Tag Archives: shin splints

15 Myths and Facts for Runners

runningRunners are a very particular type of athlete and will try almost anything to run longer, faster, and remain injury free. Unfortunately, there is a lot anecdotal and pseudoscience being pulled from the internet that leads runners astray. In this article I talk about the biggest myths and facts in running.

  1. Static stretching decreases performance.

MYTH: A study done a few years ago demonstrated static stretching reduced power output and performance. Suddenly, performance experts started saying “Static stretching is the worst thing you can do.” This is not true! These people just misinterpreted the facts.  The data stated that performance decreased when the muscle was stretched for 45 seconds or longer… When a stretch was held for 30 seconds or less – as recommended – there was no performance loss.  A recent study published in the Journal of Strength and Conditioning confirmed this (1). This study found that the threshold of continuous static stretching in which muscular power output decreased was 60 seconds. Static stretching for a short-duration (30 seconds) had a negligible influence on performance.

  1. Static stretching can increase tightness.

stretchFACT:  Muscle is made up of two types of fibers, intrafusal and extrafusal.  Inside the intrafusal fibers is a receptor called the muscle spindle. It’s like a spring-loaded sensory detector. It is a protective mechanism that when over stretched sends a signal to the brain and spinal cord telling the muscle to contract and protect itself, thus making the muscle tighter. Some muscle spindles are overly active causing chronic tightness. So, when you stretch a muscle that already has over active muscle spindle, the tightness can increase. I wrote an article about this phenomena, if you want to read more about that.  I understand this can be confusing, but when you read #3 you will see how all of this comes together.

  1. You should foam roll after running.

Foam Roll TFL

MYTH: Foam rolling or self myofascial release is one of the most effective tools to improve motion and prevent muscle injury. Unfortunately, many runners foam roll after a run. It is just as important, or even more important, to foam roll before a run. As I mentioned in #2, muscle spindles create tightness when stretched. Due to the repetitive nature of running, runners are very susceptible to developing hyper-active muscle spindles. Foam rolling or self myofascial release targets the muscle spindle and inhibits it (hence the term release in myofascial release). Foam rolling overloads the muscle spindle and the nervous system and gets it to relax and turn off. This allows the muscle to be stretched without the muscle spindle becoming overprotective. Every client I see is directed to foam roll first, stretch, then exercise.

  1. Icing or an ice bath after a run helps injury and speeds recovery

MYTH: Inflammation is REQUIRED for the body to bring supplies to worked areas, clean up any debris and help rebuild tissue. When we ice that sore knee, aching Achilles, or painful plantar fascia after a run or workout we are delaying our body’s innate ability to repair that tissue. Yes, icing is not all it is cracked up to be. Even the physician who coined the term RICE (Rest, Ice, Compression and Elevation) has said that icing is wrong. I’ve written many articles about this, but the most recent, explains why RICE is no longer accepted as the cure-all.  If you want to recover, cool down with foam rolling and stretching, and have a few days of light exercise or rest.

  1. Drinking extra liquid will prevent heat illness.

MYTH: In general we overhydrate. Tim Noakes, MD, a long-time researcher of water balance and author of “Waterlogged:  The Serious Problem of Overhydration in Endurance Sports,” says we have been misled to believe that we need to drink to stay ’ahead of thirst’.  Hydration prevents dehydration, but it does NOT prevent heat illness. Dehydration and heat illness have very similar symptoms and often we use the two interchangeably, but they are not the same. If someone is suffering from heat illness, giving them water is not the answer, cooling their body temperature is. Giving excessive water to a person suffering from heat illness can cause a serious or fatal event called exercise-associated hyponatremia encephalopathy (EAHE).   Marathoners and distance runners who drink at every aid station or drink excessively before a run put themselves at risk for this condition. Dr. Noakes states we should aim for ingestion rates that never exceed 27 ounces/hr (2). 20140501More about our hyper-hydration nation can be found in this article.

 

  1. Dehydration kills performance.

MYTH: It’s long been held as fact that losing more than 2 percent of bodyweight to dehydration will hurt performance. But several recent studies, as well as anecdotal evidence from the world’s top runners, suggest it’s possible to lose more than 2 percent with little to no detriment to performance. A study in the British Journal of Sports Medicine found that current hydration guidelines are erroneous and that dehydration does not impair performance (3). In this article the authors found weight loss of up to 3 percent did not slow down athletes (cyclists, in this case) or lower their power output.  Finally, in 2012 a study found that Haile Gebreselassie lost a whopping 9.8 percent of his bodyweight during the 2009 Dubai Marathon—and still won, in 2:05:29 (4).

