Running Overuse Injuries

Many of us runners do run some of our highest mileage of the year in the fall whether it be due to a fall marathon, cross country season or just because we enjoy it. Higher mileage can sometimes lead to overuse injuries if we are not careful. 

I absolutely love running in the fall. The temperatures are ideal almost all day long. The changing leaves are beautiful. The air is crisp and smells good. And of course, fall is cross country season so there is a certain amount of nostalgia mixed in. If I could, I would probably try to run every single day during the fall months. In the years that I ran the Chicago Marathon in early October, I would feel a little sad that I had to take time off after the race and couldn’t keep running through the golden leaves and cool mornings. 

What is an overuse injury? Put simply, an overuse injury is caused by too much impact and too little recovery. They happen gradually over time. The other type of injury is an “acute” injury which is something that happens in one moment like a sprained ankle or getting a cut. 

This week we will go over 3 common overuse injuries and how to avoid them. If you just so happen to be beyond the point of prevention and you think you might have one of these overuse injuries I strongly recommend consulting with a sports medicine professional like an athletic trainer, physical therapist or doctor. 

  • Plantar Fasciitis – The plantar fascia is a layer of tissue that covers the bottom of your foot. It can become irritated and painful  when someone spends too much time on their feet. In addition to being a common running overuse injury, plantar fasciitis happens a lot to people whose jobs require lots of standing or walking (nurses, restaurant waitstaff). The fascia is closely linked to the Achilles tendon, so having tight calf muscles can also exacerbate this injury. 
  • Patellofemoral Pain Syndrome (“Runner’s Knee”) – Despite having a nickname related to running, PFPS is the most common type of knee pain in all physically active people. It is characterized by a general, annoying knee pain that can be hard to localize to just one spot. 
  • Stress Fracture – A stress fracture is a broken bone that gradually happens over time from too much impact on the bone. These are no less serious than an acute fracture. However, because they don’t happen in one painful moment and don’t break through the skin, they can sometimes be accidentally ignored or missed. It is a common misconception that stress fractures don’t show up on an x-ray. They just look different on an x-ray. There isn’t always an obvious fracture line but there are other types of evidence that a trained sports medicine physician will see. 
What can be done to prevent an overuse injury? Here are some easy things you can do to protect yourself. 
  1. Increase your mileage gradually. As tempting as it may be to start running every day in the fall, it is very important to always give your body at least one day of complete rest per week. If you were running 3 days per week all summer, it is perfectly safe to increase to 4 or 5 days. Our bodies need a little time to adapt to increased impact. Remember, they are called “overuse injuries” because they happen from overusing a body part.
  2. Listen to your body.  Our bodies give us signs that we are overdoing it long before overuse injuries appear. If you are feeling much more fatigued than usual or much more sore, you may need extra rest. If you are feeling crabby or going for a run sounds like a yucky chore instead of fun, you may be on the verge of over training. 
  3. Correct any imbalances,  In earlier posts I have written about things like movement assessments, gait analysis and corrective exercises. If you are planning to increase your running mileage, it would be a really great idea to have a trained professional evaluate your movement patterns and/or gait. Running thousands of steps on a movement imbalance can cause an injury to set in more quickly. 

If you are hoping to take advantage of the beautiful fall weather in Minnesota by running more frequently, Superior Running Medicine would be happy to help you do so safely!

Endurance Running Nutrition

Athletic trainers are experts in providing health care for active populations. Almost all of us have a master’s degree in athletic training or a closely related field. However for some concerns, like nutrition, we rely on our colleagues who are registered dietitians. 

I have been receiving a lot of  nutrition related questions from my clients lately so I reached out to Alex Larson, a registered dietitian who specializes in endurance athletes. Here are some of her pearls of wisdom!

Q: What advice would you give to someone who is about to train for their first marathon and is overwhelmed by all the choices of  gels, chews, etc?

A: See if you can buy a few varieties of products in flavors that you tend to enjoy. Try them out either before or during your runs to see how you like them. Make sure to also consume them with water! .  Another option is to research what your race will be offering at aid stations and to trial those well in training. 

