Category Archives for Injury

Best Articles on: Foot Shape & Movement

Application of the Wet Test & Static Arch Height for Assessing Running Shoes | Pete Larson at RunBlogger | “despite significant differences in arch collapse between the groups during static testing, arch collapse was identical in all three groups during walking, and the only difference observed during running was a small but significant difference between the hypermobile and hypomobile groups”

Can Arch Height Predict Your Running Injuries? | Alex Hutchinson | “There’s no simple, guaranteed connection between your arch height (or any other foot or stride parameter) and your injury destiny or your shoe needs. But there are risk factors that may tilt your odds one way or another—so if you struggle with recurring running injuries, knowing your arch height may offer one more clue to help you sort them out.”

Running Pronation & Over Pronation | Steve Gangemi at SockDoc | “If you want to move well you’ll want to pronate!”

How Does Your Arch Height Affect Your Shoe Choice and Injury Risk? | John Davis at RunnersConnect | “Overall, whether you have a high or low arch will not affect your risk of injury, nor should it affect what type of shoe you choose, but it could affect where you get injured.” 

Do You Pronate? A Shoe Fitting Tale | Pete Larson at Runblogger | “If you pronate, you should get one of the shoes labeled stability.”

You may also like: Best Articles on Shoe Selection

Good Pain VS Bad Pain

Good running pain compared to bad running pain.

This can be a tricky distinction, but one that must be addressed.

Pain / Discomfort that you can run through is

  • General muscle soreness
  • Not in a very pinpointed specific area
  • A dull soreness.
  • Delayed Onset Muscle Soreness
  • Comes on the day after a workout and goes away in 1-2 days

Pain that you should Not run through is

  • Very quick and sudden onset
  • Sharp / stabbing pain
  • From an acute accident/fall/twist

ITBS – What has worked + Further Reading

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As both a coach and someone who has ran thousands of miles, I’ve learned a thing or two about injuries.

The primary lesson is that they are almost always from a combination of doing too much too soon before your body is ready and not giving your body ample opportunity to adapt and recover to the training load.

Illiotibial Band Friction Syndrome is a hotly debated subject. The human body is a complicated piece of machinery and as much as we like to pretend, we actually don’t know that much about how it works. For example, a new muscle was recently discovered! With ITBS, if you click on 10 articles you’ll likely see a number of different causes and resolutions.

It is simply described as a main on the outside of the knee:

Below are just a couple methods that may resolve the discomfort.

First, in my personal experience with Illiotibial band discomfort in the knee many years ago as a new runner who was running too much, the “standing glute stretch” as shown at the top of this article would literally shut off the pain.

I remember an instance when I was out running and 2-3 miles in the little niggle started to come on in the knee. I stopped, stretched for a minute, and was able to continue on for the rest of the long run without any discomfort. A slight stretch was enough to get something to relax, and I was good to go.

Another experience I had was with shoes. Now, I almost never attribute footwear to injury. However, different shoes cause the body to activate, load, and move differently. This can often be enough to make or break a niggle into no pain or into an injury. One time I was forced to spend a week in an old pair of shoes of a vastly different model and the ITBS pain which was basically resolved at that point came back with a fury when running in the new shoes. After getting my old pair back, it again eased up.

Finally, with a couple athletes I’ve worked with over the years who have had ITBS issues, one realized that when she looked farther up the road instead of down closer to her body, her ITBS pain greatly diminished. I even went as far as to recommend this to another runner and he had the same results. In this case, like the shoes, the different head position was changing the entire body positioning, movements, activations, loading. This is why new shoes or compression socks can lead to a sudden change (good or bad) in an injury, because they change  how the body moves.

Other Thoughts with ITBS

Compression has been experienced by some as a potentially cause of ITBS knee pain, since the area of discomfort can be compressed by the tights. This is simply something to be mindful of.

Further Reading: 

Treatment & Prevention of ITB Syndrome | Sock Doc | “If you’ve had Iliotibial band (ITB) Frictional syndrome, then you know how much it hurts, and how it feels like it’s never going to go away

Your IT Band is Not the Enemy, but Maybe the Foam Roller is | Breaking Muscle | “I would say that in 90% of the cases that present with IT band issues it is the gluteus medius (or glute med if you want to speak in sophisticated PT lingo) that is actually the culprit behind the pain.

