6 Deckers Creek Trail Half-Marathon Recovery Tips

Hope you had fun in the race. That last mile is brutal, right? Here are a few considerations to improve your recovery.

1. Active recovery. At a minimum, go for a short walk. It can be slow and relaxed. If you are more experienced, going for a short run isn’t out of the question, of course. Going for a swim is a great choice too. Anyone with at least a couple months of training under their belt will feel better having performed active recovery - if it’s done correctly. It will take at least 10 minutes of activity to get to that point though.
2. Avoid anti-inflammatory drugs. Inflammation gets a bad reputation because it’s usually accompanied by discomfort. But you need those processes to heal properly! Let your body do what it is meant to do in recovering from muscle soreness. Besides, over-the-counter anti-inflammatories are actually not very effective at improving the discomfort associated with delayed onset muscle soreness.
3. Ice anything that seems like a new injury. Yes, inflammation has a good side. But a true new injury (besides muscle soreness) can have a little too much of that inflammation. Ice is nice to be able to spot treat anything that has flared up without having the systemic effects of medication. Ice now so these areas are not still an issue in three days.
4. Regain normal hydration levels. It was hot and humid, so there is no doubt that you lost more fluid than you took in. Your urine shouldn’t be dark in color. It should be more like the color of a light beer. Drink 6-8 ounces of plain water every hour until you have achieved that level of hydration. If you have gastrointestinal discomfort at this point, then there’s a really high chance that your hydration levels are off.
5. Gently perform muscle self-massage. Use a foam roller, massage stick, tennis ball, lacrosse ball, or even a rolling pin from your kitchen to roll up and down the full length of the thighs and lower legs. It doesn’t have to be highly uncomfortable but a little tenderness is fine. Try for 30 strokes on every side.
6. Take a nap. Sleep is a great recovery method. The weather stinks today anyway. If you feel fatigued or drained then take advantage of a quick nap to boost your endocrine system’s output of healing hormones.

4 bits of advice for running Deckers Creek Trail Half-Marathon

Share these with your running friends doing the race, especially the first-timers and out-of towners that haven’t experienced the glorious hills.

1. When in doubt, eat! The half-marathon distance lulls people into thinking they can complete it without a little fueling. It’s not about assuming you don’t have enough stored energy to get it done. I’m sure you do have the energy stores to finish. But don’t you want to finish strong? It’s about subtly tricking your body into thinking that calories are coming into the system. You will feel better during and after plus your recovery time is decreased if you eat during the race. Personally, I usually have half a banana at mile 5-6 but that’s what works for me and it might not work for you.

2. Don’t underestimate the last 2 miles of the course. You will be slapped in the face with multiple obstacles all at once. Best to expect and prepare mentally for them.

• The course abruptly switches to pavement from compacted sand and pea gravel so your steps feel more harsh.

• There is suddenly little to no elevation drop, which will force you to slow your pace and change your technique.

• The temperature is much warmer because of the elevation loss up to that point, it’s later in the day, and there are no trees for shade.

• Plus, you just ran 11 miles, all downhill, so your quads are already not happy. Did someone say heavy legs?

3. Keep your turnover slightly quicker than usual to avoid killing your quads (as badly) before those final 3 miles. With the constant descent, your tendency will be to overstride, which will definitely demand more of the quads with each step.

4. Conserve effort in the first two to three miles. In most races, you don’t want to start out too hard in the first mile. In this race, the grade pitches rapidly toward 2% at the end of mile one and can get you running far faster than usual. As a result, you don’t feel the higher effort in the earliest miles that you normally would expect. Your heart rate is going to take longer to come up than on a flat course so that’s not a good indicator. Being downhill, the first 10 miles create more of a muscular demand than the average half-marathon while being less stressful to the cardiovascular system than usual. Check your splits at mile 2 and 3 and then adjust accordingly. I doubt many people will come through the 5K split and say “that was too slow.”

5. Bonus: Watch out for the cicadas. Especially if you are faster than me, I suggest wearing safety goggles and knight armor.

Does foot pronation increase risk of injury?

There is a misconception that certain structural features of the body are directly related to injuries. For years, people with lower arches were referred to as “pronators” and those with even flatter feet were “overpronators” or “hyperpronators.” They were all thought to have more injuries, and a portion of the shoe industry has really kept that mentality alive. The other two general foot types, neutral and supinated, were the supposed ideal.

