by Kathryn Macleod
By Zachary Kernan
John had been training for the St. George Marathon for the past 10 weeks and as life will have it, work and family obligations took their toll on his training schedule. Expense reports had come due and the kids had been sick for the previous 4 days, preventing him from running for the past 3 weeks. This was going to be John’s second marathon and he’s loosely followed a training program that he found online. The training guide indicated that his mileage should have been at 38 miles for the week with a tapering schedule anticipated over the next 2 weeks.
John was quite nervous about the marathon and was concerned that his training program had not been adequate enough for him to finish the 26.2 mile course. In an effort to catch up and prove to himself that he’d be able to complete the marathon, John skipped ahead on his training program and completed the current week’s prescribed 38 miles.
John was on his long run of 20 miles and at mile 16, began to feel an achiness through the arch of his right foot. The ache was initially dull and John was able to push through the run as it did not affect his pace. The next morning, John threw back the covers, stepped onto the ground and experienced a sharp pain through the bottom of the heel and the arch of the foot. The discomfort slowly dissipated by the time he was walking out the door on his way to work. After being on his feet for most of the day at work, John felt that aching foot come back to haunt him.
John is experiencing plantar fasciitis, the most common cause of foot pain in adults and one of the most commonly cited injuries among long distance and marathon runners. Pain is typically experienced through the arch of the foot or through the bottom of the heel. Symptoms of plantar fasciitis are typically at their worst with the first few steps in the morning and/or with prolonged standing and walking.
The plantar fascia is a thick piece of tissue connecting the heel to the 5 toes. Its purpose is to provide stability through the arch of the foot. There’s a higher incidence of plantar fasciitis in the running population compared to the general population due to the repetitive impact, or microtrauma, of the plantar fascia. The bones and ligaments of the foot must withstand forces that are equal to 3-4x your normal body weight with running. This repetitive microtrauma can overload the plantar fascia with faulty biomechanics or with overtraining. Read More….
The warrior Achilles is known as one of the greatest heroes in Greek Mythology. He was strong, courageous in battle, and nearly invincible everywhere but in his heel. An arrow shot directly to this area ultimately led to his downfall. This is where the term “Achilles heel” originates from.
Unlike the warrior Achilles most of us don’t fight in epic battles. However, if you are out beating the pavement, logging miles, you’ve likely had a dustup or two with your own Achilles. The Achilles most runners battle with is the Achilles tendon.
The Achilles is the large thick tendon extending down from the calf muscles (gastrocnemius and soleus) and connecting to your heel bone (calcaneus). The calf muscle is responsible for generating the power you need to push off of your big toe and propel forward as you begin your running stride. The Achilles tendon is the bridge that helps translate that power into action and is a vital component to an efficient running form.
Achilles tendonitis is typically an over use injury. This means, like most runners, you don’t listen to your body and back off when your calf is crying uncle. Other factors that increase the likelihood of this occurring are ramping up your training too fast, having overly tight calf muscles, or the smaller possibility of having a bone spur that is rubbing on the tendon.
Forty-two percent of runners experience knee pain, making it the most common injury among runners. Patellofemoral pain is the most common diagnosis of those younger than 50 years old with knee pain.
Pain in the front of the knee that is worse during squatting, lunges, stairs, or sitting for long periods of time (during car rides or at the movie theater). Pain is usually described as a dull ache, and occasionally a sharp pain. At first, knee pain will occur after a run and as the pain worsens it may be prominent during a run. There is not usually a specific injury, but a gradual increase in pain with increased activity. Females have a higher risk for developing patellafemoral pain.
It is thought that pain is caused by bad alignment of the patella (knee cap or the flat triangular bone located at the front of the knee joint), causing an irritation of the undersurface of the knee cap. The top of the patella is smooth, but the undersurface has a vertical ridge running down the middle that corresponds to a valley made by the end of the femur (thigh bone). The patella is housed in the quadriceps tendon – all four quadriceps muscles attach to the patella, and the tendon inserts just below the knee. If the quadriceps are weak, it is likely the patella is not optimally aligned during knee movement. Also, weakness or decreased flexibility at the hips can lead to pain at the knee, because the musculature surrounding the hips and pelvis controls the motion of the femur as well. It is generally accepted that patellofemoral pain is multi-factorial, and not just a result of a single limitation. The following have been identified in research, specifically in those with patellofemoral pain: 1. weakness of the quadriceps, and hip abductors (group of muscles that bring the hip away from midline of the body)
2. Decreased flexibility of the IT band, quadriceps, and hamstrings
3. Poor dynamic control when stepping down (the knee will often move across midline of the body)
by Brian Boyle, PT, DPT
Stress Fractures Defined
Stress fractures are easily described as tiny cracks in bone which occur from overuse. Repetitive forces, such as those in long distance running, promote the regeneration of bone cells, however rest allows for the addition of new bone cells. If you are not getting enough recovery you will start to fatigue the bone putting you at a much higher risk for a stress fracture.
Where do Stress Fractures Occur?
The most common areas where stress fractures occur in runners are in the shin (tibia) of the lower leg and in the long bones (metatarsals) of the foot. But stress fractures can also occur in the hip and in the thigh (femur) of runners and while less common, are no less important.
If you suffer a stress fracture you may experience any of the following:
• Tenderness over a specific spot
• Increased pain and swelling with activity
• Earlier onset of pain with successive workout
• Continued pain even at rest as damage progresses (www.mayoclinic.com)
The intensity in the room was so thick; one could cut it with a knife. A group of women sitting focused on the screen, watching the live camera view from the lead vehicle; the 100 men competing for 3 slots to make the US Marathon Olympic team. This vivid memory from Charlotte North Carolina in 1996 continues to impact my clinical decision making as a physical therapist. I will never forget the commentator’s announcement that given the same VO2 max, stride length, etc…, “the one with the most stable pelvis wins”!
I decided to write this article from my >20 year experience working with runners. I’ve had amazing hands on opportunities from working with people who like (and don’t like) to run from the beginner to professional, from biomechanical wrecks to those finely tuned machines. This given article only serves as a possible opportunity for those aspired to integrate 4 core stabilization exercises into their training. I have seen many injuries over the years, and feel strongly that prevention is the key. Cross training in all planes is imperative.
In Taber’s medical dictionary, dynamic stabilization is defined as “an integrated function of neuromuscular systems requiring muscles to contract and fixate the body against fluctuating outside forces, providing postural support with fine adjustments in muscle tension. The term usually pertains to a function of the trunk, shoulder, and hip muscles and includes the lower extremity muscles when they are functioning in a closed chain.” In short, the term is used for the development of postural stability and skilled movement control. Principals in stabilization may include: isolation before integration; slow before fast; and correct breathing.
The following, in my clinic experience, are the “4 for the core” that if preformed correctly can prevent many common running injuries. Neutral pelvis is required to perform the exercises correctly. Body alignment is essential with the ear, shoulder and hip being in a line. The pelvis position can be viewed like a bowl; the bowl is level, not dumping water out the front (sway back) or the back (flat back).
Advanced plank on elbows: lifting one leg; more difficult- lifting leg with opposite arm.