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Calf Pain

Expert Panel Question???

“What could be the cause of medial calf pain? I strained my left foot about a year ago and when I started running again my right calf hurt. It went away in about a month; now it is back. Is there something I can do to ease the pain and make it go away?”

Answer!!!

Calf pain is not an uncommon problem in runners because the muscles included in the calf are key to propelling us forward. The calf actually comprises 5 muscles with 2 of these in one “compartment” (a compartment is a bundle containing one or more different muscles) and 3 in another. It is important to know which specific muscle or muscles are injured in order to determine the best treatment options.

The most commonly injured muscles are the two in the compartment closest to the surface – the gastrocnemius and its deeper partner the soleus. These are the “foot to the accelerator” muscles. They are the main muscles working when a runner gets up on his or her toes to push off, run up hills or sprint. As a result, they are most commonly injured during interval, hill or faster paced workouts. The typical injury involves a tear (known as a strain) of the muscle. Strains are often graded on a scale of 1-3 with a 1 being a severe stretch of the muscle fibers, a 2 being a partial tear and a 3 a complete tear.

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Runner’s Knee

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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Energy and Electrolyte Drink Comparison 2010

Proper hydration for athletes requires more than water. Last month we established the critical role electrolytes play for exercising athletes. (See A Tale of Five Electrolytes) During exercise electrical impulses are being carried, muscles are contracting, calories are burning, heat is being produced, and sweating occurs. To keep these systems within optimum parameters, electrolytes need to be maintained and energy stores need to be replaced—all within a fluid medium. The endurance athlete is faced with an ever-increasing variety of products to meet these nutritional needs. We have put together an updated comparison of currently available drinks and some thoughts to consider when selecting an exercise drink.

The volume of fluid consumed during exercise should nearly match the volume of fluid lost by sweat during the exercise period. Fluid losses exceeding as little as 2% of body weight can lead to significant decreases in performance. You can calculate your sweat rate by weighing yourself before and after a one-hour exercise session. This number less the amount of fluid consumed during the session is your sweat rate.

Our bodies depend on fluid to do the business of exercise, but that fluid contains more than water. It contains electrolytes primarily, along with some amino acids and vitamins. Electrolytes are dissolved mineral salts that are found in the fluid both inside and outside of the cells in our bodies. The primary minerals lost through sweat during exercise are sodium, potassium, chloride, calcium, and magnesium. Nutrition during exercise should include these five critical electrolytes. See A Tale of Five Electrolytes for a discussion of why electrolytes are important.

For athletes participating in longer duration and/or higher intensity exercise, the electrolytes lost through exercise can exceed what is available in many sports drinks. Some companies have recognized this and recommend supplementing with electrolyte tablets during exercise. Adequate amounts of electrolytes should be available in the sports drink. In the chart below notice the concentration of electrolyte losses versus the concentrations available in a typical sports drink. You might want to then refer to the label on your favorite sports drink or look at the comparison chart we have put together.

Electrolyte Drink Comparison Chart

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How do I heal a neuroma?

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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Seven Shin Splints Secrets: Ken’s Secrets to Happy Shins

A few of you have asked questions about what to do for shin splints. Over the years, I have found that “shin splints” is something people use to describe pain in their lower leg. There is specific medical terminology and other technical gobbledygook which clarifies what exactly the pain in the lower leg is, but what I’d like to focus on in this article is what has worked for me and people I have trained with and coached. Here are a few secrets:

Secret #1: Typically, shin splints are an “overuse injury”, so my first recommendation would be to read the article on overuse injuries written by Dr. Scharmann and Dr. Blackham. Okay, now that you’ve read that, let’s move on to the other secrets on my list.

Secret #2: Keep a log and evaluate any recent changes you made in your training. I always take a look at my log when I start feeling any aches and pains. Did I change something a little too quickly? What surfaces have I been running on lately? If I realize I made a mistake, I adjust and make sure that I don’t repeat it. If it doesn’t look like I made a drastic quantity or intensity change, then I move on to the next item on my shin splints secrets list to see if I can isolate the problem.

Secret #3: Take a look at your shoe situation. You guessed it – I look at my log. If you don’t track your shoe mileage in your log, you should start now. Usually you can get anywhere between 300 and 500 miles on a pair of shoes. Obviously, that is just a general estimate and your weight, running style and other factors could impact how many miles you’ll get out of a pair of shoes. When I get toward the tail end of what a pair of shoes can take, I start feeling things like shin splints. You may just need a new pair of shoes. And since we’re talking about shoes… you really should go to a specialty running store and make sure you’re in the right kind of shoe depending on your level of pronation or supination.

You’ll notice that those first three really deal with prevention. Educate yourself on injury issues, make sure you’re in the right shoes and don’t make poor training decisions and you’ll be able to avoid dealing with shin splints (and other injuries) most of the time. If you weren’t able to prevent them this go around, you’ll definitely want to keep reading.

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A Tale of Five Electrolytes

If you are reading this you are probably an endurance athlete looking to improve your training and performance. You may recall from high school science class that electrolytes are dissolved mineral salts contained in our body fluid–both inside and outside our cells. It is not our focus here to review in depth all of the cellular biology related to electrolyte homeostasis. The enlightened athlete needs to know where electrolytes go when they are lost, what the symptoms are when electrolytes are deficient, and how to maintain electrolyte levels to achieve optimum performance. The five key electrolytes for endurance athletes are Sodium (Na+), Potassium (K+), Chloride (Cl-), Calcium (Ca++), and Magnesium (Mg++)

In our bodies, hydration is linked intimately with electrolyte concentrations. For athletes, electrolyte losses occur primarily through sweating. Early experience with endurance athletes recognized dehydration as a significant problem. Fluid losses as little as 1-2% of body weight can cause a drop in performance, while losses exceeding 4% of body weight can cause critical failure. Realizing this, athletes drank. Things got worse for those athletes when they drank primarily or exclusively water. Consuming water without electrolytes replaces fluid losses, but dilutes electrolytes. In Ironman medical tents, electrolyte deficiencies are now found more commonly than dehydration. Hydration before and during longer events should contain electrolytes.

Sodium (Na+) and Chloride (Cl-)

Sodium is the most abundant and perhaps the most important of the electrolytes. Na+ is found in higher concentrations outside of cells in our bodies. All cells depend on sodium and potassium to bring nutrients inside the cell and to remove waste. Nerve conduction–a process important for thinking and for activation of muscles—is also heavily dependent on sodium and potassium. Sodium Chloride (NaCl) is table salt and often referred to simply as “salt.” Many foods contain sodium. Deficiency of sodium is called hyponatremia. Hyponatremia is the most common electrolyte disorder in the U.S. Hyponatremia in athletes is usually due to sodium lost in sweat. Other disease processes may cause hyponatremia, but the symptoms of hyponatremia are the same for athletes and non-athletes. These include fatigue, muscle weakness, muscle spasms or cramps, convulsions, nausea, vomiting, confusion, or decreased consciousness. Vomiting due to hyponatremia can cause Na+ levels to drop even further.

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