Q: I have had so many runners tell me that they just can’t stomach any food in the morning before an early run. I usually say that at the minimum I want them to try a banana and a full glass of water. Do you have other tips?

A: A banana is a great start. Liquid carbs will usually be more tolerable when you don’t have an appetite, such as applesauce or juice. Simple foods like graham crackers are popular to use. Or, use sports fuel like some energy chews. 

Q: One of my running buddies suggested I write a blog post about fad diets. I think that topic is way too big and beyond my scope. Would you be willing to share a couple of sentences about what a runner should do if they see a diet on their social media and think “Hmm maybe I should try that?”

A: Run away! 

Fad diets tend to be restrictive, nutritionally inadequate, difficult to comply with and while they may result in quick weight loss, the weight loss is temporary. Don’t fall for the claims that the fad diets report. It’s going to do more harm than good. When it comes to diet and diet products, if it sounds too good to be true. It likely is.

The Best Running Shoe For You – Part 2

Various trainers from collection.

At the end of my last post on finding your best running shoe, I mentioned some words you may have heard before in relation to running shoes. They were pronation, motion control, shoe drop and carbon fiber. In this post I plan to unpack each of those things a little further. 

Pronation/Over Pronation

Some running shoes are marketed as having “pronation control”. Pronation is a natural movement of the foot that happens when you walk or run. Pronation is a movement word that can actually be used to describe actions at other parts of your body, too. Your hands can pronate. Your entire bodies can “lie prone” if you are facedown on the floor. Over Pronation occurs when the inner portion of the foot and the inner portion of the ankle collapse inward too much. An athletic trainer or physical therapist can take a video of you running and measure your amount of pronation with a motion analysis software. They can tell you whether your amount of pronation is within normal limits. 

Motion Control/Stability

If you are someone who legitimately falls into the Over Pronation category, you could benefit from a motion control or stability running shoe. These shoes are designed with extra support that reduces the amount your foot rolls inward while running. If you have met me in my clinic yet or attended one of my presentations, you know I am also a huge advocate for corrective exercises. There are excellent foot and ankle exercises that can help your body support itself while running. A good place to start is the “Short Foot” exercise.
Combining the shoe that is right for you with the exercises that your body needs is the perfect recipe for reducing injuries. 

Shoe Drop

Shoe drop or heel drop is the difference between the sole thickness at the heel of the running shoe and the thickness under the ball of the foot. You can think of this somewhat like a pair of high heels. A 3” pair of heels would be a 3” drop. Obviously the drop in a running shoe is not that dramatic. The drop is anywhere from 0 in a pair of racing flats up to about 10-12 millimeters in thicker, more heavily cushioned shoes. In general, cushioned shoes with a higher drop tend to encourage a runner to land farther back on their heel while running. These shoes tend to be more beneficial for a runner who has been experiencing heel pain like plantar fasciitis. The lower drop shoes facilitate midfoot to forefoot striking.  This can reduce the risk of other types of injury because this gait pattern reduces overall forces through the lower leg while running. 

Carbon Fiber

For about 4-5 years now, the elite field of every major marathon has shown up wearing brightly colored, very thick racing shoes that have carbon fiber plates. A primary reason for this is that the carbon fiber plates have been shown to reduce the “energy expenditure” of running. This means that the runner uses less of their own energy. Over the course of a race like a marathon, this is a HUGE advantage! Lots of research is being done on these shoes to see whether they offer any injury prevention benefits. There is also work being done to determine whether it is safe to do a majority of training runs in them or if they should be saved for races and speed workouts. At Superior Running Medicine, my position is that these shoes can be a great tool to use for road races. Like anything, they should not be used only on race day and they should occasionally be trained in so your body gets used to them. In my experience, they do not last as long as a typical training shoe, so you should not wear them for all of your training miles. 

The Best Running Shoe for You

How can a runner find their bet running shoe? I am undertaking a lot by even attempting to scratch the surface of this topic in a 400 word blog post, so let’s dive right in!