IT Band Hell | Kelly Starrett | “It’s this nebulous catch-all…meaningless thing.

ITBS: Treating the Real Causes | Brad Neal at Kinetic Revolution | “I would argue that this syndrome is one of compression as opposed to friction”

Here is the routine I have my athletes do if they are experiencing IT issues. Most notibly was a lady who started with me, unable to run due to ITBS. I had her do this routine daily and eventually only 2-3 times weekly. She was able to progress from no running to full marathon training 🙂

How to Easily Convert Run Training to Cross Training

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One of the biggest mistakes people make when taking a period of rest from running due to injury is NOT cross-training.

With cycling, rowing, swimming, water running, or the elliptical, you can preserve a great deal of running fitness while at the same time letting the injury heal.

For runners on a training plan, the simplest method is to simply continue their plan or routine while converting running minutes to cross-training minutes.

Below is a sample running week.

M: EZ4 (miles)
T: EZ8 with strides
W: EZ4
T: EZ3, MOD3, EZ2
F: EZ4 with strides
S: EZ10+HARD2
S: Rest

Now if you know your average training pace is roughly 9 minutes per mile, simply take 9 or 10 minutes for every mile and do that on the bike or the elliptical.

It would look like this, numbers slightly rounded:

M: EZ40 (minutes)
T: EZ80 minutes with accelerations
W: EZ40
T: EZ30, MOD30, EZ20
F: EZ40
S: EZ100+HARD20
S: Rest

Stability Shoe Pseudoscience

My friend Rick at EngagingMuscles.com made a comment at a blog recently, and I wanted to post it here for you to read and consider.

The original post:

With less than two months to go until the half marathon (eek!) I thought it was about time I invested in some proper running trainers. My Nike IDs have been amazing – they started my running journey, are great trainers for the gym and have been the first ever pair of workout trainers that I have actually worked out in. Pretty impressive. But as I have been notching up the miles I have noticed more rubbing on the insides of my feet and a few blisters starting to form. I thought it was about time I headed to a running store to see what the experts advised. I had a gait test to establish what kind of runner I am. I ran on a treadmill in my Nike IDs for a few minutes whilst the store assistant filmed it. Afterwards we watched my running back and watched, in slow mo, how my feet hit the ground and how they left it. It was really interesting to see myself running and it taught me a lot. The assistant advised me that my running style was good and that my legs were straight when hitting the ground but as my feet left the ground they were turning in slightly, which can cause blisters and knee injuries. Apparently this is a common thing for runners.

Based on the gait test he gave me three pairs of running trainers to test. And it was a thorough test – I was even able to run outside in each pair to test them for comfort. The ones that appealed to me most were the Asics GT-2000. They were cushioned, gave great support and the inside arch has an extra support to stop your foot from turning in after it leaves the ground. In theory this should provide a much more comfortable run and limit damage to your knees. So I purchased them and have now been out three times in them, a few 5Ks and a 10K.

So far, so good. They are very comfortable and light-weight but they also feel strong, like they are really supporting your entire frame. The heel is cushioned so I feel like the impact is definitely getting reduced. My toes have started to hurt slightly – I’m not sure whether that’s because my feet are being forced into the right position and they are used to running in the wrong one! Only time will tell. But with only a few months to go until the race I better start increasing the miles…

Rick’s comment:

I just came across your blog for the first time. From what I’ve read it sounds like you take running and training seriously. Because of that, I figured I’d take a moment to let you know that making the jump from a Nike Free Run to a “stability” running shoe is going to decrease your *performance* and most likely lead to an injury over the long-haul.

To say the same thing in a slightly different way, although your new shoe is providing your entire chain with an artificial support, it’s also making your feet and the entire chain (much!) weaker on every step.

There are various factors that contribute to a walk-in running shoe store wanting to sell you a “stability” shoe. There are even times where the sales person makes a few dollars more. That being said, I don’t have anything to gain by convincing you that a running shoe with an orthotic built into it is the right thing for you. But I do have the knowledge to back up what I’m telling you here.