Image Courtesy http://www.mikevarneyphysio.co.uk/wp-content/uploads/foot_pronation_supination.png

If you watched the pronator group walk, they might not appear to maintain their arch height very well. But is that always a problem? In the people labeled as pronators there are often joint structure differences that allow more inward collapse of the ankle and foot. In the supinator group there are joint differences that would keep the ankle and foot raised upward. Regardless of foot type, some level of pronation is a normal movement because it allows for shock absorption as the leg is loaded. A certain amount of supination is also normal because it allows for a rigid push off.

We begin our childhood with a lower inner arch height, largely due to a lack of bony structure, and this results in a pliable foot. With normal growth, as the foot bones develop, the inner arch tends to rise and the bones of the leg also change their orientation a bit. In some people the arch really doesn’t increase its height much with growth. And even if it does, in adulthood there can be contributing changes that would affect foot and ankle position:

• degenerative or use dependent joint changes at front of the foot, the middle of the foot, or the rear of the foot  

• lower leg muscle shortening

• weak, inhibited, or injured lower leg muscles or tendons (commonly the posterior tibialis)

• general hypermobility throughout many of the body’s joints

• tibia and femur bone structure (twisting, length discrepancy)

The concern is that these changes are also able to affect the movement of the knee, the hip and then even the pelvis and back. We all have a certain acceptable range of motion within each of these areas. If the changes in the foot allow the knee or hip to operate just on the edge of their tolerated position of use then, conceivably, you might have an increase in risk for knee or hip injury.

In actuality, foot structure may be more related to the type of injuries acquired than frequency of injury.

• According to a 2001 research article in Clinical Biomechanics, higher arched runners developed injuries most often on the lateral side of the leg and had more ankle and bony injuries. Their lower arched counterparts had more knee and medial lower leg injuries.

• A 2005 research article in the Journal of the American Podiatric Medical Association indicated that triathletes with a more rigid, high arch were at a higher risk of injury compared to neutral and pronated foot types.

• More recently, in 2014, a meta-analysis in the Journal of Ankle and Foot Research indicated a very slight increase in risk of overall injury rate with the more pronated foot type being related to increased risk of kneecap pain and medial tibial stress syndrome (a.k.a. one of the types of shin splints.)

As you can see, the research is conflicting. The rate of injury is similar between athletes with all foot types. Perhaps we would have different results if we broke the common groups (pronator, neutral, supinator) down into subgroups based upon strike patterns (heel, midfoot, forefoot) to account for variations in demand.

My concern is that many of these studies assess the foot arch height while standing still. Unfortunately, this does not mimic how you use the foot in activity. Someone with a pronated foot structure while standing may not even touch their heel to the ground with running. Is it really going to be effective to put them in a motion control or stability shoe designed with a heel striker in mind?

A 2009 study by J. Dicharry demonstrated that while running the total motion of the navicular bone in the arch isn’t drastically different regardless of foot type. They called the pronators the hypermobile group in this case. Even if the arch of a pronated foot is at a lower position in standing, it’s total amount of motion is only slightly increased from a neutral or supinated foot while running. Neutral and supinated feet were 0.3 mm different between walking and running. Pronated feet were 1.2 mm different from walk to run. 

Should you be concerned with such minor differences and trying to use external devices like shoes to accommodate for them? The first step is to determine whether the pronation that is occurring is structural or a compensation. If forced to compensate, as in the case of decreased calf muscle length, you may need to focus on increasing mobility where it has been lost, like at the ankle joint, by elongating the calf muscles. Forcing mobility where it has already reached an excessive level in the midfoot by neglecting the calf length is not going to be helpful.

Our bodies are very good at adapting to gradually applied stresses, so a person with a more flexible, lower arch should be able to safely progress their activity just like anyone else. The research would suggest addressing the tissues that are the most likely to be injured with each foot type.

For instance, someone with a higher arch could focus on single leg balance and strengthening of the outer lower leg muscles. Those with a lower arch could focus on increasing strength of the inner lower leg muscles. I suggest we should focus on keeping both sides of the lower leg as strong as possible without one side becoming more dominant.

An often overlooked factor is inner foot muscle strength. Several of those muscles are meant to stabilize the arches of the foot, so it would be no surprise to me that decreased inner arch height can be associated with decreased muscle strength. But it’s not always a 1:1 relationship. Little research exists on this because it’s difficult to measure intrinsic foot muscle strength. Look for my blog article on intrinsic foot muscle strengthening soon.

