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.

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...

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.

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.

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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.

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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.

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.

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.

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8 Essentials For Recovering From A Running Injury

1. Don’t assume you should stop running entirely. There’s a good chance you will make the situation worse by fully stopping. One or two days off is reasonable. Your body’s tissues maintain themselves best when there is a baseline frequency of exercise. Take that particular baseline away for several days and those tissues have no reason to maintain their adaptations to exercise, so they will actually weaken and regress. Tendons, muscles, ligaments, it doesn’t matter. All of these tissues begin to degrade without regular use. It’s the same reason astronauts become weak and lose muscle mass when they travel to space. The frequent demands of gravity here on earth are suddenly gone so their body says “if you aren’t going to use this *fill in tissue name here* anymore, then I’m going to start to break it down - it’s a waste of energy to maintain it for nothing.” You don’t want to lose more of these hard-earned adaptations than you have to.

2. Don’t be afraid to deviate from your previous running pace and distances in order to stay active. If there is one thing that happens very commonly after an injury takes hold, it’s that folks assume resting fixed their problem entirely when the pain *appears* to go away. So what if you took two days off? Expecting to jump back in at the same level of pace and distance is often disastrous. Just as I mentioned above, the tissues maintain a certain level of adaptation. By jumping back in at the previous intensities and distances you may actually be stressing the tissue at a rate greater than it can adapt. Remember, this was injured tissue that caused pain just a couple days earlier, which probably means it wasn’t adapting quickly enough to begin with. It is unlikely that magically, with a short little rest, that the area suddenly became “normal” uninjured tissue again and you can start beating it down with your typical training. Temporarily decreasing the intensity and distance to decrease (but not eliminate) the overall demand on the tissue is often a better solution for overuse injuries. It typically takes weeks and months for an injured area to remodel and you can certainly progress again during this time if the running is dosed appropriately.

3. If you have a competition coming up and it’s something like one to two weeks away, there’s a good chance you can still compete and do so at the level you had hoped - if you play your cards right and don’t panic. How much measurable fitness do you really think you were going to gain from that one last long run? This is more of a psychological barrier than a physical one. If you had been training consistently for two or three months, or years for that matter, then you have the necessary fitness. Yes, it’s frustrating and a blow to the ego. Nothing ever goes as planned anyway, does it? It’s usually not worth testing things to their limits when you can easily increase or maintain fitness with things like cross training.

4. Cross train, but do it right. Yes, I understand that no other form of exercise seems to cause the same type of wonderful fatigue and satisfaction that running does. Which, again, is why people try to push the distances and paces prematurely. But if you need to cross train, doing hard interval or tempo work everyday on the bike or elliptical isn’t the right way to go. I would hope you wouldn’t do that running (although I know people who do). The same principles apply to cross training as they do to running:

• super easy recovery to stay warmed up and loose after harder days
• aerobic work for aerobic fitness
• intervals and tempo work for improving anaerobic fitness
• maximal efforts for improving that nerve/muscle connection and gaining more anaerobic fitness

I am absolutely convinced that a semi-experienced runner can cross train for several weeks, never run, and still achieve their goals if they do it correctly.

5. Don’t forget about this current injury when the next injury comes along. More often than not, these injuries will be connected to one another. Every week I see people who had a low back injury that eventually played into a hip problem that became a calf problem which morphed into a foot problem. Our body’s are so good at compensating for pain, loss of motion, and weakness that we can nearly always get the job done - for a little while. The trickle-down and displacement of forces doesn’t bode well in the long run. Fixing problems correctly the first time around will play out better.

6. Some medicines are actually inhibitory to normal healing processes if taken for prolonged periods. This is partly due to the fact that inflammation is a desirable and necessary part of healing. It is just that inflammation is accompanied by pain and we all want to get rid of that part of the equation. Taking drugs to modify the inflammatory response over a longer period of time (>2 weeks) may result in an incomplete cycle of healing. Here’s one recent review (https://www.ncbi.nlm.nih.gov/pubmed/22744434). These drugs are also an important factor to consider in bone healing from issues like stress fractures, as reviewed here: http://bjsm.bmj.com/content/39/2/65.

