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Plantar Fasciitis – Prevention, Causes, and Treatment

 

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….

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The “Achilles Heel” of Distance Running

“Myth” Busters

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.

Read More….

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Stress Fractures: What are they, How Do I Prevent Them, and What Can I Expect If I Develop One?

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.

Symptoms
If you suffer a stress fracture you may experience any of the following:
• Swelling
• Pain
• 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)

Read More….

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4 for Core

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).


1. Plank on elbows: Pelvis is neutral, avoid arching the low back by tightening your abdominals (bring your belly button towards the spine).

Advanced plank on elbows: lifting one leg; more difficult- lifting leg with opposite arm.

 

 


2. Side plank on elbow: Pelvis is neutral, visualize yourself between 2 plates of glass and lift trunk toward ceiling.

Read More….

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Stretching Exercises

Stretching is an important tool in preventing injuries. It increases joint mobility as well as the length and elasticity of your muscles.  Below are basic stretches to assist in stretching the main muscle groups used in running.  It is best to stretch a muscle that has been warmed up, so stretching for 10-15 minutes after a run is always a good idea.

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Tips for Training for a Marathon

Expert Panel Question???

“I’m a 62 year old male runner, have run many half marathons but never a full marathon. I run 3 – 4 times a week averaging 25 to 35 miles. I play golf and weight train moderately. I’m training for a marathon and would like to feel more energized – suggestions?”

Answer!!!

Realize that training for a marathon at any age is an energy draining pursuit, but to help you feel as good as possible try the following:

1. Keep your run days to 3-4 times a week
2. Keep your weekday runs to no more than an hour.
3. Do long runs every other Saturday and start them about 16 weeks out(assuming you already can run 90 minutes for a long run)
4. Do your longest training run at 22 miles and do it 3 weeks out from your race.
5. Focus on eating really well after all your runs. Drink a recovery drink IMMEDIATELY upon finishing a run and then eat a whole food meal within 45-60 minutes following that has a lot of carbohydrates, lean protein and healthy fat.
6. Drink lots of water each day.
7. Sleep really well.
8. Use a sports massage therapist twice a month
9. Take a solid vitamin/mineral/ antioxidant supplement day and night.
10. Take an ice bath after each long run.

by Debbie Perry

Certified Sports Nutrition Advisor

USA Triathlon Certified Coach

Colgan Power Program Strength Trainer

Local Elite Runner/Triathlete

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