Final thoughts:

• Progress running intensity and duration in a safe manner using the 10% rule.

• Keep the calf muscles loose to prevent ankle motion loss with a combination of rolling, massage, dry needling, and maybe stretching.

• Strengthen the muscles that take the ankle and foot in all directions.

• Strengthen the intrinsic foot muscles.

• A pronated foot type does not necessarily require a bulky, stiff shoe and orthotics.

• A pronated foot type is not going to be an immediate cause of injury, there are other factors to consider.

• Don’t spend too much time worrying about your foot type because anatomical variation is normal.

• Let your feet work how they were intended.

Geek out:

http://www.ncbi.nlm.nih.gov/pubmed/19648718

http://www.japmaonline.org/doi/abs/10.7547/0950235

http://www.clinbiomech.com/article/S0268-0033(01)00005-5/pdf

http://jfootankleres.biomedcentral.com/articles/10.1186/s13047-014-0055-4

http://journals.lww.com/cjsportsmed/Abstract/2001/01000/The_Role_of_Impact_Forces_and_Foot_Pronation__A.2.aspx

Please let me know if you have any questions at derek@mountainridgept.com and feel free to share this article via the share button below.

Training errors in the athlete, part 6

Too much, too soon, particularly after an injury. Most athletes understand that progressing too quickly in their regular training can cause injury. What they don’t often understand is how to return to sport after an injury. This is the easiest time to go too hard or too long. You can have the “I’m all better” concept down too well.

Injured or not, the body is only capable of adapting at a certain rate. Some tissues can adapt in a few days (cardiovascular system, nervous system pathways), some in a few weeks (muscles), and others in a couple months (tendon, bone). Depending on the location of the injury you must consider what are known as “tissue healing constraints.” For example, a tendon overuse injury can take 1-3 months to resolve with correct progression. A low-grade muscle strain could take 1-4 weeks.

If a runner has tendon pain from a new tendinitis that has been present for 3-4 weeks then I would expect it is going to take weeks, not days, before returning to their pre-injury mileage. It doesn’t always mean you can’t run at all during recovery. It must be a controlled progression. And there is always some type of cross training you can do.

The first day back to running should not be a 5 or 7 mile long run, regardless of terrain or intensity. And that’s what I see many people try to do when they return from injury. They want to get right back up that mountain quicker than they came down it. Stay in the valley for a couple days. For every week away from running I would expect a need for at least a 30% drop in average weekly mileage upon return.

It’s going to take at least a week of no exercise before you actually have a loss of fitness. The fitness losses from 2 weeks of inactivity are similar to those of 4 weeks. And I’m sure you have been cross training to minimize those losses. Point being, don’t rush back into it simply to regain fitness that doesn’t really need to be regained.

Not listening to your body’s warning signs of insufficient recovery. This is similar to what I mentioned last week about not respecting a specific injury early. But you also need to consider a whole body factor. Something is up when your muscles have been feeling constantly tired before, during, and after workouts. You might wake up more groggy than usual or old injuries start to reappear. You need to consider what your body is trying to tell you.

It’s normal to feel a little stiff and achy in your muscles when you start to push them. But when a slow, easy warm-up doesn’t put some pep back in your step after 20-30 minutes then there’s a good chance you could be digging yourself into a hole. If you feel good at that point, then a hard workout is reasonable. If you still feel slower than normal and better yet, are actually slower than your normal, then it’s not a day to push your effort.

For the uninjured, refrain from making any judgments about how your workout is going to proceed until your system is well warmed-up, at least 15 minutes into exercise.

Not performing regular soft tissue maintenance like foam rolling, massage, and compression in recovery, especially after the hardest and longest efforts. Repetitive wear and tear beats up your muscles. Unhealthy muscle tissue equals decreased performance and even pain. As athletes, we surely can’t expect that pushing into exercise-related discomfort multiple days per week generates only 100% positive adaptations in the muscles and other tissues. There are gradual negative adaptations too, like trigger points, adhesions, and loss of muscle tissue length.

Show those muscles a little love with self-massage. Help your lymphatic system function at its best by preventing fluids from accumulating in the spaces around your muscles and other tissues with compression. Options for compression include compression socks or for a more massage-like treatment, a pneumatic compression system, like the Normatec. Most athletes find that massage and compression simply feel good after prolonged exercise.

