The Anatomy of a Runner: Wooly Chaps and the Big Joint (the knee)

The fourth in a series of posts about what makes runners uniquely equipped to run. This post is a comprehensive review of the knee, including function, injuries, recovery and strengthening specific to runners.

THE KNEE

FUNCTIONAL OVERVIEW

IMG_3203
Courtesy: Hospital for Special Surgery

The knee is a complex synovial joint that flexes, extends and twists slightly from side to side. It joins the thigh bone (femur) to the shin bone (tibia). When we’re sitting, the femur and tibia barely touch; standing they lock together to form a stable unit.

Two groups of muscles support the knees, including the hamstrings, which are the muscles on the back of the thigh. They run from the hip to just below the knee and work to bend the knee. The other are the quadriceps, which are the four muscles on front of the thigh that run from the hip to the knee and straighten the knee from a bent position.

Webmd.com defines knee conditions not covered in this post, such as ACL strains or tears which leads to the knee “giving out,” damage to a meniscus – the cartilage that cushions the knee, which often occurs with twisting the knee, rheumatoid and knee osteoarthritis, bursitis, and gout (also a form of arthritis).

IMG_3240

A common sporting injury is pulling or straining the hamstring tendons, two groups of string-like connective tissues at the back of the knee and thigh that connect some of the major muscles of the knee.

Knee injury symptoms include pain, tenderness, swelling, locking, “giving way,” snaps, crackles, or pops.

For this discussion we’ll focus on the most common runner’s knee injuries, which fit into two categories – they rarely occur together:

1. pain on the side: iliotibial band syndrome (ITBS)

2. pain on the front: patellofemoral syndrome (PFPS)

PFPS affects the kneecap and surrounding area, where ITBS definitely affects the side of the knee (the side facing outwards).

Iliotibial Band Syndrome (ITBS)

IMG_3244The iliotibial band (IT band) is a band of fibrous tissue that runs along the outside of the thigh, from just above the hip to just below the knee, (like a cowboy’s chaps).

The IT band is made up of fascia, an elastic connective tissue found throughout the body.

Fascia is a sheath that encloses muscles, connects muscles to bone and compartmentalizes muscles that serve a similar function. The IT band is the largest piece of fascia in the human body.

It has traditionally been understood that the IT band provides stability to the knee and hip, and helps prevent dislocation of those joints. Hold that thought.

Understanding the IT Band

Opinions regarding the IT band, its definition, function, injuries and recovery, have evolved. In fact, precise descriptions of the IT band – which muscles attach to it and where – have been all but non-existent leaving this part of the anatomy perhaps one of the most controversial of all.

An injury of the iliotibial band, Iliotibial Band Syndrome (ITBS), was first identified in the 1970s and was thought to be the result of the IT band becoming tight or shortened, thus the recommended treatment of stretching.

Researchers at the University of Kentucky compared runners with IT band syndrome to healthy runners, however, and found that the injured runners actually had longer IT bands on average, but weaker hip muscles, indicating that strengthening the hip muscles may be more effective – not only for rehab, but for preventing the injury in the first place.

New studies have set out to prove that the iliotibial band moves, which also gave way to a new name for its injury: Iliotibial Band Friction Syndrome, or ITBFS –  except that this entire study contradicts other studies that have concluded motion of the IT Band is simply an illusion.

One of the more recent studies, reported in the Harvard gazette (August 2015) examined whether the iliotibial band actually stores and releases elastic energy to make walking and running more efficient (similar to an elastic band – as with the Achilles’ tendon).

To understand what role the IT band plays in locomotion, the researchers developed a computer model to estimate how much it stretched during walking and running ― and by extension, how much energy it stored. Then, using a custom-built frame, Carolyn Eng, the first author of these studies, manipulated human and chimpanzee cadaver limbs measuring how much the IT band changed in length for each shift in joint angle.

The study concluded that part of the IT band stretches as the limb swings backward, storing elastic energy. That stored energy is then believed to be released as the leg swings forward during a stride.

giphy

Computer simulation of a human leg running (Credit Carolyn Eng)

The view that the IT band acts as a ‘spring’ contradicts all previous understanding that its primary function is to stabilize the hip, but then it seems almost everything we thought we knew about ITBS is subject to change – and then change again.

Why it hurts: ITBS is no longer thought to be a tightening of the iliotibial band, but instead a layer of tissue under the iliotibial band that becomes inflamed (possibly causing a layer of fat and loose connective tissue to become pinched between the iliotibial band and the knee, causing ITBS).

What we do know is that ITBS is an overuse injury most common in runners and cyclists where the overuse creates stress the body cannot repair, and soft tissue breakdown occurs – the result of weak hips, running only on one side of a crowned road, or only one way around a track.  Studies also demonstrate that weakness or inhibition of the lateral gluteal muscles can be a factor.

Training errors can also cause iliotibial band issues – too much too soon or abrupt changes to intensity, as well as anatomical issues, such as leg length discrepancies, high arches, supination of the foot, excessive foot-strike force, knees that lean inward, and muscular imbalances within the hip.

And ITBS can be a common injury in activities such as gardening, hiking, treading water, running up and down stairs, excessive up-hill and down-hill running, and is increasingly recognized in other sports including soccer, weightlifting, and skiing. In other words, there are a plethora of causes for ITBS.

A good discussion of IT band pain can be found on runireland.com and at painscience.com.

Note: Up to 50 percent of cyclists experience knee pain. In one observational study of 254 cyclists over six years, 24 percent of the cyclists presenting to a sports medicine clinic for knee pain were diagnosed with ITBS.

Cyclists can develop ITBS if the saddle is too high, too far back, or if there is excess internal rotations (toed-in) of the lower leg – all of which put additional stress on the iliotibial band.

IMG_3215
Courtesy: moveforwarddpt.com

Where it hurts: An injured IT band can cause pain on the side of the hip, down the outside of the leg, and eventually on the outside of the knee, which is then considered IT band Syndrome (ITBS).

The epicentre of ITBS pain is on the outside of the knee – specifically the spot on the side of your knee, around the most sticky-outy bump (a technical term I’ve recently discovered), that is sensitive to pressure, while the kneecap is not particularly sensitive when pushed firmly straight into the knee.

  • It really hurts to go down stairs (or downhill running) but not so much going upstairs.
  • Doing a deep knee bend doesn’t necessarily hurt.
  • The onset of pain happened rather quickly – over a few hours rather than days.
  • Pain is worse after sitting for long periods of time.
  • Left unchecked, ITBS will produce a pain so great that running is impossible – bringing the body’s largest joint to its knees (so-to-speak).

