This is my first attempt at using animation for patient informational videos. Don't laugh too hard :) Send me topics you would like in this media!
The top three questions runners ask about custom foot orthotics are:
1. Should they use orthotics in their shoes while running if they don’t have an injury?
2. If they have fatigue in their legs while running or a jacked up gait, they often wonder of orthotics will help?
3. Should they wear orthotics forever after an overuse injury?
The answers are yes, yes and yes!! A new study showed that orthotics have a significant benefit in reducing running injuries as prophylaxis. It makes common sense, that if you have an underlying biomechanical deficit, orthotics give you better alignment so therefore should reduce overall abnormal stressors and subsequently injuries. Now there is a new study that shows just that! Piggy-back that on years of biomechanics research and the answers get much more clear.
This study demonstrated that the subjects who wore orthotics had "a significantly reduced rate of exercise-related lower limb injury across the training period". The authors emphasized that participants were not treated for an injury with orthotics, but were prescribed orthotics to prospectively reduce the risk of injury. In addition, they believe that these "preventative results can be cautiously extrapolated to a recreational running setting and should be considered by sports and exercise medicine professionals."
We generally prescribe foot orthotics to treat specific injuries. This study indicates that orthotics can be a valuable prophylactic tool for injury prevention, supporting orthotic use in at-risk populations (e.g. runners) for medial stress syndrome, iliotibial band syndrome and Achilles tendinopathy.
Considering the results of this study and the results of a previous study on the use of orthotics in runners by Mundermann, it is recommended to use at least a pre-fabricated Powerstep orthotic which incorporate a medial heel skive and rearfoot post, as a cost-effective means of providing prophylaxis with corrections proven effective in runners.
Runners with a previous history of these injuries and/or those that develop symptoms would be good candidates for custom orthoses based on the results of these two studies.
Franklyn-Miller A, Wilson C, Bilzon J, et al. Foot orthoses in the prevention of injury in initial military training: a randomized controlled trial. Am J Sports Med 39(1):30-37, 2011
Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech 18(3):254-262, 2003
Run Happy! And with your orthotics!
Let's talk about how to reach your goals in 2012!
Happy New Year! More in 2012!
So RunDoc weighs in on the question: "Does Running in the Rain Make You Sick?"
You asked for more video blogging, so here is the newest segment!
Run Happy! And feel free to jump in puddles!!
I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?
Let’s talk about ITB syndrome.
The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.
Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.
Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.
Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.
During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.
The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.
The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!
Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.
I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)
I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!
A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!
The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.
My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.
Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.
If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.
Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!
Hot running is here again this summer. A little too soon for me! It’s 80 degrees at 6:30am, 100 degrees by 1pm; and let’s face it: it’s really hard to get motivated to run!
Goals are important during the summer training months. When you look at your calendar and see the races you have penciled in, getting out of bed is a lot easier. Pick a race in the fall and enter! I have already entered the Ironman 70.3 Pocono Mountains in October and the White Rock Marathon in December. The power of the race calendar gets me motivated to get the workouts done on these hot, hot days.
I also encourage everyone to try to get their workouts in either early in the morning or inside at the gym in the afternoon. Ozone is so high during the afternoon hours and poor air quality warnings abound this time of year. No reason to stress your upper respiratory system; do it early or do it inside!
Just a few tips to keep yourself safe this summer while running in the heat:
Get motivated and get out there, but run safely in the heat so we can all enjoy the fall race season!
Wow! What a great panel discussion put on by Saucony in Boston last Thursday night. I love going to Boston during marathon week. It's like Marathon Mecca! The whole city seems to buzz with running excitement. Boston will always be my favorite marathon.
I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.
The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours.
After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!
Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.
Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.
Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.
That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come.
Watch the video to help you perform these exercises correctly
Part one talked about why shold you embrace minimalism?
A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.
Six Simple Exercise to Stronger Strides
Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.
These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down.
Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.
Watch the video if you need help with the exercises!
Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.
Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.
Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.
A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.
A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.
So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.
A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.
Who shouldn’t try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.