  1. Energy chews prevent bonk or fatigue.

FACT: But don’t be fooled: Energy chews do work to prevent fatigue during long distance running events, but so do raisins!  A study published a few years ago compared raisins vs. energy gummies. There was no difference in performance between the raisin group and the gummy group. In addition, the raisin group showed a lower insulin spike when compared to the gummy group, a win for the raisin. Plus, the raisin group demonstrated higher free fatty acid content in the blood post activity, demonstrating more fat metabolism. So, for the same performance gains, you can gain additional benefits from raisins over energy gummies.

  1. Bananas prevent cramps

MYTH: While bananas are a great source of nutrition and do contain many electrolyte replacing nutrients, they alone do not prevent cramping. Cramping can be caused by a large number of reasons, including over hydration (see above) or poor conditioning. Tim Noakes, MD, in Lore of Running, 4th Edition, suggests muscle cramps are caused by muscle fatigue and that cramping has more to do with not training properly than nutritional or hydration deficits.

  1. Runners need to strength train.

FACT: Running strengthens your muscles, but it only strengthens certain muscle fibers to a certain degree. A total body strength training is imperative for running performance. Strength and stability of the core and shoulder help translate to lower body power and efficiency. If you need a kick to climb a hill faster or sprint to beat an opponent to the line, strength training is imperative. Proper strength training and targeting specific muscles will also prevent injury. John Martinez, the assistant head doctor for the Ironman World Championships says “You can run five days a week and you’ll finish a marathon, but if you want to PR or qualify for Boston you need to have some kind of strength training in there. It’s about improving our performance.” Always add a strength training component to your training program. Running alone is not enough.

  1. Running is the best way to lose weight.

Graphics like this misguide those seeking weight loss.

MYTH: You’re being duped folks! Long duration cardio training does not make you lose more fat or weight. Running in the “fat burning zone” as depicted on a cardio machine does NOT burn more fat. If you want to lose weight, you need to burn calories. What burns calories? Intensity! Higher intensity requires more oxygen demand and thus a greater oxygen debt.  High intensity training has a caloric after burn that lasts for 12-24 hours. Standard steady state running only has a caloric after burn of 1-4 hours. You can burn more calories in a 20 minute high intensity interval training program than you can running for 60 minutes at a steady pace. If you want to lose weight, get off the treadmill!

  1. Minimalist shoes improve running mechanics and prevent injury.

vibram-shoes1MYTH: Will the minimalist running trend ever end? Minimalist shoes do not prevent injury. In fact, those who jump from a normal shoe to a minimalist shoe without proper training or adaptation are at an increased risk for injury. Five separate studies presented at the annual meeting of the American College of Sports Medicine “found no significant benefits, in terms of economy, from switching to minimalist, barefoot-style footwear.” Minimalist shoes also do not magically improve your running mechanics. There are no quality studies that show running in a minimalist shoe improves mechanics. In order to improve mechanics, you need a quality strengthening and flexibility program that encourages appropriate muscles firing. If you want to go the minimalist route, walk first. Adapt to the new style and supplement with a structured training program.

  1. Getting a shoe that matches your arch height will prevent shin splints.

MYTH: Shin splints are not caused by a high or low arch. Many runners with a high or low arch can avoid shin splints. Similarly, runners with a “perfect” arch can develop shin splints. The cause of shin splints is multifactorial and correcting musculoskeletal dysfunction through a structured program prevents shin splints. The article Shin splints 101 demonstrates how to prevent shin splints. A systematic literature, published in the Journal of Sports Physical Therapy found that selecting running shoes based on arch height had little influence on injury risk. (5)

  1. A midfoot strike is best for performance.

MYTH: If you run slower than a 5-minute mile, it may be most efficient to heel strike. A study published in Medicine and Science in Sports and Exercise found that rear-foot strikers are up to 9.3 percent more economical than midfoot strikers (6). Lead author Ana Ogueta-Alday believes the reason for the improved efficiency stems from the increased ground contact time the study observed in rearfoot strikers. More contact time with the ground allows for more force to be applied, while also decreasing the metabolic cost of running. If you’re a heel striker and haven’t been chronically injured, there’s no need to change your ways.

  1. The more mileage you run per week the better your performance.

MYTH: If you want to improve, you need rest, recovery, and varied training. I challenge you to find an elite marathoner who trains only by running. The elite runners have rest and cross-training built into their weekly programs. See the importance of strength training in item #9 above.  Two of the best known experts on running, Jack Daniels and Hal Higdon, provide run training programs. There programs stress the importance of recovery days and strength training days. In fact, Jack Daniels says that when training for long running events, train for time, not mileage. Getting 20+ miles is not the best for all runners and could cause injury.