Let me know if you have any questions: derek@mountainridgept.com

Running technique: 3 reasons why runners develop shin splints and 7 ways to fix them

I really dislike the term "shin splints." Probably more than you dislike actually having pain from shin splints. That's because the term has been used to describe about five different problems that occur in the lower leg. It's terribly vague.

The term "shin splints" has been applied to injuries that are more specifically described as medial tibial stress syndrome, tibial stress fractures, and exertional muscle pain. Exertional muscle pain is the most common type of problem, so for the sake of this article, I will refer to the shin muscle and tendon pain from exertion as “shin splints."

One of the shin muscles is the anterior tibialis, which is the biggest muscle on the front of your shin region. It’s main function is to pull the front of your foot upward. That's called dorsiflexion (see photo). It's helped by the neighboring extensor hallucis longus (EHL) and extensor digitorum longus (EDL) muscles.

While walking and running, they keep you from catching your foot and toes on rugs, roots, stones, steps, and generally rough surfaces. We’ve all caught a toe, tripped, fallen and groaned in pain as we lie on the ground. These are the muscles you can thank for keeping you from biting it everyday.

There are several reasons why runners will develop exertional shin splints. Some of them include:

Heavy reliance on heel striking. This is the most likely reason a runner, especially a new runner, would develop shin muscle overuse pain. With a heel strike, you must increase use of the anterior tibialis muscle or your foot will slap down to the ground. Runners who heel strike demonstrate a greater dorsiflexion (pointed up) angle upon ground contact compared to a runner who lands with their entire foot flatter or on their forefoot.

In the picture below the ankle is pulling up into dorsiflexion 15 degrees above a neutral ankle position. This is in contrast to the midfoot strike images below where the foot is contacting the ground in a slightly plantarflexed (pointed down) angle. In order to lower the front of the foot to the ground from a heel striking position, the anterior tibialis muscle needs to work extra hard. All of that extra work results in a chronic state of overuse in the shin muscles and tendons, which is easy to imagine when you are asking them to perform 700 contractions per mile. 

Initial contact with heel strike pattern

Overstriding in the forward direction. Along with the heavy heel striking pattern, reaching the leg too far forward with each step will increase the stress on the shin muscles. You can use a heel strike pattern without causing shin splint pain if your foot contacts close to your center of mass. Imagine your center of mass being a line drawn straight down from the center of your hips, as in the following picture. If the foot contacts the ground 12 inches in front of the line instead of 10 inches, the demands are much different on the muscles, tendons and joints.

Most runners who shorten their stride in the forward direction start to land on their midfoot instead of their heel. Compared to the heel strike picture above, using a midfoot or forefoot strike pattern (and sometimes a slightly quicker turnover) causes the stride to be slightly shorter in the forward direction. That's evident with the lower hip flexion degree value. But it's most noticeable that the distance line to the point of contact at the bottom of the picture is clearly shorter than in the previous heel striking picture. It is possible to make an initial contact at this same closer point and use any of the three types of contact patterns. 

Initial contact with midfoot strike pattern

Short/tight calf muscles. If the muscles on the back of your lower leg are so short that you can’t take your ankle into the normal level of upward dorsiflexion motion, the shin muscles are going to need to work harder to overcome that passive resistance. One quick way to assess whether the muscles on the back of the lower leg are too short is to do a full squat. Barring any unusual knee or ankle joint and bone issues, if the feet can't stay flat on the floor, especially without turning the feet out or the arches collapsing, you may have a limitation in the length of those muscles.

Tips for correcting these issues.

1. In the cases of both heel striking and overstriding, the solution is much the same. The foot needs to land closer to your center of mass. You could simply think about taking shorter steps. You can think about it landing directly beneath you (which will never actually happen). A one-inch change in the initial contact point is going to feel like a 12-inch change but I assure you that the awkward feeling is normal at first.

2. Some runners need an external focus to prevent overstriding forward, so matching their cadence to the beat of a metronome can be helpful. Count the number of steps you take with one leg in one minute of running. Those who overstride are often taking less than 82 steps each minute. The metronome can be set for a value greater than 82 while you try to match the step rate with one leg.

3. For tight calf muscles, everyone’s first thought is “stretch.” Stretching is fine if you hold the stretch for at least 1 minute but 2-3 minutes is more effective to mechanically lengthen these tissues. And you would have to do it daily for at least a month to get much change. It can be more effective to perform soft tissue work with a foam roller, massage stick, tennis or lacrosse ball, massage therapist, or manual therapy from a Physical Therapist. Regardless, just try something! Lessons on muscle rolling here.