A side note of caution to anyone trying to go “less is more.” When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the “too much, too soon, too fast” syndrome that can sideline even the most cautious of runners.
Join Dr Crane at the Boston Marathon discussing minimalist shoes and training with an expert panel!
For more info, click here
Come join me in Boston on April 14th at 6pm
Saucony presents "Step into Minimalism"
Click here for more info!
Run stronger and happier!
EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.
The Top 16 FAQ’s About EPAT Therapy for Heel Pain
These are the top 9 questions parents ask about their child’s sports injuries. Hope they help keep your kids safe and enjoying all their sports!
Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).
I wonder how many of them were runners? I watched from my window this morning as one of my crazy neighbors fell running on the sidewalk in front of my house. The snow had not even stopped coming down yet! Crazy! Even I ran on the treadmill this morning, and most of my peeps will tell you: I Hate Treadmill Running! Better the treadmill than the emergency room!
Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.
It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:
Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping. Trail running shoes are better than your regular road shoes.
Run or walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run quickly. Run in high alert!
Run or walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying anything that may cause you to become off balance. This even means leaving your precious water bottle at home.
Run or walk "small." Practice your "Chi" running and throw your center of gravity forward. Avoid an erect, marching posture. Look to see ahead of where you step.
When you step on icy areas, take short, shuffling steps, curl your toes under and run or walk as flatfooted as possible.
Run where the path has been cleared. Even in your own yard, remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Don't be stupid like my neighbor and try to run while snow is still flying!
Even when you practice safe running and walking habits, slipping on ice is sometimes unavoidable. It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.
When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.
People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If it is not a choice to hit the treadmill, practice caution while running in the snow and ice. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn’t mean it is not broken.
Run Happy and Be Careful! Don't Be a Statistic!
Hey RunDoc: I read in the NY Times that orthotics often don’t work and I should try running barefoot to strengthen my feet. I tried and my feet got a lot worse. I know you wear orthotics and make a lot of them for your patients. Why do you think custom foot orthotics work in your hands?
Hmmm….Good question! I read the article in the New York Times and laughed then cried. They are so biased against orthotics that this is bout the tenth time in the last few years they are trying to make them voodoo. Fortunately, they are wrong and there is science behind it.
Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.
There are many studies published in peer reviewed medical journals showing the effectiveness of orthotics in reducing injury and relieving pain.
One of the most important factors creating the need for orthotics is that we usually walk on essentially hard, flat surfaces that do not exist in nature.
Walking or running barefoot does not change the above.
The science of biomechanics relating to orthotics is complicated and requires years of study. This is why you should have your orthotics made by a well-trained podiatrist in biomechanics and even better, one who has an understanding of your specific sport.
The process of getting an orthotic to be most effective is iterative, often requiring serial adjustments. This is because everybody is different and may not tolerate “perfect” biomechanics.
The conditions for which orthotics are prescribed often take years to develop. They are not going to disappear overnight with the use of orthotics.
Orthotics should not be chosen by how comfortable they feel. Often, they are uncomfortable at the beginning because they are “correcting” your biomechanics with an external device and you have to get used to them.
The reason foot impressions (casts) are taken off-weight-bearing is so the foot can be positioned in an optimal shape that will allow it to naturally bear weight on its own. A three dimensional scanner can also be used to get a “true” picture of the foot without a cast.
Orthotics are not arch supports. A true orthotic is not an over-the-counter device. They guide the foot through a proper gait cycle, allowing the foot to achieve various optimal positions at the correct time and creating a means for shock absorption, weight bearing, and propulsion.
A flat foot by itself is not good or bad. A high arch by itself is not good or bad. How the patient functions with those features is the issue.
If you have been told you need orthotics and you’re in doubt, get a second opinion. If you have orthotics and they are not working, get them adjusted.
Correctly made functional foot orthotics work! I have built my reputation with them.
Run happy! And with orthotics if you need them!
