2. It is a great pain reliever.

3. It makes the end of a race much more enjoyable.

4. It can precipitate post-race amnesia making you want to do another one.

5. It tastes much better than Gatorade.

6. I think I even read a study that showed beer helps flush out all that lactic acid!

7. It promotes social activity after a race when you feel like you just got run over by a truck

8. It’s a great carbohydrate replacement recovery drink.

9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work 

 

All right, all funny aside, how about the ice versus heat question?

 

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!

 

Run Happy!

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!

 

Run Happy!

 

Good question! I spent four hours this week with a Retul specialist, Craig Fulk, in Roanoke, TX. He is a fantastic cyclist with a quirky sense of humor who practically killed me by making me ride the bike trainer for hours getting my fit just right. In the past, I’ve had cervical spine pain, left leg numbness and felt like I was cycling mostly with my right leg. I felt like I was all over the saddle and could never find a comfortable position. Since Ironman is my goal, I had to find the sweet spot on my saddle and try to find some more power, since I ride about as fast as an 80-year old Grandma!

 

Retul is a dynamic bike fitting computer system that helps adjust your cycling position. Most bike fittings are done in a static position. Most bike fit specialists use a tape measure and plumb bobs and cannot take an accurate measurement when the cyclist is pedaling. The Retul computer system captures the rider’s position relative to his pedaling motion and creates the most realistic replication of the rider’s biomechanics. It measures the actual pedal stroke and body position when the cyclist is riding. Retul uses a 3-dimensional view to see everything from knee extension (from the side view) in relation to knee wobble (from the front view) in order to make the best decisions on adjustments to the cyclist. I felt like I was all wired for sound! Imagine little sensors attached all over your body and then cycling. The computer model showed how pathetic I was to start and how fabulous my biomechanics were when we were finished. I think we spent an hour just adjusting my cleats! It seemed like a lot of minimal adjustments, but together it was fabulous! Who knew I could feel this good on my bike!

 

After four hours of sheer torture, I had found the sweet spot I the saddle and actually felt so much better on my bike. I even found 15% more torque from my pedaling! An added bonus that will hopefully make me a little more competitive! Here I come New Orleans 70.3 in April!

 

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.

 

 I spoke on running injuries and more specifically the need for a complete biomechanical exam to not only diagnoses, but to guide your treatment plans. This way the runner can return to running in much better shape than they walked into your office. I feel it is a missing link in a lot of offices due to the time involved. Dynamic gait analysis can actually help the clinician diagnose the root cause of an injury instead of just treating the symptoms. This will decrease the chance of a repetitive injury.

 

 I also talked about the current barefoot running phenomenon and the fact that the average runner will most likely not benefit from barefoot running due to poor biomechanics and muscle imbalances. There is much more of a chance that they will actually hurt themselves. Those runners with fairly good biomechanics and patience can benefit from some barefoot running in a controlled environment. Lots and lots of questions still exist and more biomechanics research needs to be done in this arena.

 

The need for functional foot orthotics was also discussed. No! Every runner does not need orthotics, but almost 80% need some kind of biomechanical help. Most can be accommodated with shoes, stretching and strengthening programs. You would be amazed how much impact a core strengthening program can have on your running biomechanics. Recurrent, nagging injuries often require orthotic control to alleviate recalcitrant pain.

 

The last thing I discussed was the need for a gradual return to sport so there will be no more of the too much, too soon, too fast phenomenon that plagues so many runners!

 

A great question and answer session followed. I gave away a few copies of my book, If Your Running Feet Could Talk. I think we all learned something this morning. A good time was had by all and all the athletes in the Dallas-Fort Worth area and all over the State of Texas will benefit!

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.