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4. Relax the anterior tibialis muscle with consistent soft tissue maintenance. Trigger point dry needling or myofascial release can work wonders to make the muscle happy and decrease pain quickly. The massage stick can be great too. Lessons on muscle rolling here.

5. Practice engaging the anterior tibialis muscle by walking on your heels for 30-60 seconds continuously each day. Preferably after your symptoms have calmed down a bit.

6. Progressively increase your mileage. Going for a 4 mile run after a month of no running is a huge training error. Sometimes those muscles just need to be conditioned correctly. 

7. Try a different shoe with a lower heel height. Pair this with the other solutions. A thicker heel can mean greater shin muscle load. And that thick heel is often the reason people heel strike hard in the first place. 

If you battle repeatedly with shin splints, consider having a thorough running technique and gait evaluation. Yes, I can get the pain to go away easily with a couple treatments but don’t you want to keep it away permanently? A couple of small changes can mean a huge difference in your pain onset.

I can be reached at derek@mountainridgept.com if you have any questions. 

Please share this article with your running friends! To receive updates as each blog comes out, complete the form below. I can be reached at derek@mountainridgept.com if you have any questions. 

Training errors in the athlete, part 5

Training with other people all the time. Do you thrive on attention and praise in order to push through a workout? Sometimes you just need to go it alone to build the mental fortitude required to perform at a higher level. I mean Rocky Balboa trained alone most of the time and he seemed pretty talented so that has to be a sign it will work for you too. Gonna fly now...

I don't see anyone else around, do you?

Moving on to the other end of the spectrum, there’s the chance that other athletes can push you too hard, too often. Peer pressure kicks in and although your instinct says “that’s enough,” you go beyond your safe limitations and become injured. Save it for the competition. That’s where it is nice to have a coach to tell you when to shut it down.

Skipping the warm-up. Warm your muscles up slowly and they will perform better. A gradual warm-up can improve performance. Research indicates muscle fiber exposure to lactic acid just before intense exercise allows the fibers to tolerate even more lactic acid production. The physiology of the muscle fiber can function better at a higher temperature too (up to a point of course).

According to a 2012 literature review in BioMed Central Medicine, a proper warm-up containing “stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques” can be effective for preventing injury. This is unfortunately more involved than many athletes envision when thinking about a warm-up routine and they shy away from it as a result. 

At the least, warming-up should be a whole body routine that emphasizes full joint mobility, a gradual increase in heart rate, directional changes, and most importantly, rock music. The warm-up period, especially just before a competition, can be a powerful psychological motivator.

Ignoring joint mobility and flexibility. Some people have really poor mobility. I don’t mean, can you bend over and touch your toes? I mean will your hip flex to a full 120 degrees to allow you to squat all the way down at Crossfit? Do your ankles have the full range of motion necessary to prevent your arch from collapsing while running? Limits in mobility set by a single joint or muscle can impact movement further away than you might realize (ie. ankle movement can change hip movement).

The type of exercise you expect to participate in should dictate what motions you need to improve. If there are specific known limitations, they should be addressed in order to decrease stress on adjacent tissues and regions. Mobility limitation is the reason that the Crossfit “Mobility WOD” exercises exist. The point is that you have to take care of your body with a little routine supplemental work in order to enjoy your regular sport safely and improve performance. 

Training errors in the athlete, part 4

Underestimating the importance of proper recovery. When it’s time to work hard in a workout or competition you need to have some gas in the tank. That tank doesn’t get filled up without good recovery techniques like full days off, active recovery days, consistent sleep, compression, nutrition quality and timing, proper hydration and muscle maintenance.

If you start every competition or workout on a half tank, guess what happens? You go half as far with half the intensity. Sometimes that's intentional and planned. But many times it's not. Then as injury and overtraining occur, you have to ask yourself, “What am I really getting out of this?” In order to feel your best, remain healthy, and perform at your best, recovery is a huge part of the equation. Don't dig yourself into a hole that you can't get out of. 

Not working hard enough to produce a strong stimulus that the body wants to adapt to. Athletes are supposed to be constantly pushing their bodies on many of their training days. That’s how you become better, right? Unfortunately it’s also how you become overtrained, injured, stale, and burned out.