Recovery:

First, the recovery steps that are not controversial:

  • Rest & Ice to reduce inflammation;
  • Stop the perpetuating factors that caused the irritation;
  • Sleep with a pillow between the knees to decrease tension on the IT band through recovery;
  • Add strengthening exercises for the hips to your exercise program.

Massage vs Stretch: for many years IT band stretches were suggested to relieve the pain associated with ITBS and to reduce the tightening of the fascia.

It is unclear that the IT band itself will stretch, however, leading some experts to  suggest it is most effective to stretch and strengthen the surrounding gluteal, quadriceps and hamstring muscles, which can cause tension on the IT band.

(A February 2017 study says the iliotibial band tensor fascia lata complex  (ITBTFLC) “is capable of tissue elongation under normal physiologic loads that simulate a clinical stretching protocol. It is uncertain whether this “stretch” translates into sustained, clinically meaningful tissue elongation.”)

While some physiologist swear stretching the IT band is 100% ineffective in treating ITBS, my research took a significant turn when a post on LinkedIn caught my attention, “Ilio-tibial Band: Please do not use a foam roller!” , which suggests it is actually massage that should be avoided at all costs – and it was in the comments  readers wrote in response to this LinkedIn post that I discovered even more controversial thoughts on ITBS.

I would suggest, in the absence of a more direct and agreed upon plan of action, that we all do what works best for us as individuals (remember N=1). I dealt with ITBS for several years before learning what worked best for me, which includes massage of the IT band (from the hip all the way to the outside of the knee) to relieve the soreness and relax the tendon (or whatever it is that’s sore), strengthening of the hips, and prevention.

Stretching the band provides temporary relief from the pain, but deep massage will relax and release the tension on the band (it can feel like a guitar string just under the skin). Massage can be uncomfortable at first so you want to be careful that you don’t make the soreness even worse: start with a minute and work up to 3 – 4 minutes at a time working (or using a foam roller, if you dare) up and down the outside of your thigh.

Massaging the band whenever it becomes sore will effectively prevent the progression of ITBS and the resulting pain in the knee, although it is important to understand what is creating the injury in the first place.

Running can be maintained during ITBS recovery only to the point the pain returns (i.e., if the pain returns after 3 miles of running, reduce your daily mileage to less than 3 miles so the entire run can be finished pain free). In my worst case of ITBS, I discovered I could run exactly 18 minutes before the pain returned, so I stopped at 17 minutes regardless of how much distance had been covered.

In some cases, the IT band has become so severely injured that running is impossible, and recovery and strengthening efforts only exacerbate the problem. In this case, total rest is recommended. Cross training may be considered, keeping in mind that some sports, such as hiking and cycling, may be counterproductive.

Runner’s Note: A review in the National Institutes of Health states that biomechanical studies have shown that faster-paced running is less likely to aggravate ITBS, and faster strides are initially recommended over a slower jogging pace.

IMG_3249
TREATING THE IT BAND; THE OTHER RUNNER’S KNEE (asimplehabit.com)

Patellofemoral Pain Syndrome (aka runner’s knee):

IMG_3216.JPGAlthough pain in or around the center of the knee has become known as runner’s knee, it can affect almost anyone – athletes and sedentary folks alike. Some say runner’s knee isn’t a specific injury but rather a broad term that describes the pain you feel if you have one of several knee problems.

Wikipedia says, “The diagnosis of patellofemoral pain syndrome is made by ruling out patellar tendinitis, prepatellar bursitis, plica syndrome, Sinding-Larsen and Johansson syndrome, and Osgood–Schlatter disease.”

Why it hurts: The medical cause of PFPS is thought to be increased pressure on the patellofemoral joint, although it is generally accepted that PFPS is brought on by many of the same issues, such as weak hips or muscle imbalances, training that progresses too fast too soon, extensive periods of sitting, a tilted patella, and other factors that place extra stress on the bone including flat feet, abnormal rotation of the hips, and tightness of the IT band or hip flexors, and wearing down, roughening, or softening of the cartilage under the kneecap. Obesity can also play a role in causing PFPS.

Where it hurts: The epicentre of PFPS pain is somewhere under or around the kneecap. It’s uncomfortable pushing your kneecap straight into your knee, but there is no particularly sensitive spot on the outside of the knee.

  • A deep knee bend definitely hurts.
  • The onset of pain happened slowly, possibly while ascending stairs or running uphill,
  • it definitely hurts when going upstairs, but may hurt going up and down.
  • Sitting with bent knees hurts, and hurts worse after standing up.

Recovery efforts begin with R.I.C.E. to “quiet the knee” followed by identifying any irregularities, such as pronation or supination. A physician should be consulted sooner rather than later to make a proper diagnosis and treatment plan.

Note: Chondromalacia Patellae and Patellofemoral Pain Syndrome/Runners Knee are terms often used interchangeably to describe anterior knee pain regardless of the cause of the pain. Although PFPS/Runners Knee may lead to Chondromalacia Patellae, the latter is a chronic degenerative condition affecting the articular cartilage on the under surface of the kneecap (although this too is different from the degeneration of knee osteoarthritis).

Does Running Cause Knee Problems and Eventual Arthritis?

A 2006 study measured the changes in the cartilage volumes in the tibia, patella and medial and lateral meniscus (the cartilaginous tissues that provide structural integrity to the knee) after the extreme dynamic loading that occurs in long-distance runners. It also examined the rate of recovery from the alterations occurring at the knee joint due to loading during distance running. This study revealed that after 1 hour of rest no significant reduction of cartilage volume was measured for the patella, the tibia or the lateral and medial meniscus.

Although there were significant changes after a 5, 10 and 20 km run, the conclusion on the basis of the study was that the cartilage is able to adapt well to the loads caused by running and that the articular structures were found to recover rapidly so that exercise could be continued after a short rest without reservation.

Every source seems to agree on several things we can do to help prevent long term damage to our knees due to injury and/or prevent the onset of osteoarthritis regardless of our chosen sport.

Avoid Carrying Extra Weight: Increased body weight, which adds stress to lower body joints, is a well established factor in the development of osteoarthritis. Your knees, which carry the brunt of your weight, are particularly at risk. For every pound you gain, you add 4 pounds of pressure on your knees and six times the pressure on your hips.

