This can progress to single leg hopping and jumping activities while keeping the pelvis stable.

4. There has been some controversy over whether athletes should foam roll their ITB, which I discussed previously here. Don’t bother trying to stretch your ITB unless you like to waste time and potentially worsen the problem. Most ITB stretches simply stretch the hip muscles that are already weak, which is absolutely counterproductive. And the ITB’s connective tissue is extraordinarily strong so you aren’t going to stretch it.

image courtesy 220triathlon.com

image courtesy 220triathlon.com

5. Running technique changes can be effective to normalize demands on the hip muscles and move in a less painful range of motion. The knee needs to maintain a high level of bend during swing. If you have a tendency to overstride far forward of the body’s center of mass then you will place greater demand on the gluteus medius muscle as soon as the foot makes contact, setting yourself up for failure. You may only need to increase your cadence 4-6 steps per minute and think of nothing else. There’s more information on cadence changes in my shin splint article here. The relationship of the ITB to the femur bone beneath it also changes as the knee is bent and straightened so changing the technique can change that relationship. In some runners there can be a benefit to running quickly for 20-30 seconds and then walking to vary the mechanical position of the ITB to the femur.

Poor right hip abductor engagement

Poor right hip abductor engagement

6. If you have been unable to exercise secondary to ITB pain, make sure you take full recovery days between the days that you do start to exercise. These off days are great to emphasize the strengthening, balance, maintenance, and so on. For running that first time back, short and consistent is the name of the game. Better to run one mile each on three or four days than three to four miles at once. Depending on the number of days you have taken off, a mile isn’t an unreasonable distance to start at and that may also require a walk/run program. 

Please let me know if you have any questions at derek@mountainridgept.com. 

Training errors in the athlete, part 2

Poor hydration habits before, during, and after exercise. Our bodies are around 55-65% water. Humans can live for weeks without food but only days without water. We depend on good hydration for basic function of our systems. For athletic performance, the demand is even greater because athletes need to maintain a greater blood volume, sweat for temperature regulation, sustain tissue integrity, and repair exercise-induced damage and injuries.

Dehydration will decrease blood volume and with that decrease you won’t be able to cool yourself effectively or supply the working muscles with enough blood. If your core temperature reaches 103-104 degrees, the hypothalamus in the brain will just say “no.” Your movements will slow down and your entire nervous system will not function at its optimal level. And nobody loves that dizzy feeling of decreased blood pressure after you stand up from sitting or lying down when dehydrated.

As far as structure is concerned, hyaluronan molecules bind with water to keep your connective tissues, like cartilage and tendon, strong, supple and resilient. Keep the hyaluronan happy by staying hydrated! And we want the muscles to remain loosey-goosey!

Take in 5-10 ounces of fluid every 15 minutes in a warm to hot environment during exercise. Otherwise, try to keep your urine nearly clear. Don’t over drink though, as that can have negative consequences as well.

Avoiding strength training. People tend to gravitate toward what they enjoy most. For many athletes, they just want to do their sport and that’s it. Unfortunately, regardless of sport, some muscles and movements aren’t worked hard enough or frequently enough. We will become very good at using certain muscles, like the hip flexors, which slowly shuts down important muscles like the gluteus maximus.

Core strength is important regardless of sport because your trunk needs to be a stable base while the arms and legs move. As running guru and PT Jay Dicharry says, “You can’t fire a cannon from a canoe.”

A loss of muscle mass as we age can be counteracted (to some extent) with strength training. Overall, it comes down to being a healthy, well-rounded athlete -- and without strength training that’s not possible.

Being afraid to let go of a regimented training program. For those Type-A personalities this is difficult. Your long run doesn’t always have to be on Sunday. Some weeks, you might even need to skip that long run altogether. That twinge in your shoulder while swimming is trying to tell you something, so listen up.

Sticking to a “must do” mentality is a great way to dig yourself into a hole of over-training, injury, staleness, and boredom. That’s particularly true when you aren’t able to optimize the other aspects of training, like nutrition, soft-tissue work, compression, sleep, and so on.

I liken it to the “pay me now or pay me later” philosophy. Take an easier intensity day or a day off when you clearly need it or end up taking several of them in a row once your performance drops, you become ill, or you develop an injury.

7 Exercises to Get Ready for Gardening and Yard Work Season

As I sit and look at the snow that should have surely been gone for the season, I am reminded of the approaching outdoor tasks that many of us jump into at springtime. It can be an abrupt change from winter’s dark and lazy days. Try these exercises at least a week before the outdoors tasks to get the blood pumping and move through some of the motions that gardening and yard work require.

Abdominal bracing:

Why it’s important: This is the most critical exercise in this entire list. Any lifting or carrying task should be performed with your abdominals active. Unfortunately, many people don’t do this and it is one of the reasons they strain their low back while lifting.