I included the words “for you” in the title of this post, because the best shoe really is whichever one is right for YOU. Not necessarily the shoe that the most professional runners wear or the one that your best running buddy wears. 

I think one of the best ways to illustrate this is to look at the recent history of running shoe trends. It has really not been very long since “barefoot” running shoes were everywhere. Lately we have gone the opposite direction and shoes with very big soles are flying off the shelves. 

Here are three things to consider if you are new to the world of running shoes or if you are looking to make a change. 

Go to a run specialty store if you are able to. 

A run specialty store is just what it sounds like – a store that specializes in selling running shoes and gear. There are some that have clusters of locations around the country. (Fleet Feet, Road Runner or Pacers) These stores also have an online presence. Other running specialty stores are local, privately owned small businesses. In Duluth we have Duluth Running Company, Tortoise and Hare and Austin Jarrow

The staff members at these stores are often runners themselves and are great resources. Some locations have treadmills in the store and will let you run in a pair of shoes to get a feel for them. 

Buy from a store that will let you return a worn shoe within a certain period of time. 

Even if you run on the store treadmill in your new shoes, you won’t really get a feel for how an entire run (especially a long run) will go. Even one run won’t be a perfect indication because the shoe might be a little stiff when it comes out of the box. At the store, be sure to ask the sales associate if they have a trial period during which a worn shoe can be returned.

Have an experienced clinician watch you run before you go shopping. 

We have not yet gotten into a lot of the confusing parts of choosing a running shoe. Keep your eyes open for more upcoming posts on topics like pronation, motion control, “drop” and carbon fiber. To simplify the process, an athletic trainer, physical therapist or podiatrist can evaluate your running gait to help you demystify your foot. For example, did you know that everyone is supposed to pronate some when they run? We often hear it talked about like a bad thing, but your foot has to pronate as part of the running gait. 

If you want to know more, reach out to Superior Running Medicine for a video gait analysis! I would be thrilled to help you find your best pair of shoes. 

What is “Good Running Form?”

If you have been running for any length of time, you have probably wondered if you are running with “correct form”. Especially if you’ve had a body part become sore or injured from running. It is a good question to ask yourself, because when we run, we take anywhere from 160-190 steps in a single minute and our body weight is increased by 3-6 times. This means we really take a pounding! And if there is something wrong with our form, doing it 9,600 times over the course of an hour can lead to a problem. 

Today I will go over two self-checks you can do to see if you are making a running form error that might be slowing you down or causing you pain as well as one sign that you might need to consult with a specialist. 

Do you get sore, tense shoulders after a run? Or notice a tension headache after running? 

If so, you may be carrying your arms high and tight to your body. Our arms should swing forward and backward when we run and our shoulders should be relaxed enough that our hands swing past our hips. Even when we are tired! Our arm positioning helps us maintain our balance while running and can help propel us forward so our legs are not doing ALL of the work. Check yourself by occasionally brushing your fingertips against your hips to be sure they are low enough. Mentally check where your shoulders are – do you feel them tensing up and rising towards your ears? Take a deep breath and drop them down. Occasionally relax all your fingers and shake out your hands.  Remember, a T-Rex does not have good running form.

Do you kick yourself when you run? Do you get home and notice that your inner calves are dirty but the rest of you is not?

If this happens to you, your leg may be internally rotating too much. This can be a side effect of weak or fatigued hip muscles. Strong hip and glute muscles are a necessity for healthy running. Some of our most important hip muscles are the ones that rotate our leg outward. I have an earlier blog post that goes into this in more depth. https://superior-running-medicine.com/2021/12/17/get-your-rear-in-gear/ If you are internally rotating and kicking yourself, I strongly recommend adding muscles for your external rotators and abductors so you are not an injury waiting to happen. 

Does something hurt while you run or hurt at times throughout your day? 