7. Prevention is the best medicine. Remember, you can have too much of a good thing. Exercise and running are good only up to a certain point and that point is different for each of us. Maybe if you had just taken a full day off every week for the past month, then perhaps this injury wouldn’t have happened. You will do best by emphasizing proper recovery time, doing regular soft tissue maintenance, refining your running technique, attending to nutrition, and being consistent with slow progressions in training. If I had a dollar for every time I’ve heard “well, I felt good so I decided to go an extra four miles” from people that aren’t feeling so good right about the time I see them in the clinic. There is always a breaking point and you can find it by throwing caution to the wind. (Not saying I haven’t done these things myself!)

8. Don’t “test” an injured tissue repetitively and expect a different result. Here’s a common scenario: Monday I tried to run and my leg hurt within 200 yards, so I stopped, figured I would just rest a day. Tuesday I tried to run again (because Monday was a failure) and the pain started again at around 150 yards. Ugghh, I hate being hurt. Wednesday I’m really aggravated and surely the last two days of “rest” have fixed it so I run for 300 yards, even though pain started at around 200 yards again, before I reluctantly quit because of the pain. Thursday I’m really angry and try to run again. Friday again... Notice a theme here? Numerous days of testing the injury, pushing until and through pain, ultimately delays improvement. It’s clearly not going away. The right thing to do is seek help from an injury treating professional, not a personal trainer and not a coach unless they are going to refer you to a valid licensed professional. It is important to consider what pain intensity we are referring to. If it’s enough to make you consider quitting the run, that’s probably a good sign that you should indeed stop. Nor would it be good to push through pain that makes you change your technique for pain avoidance. If the pain is occurring early in the run and worsens rapidly, you aren’t going to win the fight. Every time you test an injury like this, it’s just inflaming the tissue all over again after it has tried to calm down.

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The latest research on compression garment effectiveness

The main reasons to wear compression garments, like compression socks, would be to: 1) improve athletic performance or 2) improve recovery. Is compression wear worth the hype in either of these cases?

Performance:

A 2016 review on the effects of multiple types of compression garments (Engel et al.) examined 32 studies performed between 1987 and 2015. In eight of the studies they found no significant improvement in race completion time with compression for any distance from 400 meters to marathon. In seven studies, they did find a small improvement in time to exhaustion while wearing compression. Four studies reported improved running economy values. Sixteen of the studies were associated with improvements in psychological variables.

Despite being financially supported by a garment manufacturer, a 2015 study by Areces et al. found no benefit of compression socks in post-marathon exercise performance or race times.

In a 2015 literature review of four studies by Stanek, compression socks were reported to have no effect on several physiological measures like heart rate, perceived exertion, and lactate levels. Although one of the four studies noted an improvement in maximal running speed.

Recovery:

Performance improvements are often based on perception of effectiveness. In a 2016 study by Brophy-Williams et al. the participants were asked about their perceptions on the usefulness of compression socks in enhancing exercise recovery. This article is ahead of print, but according to the abstract (yes, I know that’s bad science) the participants performed better if they believed the compression was going to be helpful in recovery. Thank you placebo effect.

The 2016 Engel review of 32 studies found nine articles reporting large positive changes in exercise or post-exercise muscle soreness.  

A 2013 meta-analysis by Hill et al. revealed some benefit in reducing the pain of delayed onset muscle soreness. They also found that muscle strength and muscle power measures recovered more quickly with compression usage.

A 2016 meta-analysis by Marqués-Jiménez et al. identified several studies indicating multiple biochemical markers were improved following exercise if compression garments were worn. In five studies, muscle swelling was also improved. Another eight studies indicated improvements in exercise recovery in muscle strength and five studies in muscle power.

Anecdotally, I don’t find compression to change anything about my personal running performance. Maybe I would notice a change if I used it more often. But I definitely do like the way compression feels for a day or so after a hard workout or race. I really love the way compression feels at super high levels with a compressive device - above 80 mm Hg, which isn’t what these studies and reviews analyzed. Even if compression garments aren’t changing recovery on a physiological level, they are all capable of decreasing the sensation of soreness.

It appears that the most recent research evidence supports the use of compression in decreasing the intensity of delayed onset muscle soreness. The helpfulness of these garments may be event greater in an individual that must spend more time on their legs during the post-exercise period of soreness. Let’s say in a multi-day event or going back to work on Monday.

Could you make arguments for using compression using the latest literature? Sure. Would I use it in every race or workout? Nope. The reality is that if you think it helps you, then keep using it.