I was running around Grapevine Lake this morning at 5:30am and was amazed how many people were out and about. Seems like everyone was going around 20 miles today, so they all started really early. Everyone had a fall marathon on their schedule; some going to Lake Tahoe, some Chicago, some New York. And of course, a lot of people gearing up for the Dallas White Rock Marathon in December.
It is amazing how the marathon bug has bitten so many people! Even Amani Toomer, former New York Giants' wide receiver, is running the New York City Marathon this year for charity. I remember when I planned to run my first marathon in 1999, most people thought I was a little crazy, and the Cowtown Marathon only had less than a thousand people every year. Now, it seems almost everyone is attempting a marathon or two; and the local marathons are busting at the seams with entrants. The Houston Marathon even went to a lottery because it has sold out so quickly the last few years! Wow! So many runners and so many "training theories" for people to hurt themselves with!
Here are a few tips to keep you on the roads and out of my office:
Tip #1: Do not increase your mileage by more than 10% per week. The body grows stronger if it is stressed in small increments, but starts to break down if it is stressed too much. Studies show that increasing your mileage by no more than 10% per week will help you grow stronger without breaking you down. Avoid increasing duration and pace at the same time.
Tip #2: Always follow a hard workout with an easy one. The body’s like a cell phone. If you continue to use it without recharging, it will eventually wear down. By incorporating easy workouts or cross training into your program, you’ll allow your body a chance to rest and repair itself.
Tip#3: Add strength training to your workouts. Strength training is usually absent from most training programs, but cross training with weights is the only component that has been proven to reduce running injuries. Proper strength training can help you overcome muscle imbalances that lead to injury, as well as strengthen connective tissues that help support your joints.
Tip#4: Do regular self-checks. Tune into what your body is telling you. How do your muscles and joints feel? How does your breathing and heart rate feel? Are you straining to keep up your pace? Anything that doesn’t feel the same may be an early sign of overuse. Keep a training log of not only your mileage, but how you feel during and after each workout. Fatigue over a period of a few days is a huge red flag that your body is trying to tell you something.
Tip#5: Respond to pain immediately. If you experience pain during or after a workout, follow the rule of R-I-C-E (rest-ice-compression-elevation). Use an ice massage or cold pack for 10-15 minutes every 4-6 hours to relieve inflammation and swelling. Elevation is also quite helpful in the first 48 hours. Apply a compressive wrap and hang out on the couch for a few hours and rest. After 48-72 hours, if the inflammation has subsided, apply heat to help promote healing.
Tip#6: Do not take pain-relief medication to finish a workout! Non-prescription anti-inflammatory medications can reduce inflammation and pain, but they do not speed healing. Taking anti-inflammatories prior to a workout may decrease your discomfort and allow you to finish a workout, but they also allow you to overstress already damaged tissue. This can prolong the healing process. Pain is a sign you should not ignore!
Tip#7: Choose relative rest over inactivity. Active rest, or easy exercise, is better than inactivity because it stimulates blood flow and promotes healing. If slow running is painless, but picking up the pace is painful, then stick to slow running until you feel better. Or do other activities, like swimming, cycling, or aqua running until you can run pain-free.
Tip#8: Don’t wait too long to seek professional help. If your pain does not respond to a week of R-I-C-E and cutting mileage by at least 50%, see a sportsmedicine specialist. Not only can a professional help you diagnose and treat the condition, but they may also help you determine and biomechanical abnormalities that can lead to recurring injuries.
Tip#9: Try to maintain a positive attitude. You immune system fights injuries with a complex army of nutrients and special cells. But, you immune system doesn’t work alone. Your mind also has a voice in what goes on. Attitudes and feelings are organized in your brain to communicate with your immune system with chemical messengers. A positive attitude can go a along way to help speed healing.
Tip#10: Ease back into your regular training program. Remember, too much, too soon, too fast is what hurt you in the first place. It’s tempting to jump right back in where you left off, but your injured tissue may not be fully recovered. It’s during the first few weeks back that most runners get re-injured. Use the 10% rule to ease back into mileage….