  1. Preventing injury is a matter of not doing too much too fast.

FACT: There are many things that can cause injury, but one of the biggest determinants of injury is doing too much too fast. A study in the Journal of Sports Physical Therapy evaluated progression of running distance and its relation to injury. The authors found novice runners who progressed their running distance by more than 30% over a 2-week period seem to be more vulnerable to distance-related injuries than runners who increase their running distance by less than 10% (7). Owing to the exploratory nature of the present study, randomized controlled trials are needed to verify these results, and more experimental studies are needed to validate the assumptions. Still, novice runners may be well advised to progress their weekly distances by less than 30% per week over a 2-week period. So stick with the 10% rule.

If you are a runner and look to increase performance or prevent injury, please feel free to contact me for a free consultation.

References:

  1. Pinto, MD, et al. Differential Effects of 30- Vs. 60-Second Static Muscle Stretching on Vertical Jump Performance. December 2014. 28:12. p 3440–3446.
  2. Noakes, T. Waterlogged: The Serious Problem of Overhydration in Endurance Athletes. Human Kinetics. Champaign, IL. 2012.
  3. Wall, BA, et. al. Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat. Br J Sports Med. 2013 Sep 20.
  4. Beis, LY, et. al. Drinking behaviors of elite male runners during marathon competition. Clin J Sport Med. 2012 May;22(3):254-61
  5. Knapik JJ, et, al. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014 Oct;44(10):805-12.
  6. Ogueta-Alday, A, et. al. Rearfoot striking runners are more economical that midfoot strikers. Med Sci Sports Exerc. 2014; 46(3):580-5.
  7. Nielsen RØ, et. al. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther.2014 Oct;44(10):739-47.

 

 

Season of Running and Injury

Illinois MarathonIn April, the Boston Marathon kicks off yet another season of running. Whether it is 5k or a Marathon, from April to October running enthusiasts have no trouble finding a running event to participate in. Here in my town of Champaign, some 20,000 participate in one of the Illinois Marathon events. With these races comes training and where there is training, you can find injury close by. Continue reading

A Runner’s Story: From Pain to Performance

Photo_shoot_runningIn 2010, I left clinical rehabilitation and performance training. While I love my current job, I do miss the clinical aspect, which is why I seize opportunities to take on random clients with complex issues.  I’ve never written about my clients, but this case is so common, yet complex, that I thought my readers might be challenged with similar clients/athletes, or might be experiencing similar issues themselves. Here is a runner’s story that went from marathon training, to painful walking and an inability to run. Her experiences with continued failed treatment and the road we have taken to get her back to training and setting personal records. Continue reading

Shin Splints 101

This blog post is long overdue. I have had countless people – friends, family members, athletes, clients – all ask me about shin splints. OK, before the Athletic Trainers, Physicians, PTs and other health care providers jump down my throat. Yes, shin splints is a junk term. I am talking about MTSS. I understand this, but the people you treat know them as MTSS, so relax. What are they? How can I get rid of them? Can they be prevented? Despite being one of the most common athletic injuries, recreational or competitive, shin splints are easily treatable and very preventable. Too often sufferer’s deal with the pain and never fix the problem. My goal with this blog is to provide tips to fix the problem and resolve shin splint pain.

Shin splints, or Medial Tibial Stress Syndrome (MTSS), is a chronic injury typically described as dull-ache on the medial, mid-to-lower-third portion of the lower leg. Pain is common during or after activity. In severe cases pain may last for several hours after activity and occasionally the individual will experience nighttime throbbing in the lower leg.

The pain from MTSS is attributed to irritation of the periosteum – a saran wrap like covering around bone – or a stress reaction to the underlying bone. Repetitive pounding or muscle pulling from these structures precipitates the injury. Popular belief is that shin splints are due to poor shoes, training intensity, and training surfaces. However, a critical review article written by Moen, Tol, et al., published in 2009 Sports Medicine found this was not the case. MTSS is often caused by poor joint movement and muscle imbalance.  These movement patterns and muscle imbalances are easily identifiable. The best part is that you can fix these problems at home by following a simple flexibility and strengthening program.

IMG_2285

Blue lines illustrate normal hip-knee-ankle-foot alignment.
Red Lines illustrate femoral and tibial adduction and foot external rotation.
Green arrows show knees caving in and foot arch flattening.