This leads you to constant training at a moderate effort on “dead” muscles. Or running the same distance every day. Monotony is the straw that broke the camel’s back. For runners, yes, you need days to emphasize aerobic conditioning in easy efforts ranging from 30 minutes to 3 hours. Other days you can have interval training that emphasizes anaerobic work at a really high effort for anywhere from 30 seconds to 5 minutes. Sure there’s a place for a moderately paced tempo run of 15 to 60 minutes, but not every day.

Strength training athletes need to avoid constantly using a weight that causes failure at 10, 12 or 15 repetitions. Or always doing just one set. If you are really after a change in performance, there needs to be a training cycle where the weight is significant enough to cause failure at other points, like 8, 5, or even 3 repetitions. And other times it’s fine to do 20 repetition sets. The point is, change the stimulus.

Indoor general fitness athletes are often one of the most guilty of this mentality. Three and four times per week they bounce from one cardio machine to another, being sure to start breathing harder and break a sweat at each machine for 10 or 20 minutes. They occasionally check their heart rate and compare it to the machine’s chart. No surprise to see a heart rate of 70% of the predicted maximum. And they wonder why they never see significant fitness changes.

Then there are the athletes that push a little harder but it’s just to that 85% level, which definitely hurts more. But then they struggle to sustain it as one steady effort for longer than 10 minutes (because it hurts) at which point the effort drops a notch. Meanwhile, other people in the gym are barely working at all.

In any sport, the key is variety. Variety in intensity, duration, training surface, speed, force produced, and direction of movement. Yes, you want adaptation to a consistent stimulus for a while but then you have to change that stimulus to continue making gains. 

Ignoring injuries when you first begin to have symptoms. Some injuries classically only hurt at certain times in their formation. That doesn’t mean they aren’t a problem. It doesn’t have to hurt all of the time to be a problem. Don't ignore it. Never ignore it. Yes, you can try to treat it yourself for a little while. That really might work.

But please make your life and my life easier by just coming to Physical Therapy within a couple weeks of the problem onset, even if it’s just for a consultation. If you don’t like what I have to say about it then seek another opinion. Regardless, if you intervene early, and start the right treatments, your recovery time is going to be drastically different.

For instance, if I see someone with back pain from a sacroiliac joint sprain in the same week they are injured, then they often recover in well under a week. If the sacroiliac joint has been a problem for 2 months and had no proper treatment, then buckle up for at least a month of consistent work. #getPT1st

Training errors in the athlete, part 1

Which of these are you guilty of performing?

Specializing in a sport and being entirely unwilling to deviate: Variety is critical for injury prevention, mental outlook, and general health. Unless you are a triathlete, pentathlete, or decathlete, you might find yourself unwilling to stray from the single sport you know. First off, you should strength train. Strength training is no longer an option; it is a requirement. Crosstrain before you get hurt (and you might not get hurt in the first place). Try something that is non-competitive and don’t turn it into a competition. (Yes, that’s probably hard.) Take a yoga class. Play pickup basketball with a couple friends or just shoot around. Try swimming. Just do something that is very different than your normal and do it often. This is especially true for young athletes who aren’t finished maturing. Research suggests that athletes who didn’t specialize at a young age can perform better as long as they were performing some form of athletics. The key for all of us is simply being an athlete.

Assuming your skills and technique don’t need further work: Skill work is primarily about training your nervous system to use a specific pattern. A good overall athlete has more options for movement patterns. Some patterns are highly ingrained and some are not. You want instinctive patterns to be close to an ideal. That way, when fatigue occurs you still demonstrate precision and efficiency. Every athlete could improve their performance with at least weekly emphasis on movement drills, strengthening specific motions, increasing muscle power output, and basically fine-tuning they way the nervous system creates each sports-specific motion. Regardless of sport, there’s room for greater efficiency and adding skills to your repertoire. Even running, which some people assume is innate, is a skill that should be broken into components for drill work. 

Training alone all the time: Sure, you are probably mentally tougher than the average bear, but this problem allows you to slack off occasionally when there’s no one there to push you. Which means you drop into the dreaded moderate efforts that lead to “dead” muscles, overtraining, and slower than optimal nervous system patterns. My motto is “there’s always someone faster and stronger.” Go train with that person at least once a week. A coach could assume part of the role of a training partner, so I’ll give that half an exception.

Footwork Friday - Why am I developing black toenails?