Running can be so much fun but when you are first starting out it can be really hard! And then later in your running life when you get good at it, sometimes you will make it really hard for yourself again by doing intense workouts and races. The hard kind of hurt is totally OK. But if something hurts in a way that you know just isn’t right, it is time to seek the advice of a sports medicine professional like an athletic trainer. This person can help you determine whether or not some part of your running form is causing the pain and what steps are needed to correct it. We are a lot less scary than the overwhelming results you are likely to get from Dr. Google!

Are you looking for some advanced help with your running form? Check out our Services page. Feel free to reach out to chat and see if Superior Running Medicine might be a good match for you!

Optimizing Changes to Your Running

If you have ever been evaluated for a running injury in the past, the clinician treating you probably asked the question “Have you changed anything recently?” They may further question you as to whether you changed your shoe brand or model, significantly increased your mileage or took up trail running. We ask these questions because we know from years of experience that making any one of those changes can cause a problem. 

Which isn’t to say that you shouldn’t do them! Sometimes you should change your shoe brand if the previous one wasn’t working for you. Trail running is a beautiful activity! Mileage increases should be gradual, but if you are training for a longer distance event, your mileage will likely need to increase. 

There is a wealth of information available on the internet but sometimes it can all be overwhelming and we just want an expert to help us. Let’s take a closer look at those 3 questions I previously mentioned and how Superior Running Medicine can help. 

  1. Are you considering a shoe change? 

Shoe trends have taken a 180 degree turn in the last 10-15 years. In 2010 the minimalist shoe movement was so popular that I actually saw folks running entire marathons completely barefoot that year. Now, thick support and stability are everywhere. Which is correct? Neither? Both? At Superior Running Medicine, I will look at your foot and your running mechanics and help you determine which type of shoe is best for you. I do not sell shoes and I am not affiliated with a brand. My only motive is helping you run comfortably. 

  1. Would you like to increase your mileage? Or start adding speedwork to your routine?

Most of the runners I work with enjoy running for its own sake but also love to participate in organized races. These events give us a chance to work towards a goal, to structure our week of running.Competition is fun whether we compete against others, a clock or ourselves. Continuing to improve our performances means we need to push ourselves outside our comfort zone either with a few more miles, speedwork or increasing our strength training. Doing all 3 at once is the perfect recipe for an injury. We can work together to determine the best place for you to start. 

  1. Have you moved to an area with different terrain? Or are you interested in taking up trail running? 

These surface changes can feel like a big deal to our bodies. Switching from road to soft surfaces means more work for the small stabilizing muscles of our feet. Uneven trails with roots and rocks are a challenge to our balance. A movement assessment by a professional can help you identify body areas that may need strengthening in order to safely navigate your new environment. 

If anything in this post resonated with you, please reach out! I would love to consult and see how Superior Running Medicine can help you run happily and free of injury.

What is “Scraping”? Is it Good for Runners?

One of the most popular treatment options I provide is commonly called “scraping” by the athletes who request it. The official name for scraping is “Instrument Assisted Soft Tissue Mobilization” (IASTM) which is definitely a mouthful. You will also hear this treatment referred to as “Graston” because the Graston Technique is one form of IASTM.

Clinicians like athletic trainers, physical therapists, chiropractors and massage therapists can take courses provided by the various instrument companies. These companies train the provider to use their tools in a safe and effective manner. Most of the tools are made of stainless steel but some may be hard plastic or ceramic. In addition to Graston, other company names include Hawkgrips and RockTape.

So what does scraping do? First let’s have a tiny anatomy review. Our muscles are covered in a connective tissue called fascia. You can think of this as being like a sausage covered in a casing. Our muscle is the sausage and fascia is the casing. Repetitive movements like long distance running cause the fascia to crinkle up. Clinicians call this crinkling “myofascial adhesions”. This crinkling doesn’t feel good – our bodies interpret myofascial adhesions as pain or tightness. Scraping the area with a tool can resolve the adhesion by mobilizing the tissue.

This treatment is most effective prior to an exercise session. Your clinician may have you do a brief warm up and may have you stretch the area immediately after. Scraping can be done safely even right before a race. It should not be done on the same body part on back to back days.