The bottom line is this: If you want to perform *optimally* and avoid an injury, don’t wear a “stability” shoe. Does that mean you won’t have an injury down the road? No. But at least you’ve taken a step in the right direction to avoid an injury.

For the most part, it sounds like your Nike Free wasn’t too short or narrow. (Side Bar: Nike running shoes fit a 1/2 size shorter than other brands) In most cases, blisters are due to these three factors: (1) Wearing a non-technical sock that’s primarily made from cotton and (2) wearing a shoe with a mid-sole cushioning system that’s broken down and (3) lastly, a sloppy fit.

An Injinji toe sock is always a good investment! They make a technical sock that will allow your toes to move throughout the toe box.

If you like the feel of of the cushioning in the ASIC’s 2000, they also make the Cumulus. That shoe is in the “neutral” category. It will provide you with close to the same amount of cushioning, and still allow you to perform better over the long-haul.

As far as what the running shoe specialist at the store told you about your foot mechanics: The front of your foot is supposed to roll in just prior to leaving the ground, e.g., propulsion. And if that’s not enough to reinforce my point, consider this: Running on a treadmill is nothing like moving across planet Earth.

I hope you find this to be helpful.

My own comment.

A few thoughts…

As Rick pointed out, your foot is absolutely supposed to turn inward and pronate before leaving the ground. That’s natural and necessary. My feet do it. Rick’s do it. The world record holder in the marathon’s feet does it.

With your running style, I find it interesting that people purchase shoes to make up for poor running form/lack of strength rather than simply try to strengthen their own body and improve technique. I believe Rich is correct when saying that a cushioned shoe will weaken the foot. You know what happens to a leg when placed in a cast…

To the original poster, my first thought when reading that you were getting blisters but also increasing your running pace and volume was that it’s possible with the increased volume you’re simply spending more time running when slightly fatigued. It’s common for that compromised running form to result in a bit more of a shuffle, which can increase the amount your foot moves around inside the shoe and causes blisters.

In my own experience as someone that was sold very cushioned and controlling shoes do “deal” with my “over-pronation”, I’ve been much happier and uninjured over the last 10,000+ miles in neutral, zero drop, and low profile footwear.

Strength is in your BRAIN

This is a quote that was posted on Facebook, and I wanted to share it here.

There is a lot of talk in the running world about the importance of strength training for increasing performance and injury prevention. I agree with the current research that explosive and heavy resistance training increases stiffness within the muscle-tendon system resulting in increases in running economy, but running economy is measuring steady state oxygen uptake (VO˙ 2). Running economy is more a measure of physiology (performance measure) than pure mechanical efficiency. It is not looking at how the athlete gets from point A to B. General strength and the ability to generate force is extremely important, but only if produced in a coordinated and timely fashion to produce the desired outcome of the individual athlete. Most athletes are not structurally ready to handle explosive and/or heavy resistance training. Running with 2.5x body weight while on one leg, over time and distance at a given pace is hard enough. Data can show increases in power, reduction in contact times, increases in muscular stiffness, and even reductions in right/left asymmetries, but it doesn’t automatically preclude the athlete from injuries. Quantitative data is only useful if it helps improve the athletes “Running Resiliency”.

I believe it is important that runners understand MUSCLES are STUPID. Muscles need the brain to consciously and unconsciously tell them what to do, and at what time to do it in, in order to produce the muscular patterns that are appropriate for the desired task. I am not going to give the muscle, in isolation, that much credit and responsibility to automatically pull to body into the correct position when running. The brain needs to intrinsically understanding the goal of the desired movement, and then needs to organize a movement plan that will be sent to the musculoskeletal system in order to produce the desired task (running). This requires skill, are you training skill or just strength without purpose?

I truly Believe runners can run with fewer injuries. I Believe we are uniquely design to move/run, but culturally have devolved and are structurally less skillful. I Believe we have complete control over our bodies and movement, and thus ultimately the incidence rate of our injuries. Are you training better movement by training your brain to express more efficient and optimal movement patterns? Don’t get me wrong this can and needs to happen in conjunction with a specific plyometric and heavy resistance strength training program, but you better be in the right place at the right time when performing these exercises. Open for discussion. Please share and discuss!