Research shows that excess body fat produces chemicals that travel throughout the body and cause joint damage, which would mean obesity plays a systemic, not just a mechanical, role in osteoarthritis onset.

Avoid Overuse/Injury: While running itself doesn’t increase the risk of osteoarthritis, running injuries can – especially when you delay treatment or rush recovery. If an injury is not properly cared for, the non-healing of it can cause the degenerative process of arthritis to start in the joints.

Train smart: don’t ramp up too quickly, don’t train if you’re injured.

Be Strong: Studies show that weakness of the muscles surrounding the knee is associated with osteoarthritis, especially in women, and makes the pain and stiffness worse after onset. Strengthening exercises for thigh muscles are also important in reducing the risk.

Strengthen the Knee

Minor increases in the strength of the quadriceps has been shown to help reduce the risk of knee osteoarthritis and its progression as well as reduce pain. Those suffering from arthritic knee pain can also benefit from exercise due to the support it provides to the joint area.

IMG_3241

This post is meant for informational purposes only. Please consult a physician to discuss your specific injuries.

 

Other Posts in this Series:

The Anatomy of a Runner

The Anatomy of a Runner: it’s all about that bass (the Upper Leg & Glutes)

The Anatomy of a Runner: be still my beating heart

The Anatomy of a Runner: Mind the Hips

Advertisements

The Anatomy of a Runner: Mind the Hips

The third in a series of posts about what makes runners uniquely equipped to run. Although this post was intended to cover the hip and the knee, the two topics proved difficult to combine because the big joint turned out to be bigger than I thought it was going to be.

FUNCTIONAL OVERVIEW

The hip joins the leg to the trunk of the body at the hip joint. The femur, the biggest and strongest bone in the skeleton, terminates in a ball that fits into the socket of the hip, and articulates with the pelvis to form the hip joint.

The primary function of the hip joint is to support the weight of the body in both static (standing) and dynamic (walking or running) postures, and retain balance.

The hip joint is one of the largest joints in the body and a major weight-bearing joint – stresses on the hip can be 5 times a person’s body weight during walking.

Increasing the extension of the hip joint improves speed for runners while disease or injuries of the hip affect a runner’s gait and places abnormal stress on other joints, such as the knee.

Mind the hips and the feet will take care of themselves.

IMG_3196
Wikipedia

Dean Kamen (son of Jack Kemen, an illustrator for Mad, Weird Science and other EC Comics publications) introduced his invention as “the world’s first self-balancing human transporter.” Kamen’s model for the Segway was — the human body.

Usually we don’t fall on our faces when we stand up and lean as far forward as possible. Your brain knows you are out of balance – fluid in the inner ear shifts triggering you to put your leg forward and stop the fall. If you keep leaning forward, your brain will keep putting your legs forward to keep you upright, and instead of falling we walk forward, one step at a time.

Like the base of a Segway, a runner’s hips should remain solid, level and neutral. That’s not to say runners don’t compensate for certain genetic tendencies, but most experts agree we should shore up any posture issues, including anterior pelvic tilt, before beginning a running program. (Read more at Runners World here).

Do you have Anterior Pelvic Tilt?

THE HIP

IMG_3199

Photo courtesy: Functional Anatomy of the Hip Complex by Coach Sean Cochran

MAJOR PLAYERS:

Viewing the hip joint in terms of layers, the deepest layer is bone, then ligaments and tendons, and finally muscles.

Tendons allow for the power of movement across the joints; ligaments support joints by attaching the bone ends and allow a stable range of motion. Muscles are on top, which, in the case of the hip, consists of over 20 muscular attachments.

1) HIP BONES

Anatomy Of The Hip And Pelvis Hip AnatomyThe hip joint is a ball and socket joint, formed by the head of the Femur (thigh bone) and the acetabulum of the pelvis.

Cartilage, a stiff but flexible connective tissue allows smooth movement of the joint. Less rigid than bone, you can think of cartilage as the tissue that forms the more flexible structures of the body – the septum of the nose, the external ear, the trachea.

Cartilage is good with weight-bearing, which is why it is found in our joints, although cartilage has almost no blood vessels and is very bad at repairing itself. Bone is full of blood vessels and is very good at self repair.

IMG_3226
Mendmyhip.com

Where friction occurs between muscles, tendons, and bones there is a structure called a bursa: a thin sac of tissue that contains fluid to lubricate the area and reduce friction.

Injuries of the hip bones can be a result of arthritis or a fracture of the bone, but can also be a tear in the labrum (the cartilage between the bones), inflammation of the bursa sac, or the impingement of the iliopsoas tendon.

Hip pain across the front of the hip is worse than pain on the side – the general rule being that hip pain over the front of the hip joint is more serious than pain on the outside of the joint.

A FRACTURE is a break in a bone.

Where it hurts: Pain coming from the bones of the hip joint, or the cartilage between these bones, most often hurts in the groin area. Tenderness on the bone is indicative, although the bone is difficult to push on because of the overlying muscle.

Symptoms of a broken bone include pain (intensified when the area is moved or pressure is applied), swelling, bruising, and loss of function. Fractures may also cause the area around the bone to appear distorted or deformed.

IMG_3217
Stress Fracture Symptoms & How To Speed Up Recovery”  draxe.com

STRESS FRACTURE is a hairline crack in a bone that worsens over time.

Where it hurts: Deep pain in the area that worsens with running or hopping and gets worse over time is suspicious for a stress fracture. In addition to pain (increasing with activity and decreasing after rest), symptoms include swelling and tenderness.

Stress fractures of the hip and pelvis are common injuries for runners, and can initially feel like a pulled muscle sometimes delaying a correct diagnosis.

A stress fracture in the neck of the femur hurts mostly in the groin area, is made worse with every step during the foot-strike phase of running, and may also hurt at night.

X-rays usually don’t show a stress fracture for 3-4 weeks, requiring the use of a MRI for diagnosis.

Runner’s Note: Women who miss menstrual periods are at increased risk of developing stress fractures.

LABRAL TEAR: Just like the ball and socket joint of the shoulder, the hip joint has a labrum – a circular layer of cartilage surrounding the outer part of the acetabulum (the socket of the hipbone, into which the head of the femur fits) effectively making the socket deeper to provide more stability. Labrum tears are a common injury to the hip joint.

Where it hurts: Symptoms of a labral tear include pain in the groin area, stiffness, and mechanical issues in the hip such as clicking, catching, or locking. Labral tears can heal with rest, but may require surgery.

IMG_3219

BURSITIS: an inflammation of the bursa, fluid-filled sacs located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation.

