Expert Panel Question???

“After a run my knee begins to hurt fairly badly. It hurts a little during the run but mainly after. Is there a certain type of shoe that would help with my knees or is the only solution not to run?”

Answer!!!

Knee pain is probably the most common injury complaint in runners and has a variety of causes. The most common, Patellofemoral Syndrome, actually also goes by the lay name “Runner’s Knee”. It is more common in women but can occur in men too. It is characterized by pain in the front of the knee, is worse going up and down stairs, during squats or lunges and often results in a deep ache in the knee after a prolonged knee-bent position (such as sitting in a class, movie, car or on a plane). The fact that your knee pain is not so bad during your runs but afterward makes this the most likely problem although it can get bad enough to become an issue during runs too. It is thought to be an injury that occurs to the under surface of the knee cap (the patella) when the knee cap and the bone below it (the femur) are not in alignment.

The under side of the patella has a small ridge running vertically through the middle of it and the femur below has a corresponding groove. These two should remain lined up as the knee bends and straightens. A misalignment between the patella and the femur can be due to genetic factors, biomechanical problems or the result of muscle imbalances. Since we can’t do much to change our genetics, the focus is on the muscle imbalances and biomechanics. As a one directional sport i.e. straight ahead, even elite runners are notorious for developing muscle imbalances.

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Expert Panel Question???

Question: “Can a person run anyway if they have an achilles problem or do I need to take time off. I am in training for a marathon.”

Answer!!!

I would not recommend running with an achilles tendon problem. The gatrocnemius and soleus muscles blend together to form the achilles tendon and are a vital part of the biomechanics of running. If they are not functioning properly, one risks possible rupture of the tendon or injuries of the foot, hip, knee, or lower back from the altering of running mechanics to compensate for the sore achilles.

I would recommend seeing a good sports medicine physician and/or a physical therapist for an evaluation.

by Julie Thieszen – Physical Therapist, CMPT | Certified Specialist in Orthopedics

The term neuroma implies a painful, benign tumor of a nerve. Many people mistakenly use the term neuroma to refer to a painful, burning sensation in the forefoot (part of the foot towards the toes). In most cases the burning pain is a result of pressure on the sensory nerves coming from the toes. The pressure is usually caused by a combination of swelling in the metatarsal phalangeal joints (toe joints) and compression of the foot in footwear. The swelling in the metatarsal phalangeal joints is caused by overload of the metatarsal heads (ball of the foot). The shape of one’s foot, poor running mechanics, or muscular imbalances such as tight calf muscles or toe extensor recruitment may cause overload of the metatarsal heads.

To heal a neuroma you have only to alleviate the forefoot pressure causing the pain in the first place. A well-cushioned shoe of the type correct for your foot (see my article How do I pick a good running shoe?) can help considerably. A custom foot orthotic or shoe insert may also help to alleviate pressure. Anti-inflammatory medications may help to alleviate pain and swelling in the joints, and thereby, eliminate neuroma pain. Many patients ask about cortisone injections for neuroma pain. I do not recommend cortisone injections because they can cause atrophy of the skin and the necessary padding in the forefoot.

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Expert Panel Question???

Question: “What is the best way to recover after a long run?”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

After completing a long run, your first priority is to REFUEL. Since your body’s muscles are depleted, it is important to get something in your body to begin the refueling process as soon as possible – the sooner the better but definitely within an hour. I approach Recovery Nutrition in stages, aim for 3 eating episodes over a four-hour period.

Stage 1: As soon as possible. Often this first eating episode involves a drink containing readily available-easy-to-digest carbohydrate with small amounts of protein (10-20g). The carbohydrate helps replenish depleted muscle stores and the protein helps initiate the muscle rebuilding process. Choices include sport drinks, smoothies, recovery drink mixes, or chocolate milk). Drinks serve the dual role of re-hydration and nutrient replenishment; however, don’t feel limited. Sport bars/gels, bagels, cereal, yogurt, crackers, and PB&J sandwiches are all examples of readily available carbohydrates, with some protein, that you should be consuming within 30 minutes of completing a long run. What you choose depends on where you finish your run, convenience, and how you feel. If your run is more than 90 minutes, you should also be consuming some carbohydrates during the run – this will hugely impact how you feel after the run and how quickly you recover.

Stage 2: Within 2 hours of completing your long run, aim to have a meal. This should be a balanced meal, replete with carbohydrate, protein, and small amounts of healthy fat.

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As an L.M.T at this time of year I see many clients with multiple running over use injuries (plantar fasciitis, shin splints, patellar tendinitis, IT band syndrome, SI pain/ dysfunction). As runners increase mileage and intensity to reach performance goals it is common to create myofascial irritation leading to compensation pain patterns that inhibits bio-mechanical function. Pain in a single workout that heals with rest and change of training tends to be a simple acute strain and a normal effect of being a hard training athlete. But continued or increasing discomfort with training may lead to a substantial soft tissue injury and should be evaluated by a health care professional.

Sports specific massage therapy can be a good tool to help recover from or even prevent an over use myo-fascial pain or guarding response. Myo-fascial manipulation breaks up adhesions and areas of congestion in muscle bellies and along tendon and ligament attachments. Soft tissue work opens pathways of circulation to help with ischemia (lack of oxygenated blood) and allow drainage of chemicals of inflammation (a byproduct of muscle metabolism) and the stretching of connective tissues to decompress pressure and pain receptors in the nervous system. A skilled sports massage therapist can sculpt myo-fascia along muscle compartments to improve bio mechanical function, increase range of motion at joints, free adhesions of scar tissue and improve tracking of muscles as they contract and expand.

When I work with athletes, I evaluate posture, alignment, passive and active movement, tissue health and areas of tenderness on palpation. Even with a specific diagnosed injury I will treat the whole structure to prevent secondary compensations that form with favoring the injured area.

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Expert Panel Question???

Question: “I’m 60 yrs old and my muscles are always sore after or sometimes during the run. I run about 45 to 60 minutes four times a week and weight train twice a week. What causes the soreness?”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

Dear sore muscles – there are many causes of more noticeable muscle soreness (myalgias) that occur with or after activity – one of which, of course, is your age but let’s not go there yet. Questions I would ask are the following: are you taking any medications, particularly those for blood pressure, cholesterol, restless leg syndrome or prostate symptoms. Cholesterol lowering medications in particular have been known to cause myalgias even months after a person has been taking them.

The most common complaint is a sense of having done a hard workout even when that hasn’t been the case. The muscles are often sore to touch and seem to cramp easily. Many blood pressure medications have a mild diuretic (water pill) as a component of their formula and these can affect important electrolytes necessary for effective muscle contractions such as sodium, potassium and magnesium. Others contain medications that cause blood vessels to respond more slowly to changes in muscle blood flow needs. Aside from medications, proper hydration is always a concern with muscle cramps as is adequate dietary sodium intake especially if you sweat heavily during exercise.

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