Above all, have fun! Marathon running is a challenge that is mental as well as physical. The miles between 20 and 26.2 take determination, stubborness and probably a tiny bit of inner insanity! Whether you finish in 2 hours or 6+, you are still a marathoner forever after you cross the finish line!
Run Happy! And Injury Free!
Seriously, I crawl over the finish line and the first thing I want is a beer (or twenty)! I think that beer is a great adjunctive therapy for injury rehabilitation. Think about the benefits of beer:
1. It relaxes you.
9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work
Ice versus heat? This is a common question a lot of athletes, coming into my Grapevine, Texas office, ask. Most understand that ice immediately after injury is very important. The questions usually revolve around when to use heat. There are some basic guidelines that every athlete can use to reduce confusion.
Immediately ice the “fall down, go boom injuries.” Ice works well for reducing redness, swelling and internal bleeding in acute injuries. It also is a great pain reliever. Acute injuries and post surgical pain and swelling usually respond well to 10 to 15 minutes of ice every few hours. This should be done for up to several weeks after an injury or surgery. Ice can be in the form of an ice pack (ice wrapped in a protective towel) or ice massage (massaging with a frozen water bottle or block of ice).
Ice can also be helpful in reducing swelling in a chronic injury like runner’s knee or plantar fasciitis. Icing immediately after activity can prevent further inflammation of an already annoyed area and help in recovery.
So where does heat come in? Heat can be used in several different ways. Contrast baths with ice/heat/ice can be helpful in chronic injuries. Especially those joints or tendons that still have just a little inflammation or edema. Heat should never be used alone in these cases. Moist heat is best for chronic stiffness and old injuries with scar tissue. It can also help in the rehabilitation process. For example, when plantar fasciitis becomes plantar fasciosis after four to six months (which is a chronic degeneration of the plantar fascia), deep heat therapy with ultrasound or moist heat packs can help increase range of motion of the area and increase the effectiveness of physical therapy. Heat actually temporarily increases inflammation in an area, but this is often helpful in kick starting the healing process. Heat can also be used to calm muscle spasms and relax a tight muscle.
Heat causes an increase in circulation to an area, so it should never be used in acute injuries or chronic injuries with a lot of swelling. It can actually make an injury worse if there is still a little internal bleeding going on. A great way to heat a joint or tendon is to use a reusable heating pack or an electric heating pad for about 20 minutes before stretching, massage or other therapy. Heating an old injury before exercise can also be helpful in warming up the area to ready it for increased activity.
The simple rule of thumb is that ice is used for acute, swollen injuries and heat is used for stiff, chronic injuries. This subject is debated continuously, but I hope this discussion clears up the mystery of ice versus heat!
Spring is finally here! That means more and more older runners and athletes are flocking to my Grapevine, Texas, office complaining of a multitude of aches and pains. 'Tis the season to overtrain and suffer from the dreaded tendonitis. What is this mysterious 'itis? Why does it effect aging athlete's more than the younger ones? Why does one person have multiple bouts of recurrent tendonitis all over their body and another does not? These are all great questions!
Let's start with the basics. A tendon connects your muscles to the bones. It is a flexible but really tough band of fibrous tissue. A muscle contracts to move one of your joints and transmits a force on the tendon to cause the movement. Tendons, when functioning normally, glide very smoothly when the muscle contracts. When they are irritated, they cause pain and even creaking when they glide. This is tendonitis or in easier terms, inflammation of the tendon.
Tendonitis can occur in any tendon, but in your foot and ankle the most common tendons effected are the ones that stabilize you foot when you run, jump and play with the other kids. These are the Achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendons. Less likely to be irritated are the multitude of smaller flexor and extensor tendons in your feet.
Tendonitis is more common in your aging athletes between 40 and 60. This is because the lovely aging process causes our tendons to become less elastic and therefore less forgiving. A stress that would've been easily absorbed in our 20-year-old tendons causes tendonitis and even rupture in our 40+-year-old tendons.