The bursa that sometimes causes problems in the hip is sandwiched between the bump on the outer hip (the greater trochanter) and the muscles and tendons that cross over the bump.

This bursa, called the greater trochanteric bursa, can get irritated if the iliotibial band is tight (the ligament that runs along the outside of the thigh and discussed further in the post about the knee).

Another bursa sits in front of the hip joint, and a third bursa over the bump of bone in the buttocks.

Why it hurts: Bursitis is caused by overuse, a tight hamstring or tight iliotibial band.

Where it hurts: If you feel burning, rubbing, a popping sensation, or have tight leg muscles and feel a dull ache on the outside of your hip during or after a run, you could have bursitis.

IMG_3220Note: Bursitis can occur around any joint in the body, but the joints that are most active are the more common sites for bursitis, including the hip, knee, heel, shoulder, elbow, and wrist.

IMG_3236
HIP (TROCHANTERIC) BURSITIS EXERCISES (Summit Medical Group)

Hip Bone-Related Recovery: Most hip bone related injuries can be treated with cold/hot compresses (to reduce inflammation/pain) and rest from running, however, some are more severe and crutches or even surgery may be necessary. Consult your physician.

As stated earlier, labrum tears may require surgery. These injuries typically occur because of an error in training (doing too much too fast).

2) HIP LIGAMENTS & TENDONS

IMG_3205

The stability of the hip owes greatly to the presence of its LIGAMENTS, which shape and stabilize the hip by limiting hyperextension and attach the pelvis to the femur.

Why it hurts: Ligament strains or ruptures occur if the joint is twisted or overstretched.

Where it hurts: Usually a “snapping” or “cracking” occurs when a ligament ruptures, which is followed by bruising, swelling and pain. Movement of the hip will usually be limited due to pain.

The most commonly injured TENDONS in the hip are the iliopsoas tendon, iliotibial band tendon (IT band), and the ischial tendon — although the most commonly injured tendon of all of these is the iliotibial band (which will be covered in-depth when this series reaches the knee).

Why it hurts: Tendons in the hip area that attach the hip muscles to the bones can become brittle with age, overuse, or from old injuries that have not properly healed.

Tendon injuries in the hip can range from a mild strain to a full rupture (three different grades of injury determined by the severity of tissue damage). Other soft tissue damage in the immediate area may also occur with a tendon injury.

Unfortunately, tendons by nature receive very little blood flow, which prevents them from getting adequate oxygen and the nutrients necessary to repair themselves.

Where it hurts: pain and tenderness likely in the injured area of the hip and/or groin.

Recovery: X-rays, MRI or CT-scans may be required to properly diagnose certain hip ligament and tendon injuries. Consult a physician, sooner rather than later.

3) HIP MUSCLES

The hip muscles provide dynamic support to the joint and occur in three planes: 1) the iliopsoas in the front, 2) the tensor fascia lata on the side, and 3) the gluteus muscles on the back of the hip joint.

IMG_3222.JPG

[Runningplanet.com offers a comprehensive description of all of the hip muscles and their contribution to running.]

The muscles of the thigh and lower back work together to keep the hip stable, aligned and moving – including the four basic movements of the hip: bend, straighten, taking the leg away from the body, and bringing the leg back toward the body (flexion, extension, abduction, adduction).

The gluteus maximus also keeps the head of the femur from sliding forward in the hip socket; if it can’t do this, pain results from the femoral head pressing against the soft tissues in the front of the hip joint.

IMG_3238

IMG_3206
The Iliacus and Psoas Major

1) The iliopsoas muscle is actually made up of two separate muscles located in the front of the hip area: the Iliacus and Psoas, which are responsible for lifting the upper leg to the torso, or flexing the torso towards the thigh (as in a sit-up).

Why it hurts: Iliopsoas tendonitis is mostly caused by repetitive hip flexion or overuse of the hip area, resulting in inflammation.

Iliopsoas Syndrome is caused by a sudden contraction of the iliopsoas muscle, which results in a rupture or tear of the muscle, usually at the point where the muscle and tendon connect.

Athletes at risk include runners, jumpers and participants of sports that require a lot of kicking. Also at risk are those who participate in strength training and weight lifting exercises that require a lot of bending and squatting.

Where it hurts: Pain and tenderness of the muscle are common symptoms of both conditions; however the onset of pain associated with iliopsoas tendonitis is gradual and tends to build up over an extended period of time, whereas the pain associated with Iliopsoas Syndrome is sudden and very sharp.

Tendonitis of the iliopsoas muscle group also hurts in the groin, but unlike a stress fracture, it tends to hurt with lifting of the leg, such as during the striding phase of running.

Recovery: A self-treatment recommended for a soft tissue injury of the iliopsoas muscle, like for other soft tissue is a RICE regimen lasting for at least 48 to 72 hours after the onset of pain. “Rest” includes avoiding running or hiking (especially on hills), and avoiding exercises such as jumping jacks, sit-ups or leg lifts/flutter kicks.

If self treatment is not successful or the injury is interfering with normal activities, consult a physician.

IMG_3213.JPG

IMG_3239
Summit Medical Group
IMG_3214.JPG
imgarcade.com

2) The tensor fascia latae (TFL) keeps the iliotibial band taut and braces the knee, especially when the opposite foot is lifted.

When weight is on one leg, the tensor fascia latae contracts, pulls down on its own side of the pelvis and lifts the opposite side, as the opposite leg swings forward.

Athlete’s note: The tensor fascia lata is also heavily utilized in horse riding, hurdling and water skiing.

Why it hurts: Weakness in the rectus femoris muscle, the top quadriceps muscle along the front of your thigh, and excessive tightness and shortening of the primary hip flexor (a common occurrence in those of us who sit for long hours). Read more at lower-back-pain-answers.com.

IMG_3221

 

The TFL along with part of the gluteus maximus form the two arms of the letter “Y”. The long vertical portion of this complex is the iliotibial band.

 

Runner’s Note: TFL issues can be more exaggerated in runners who are heel strikers because the quadriceps, and especially the rectus femoris, are severely underused. Read more.

Where it hurts: A tight or shortened TFL causes pelvic imbalances that lead to pain in hips, as well as pain in the lower back and lateral area of knees.

The gluteals or the piriformis muscle can suffer from the unnatural “pull” from an excessively tight TFL, resulting in pain felt in one or more of the following areas…

  • Deep in the hip joint, the groin, or wrapping around the outer hip;
  • Deep in the gluteal muscles, the sacroiliac joint, or traveling down the leg.