Many runners develop black toenails, especially after longer runs. This is a very specific type of bruising known as a "subungual hematoma." It has often been believed that this is caused by the shoe's toe box size restricting the toes to so much that direct trauma and bruising develops. This isn't always the case, and The Gait Guys suggest that there is another cause in one of their older blog posts.

Many runners tend to curl their toes downward in an effort to grip the inner surface of their shoe. In addition to black toenails, another sign of this habit is the presence of a callus on the very tip of the toe. Curling your toes downward requires heavy use of the flexor digitorum longus and/or flexor hallucis longus muscles. Using these muscles is a way to gain stability within the shoe, but it is not a good habit. Regardless of the presence of black toenails, this should be avoided because these muscles are not built to produce larger amounts of power or engage in constant stability control.

The area under a toenail has a large blood vessel supply close to the nail bed, so bruising occurs more easily with any vessel damage. Gripping downward combined with a small forward/backward movement of the shoe causes a shearing force through the skin and fatty tissue of the toes. That repetitive pressure with this shearing force against the insole is thought to be enough trauma to disrupt the blood vessels. The solution? Don't grip the shoe with your toes.

Shorter runs usually aren't enough repetition to harm the vessels, but longer runs will. Especially as we fatigue we  rely more heavily on muscles that aren't fatigued as much during shorter runs. Trail running could cause a greater problem because the trail surfaces are unstable and the runner will more frequently seek stability by gripping with the toes. Also, there is a greater likelihood of steeper inclines and declines that will cause more sheer force of the foot against the insole.

Although there isn't existing research to back up this idea yet, it makes good sense. Next time you are running, think about what your toes are doing. If you are gripping the inside of your shoe then STOP IT!

Let me know if you have any questions at mountainridgept@gmail.com. 

Balance and proprioception: overlooked training for runners and athletes with knee pain and other leg overuse injuries

After reading the title you’re probably wondering a few different things:

1. “What does balance have to do with being a good athlete?”
2. “What the heck is proprioception?”
3. “What’s for lunch today?”

These issues come up time and time again when I work with injured athletes from many different sports. I’ll address the first two questions and you are on your own for that last one.

Let’s review some anatomy first. There are specialized nerves in your joints, ligaments, muscles and tendons that help sense position and movement of your body. That sense is referred to as proprioception. Without these and other specialized nervous system parts you couldn’t close your eyes and know how your body is positioned at any instant. And you couldn’t stand up or walk in a stable manner. Clearly you don’t absolutely need vision to know where your body is or you would be watching your feet while you walk or run, right? By sensing position, these special nerves are also part of what keeps us stable so we aren’t just stumbling around like a drunk college student on Friday night. But many of us, even some of the best athletes, have poor proprioceptive awareness. For so many of us these proprioceptive pathways aren’t challenged often, and then the “use it or lose it” principle kicks in. Especially as we age, we begin to lose the efficiency of these specialized nerves. As these nerves degrade we can’t precisely place each leg with athletic movement. This decreased precision leads to poorer biomechanics that can be related to overuse injuries. Also, a previous or current sprain at the knee or ankle ligaments will negatively impact your positional awareness and movement precision because of the damage that a sprain will do to these special nerve endings. All in all, aging, previous injury and a lack of training stimuli are going to degrade the quality of your movement precision.

Do you think you have good balance and stability? Let’s find out in a couple simple steps. Try these in your bare feet.

1. Stand on one leg as long as you can without touching anything and count slowly. How many seconds can you last on each one? Less than 30 seconds? In that case you’ve got a lot of hard work to do. More than 30 seconds? Well that’s a good start but we’re only getting started.
2. Now stand on one leg as long as you can with your eyes closed. I bet most of you aren’t going to brag about this one. If you don’t make it to 30 seconds on one leg with your eyes closed then there’s likely to be some room for improvement in this aspect of your training.
3. If you have some kind of superhero balance, try standing on one leg, keeping the eyes closed and tilt your head backward or turn your head to each side. This is really hard and will likely stop all but the best balancers.