Sources:

http://journals.humankinetics.com/doi/pdf/10.1123/jsr.2015-0048

http://journals.humankinetics.com/doi/abs/10.1123/ijspp.2016-0162

https://www.researchgate.net/publication/301581402_Is_There_Evidence_that_Runners_can_Benefit_from_Wearing_Compression_Clothing

http://www.jospt.org/doi/full/10.2519/jospt.2015.5863

http://starkandwatson.com/wp-content/uploads/2014/10/Compression-and-Excercised-Induced-Muscle-Damage.pdf

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0031938415301566?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0031938415301566%3Fshowall%3Dtrue&referrer=http:%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0031938415301566

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

Are you bonking?

Anyone who exercises for an extended period is at the mercy of their stored energy and blood sugar levels. Glucose is the basic sugar circulating in the bloodstream and it is well controlled within a specific range for a healthy person. Stored sugar, glycogen, from your liver and muscles, can be used to keep the blood glucose regulated.

If your blood sugar decreases to lower levels during prolonged activity and can’t be stabilized, your brain will prioritize itself over anything else because glucose is its primary fuel source. This means working muscles are not exactly high on the list. You are in the process of bonking, otherwise known as non-diabetic hypoglycemia or exercise-induced hypoglycemia.

Risk of bonking increases with the following:

1. Longer duration of exercise
2. Higher exercise intensity
3. Exercise in a hot environment
4. Insufficient calorie intake during the day of exercise
5. Chronically insufficient calorie intake over a period of days
6. Insufficient recovery time from a prior bout of exercise or multiple days of exercise as it takes nearly a day to restore glycogen after it has been used (in ideal conditions)
7. Another recent episode of bonking
8. Dehydration
9. Limited prior exposure to depleting exercise
10. Athlete inexperience

Athletes are not always aware of the signs and symptoms of bonking until they become more dramatic. Some symptoms of the blood sugar drop are mental and others are physical. The initial cues can be subtle but the symptoms can progress to more severe levels rapidly. Many marathoners know this as the feeling of “hitting a wall” around mile 18 to 20.

When bonking, pace per mile might initially change by something small, like 15 or 20 seconds. But if the effort continues and no calories are consumed, you could easily slow by 1-5 minutes per mile or even more.

I’ve known many hard-working, well-trained marathoners that train months for an “A” race, doing tons of distance and maybe even trained up to 23-26 miles. They feel strong but depleted at the end of those long training runs but they train more slowly than they race. So by running faster in the actual race they burn through their energy stores sooner and completely crash despite decreasing mileage for several days in advance of the marathon. That’s tons of training wasted because they refused to learn to eat a little something in the marathon.

Bonking happens around the same point for most people because we all store similar amounts of glycogen that are used up at similar rates. It’s possible that years of training could allow someone to burn a greater percentage of fat for energy, but harder efforts always require higher glycogen dependence. And having run for just a couple years isn’t long enough to perfect a fat burning metabolism.

The signs and symptoms of declining blood sugar, in a general classification order of increasing severity:

Your job is to detect symptoms as soon as possible in order to keep your state from declining further. Ignoring the symptoms and hoping for the best is never going to end well. If you have signs and symptoms consistent with the green items, there’s a good chance you can pull things back together if you take appropriate action, though it won’t be a day of personal best performances.

A few experienced and lucky athletes might be able to come back quickly from the yellow zone but nobody is bouncing back from the red zone. Only the more stubborn people will even push themselves far into the yellow zone. It’s a super dangerous, slippery slope. Don’t do it. You can’t win against physiology.

Many people don’t have the motivation to put themselves deep into the pain cave, so they just automatically slow down in order to feel better when they feel uncomfortable and have persistent negative thoughts. Kudos to you for not being a ridiculously stubborn fool like some of us!

Simply slowing down may be sufficient to finish out the workout or competition. If you don’t want to slow down, then you need to eat something containing carbohydrates as soon as possible. Ideally this would be something with simple and complex carbohydrates. There are receptors in your mouth that detect sugars and just the act of eating can immediately reduce the brain’s stronghold on protecting you… from you.

But there’s a good chance that you need to slow down AND eat something, depending on how long you are planning to exercise. If you are bonking after 90 minutes and planned to be active for 3-4 hours then it’s going to be unreasonable to sustain the same effort without eating many more calories.  

Three truths about bonking:

1. You have to learn to eat during prolonged activity, even though you often won’t feel like eating, or the bonk will occur.
2. If you don’t eat and your intention is to maintain both a high intensity and a prolonged duration of greater than 2 hours, the bonk will occur.
3. Bonking is completely preventable.