Recovery/Treatment: Massage therapy of the tensor fascia latae is the best treatment. Use a pillow between the legs when lying on your side during recovery, maintain mobility and flexibility of the entire hip by stretching the hip flexors. For more information, click here.

Additional Reading:  “One Tensor Fascia Latae, please.”

Note: although self-massage can be very effective with an ITBS injury, the location of the greatest pain in a TFL injury can be difficult to reach due to the bones of the hip. The assistance of a qualified massage therapist may prove beneficial.

RUN FASTER: it’s all in the hips

Research shows the main difference between walking, running and sprinting to be at the hip. The ankle and knee joints go through about the same range of motion for all three activities, but when increasing speed, the hips must be more active.

Because distance runners don’t normally sprint, there is little need for the muscles around the hips to be strong. Another problem is that runners tend to only run straight ahead so that the hips have no reason to work in multiple planes of motion.

The most immediate improvements for distance runners is to perform agility drills. These multi-directional movements will force the hip muscles to activate, become stronger and correct muscle imbalances – just as any cross-training effort improves the opposing, lesser used muscles.

Hip Mobility

Test it With:

Prisoner Squats. With your feet shoulder-width apart and your hands clasped behind your head, sit until your thighs reach parallel. If you can’t get that low, your knees collapse inward or your heels lift, that’s an “F.”

IMG_3223

Fix it With:

Plate Squats. Perform Squats while holding a 10-pound plate with your arms extended in front of your chest. Make sure your thighs reach slightly below parallel. Perform 3 sets of 10 reps.

IMG_3224

Runner’s Note: Ideally the hip joint acts as a fulcrum as your body moves forward when you run. Adequate mobility is needed to take advantage of this forward propulsion. This results in a sufficient stride angle during running gait.

“Usain Bolt Flies on Big Stride Angle” from somaxsports.com.

The stride angle is the maximum opening between the front and back thighs. The stride angle is critical for running speed because research has shown that for every degree you increase your stride angle, you increase your stride length by 2%.

Stride, angle and rate will be covered when The Anatomy of a Runner series touches ground in our post: Stride Right.

HIP EXTENSION: Rather than trying to lunge the leg out as far as you can, kick the leg back as far as you can, increasing the hip extension. Propulsion in running occurs in extension. Achieving maximal hip extension allows the feet and the rest of the lower body to work correctly, producing a faster pace.

A video on improving hip extension to become a faster runner. Also found at philly.com

IMG_3198

 

 

11 Exercises to Boost Hip Strength For Cyclists by Active.com

 

Hip Strength For Runners at runnersconnect.net.

IMG_3202It’s All In The Hips” by Runners World

This post is meant for informational purposes only. Please consult a physician to discuss your specific injuries.

The Anatomy of a Runner: it’s all about that bass (the Upper Leg & Glutes)

IMG_2926.PNG

The first in a series of posts about what makes runners uniquely equipped to do what we love to do most. . . run.

Functional Overview:

The lower leg is the part of the lower limb that lies between the knee and the ankle. The thigh is between the hip and knee and the term “lower extremity” is used to describe the colloquial leg. For this discussion, the runner’s base is considered the upper leg, which begins at the hip and the Gluteus Maximus and continues to the knee.

In human anatomy the knee is the connecting line between the upper leg and the lower leg. This connection, and the resulting tension caused by its relationship between the two has caused the topic of the knee to be moved to another post. We’ll get a feel for the knee’s function as it relates to the upper leg, but delve into specific knee injuries another time.

Key Facts: The only bone in this region is the femur, the largest bone in the body. The femur’s head creates the ball of the ball-and-socket-style hip joint. The base of the femur makes up part of the knee.

Major Players:

Gluteus Maximus (the “glutes”): muscle located in the buttocks regarded as one of the strongest muscles in the human body. Responsible for movement of the hip and thigh, contributes to good running form and alignment. Standing up from a sitting position, climbing stairs, and staying in an erect position are all aided by the gluteus maximus.

Hamstrings: three muscles at the back of the thigh that affect hip and knee movement.

Quadriceps: the strongest and leanest muscles of the body – a four-muscle group at the front of the thigh that work to extend the knee and lower leg.

Knee: a pivot-like hinge joint that connects the bones in the upper and lower leg. It is the largest joint in the human body. The knee is where the femur in the upper leg meets the tibia and fibula bones of the lower leg. The patella, or kneecap, is at the center of the knee.

Tendons, ligaments, and protective elements, such as cartilage and bursa, connect and protect the bones to keep them in place and prevent them from grinding against each other while also allowing the knee joint to flex and twist slightly.

Glutes

gluteus_all
Healthline.com

Why it hurts: The most common cause of a gluteus injury is stretching or straining one of the muscles beyond its normal range of motion – especially prominent with soccer, football, and baseball players who make sudden movements and overexert their legs during a play.

However, track events such as hurdles or the long jump, or a runner’s rapid acceleration (particularly up hills) can also increase the likelihood of a gluteal strain.

Excessive acute stress on a gluteal muscle can cause it to tear, which usually results in immediate pain and leg weakness.

Where it hurts: symptoms include numbness in the buttocks, hip and possibly the thigh down to the ankle with difficulty walking normally and rising from a seated position.

Prevention/Recovery: rest, cold/hot therapy, massage, and eventually strengthening exercises. According to a review in the November 2005 issue of “New Zealand Journal of Physiotherapy,” a full squat and running on an incline require the greatest gluteus maximus function. Start slow and easy.

Test Your Strength:

30 Second Chair to Stand test: this test measures the ability to stand up from a seated position as many times as possible in a thirty-second period of time. Testing the number of times you can stand up in a thirty-second period helps assess strength, flexibility, pain, endurance, and progression of recovery.

Runner’s Note: according to the physique-oriented website Waist, Hips & Thighs, doing repeat sprints using starting blocks is the best way to build the gluteal muscles. If you’re hoping to avoid the over-emphasized glutes (aka “bubble butt”), focus on long, easy mileage rather than short, intense bursts of speed.

Hamstrings

Why it hurts: also known as a pulled hamstring, is defined as an excessive stretch or tear of muscle fibers and related tissues. Hamstring injuries are common in athletes participating in many sports and are very difficult to treat and rehabilitate. Track and field athletes are particularly at risk, as hamstring injuries have been estimated to make up 29% of all injuries in sprinters.