So what are you doing to train this aspect of your abilities? I imagine several folks are going to say “nothing” because they didn’t know it was important. For what is essentially very little effort, I’d suggest working on your balance, stability, and proprioception to improve your running and prevent injury. Here are a couple ideas to address this area:

1. Stand on one leg with your eyes closed. Sound familiar? If you are able to stand steadily on one leg with your eyes closed on a flat floor then stand on an unstable surface like a folded towel or pillow with your  eyes closed. Or, you could try moving your head as mentioned earlier. Aim for 30 seconds of the most difficult, but achievable, level. Switch sides.
2. Single leg Russian dead lift. One of my favorite exercises. 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 trunk goes downward. Don’t round your back. Repeat 8-15 times until the hamstrings and buttock muscles tire. Switch sides. You can do this with and without weight. 
3. Single leg step down. Stand on a single leg on the edge of a step. Drop down very slightly by bending the weight-bearing leg, keeping your weight back on your heel. Return to the start position. Don’t let your bending knee travel too far forward beyond the front of your foot. Think about keeping your buttock back. Repeat 8-15 times, at least until your hip muscles and quadriceps are getting tired. Switch sides. You can also do this with and without weight. 

Let me know how you do with these activities at mountainridgept@gmail.com. Easy? Hard? These skills become particularly important for runners and other athletes with overuse related knee pain, ankle pain and foot pain.

Footwork Friday - Runner's bump

I thought I would throw this one out there since it's recently affected my running on a small level. A couple weeks ago I noticed I was developing a small bump at the base of my anterior tibialis tendon after a long run. Getting old is such a great thing isn't it?! It hasn't really been painful but the bump will snap up and down if I have my shoes laced tightly. It's a synovial sheath irritation in the slick layer that allows the tendon to glide smoothly. 

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Runner's Bump

Ultimately, excess lacing tightness is what caused the bump to form. I have a habit of really cinching down on my shoe laces and this caused some increased stress on this area. Now, if I was to over-tighten the laces, it would cause the little bump to snap up and down under the laces and eventually swell even larger. So that's clearly not ideal. The repetitive snapping is annoying and might become painful with enough exposure. I'm not waiting to find out. Another factor that could contribute is frequent uphill running because it would cause you to increase the use of the anterior tibialis muscle and tendon, close the ankle joint up further and increase the friction across the front of the tendon against the shoe. My right foot collapses inward slightly more so the tendon may experience slightly more stress from that as well. 

As a result I've done a slight modification to my lacing pattern to relieve the area of its pressure. By changing the lacing pattern the bumped area reduced significantly in swelling and overall size. Applying ice is another good measure to help decrease localized swelling and pain. 

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These types of bumps will also sometimes occur at the Achilles tendon from the heel cup of the shoe rubbing the tendon repetitively. In any case you could modify the shoe by cutting out a small portion of the heel material that is rubbing or get into another pair of shoes that doesn't stress the area. 

Please let me know if you have any questions about shoe lacing patterns or tendons forming mysterious bumps at mountainridgept@gmail.com. 

Footwork Friday - Basic Lateral Agility Drills

Welcome to Footwork Friday where we introduce agility drills, strengthening, and muscle care techniques for the athlete who understands how important their feet and legs are in carrying them through to the next step in their active lifestyle. 

Runners and many other athletes don't get enough lateral movement in their training. This is why we tend to weaken in side-to-side movements and we also tend to become injured because of instabilities side-to-side. Even in an uninjured state, learning to stabilize the body to prevent lateral movement can be very useful to move quickly and safely across unstable surfaces like rocks, roots, grass and mud. As far as pure performance is concerned, increased lateral movement is an energy waste when you are trying to move quickly forward.

The agility efforts do not need to be long. The technique just needs to be as accurate as possible. Like I've shown in the videos, a 10-15 yard section is plenty long enough. Go through each drill 2-4 times. For any agility drill I recommend fully recovering between efforts because you are ultimately trying to train your nervous system, not your heart or lungs.

Initially, for the first drill, focus on keeping the contact light and not crossing one leg over the other. Strive for keeping the body tall. As you learn what it feels like to "stick" the outer leg, try to make sure your knee is staying straight over top of your foot. In other words, the knee doesn't bow inward or outward. It does need to be bent for a soft landing though. This is commonly done with an agility ladder but I prefer to do them in the middle of a short and easy run or a moderate distance run to keep the right muscles awake. As you get faster you can focus on lowering your body closer to the ground. 

For the second drill focus again on light and quick contact with the ground. Emphasize keeping your stance wide and pumping the arms directly forward and backward. I like to do this in the middle of my runs as well. Just be careful because it will skyrocket your heart rate and effort levels very quickly.

Have fun and let me know if you have any questions at mountainridgept@gmail.com