First, let’s see if you have these movement dysfunctions. Observe yourself (in a mirror) walking or doing repeated squats. Do you see one or more of these four things: hips in, knees in, feet flatten, or toes point out? You may have one or all of these patterns; some may be extremely pronounced or could be very subtle. The image here shows a moderate to severe movement. If you observe this, even to the slightest degree, you are at risk for developing shin splints. Overtime, these movement patterns create a muscle imbalance, where some muscles become overactive and some become underactive.

Using the above figure as an example, here are the typical overactive and underactive muscles we would see in a person with shin splints or with these movement patterns.

OVERACTIVE

UNDERACTIVE

Hip Flexors and Tensor Fascia Latae Gluteal  Group (Maximus, Medius)
Lateral calf (lateral gastrocnemius / soleus) Medial Gastrocnemius
Groin muscles (anterior adductor complex) Anterior and Posterior tibialis
Biceps Femoris Medial Hamstrings

Our goal is simple, turn-off the overactive and turn-on the underactive; simple as that. Below is a basic 3-step program that can help correct this issue, step 1 -Turn-off, step 2 – elongate, and step 3 – turn-on. This program can be done daily and would take no longer than 30 minutes from start to finish. Here is what a basic program would look like.

Step 1: Turn-off the overactive muscles using self-myofascial release

  • Gastrocnemius/Soleus
  • Adductors
  • TFL/IT-band
  • Hip Flexors

Foam rolling is the best way to do this if you go at it alone. If you have a  qualified therapist, manual release of these muscles will do the trick. When foam rolling, roll each muscle for 90 seconds and hold tender areas for 20-30 seconds. A YouTube playlist I created, provides good examples and tips on how to perform these techniques.   

Step 2 – Elongate the overactive muscles with static stretching

  • Gastrocnemius/Soleus Static Stretch
  • TFL/IT Band Stretch
  • Kneeling Hip Flexor Static Stretch
  • Adductor Static Stretch

Perform 1-2 sets of the stretch per muscle group and hold the stretch for a maximum of 30 seconds. Brent Brookbush, has a good static stretching playlist that demonstrates these exercises.

Step 3 – Turn on the underactive with isolated strengthening

The above exercises are just examples. There are many exercises to choose from. The important thing is to target the right muscles. Fix the core, attack the glute medius and glute maximus, and work the tibialis anterior and posterior.

In summary, too often I see individuals with shin pain ceasing activity, buying new shoes, investing hundreds of dollars in custom orthotics, or giving themselves an ice bath. Shin splints do not have to be the end of training. They are easily preventable and curable as long as you fix the problem. Following a simple and structured program to correct of common movement dysfunction patterns can eliminate shin splints and many other lower body injuries like Achilles pain, runner’s knee or hip pain.

Women are Wimps!!

STOP! Before you start throwing knives at my head I don’t really think women are wimps. If I did my wife would be waiting for me when I get home to prove me wrong. In fact, it is quite the opposite. Women have demonstrated continued increase in sports endeavors and are much faster, more aggressive and powerful than in past decades. However, secondary to the increased participation in sport, women are sustaining many more injuries.

Females between the ages of 15-25 years are most often injured, with the majority of these injuries are to the anterior cruciate ligament (ACL).  Females are 2-5 times more likely than males to sustain an injury to the ACL. This injury is primarily noted in basketball and soccer, but is still prevalent in many other sports such as volleyball, softball and gymnastics.  Women over the age of 25 are also more susceptible to recreational sporting injuries compared to males.  Many of these injuries are also musculoskeletal in nature, such as ankle sprains, shoulder tendinopathy, and chronic knee pain such as chondromalacia, PFPS and ITB Syndrome. Looking at the glass half-full though,most of these injuries can be prevented with correction of movement dysfunction.

With the increased participation in sport and the commonality of musculoskeletal injuries it is prudent to understand typical movement dysfunction patterns that bring about these injuries.  Secondary to genetics, body morphology and muscle recruitment females are susceptible to lower extremity impairment syndrome.

Lower extremity impairment syndrome is a combination of muscle imbalances, joint dysfunction, and poor muscle recruitment patterns from the low back to the foot. The impairment syndrome can be characterized by foot pronation, knee valgus, femoral internal rotation, and lordosis at the low back.  When performing functional activities, such as running or cutting, these characterizations are amplified. Ultimately, this leads to ACL tears or the aforementioned chronic pain syndromes.

The good news is these poor biomechanical patterns can be corrected following focused rehabilitation techniques designed to improve muscle synergy as well as joint mechanics. Many studies have been done to show a significant reduction in the incidence of injuries, such as ACL tears, by correcting these impairments. If you are having chronic pain in the lower extremity, it might be a result of lower extremity impairment. This is a good thing, because it can be corrected.