Tendonitis is usually due to repetitive stress with an underlying biomechanical abnormality or anatomical deviation. This is why it is important to treat the tendonitis and the underlying cause before return to sport. If not, recurrence rates are high!
What does tendonitis feel like? Pain and swelling in the tendons usually first thing in the morning or at the beginning of an activity. The pain and stiffness often "warms up" in the early stages, but can become constant if you ignore the early symptoms. Sharp stabbing pains can occur but these are usually a sign that your tendon is so stressed it may actually tear!
How is it diagnosed? Usually your doctor will perform a physical exam and then rule out a bone problem or fracture with an x-ray. Sometimes an MRI is needed to rule out a small or partial tendon tear.
Treatment for tendonitis begins with relative rest. Take the stress off the inflamed tendon by doing alternative exercise like cycling or swimming. Sometimes complete rest is needed. Ice, anti-inflammatory medicines, bracing, physical therapy and even a cortisone injection may be needed. Functional foot orthotics are often quite helpful in chronic tendonitis because they stabilize the abnormal movements and help treat the underlying biomechanics of your feet.
Remember that after having a bout of tendonitis, slowly return to activity and try to avoid the overuse that caused the tendonitis in the first place! Too much, too soon, too fast syndrome is often the culprit in tendonitis!
This morning I spoke at the DFW Sports Medicine Symposium in Arlington, TX. What a great crowd! Over 300 physical therapists, athletic trainers and sports medicine physicians from all over Texas gathered to discuss advances in the medicine of sports.
Ever get those nasty blisters after a long run? Why does this happen? You wear the same socks and running shoes you usually wear but then....bam...nasty blisters. After years of meticulous research into my own blisters, I came to realize I only got blisters when I ran faster :) The biomechanics of landing farther up on my midfoot then pushing off harder made me have blisters. So, I figure either run slower or endure! Since that wasn't a great anser, I tried all kinds of lubricants and socks. My best conmo is blister free "Wright Socks" and my friend "Body Glide". Now I can run fast and beat the blisters!
So you have a lot of blisters? Want some tips on how to take care of them?
Click here for a more complete discussion of blisters and their treatments
Let’s face it….there will be a day when all of us get injured. Just like the fact that there are two kinds of cyclists: those who have fallen and those that will fall! In a recent survey 90% of runners revealed some kind of injury in the last 12 months that resulted in the loss of more than one day of training. Some of us are just more hardy than others. I have several ultra-marathon running patients (yes, they embrace the fact that most of us think they are crazy) who train like maniacs and think that running a 50K on Saturday and then a marathon on Sunday is just a fun weekend in Texas! These people and their considerably more sane counterparts, a group of which I have been fortunate enough to consider myself a member, almost never get injured unless we fall off a curb, get hit by a car, or fall in a pothole. I define those as the “shit happens” injuries and these always seem to happen at the most inopportune time. There are also runners who tend to be injury prone. Those frustrated souls who seem to be in my office or with my physical therapist on a regular basis who often follow the letter of the training programs and still seem to get hurt.
Injuries suck…and often make us borderline psychotic! (My husband and children will attest to this fact) So, how do we survive this down time and come back from injury even stronger? Cross-training a.k.a. relative rest is the key! Unless you are in a full body cast from a severe accident, there is an alternative exercise that should at least keep your endorphin addiction under control. Yes, you need to seek permission to bike or swim or core train, light yoga, etc., whatever your doctor says you can do even if it is only upper body, you need to move! Everyday! Sitting on the couch eating chips and singing woe is me will not cut it! And you will lose all the cardio fitness you have built with your running program. A good rule of thumb is to try and keep to your program by performing the alternate exercise for the planned amount of time you were going to run. This may require some circuit training, because if you are anything like me, the first time I tried to swim I lasted all of 15 minutes without thinking I was going to drown; but then I got out of the pool and attacked the stationary bike to finish my planned one hour workout. Flexibility and a willingness to try something else will get your through any injury. The best part is that you may find you even like some of the cross training (remember I did my first tri after breaking my foot).