Stephen Scott- Professor in Neuroscience, Queens University
Movement Skill: 3 Fundamental Components (3 B’s)
1. Brain
2. Biomechanics
3. Behavior

Train Better Movement!

My Experience With Foam Rolling

Today I saw two mentions/links to foam rolling come up in my news feed, so I thought I would share my experiences on it.

I used to be the chronic foam roller.

Each day I would roll and do strength work for an entire episode of Battlestar Galactica. This probably only amounted to about 20-30 minutes of actual work. However one day I read an article about the uselessness of chronic foam rolling…so I stopped.

It’s been about a year since I’ve done any real foam rolling and I can’t say I’ve noticed anything different. I’ve not become stricken with tight, inflexible, injured muscles. I’ve not been overly sore. Nada. But I do have about 20-30 minutes extra each day!

Below are three food for thought articles on rolling, or more accurately not rolling:

Foam Rolling: You May Be Hurting Yourself. | Ryan Booth at Reciprocal Innerventions | “Maybe people just don’t want to learn how to correct firing patterns in their  hips, hamstrings, quads and hip flexors etc. If your hips are mobile, of what use is a roller? None. What, after all, are you using a foam roller for? Flexibility? Pain relief? Recovery?Maybe if I told you that there is no proof it does those things you’ll stop? Maybe you’ll listen to a bit of reason.”

Your IT Band is Not the Enemy (But Maybe Your Foam Roller Is) | Robert Camacho at Breaking Muscle | “As with most movement disorders the true solution is mindfulness of your body position and mindfulness of your movements. Weak hip abduction is an insidious because it can cause all sorts of issues. Luckily, it’s rather easy to identify and deal with. Get your glutes firing again and maintain mindfulness of their proper use while working out. Yeah, it really is that simple. Now get out there and get moving.”

Foam Rolling 101 | Charles Polique | “The point is that just because a product is popular and sells well doesn’t necessarily mean it fulfills all the claims of its manufacturers and distributors. Another example: foam rollers.”

Case Study: Achilles Overuse

“There is only one thing more painful than learning from experience and that is not learning from experience.”

– Archibald MacLeish

This is a little case study from my own experience with an achilles issue that I’ve been battling.

We’ll go over the cause, symptoms, how I overcame the issue, and what can be learned from the experience that I went through.

Calves, FTW

Cause

First lets start with what I did to cause my problem.

I had been living in the plains for over two years and my climbing during runs was very minimal.

My wife was offered a job in Rapid City South Dakota, right along the Black Hills mountain range. We visited for a weekend and I took advantage of the trip to get some climbing in. I climbed a lot. I descended a lot.

When I returned to the plains (before we actually moved) there was definitely some leg soreness the next week, especially noticeable in my hamstrings, however I kept on training as usual. Tight hamstrings mean tight calves, and the next week I started to notice one of my achilles tendons was pretty sore early on during my runs.

Symptoms

What I actually noticed was some soreness in the area between my heel and lower calf. Usually it went away during a run, but it would take about 5-15 minutes for it to stop nagging at me. I also noticed it a bit in the mornings.

This was nothing terribly painful and I would hesitate to say it was an injury. More accurately it would be something I tend to refer to as a niggle. But it had the potential to become an injury!

Overcoming the Issue

Now comes the important part, how I prevented the niggle from becoming an injury.

When you notice something is not right with your body you must make a modification to your training! The definition of insanity is doing the same thing over and over again and expecting a different outcome. If you do not change the cause of the problem how is it expected to go away?

The first thing I did was reduce my training intensity. I took out anything other than easy running. When that did not quite work I also lowered my volume. I also warmed up more thoroughly prior to running since I noticed that the discomfort decreased after 5-10 minutes of running. A big thing to notice here is that I was able to resolve the pain without fulling stopping my training.

What can be learned

There is no such thing as a mistake if you learned from it.

Primarily, this was a reminder of mindfulness. I was unmindful when I did a weekend of too much vertical and I was unmindful when I did not give my legs enough recovery time afterwards. At least I practiced good mindfulness to let my achilles heal up!