Research proposes predisposing factors to injury include muscle weakness, muscle imbalance, poor flexibility, fatigue, inadequate warm up, poor neuromuscular control, and poor running technique. One of the few predisposing factors that most researchers agree upon, however, is previous hamstring injury. Brokett et al. (2004) stated that “the athletes most at risk of a hamstring strain are those with a previous history of such injury” and noted that 34% of the hamstring injuries were recurrences.”

Cameron et al. also found that 34% of injuries recur in the same season. Arnason et al. generalized these numbers, saying that previous injury was in itself an independent risk factor for re-injury.  (Reference: Wikipedia)

Where it hurts:

Grade 1: Sensation of cramping or tightness and a slight pain when the muscles are stretched or contracted.

IMG_2927Grade 2: Immediate pain more severe than the pain of a grade one injury. It is confirmed by pain on stretch, swelling and contraction of the muscle.

Grade 3: A grade three hamstring strain is a severe injury. Immediate burning or stabbing pain, unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is.

Prevention/Recovery: almost always, the hamstring strain occurs just before the lead foot hits the ground, when hamstring tension peaks to resist forward motion of IMG_2924the swinging leg. Incorporate agility and trunk stabilization exercises, stop and stretch during runs.

Avoid over-the-counter anti-inflammatories, which can interfere with tendon remodeling.

Deep tissue massage is better for recovery and pain.

It is usually possible to continue running through recovery.

Shorten your stride, increase cadence, and keep the pace slow.

If the injury is too painful to run, avoid prolonged wet-vest pool running. Although it is true pool running maintains aerobic capacity while recovering from injuries such as stress fractures, pool running fails to adequately stress the hamstrings since the resistance provided by the water forces the quads to pull the lead leg forward while the hamstrings are stressed only while pulling the leg back.

The natural function of the hamstrings is to fire eccentrically when they lengthen to stop forward motion of the lead leg. By failing to strengthen the hamstring eccentrically, pool therapy often results in rapid hamstring re-injury as soon as the runner attempts to run fast.

 

Test Your Flexibility:

Test it With:  Toe Touches. To see if your ‘strings are supple enough for Deadlifts and Olympic lifts, put your feet together, bend over and touch your toes. Can’t reach? Back rounds when you do? Better loosen up.

image

Fix it With:  Leg Lowering Pattern. Lie on your back with both legs in the air. Place a band around one foot, then lower your opposite leg, keeping the leg straight and core tight. Perform 3 sets of 10 reps on each leg.  (Read more at Champions Are Made In The Off-Season.)

image

 

Runner’s Note: the glutes and hamstrings have far more fast-twitch muscle fibers than the quads, making them more powerful and explosive. If too much attention is placed on strengthening the quads, thereby creating an imbalance, the glutes and hamstrings will suffer. A lack of strength in the hamstrings compared with the strength in the quads can result in an unstable knee joint and assorted lower-body injuries.

Quadriceps

The Marathoner vs The Sprinter

Why it hurts: As mentioned above with the hamstring movement, eccentric loading occurs when muscles lengthen and shorten at the same time. When we run, our quadriceps contracts when our foot touches the ground. This stabilizes our knee and stops us from collapsing. But even stabilized, our knee bends slightly, stretching our quadriceps as it shortens. This eccentric tug-of-war creates enormous tension on the quads.

Where it hurts: Athletes with quadriceps strains often complain of a “pulling” sensation in the front of the thigh. Pain, swelling, bruising and muscle tenderness may also occur. Its severity is categorized by the same grades as with the Hamstring injury.

Prevention/Recovery: a counterintuitive strategy for recovering from a quad injury was offered by Pete Magill in Runner’s World: Cure Quad Pain, Calf Pain, and Heavy Legs: “Running downhill can cure quad pain once a runner’s legs adapt to the eccentric overload caused by the activity,” says Beaverton, Oregon, coach and exercise scientist Tom Schwartz. “Initially, the soreness caused by downhill running can be quite harsh.

A parallel is the soreness caused by starting a new weight training regimen. Soreness is caused by the lowering of weights, which is the eccentric loading. Lifting weights, which is concentric loading, doesn’t cause soreness.”

Brisk downhill running increases the eccentric load on our quads, causing more muscle damage. The good news is that once our body repairs this damage, we’re left with quads that are pain-free, stronger and protected from further injury.

Although there is no substitute for real descent repeats, eccentric single-leg squats and lunges may also prepare the muscles for downhills.

IMG_2869

Other eccentric Quad strengthening exercises include the straight-leg deadlift, good morning squat and the calf raise used by shortening the concentric phase to one second and extending the eccentric phase to at least three seconds. (Read more at runningcompetitor.com.)

(Additional Reading: Quad Strengthening Exercises from the Bay Area Orienteering Club.)

Runner’s Notes:

Weak hip muscles can allow the legs to angle inward or outward instead of keeping each stride in line.

Underdeveloped gluteal muscles might cause the runner to lean his or her trunk forward.

An imbalance between opposing muscles, particularly, is a major cause of the repetitive stress injuries.

Next up in our series: be still my beating heart.

Meghan Trainor declared, “I’m all about that bass, ‘Bout that bass, no treble, …”, and while runners everywhere train by the very beat of their heart, Meghan’s lyrics may be more true than we first thought.

IMG_2930.JPG

The Anatomy of a Runner

Some athletes have left an indelible mark – they are so spectacularly talented it simply boggles the mind.

Michael Jordan comes to mind. I was lucky enough to have watched him play at the United Center in Chicago some years ago. He was mesmerizing. And I’m just old enough to remember Walter Payton running across the field for a touchdown, like art in motion. . . the same as watching Michael Phelps swim, or Shalane Flanagan’s stride. The examples are endless, but what is it that makes these athletes successful? The magic question.

It would be easy enough to blame it on genetics, but I would offer up Misty Copeland – the first African American woman to be named principal dancer with the legendary American Ballet Theatre. Whatever your ballet stereotypes, Copeland probably doesn’t fit them. She’s been told she shouldn’t wear a tutu – she doesn’t have the right legs, her muscles are too big.

IMG_2882Emil Zátopek was the first runner to break the 29-minute barrier in the 10,000 meters, and the instigator of interval training. Even as he trained to become an Olympian, he wore work boots instead of running shoes, and moved his torso in a way that many criticized as inefficient. His tortured facial expressions prompted one sports columnist to remark that he “ran like a man with a noose around his neck.”

He is the only athlete to win the 5,000 and 10,000 meter races, as well as the marathon (a race he had never run) in one Olympic Games.