The power of positive thinking is also relevant in this topic. Stop sitting on the couch feeling sorry for yourself and instead make a new plan, a new goal and a new training program. There is always a light at the end of the tunnel (and no, it is not a train). Cross-train, plan and conquer your injury. You will survive and often times be in better shape afterwards!
Run Happy! And Cross-train for fun!!!
Running Injuries are not Inevitable Part Two! Dr Crane advises new marathon runners on how to avoid common mistakes. Take a look!
This article is part of a series on children's foot and ankle health. I thought some of my readers might be interested even though it has nothing to do with running. As the mother of three girls, I like child sfaety tips!
The rising popularity of flip flop sandals and Crocs shoes, has brought escalator safety concerns for children in the United States to the forefront. As a physician and mother of three small girls, a few questions came to mind. These two types of shoe gear have been lumped together as increasing risks, but is this a truly fair assessment? What is the truth about the risks involving our children and escalators? Is awareness enough to protect our children? Do the shoes our children wear on escalators matter?
Let’s start with a look at the numbers. In the United States there are an estimated 35,000 escalators with approximately 245 million riders daily. The Consumer Product Safety Commission estimates that about 10,000 people go to the emergency room every year after accidents on escalators and 20 percent of these injuries involve entrapment of feet, hands, or shoes. That’s approximately 2,000 emergency room visits per year for such entrapments, which usually involve softer shoes or bare feet. The fact that these figures have been fairly constant for the past 15 years, long before the advent of Crocs, seems to nullify the idea that somehow Crocs are more susceptible to such entrapments than other soft footwear. Given the number of kids wearing Crocs today, it only stands to reason that eventually an entrapment would occur, as Crocs are not immune to rider missteps resulting in being grabbed by escalators, any more than flip flops, jelly shoes, sandals or soft running shoes.
What puts our children at risk? The fact that escalators are dangerous to small children has been well known for years. In fact, in 1997, in the Journal of the American Academy of Pediatrics, it was reported by a group of physicians from the Department of Pediatrics, New York University School of Medicine and the Pediatric Emergency Service, “Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.” The largest incidence of injury was reported to be involving children between 2 and 4 years old (50%) with the average age being 6 years old. It should also be noted that 60% of children fell prior causing their injury.
The action of stepping off the escalator is associated with an increased risk of injury. Young children may remain standing on the escalator and allow their feet to slide off at the end, instead of actually stepping off. The small size of a child's foot may increase the risk of it slipping into the gap where the last step slides into the comb plate. While stepping off an escalator may seem like a simple and natural task to an adult, the developmental level of young children limits their ability to both anticipate and coordinate this action. In addition to feet becoming entrapped during the process of stepping off, children's small extremities may become lodged between two steps or between a step and the side-rail.
We can continue to ride escalators with our children if we follow some simple safety tips from the Consumer Product Safety Commission:
1. Loose shoelaces, drawstrings, scarves and mittens can become entrapped. Make sure a child’s clothing does not put them at risk.
2. Always hold children’s hands, just like crossing the street!
3. Do not permit children to sit or play on the steps.
4. Do not carry children in strollers, walkers, or carts. Use the elevator.
5. Always face forward and hold the handrail. If you fall, you put your child at increased risk!
6. Avoid the edges of the steps where entrapment can occur.
7. Always pay attention and alert while riding with your children, note where the emergency shut off is.
Prevention of escalator-related injuries is the key and efforts should be focused in two directions. Safety education for parents should include and give specific guidance regarding injury prevention about riding on escalators. Increased parental supervision should be encouraged, such as hand-holding or even carrying of young children while riding on and especially while stepping off escalators. Children should be taught not to run, play, or sit while riding on an escalator and of course, children should face forward and hold the handrails.
The bottom line about escalator injuries is that no matter what shoes a child is wearing, if the parents are not supervising them closely, injuries can occur. There is no specific correlation between shoes and injuries; they occur even in the best of circumstances usually due to inattention and children’s unsafe behavior. Parents need to be diligent about watching their children and following the guidelines to provide a safe ride for all children on escalators.
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