Interestly, you could look at the cause of my problem in multiple ways.
Overuse (of the calf)
Under-recovery (of the legs post hilly weekend)
Lack of Mindfulness (both in that I did an excessively hilly weekend and trained through the soreness afterwards)

This case study can be applied to almost any potential injury or circumstance. It’s been years since I’ve actually had an injury (I can’t even recall it) however I’ve had numerous instances where a little niggle showed up. Each time I was able to lower my volume, move to easier trails, reduce intensity, or get off the treadmill and each time I prevented the niggle from becoming a real injury that would prevent me from running.

Learn from my mistakes, be mindful!

Also be sure to check out my other training advice & injury articles!

A coach’s job can be to hold you back

Recently an athlete of mine sent me an email asking about the strategy for an upcoming 10k.

This even was taking place on May 3rd, less than 2 months after his 3:04 marathon PR and Boston Qualification. This means he had 5 weeks between his period of rest after the marathon and the 10k. The ultimate goal of the training cycle was actually a July 4th 5k so this event was simply being used at a training run.

He continued to say that if he were doing it on his own he would be doing more speed work leading up to the 10k. But he also mentioned his frequent injuries in the past, likely from overdoing both speedwork and volume. He also brought up that some of his running friends go out for 14+ mile runs on the weekends and he must turn them down since his long runs are not that far. He then mentioned how they are continually hurting themselves…

My answer to why his question of why his training as currently like that at this time was basically what I wrote  below. I’ve rewritten for a more general audience that will hopefully be able to take something from it.

1. It’s too soon after the rest period to be during true speed or tempo work. He took the majority of two weeks completely off and with only 5 before the 10k did not have ample time to get back to the point of doing a lot of very fast running. After a long training cycle (perhaps leading up to a marathon) it’s important to take a rest period. Equally as important is to ease back into fast or long running slowly.

2. The ultimate goal for the post marathon training cycle was a fast 5k on July 4th, not a 10k less than two weeks post marathon. I did increase the amount of quick running a bit before the 10k so it would not be as much of a shock on his system, but we were not doing the very specific workouts for it that we would have done if this was a goal race after 12 weeks of training.

3. As for the long runs, with many of my athletes who are training for shorter course events such as the 5k or 10k, I will often spread their long runs out over the week instead of having them do a long run that’s 25% of their weekly mileage ever 7 days. Instead I may have them do the long run every 14 days or skip the long runs all together and instead focus on a tempo run with a warm up and cool down around it. Depending on the individual, a weekly long run may simply be too intense of a stressor all at once and increase injury risk or take too long to recover from.

As you can see, for some highly motivated athletes the job of a coach is not always to push them forward, but to hold them back and help them make smart training choices. 

I have another chronically injured athlete for whom it has been months since they’ve not been without a break longer than 5 days due to some injury. She was simply in a cycle of run run run, hurt too much to run, long break, run run run, repeat.

With her we started a fairly aggressive rehab program with stretches and strength work. As well as this we restarted her training from the beginning. I was having her do half mile jogs to start with, every so slowly they developed into mile jogs, 1.5 mile jogs, and finally 2 miles at once. All of this nearly pain free!

It just took some holding back, new eyes, and the patience necessary to keep holding back. This process is something a self coached athlete often fails to practice.

Why time off does not worry me

I’ve taken most of the week the 2nd and 3rd weeks of May off from running.

Not done out of necessity, more so because I have a “niggle” in my left calf and do not want to risk it become a full blown injury. It feels almost like a really bad knot, especially during/after rolling it out.

And no, I’m not worries about losing fitness, endurance, or speed. Not troubled at all.
There are a couple reasons for this. 1st is that I know and fully realize that taking a few weeks with reduced training is always more preferable than being injured and taking 3 months completely off. 2nd is that we as athletes actually become stronger when we do not train, or reduce our training load.

Consider this; you do not become stronger while training. You become stronger while not training.

After a hard run or a good weight lifting session, you end the workout weaker than when you started. But wait a week and your body is now adapted to that previous training stimuli. Do it enough and you gradually increase your level of adaptation. This is the process of super-compensation.

I think this ability is something many runners and athletes in general lack, the ability to reduce training load before a niggle becomes an injury. This ability has two parts, first being able to be mindful and realize there is a potential issue, second is being able to let go of one’s ego and reduce or cut training down to allow for healing.