Thanks for reading! Please let me know if you have any questions at derek@mountainridgept.com.

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.

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.

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

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 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.

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.

What is dry needling?

Trigger point dry needling, or dry needling for short, is a manual therapy technique used to increase motion, decrease overall muscle tension, and break up the painful “knots” that often form within muscles. It is known as dry needling because there is nothing injected.

I discussed how muscles often generate pain in this previous post. This type of pain is frequently overlooked. 

Dry needling the low back. Image courtesy of Corridor Magazine, 2014

Why use dry needling?

Those knotted areas are known as “myofascial trigger points.” They are often irritable and chemically different than a normal section of muscle. One type of trigger point, the active trigger point, is often the root cause of pain. Not only will the knotted area often be painful, there can be pain very far away from the actual trigger point. This is known as “referred pain” and it might be the only pain a person even feels with their injury. Referred pain can be present just a couple inches from the source but as much as multiple feet away. For instance, the gluteus minimus muscle that is deep at the side of each hip is approximately 3-4 inches in length. It can cause pain all the way down the outside of the leg to the ankle and will trick some people into thinking they have a sciatic nerve problem. Trigger points in the rotator cuff muscles of the shoulder frequently cause pain in the arm, forearm and even the hand. They can mimic a pinched nerve in the neck.

What does dry needling feel like?

There are multiple techniques that can be used when performing dry needling. A simple technique would involve placing the needle within the tightened muscle area and letting it rest there briefly. This is very easily tolerated and feels like a pressure, but it can cause a mild aching sensation in the most irritable trigger points. Another technique involves using the needle to get the muscle to contract. Again, there’s usually a sense of pressure but the aching can be stronger. The contractions themselves are more uncomfortable but are well worth the result. This is because it is common for someone to have their pain stop or nearly stop after a single session of correctly applied dry needling. Their motion is very often improved too.

What types of injuries benefit from dry needling?

Several things tend to form troublesome active trigger points. Overuse of a muscle - simply doing too much, too soon -  is a common factor. This could occur with an athlete that increases their training to quickly. A muscle that has decreased strength but is placed under a high demand will also often have trigger points. This often occurs with our shoulder’s rotator cuff muscles. They usually aren’t as strong as they should be and when we suddenly decide to clean out the garage the trigger point pain starts afterward. Trauma that suddenly strains a muscle can also be a cause of active trigger points. The low back muscles have this issue frequently, especially as repeated injuries have occurred the years. Tendon injuries commonly benefit from dry needling the muscle that attaches to the injured tendon. One of the best times to use dry needling is for a neck or low back injury that is causing nerve irritation. Relaxing the deepest muscles around the spine can decrease the nerve pain.

Are there other ways to fix trigger points?

Yes and no. Some trigger points are near to the surface and can be treated with techniques like myofascial trigger point release or massage. However, some trigger points are very deep and do not respond well to these techniques because there is so much muscle and fatty tissue to get through. I tend to favor trigger point dry needling because it achieves a great result with much less time per trigger point site. I can often have a more positive impact with dry needling three sites in 90 seconds than myofascial release to a single site that takes 4-12 minutes.

Exercise Tip Thursday - Take at least one FULL rest day every week, maybe even two

It's not the actual running mileage, the amount of weight lifted or the hard effort that makes you instantly faster and stronger. It's during the recovery (rest) in the days after that your body adapts to the stresses from exercise. The muscles and fascia (a connective tissue) generally require about 48 hours to return to baseline in a well-trained athlete. Less experienced athletes often need a third day. More experienced might only need 24-36 hours. Back-to-back days of exercise result in an accumulation of fatigue and muscle damage. This is especially true if you keep using the same muscle groups. Unless you are an elite or professional athlete then you should probably be taking more FULL recovery days. If you absolutely must exercise to stay mentally sane, get in something super easy like a slow swim or easy walk during one of the recovery days (which means it isn't a true full recovery day but an active recovery day). Otherwise, do some of the workouts that you need in a combined fashion. That means if you run five days each week and lift weights on two days then at least one of those weight training days is going to overlap with a run day in order to have a full day off. A day off is the perfect day to do your maintenance like foam and ball rolling for 5-10 minutes. 

Like the sign says, I'll be taking a full rest day after this triathlon is over. 

Please send any questions to mountainridgept@gmail.com.