IMG_2871.JPG

What many of our favorite athletes have in common is that they were unlikely candidates for their sport. They move funny, have unorthodox body types, suffered devastating setbacks, started their sport late in life. . . or didn’t burn out despite starting too early. We all have more in common than we thought.

I hold my elbows too far out when I run. It probably makes me slower. Maybe you kick one leg out at the back of your stride, over-pronate, or carry your hips off-center. Does it matter? If we review the most unorthodox athletes of all time and consider their accomplishments, I would have to suggest the answer is no, it doesn’t matter.

Does it cause injuries? Maybe.

IMG_2885.JPGMy first real issue was that my toes went numb when I ran. My husband and I tried everything – larger shoes, different socks, orthopedic inserts. Once we figured out the problem was Morton’s Neuroma, I was on a mission to discover a fix, which turned out to be as simple as taking one vitamin B-12 each day – for ten years and counting.

Whatever the injury/pain/issue, the anatomy behind the issue became as fascinating to me as the running itself.

Runners have hundreds of issues in common. We have a propensity for pulling the same muscles: the quad, hamstring and/or calf muscles. Then there are those dreaded black toenails (cut them short!).

Muscles that are the most prone to cramps are those that cross two joints. A weakened Tensor Fascia Latae can tug on the knee and vice versa. Gentle stretching may help the sore Achilles’ tendon and an out of sorts Plantar Fasciitis, but does very little to loosen a tightened ITB. If you have knee problems, it might be wise to strengthen the hip. A sore back? Strengthen the abs.

IMG_2870

Every athlete is different. Our execution varies from one to the other. What works for me may not work for you, and vice versa. One thing is certain, however, the anatomy behind our running that can (and eventually will) affect our running is shared by us all, and it spans from our brains to our little toe.

A better understanding of our anatomy may be the secret sauce in the never-ending quest to remain injury free – something else we all have in common, whether you’re a runner, walker, dancer, gardener, or mom lifting baby.

(Reader Alert: consider this the prologue of another Fartlek series of posts: The Anatomy of a Runner.)

Next up:  The Anatomy of a Runner:  it’s all about that bass.

A Moment at the Crossroads

Running has been the love of my life, and at times torture. My husband and I researched the perfect, new spot to call home taking into consideration lifestyle, weather and running, only to find the running is killing me.

Studies often debate what distance runners think about during the long hours of running. If you have a loud-mouthed muscle screaming with every step you take, I promise it’s all about pain.

Despite this current agony, mileage has crept above 50 miles per week, and plummeted to 30. For sure, this roller coaster training plan leaves a lot to be desired for becoming race-ready.

Last Wednesday, I had finished 1-1/4 miles when I came to a fork in the path. The dirt path to the right cut a peaceful trail through the center of the forest. The path to the left meant 7 more miles of pain. I stood at the crossroad balancing the pain in my right thigh with the week’s total mileage goal. . . my gaze never leaving the path through the woods.

Ailments have come and gone, and come back again over the past few weeks. The thing about perpetual sore is that it wears you down mentally. Athletes learn to distinguish between the miserable pain of sore from the sharp pain of injury, but it is the sore that can become a death sentence.

For beginning runners, sore is enough to make you quit altogether, not realizing it will eventually subside. For the seasoned runner, sore lands you squarely in the land of grey – it hurts bad enough to be maddening, but you know it doesn’t hurt bad enough that you should stop training. Eventually, you have to remind yourself these ailments are self-induced, and. . . there is a cure.

I chose the path to the right that day and reduced my pace to a leisurely stroll through the forest. It was heavenly.

Dudley and I paused to look across the lake at the fall colors.

Realizing Dudley must miss his mountain strolls as well, the two of us hiked the Nat Greene trail along Lake Brandt on Thursday. A sign identified the Piedmont’s wild animals, which thankfully did not include the untethered dog or black bear.

We meandered through the forest, Dudley focused on the cornucopia of smells, and the chore of marking each one, while I focused on ground covered. We found a compromise and enjoyed ourselves immensely. I swore I would not run the rest of the week.

On Saturday morning, I finished the 8-mile run from three days earlier. My husband said, “You just can’t quit can you?”

Sometimes a mental rest day, or two or three, is the best tool in your training arsenal.

The Subtle Dance of Running Again After Injury

background-kid.com
background-kid.com

Returning from space, Earth’s atmosphere presents a dense, fluid medium, which, at orbital velocities, is not all that different from a lake’s surface. Hit the atmosphere at the precise angle and speed promises a safe landing. Hit too steeply or too fast risks making a big “splash,” which would mean a fiery end. If the impact is too shallow, you may literally skip off the atmosphere and back into the cold of space. This subtle dance between fire and ice is the science of atmospheric re-entry.

 

Sometimes a lull in training can be traced back to events (or life) in the months, or even years prior to the lull. If this lull produces an injury, re-entry becomes the trickiest maneuver by far.

During the second half of 2014, I ran the most difficult marathon race course I’ve ever seen, followed by a fall semester of climbing, paddling and swimming at school, the Outdoorsman Triathlon, a Half Marathon, the MedicForce trip to Kenya, school finals, graduation…. and the holidays.

Determined to run a spring marathon again this year, training resumed in January without hesitation…. except, I was tired – supporting my theory that injuries often come about when we are worn out. My right foot started breaking down, and despite my prevention regimen, there was pain on top of my foot (stress fracture) and plantar fasciitis.

I went into full recovery mode: 2 weeks on the bicycle, followed by a week of 60-minute walks on the track…. followed by re-entry.

ESTABLISH PREREQUISITES

When I could finish these walks without pain, “hopping” around the house became part of my morning routine. How funny, you may think, but if you can hop on the injured foot without pain, there’s a good chance you can run. The other two prerequisites for re-entry is that there be no swelling, especially first thing in the morning, and no point specific pain (pain when you press down at the site of the injury).

DISCOVER YOUR BASELINE

It’s useful to know the distance you can run when everything has fallen apart. For me, that distance is 3 miles — the distance I could run with my eyes closed. Late in a tough race, it’s the distance I know I can cover no matter what has gone wrong, and it’s usually the longest distance I can run without pain in the early days after recovering from an injury.

Baseline is the distance you can run at a slow pace without pain during or after the run. If necessary, adjust your baseline distance. If you feel pain 2 miles into a 3-mile run, re-establish your baseline at just under 2 miles.