How to do it: The easiest way to learn abdominal bracing is while lying on your back with the knees and hips bent, feet flat. Place your hands at the sides of your stomach, just above the hard bones that stick out at the front of your pelvis. Imagine drawing your bellybutton toward your spine while tightening the abdominals. Your low back may flatten out a little, which is okay, but don’t overemphasize this. Hold the muscle contraction for 3-5 seconds and perform 10 repetitions. You must be able to breathe while holding the contraction so if you are holding your breath, keep trying. Once you have good control of these muscles lying down, try bracing while standing. After that is easier, try walking and light lifting while holding the abdominal muscles tight.

Chair squats:

Why it’s important: Squats are great to get your knees bending under a repeated load and increase thigh strength. The strength will be necessary to lift yourself to and from the ground and while carrying or pushing heavy loads.

How to do it: Think of this as a slow way to get up and down from a chair. Preferably, do this without the help of your hands. Start with a stance slightly wider than your shoulders. Lower slowly to a chair over 2-3 seconds. As quickly as you can tolerate, stand back up from the chair over another 2-3 seconds. You’ll need to stay toward the front of the chair. If you can easily go up and down a couple times, try not to even bear weight on the chair, just use it as a reference point to lightly touch. Perform enough repetitions to make your thighs feel tired, about 10-20 times. As you gain strength and confidence, you could take the chair away to squat deeper but realize there will be no surface to rest on before lifting back up to a standing position.

Golfer’s lift:

Why it’s important: The golfer’s lift allows you to take strain off of your back when performing repetitive and lighter lifting tasks from ground level. This may be as simple as picking up a tool or placing a seed in the ground.

How to do it: Most people have seen a golfer reach to the ground for their tee or ball. You are going to mimic that motion. Starting in a standing position, pivot your trunk forward from the hip of the weight-bearing leg. The other leg raises up behind you for every same degree the body goes downward. Lower down and return to standing. Emphasize keeping your back straight. You may want to hold onto a countertop or table with one hand when trying this the first few times. Repeat 10-20 times. Switch sides. Once you have the motion down, try it without holding on for balance.

Lunges:

Why it’s important: Lunges are another way to build those thigh muscles that help with getting yourself up and down to the ground. They also work hip muscles that help when you push down onto a shovel or pitchfork.

How to do it: Take a step forward with one leg that is about 50% longer than your usual walking step. Drop your body straight down toward the ground over 2-3 seconds by bending both knees. The forward knee will need to bend more than the rear knee. Don’t go so far down the rear knee touches the ground. Keep your trunk tall the entire time. Push back up within 2-3 seconds and repeat. Perform 10-20 times. Switch sides.

Bent over rows:

Why it’s important: Bent over rows are a great method to build the shoulder blade muscles and the low back. It’s nearly impossible to do much gardening without bending over sometimes. And the rowing motion is a way to use the shoulder blade muscles you need to pull weeds, use a hoe or lift.

How to do it: You will probably want to do this with some light weights of 3-10 pounds in each hand. Bend forward from your hips, not your low back. In fact, focus on keeping the entire back from the neck down in a straight line. Once there, allow the weights to drop forward toward the ground and then pull the arms back toward you, as if you were rowing a boat. Squeeze the shoulder blades together. Do not shrug the shoulders up toward your ears. Drop the arms down and repeat. Perform 10-20 repetitions, or until fatigue begins in the back or arms.

Farmer’s carry:

Why it’s important: One of the most realistic exercises you can try is the farmer’s carry. As a gardener, you are going to frequently carry buckets of water, soil, and tools. And those are often carried on just one side of the body. This puts a large and awkward demand on the low back and abdominal muscles.

How to do it: This exercise will also require weights. You could use an actual bucket filled partially with water, sand or dumbbells or just hold a dumbbell of 5-10 pounds in one hand. Walk forward with the weight or bucket in one hand 10-20 steps. Turn around and switch the hand that is holding the weight. Walk back to where you started. That’s one repetition. Perform 5-10 repetitions. Start with easier weights and progress over a couple weeks.

Deadlift:

Why it’s important: Deadlifts should mimic the technique you use when lifting anything from the ground that weighs too much to allow you to use the golfer’s lift. Imagine lifting a bag of potting soil, heavy water buckets and even when starting out the movement with a wheelbarrow.

How to do it: You are doing a deadlift as an extension of the squats mentioned before. These are more advanced. You should try this first without weight to get the technique and then try to progress to 5-10 pound dumbbells in each hand. Begin in standing with the legs slightly more than shoulder width apart. Your hands and weights will slide along your thighs while you drop slowly toward the ground over 2-3 seconds. The trunk will need to lean forward slightly from the hips at the same time. Once your hands have gotten to the middle shins, return to the starting point over 2-3 seconds. Try 10-20 repetitions.

None of this information is intended to be medical advice. Always consult a qualified medical professional before beginning any changes in your typical activity level. Information provided is suggested for healthy, active individuals.

Let me know if you have any questions about preparing your body for exercise at mountainridgept@gmail.com.