SMART SCHEDULING

A 3-mile run is scheduled in my calendar every other day with the agreement that under no circumstance will I continue the run if I feel pain. Some may disagree, but a niggle here or there does not constitute pain in my world. The return to movement after injury can cause niggles. As long as they work out within a few minutes, I keep going.

After the run, my focus is again on residual soreness, pain or swelling.

Baseline weekly mileage begins at 12 miles a week for me (3 miles x 4 days). This mileage is maintained until there’s absolutely no soreness during or between runs (usually 2-3 weeks).

MASTER BACK-TO-BACK DAILY RUNS

The next critical point in scheduling is back-to-back runs. Survive that first week of two runs in a row, and you’re in a good place. When it’s safe to advance, one extra run is added weekly until there are at least 6 days of running, and only then will I add longer runs. Elapsed time from re-entry to this point is about 4-6 weeks, with an 8-10 week re-entry schedule being a little more conservative.

Some coaches will prescribe runs of varying distances from the beginning, however, I prefer the Jack Daniels’ base-building formula of mastering 6-7 days of back-to-back runs of the same distance before adding the stress of longer runs.

It’s a slow process for sure, but the alternative of coming in too steep or too fast results in a big splash… meaning a “fiery” end to re-entry.

With the diagnosis of my first stress fracture years ago, the doctor told me a little exercise is good for rehabilitation. Loading of tissue stimulates healing – the trick being to find the right level of exercise at each stage of injury.

Don’t exercise at all during recovery and you risk a re-entry that is too shallow, leaving yourself worse off than before and more susceptible to re-injury – literally skipping off the atmosphere and back into the cold of space.

Structure your workouts during recovery and re-entry to gain strength…. become as strong as you possibly can using a cross-training program that has no impact on the injured area, keep re-entry runs slower than usual, and change only one thing at a time. Most of all, keep a positive attitude and enjoy the dance.

 

For a broader look at returning to running after an injury, including sample schedules, read Returning to running after injury by Tom Goom, a runner, physiotherapist and founder of RunningPhysio.

Related:

We promise to give you approximately 26.2 tough and memorable miles.

The 2014 Outdoorsman Triathlon and a 3rd place finish.

“There is no bad weather, only bad gear.”

Running with the Kenyans

New Remedies for Plantar Fasciitis

scenarioPatients were scattered in the cool, wet grassy area just outside the classroom. Half the students pretend to be wounded, complete with fake blood and bruising, while the other students exercise their newly learned wilderness first aid skills. I was casually roaming between medical catastrophes answering questions and asking in return, “Are you going to touch that patient without your gloves?”

This was the day I felt the short-lived, but unmistakable, sharp pain on top of my right foot – it had stress fracture written all over it.

If I know how to react to anything in life, I know how to react to that sharp, little pain on the top of my foot. Action, or reaction, is swift and aggressive: a continuous dose of herbs, the offending area is taped, and extra days of rest added to the schedule. Preventative measures escalate every few days until the issue is resolved; my focus so intense on this little pain that I totally ignored the soreness in the arch of the same foot.

After several weeks of denial, I announced to my husband, “Its plantar fasciitis.” Swift and aggressive reaction finally began.

Last June, Dr. Thomas Michaud wrote an article, New Techniques for Treating Plantar Fasciitis, and updated it this month, as if on cue for me to discover it on running.competitor.com this week – just in time research.

Predicting Plantar Fasciitis

running.competitor.com
running.competitor.com

The plantar fascia, connective tissue that runs from the heel to the base of the toes, stabilizes the inner forefoot as forces peak during pushoff (runners expose the plantar fascia to up to 7x their body weight during the pushoff phase). The plantar fascia passively stores and returns energy, while another lesser known, small muscle that goes to the toes (the flexor digitorum brevis muscle – FDB) plays a more dynamic role in variable load sharing.

When tension in the plantar fascia gets too high, the FDB muscle tenses to distribute pressure away from the overworked plantar fascia. Latest research confirms the best predictor of the development of plantar fasciitis is not actually the height of the arch (specialists have commonly believed most plantar fasciitis cases are due to excessive lowering of the arch), but rather the speed in which the toes move upward during the propulsive period (which occurs when the FDB is weak).

Treatment….

There are several tests that can be performed to confirm you have plantar fasciitis (and not heel spurs), but the most common indicator is a sharp stab or deep ache in the middle of the heel or along the arch – worst during the first few steps of the morning or after sitting for awhile.

Injuries in general will almost always respond well to stretching, massage, or both. For example, it is my experience that IT Band Syndrome (ITBS) responds best to massage, especially the jiggling motion favored by a good massage therapist. Stretching does little, if anything, to resolve ITBS.

pt3Plantar Fasciitis responds well to stretching. Pull your big toe back for 10 seconds, repeated 30 times per day. It has proven effective in relieving the pain in my heel after only a few days of consistent stretching –  no heel lifts, no night brace, not even massage.

Aside from the fact that athletes often do really stupid things when it comes to training and recovery, there are lessons we can all take away.

When I finally owned up to my injury, my husband reminded me I have been on the verge of plantar fasciitis many times. For years I maintained a stash of tennis and golf balls to massage the arch when I felt that tinge of tightness. At one point, he went so far as to buy the night brace for me, which I hated.

Every athlete’s body has certain weaknesses. Mine happens to be my feet – possibly because of my Morton’s Toe, which makes me susceptible to stress fractures, tight calves and apparently plantar fasciitis. Your issues may be with your knees, hips or lower back. We should pay attention when our body speaks, and become well versed on how to resolve the issues specific to our body. Better yet, be diligent with injury prevention that is especially specific to your issues.

Resolve issues with a swift and aggressive reaction. Think of the days of pain I could have avoided had I not remained in denial.

Recovery, after all, can only begin when we acknowledge the problem.

Do’s and Don’ts for Plantar Fasciitis

  • Avoid a mid- or forefoot strike pattern in favor of a heel-first strike, and don’t run hills until the injury is resolved..
  • Reduce stride length and increase cadence.
  • Build up gradually to minimalist shoes, especially for runners with tight calves.
  • Avoid corticosteroid injections; surgical intervention should be a last resort.
  • Use trigger point massage.
  • Consider taping the arch for support (visit kttape.com for one method)
  • Pick things up with your toes / strengthen the FDB muscle (see article below)
  • Maintain calf flexibility
  • Pull your big toe back for 10 seconds 30x/day

Read Dr. Michaud’s article: New Techniques For Treating Plantar Fasciitis