Potential side effects are small, light bruises from the increased surface blood flow. Light bruising is perfectly normal but it should NOT look like you’ve been beaten with a baseball bat. If you bruise significantly, please let your clinician know. This treatment can also be slightly uncomfortable. Part of the reason it is called scraping is that it feels like being scraped with a butter knife! However it should NOT be terribly painful. If you are experiencing a lot of pain during the treatment, please alert your clinician right away so they can be more gentle.

This is a brief summary of the basics and as always I am happy to answer any questions you may have!

Where Should a Runner Seek Help When Injured? Part 4

Physical Therapists

In my career as an Athletic Trainer, (AT) I have had the opportunity to work with some amazing Physical Therapists (PTs). For this post, I interviewed one of my favorite PTs, Elise Cirone. Elise is a PT and an AT. She works for Northwestern Medicine in Chicago, Illinois.

Physical therapists are licensed healthcare providers that evaluate, diagnose and manage health conditions and movement problems. When Elise and I worked together, I would often consult with her on cases for which I needed a different perspective.

Physical therapists can perform evaluations, screening and movement analyses to assist an individual with injury prevention. These can be general movement screenings and specific, such as a running gait analysis. PTs can also work with individuals with a running related injury and build rehabilitation plans that will return runners back to their sport as safely and quickly as possible.

Physical therapists are licensed healthcare providers. To practice physical therapy in the US, individuals must earn a doctor of physical therapy degree from an accredited physical therapy education program. The doctorate program is typically around 3 years long. It includes didactic and lab coursework, along with clinical education experiences. Physical therapists may also achieve board-certified specializations through advanced post-graduation education or years of clinical experience.

When looking for a physical therapist, you should make sure that the individual has the credential “PT” or “DPT”. Many board-certified specialists may also be valuable for a runner to work with, including orthopedics, sports and women’s health. Checking out these resources from the American Physical Therapy Association can assist you with finding a licensed provider in your area: Find a PT (apta.org) and tips for choosing a physical therapist: Resource | Choosing Your Physical Therapist | Choose PT

Many states do not require a physician referral to access physical therapy services, however, your individual health insurance policy may require you to obtain a referral. It is recommended to check in with your individual insurance provider for any requirements prior to obtaining care.

I asked Elise to tell me about a rewarding experience she has had with a patient. She said, “I have been fortunate to work with many athletes as part of a collaborative inter-disciplinary team. It is so rewarding to help an athlete back to their sport after an injury. Some of my favorite cases to work with are post-surgical rehabilitations. It is incredible to see the progress from the acute, post-operative phase and work with an individual all the way back up to competing to their fullest potential. There is nothing quite like seeing an athlete back competing after a long journey!”

Here is another direct quote from Elise that I wholeheartedly agree with. “Physical therapists are a great asset to your success as a runner! I encourage individuals to build themselves a “team” of individuals and experts to help achieve your goals! ” If you actually think of your health care team as an athletic team, your doctor would be the quarterback and your physical therapist and athletic trainer would be like the running back and wide receiver!

How Long Should I Rest an Injury?

When I worked in college athletics, every year I would give a pre-season chat to go over rules and expectations. One very important thing that I tried to emphasize was:

It is much easier for me to fix something small when it first begins. You might not even need time off from running. If we ignore a niggle and it turns into something big, I might not be able to fix it quickly and you might have to stop running for days, weeks or months.

Here is an example of how this might play out:

Susie is running 35-40 miles per week. She starts to feel a tightness in her left hip, but after she runs for half a mile, the tightness goes away. She assumes this means that once her body is warmed up and loosened up, the muscle isn’t tight anymore. What Susie doesn’t know is that the muscle isn’t loosening up, but rather after about half a mile, she has settled into a compensatory gait. Her body is just finding a different way to run that doesn’t feel tight. After a week of running this way (including an 8 mile long run on the weekend) her low back hurts when she gets in and out of her car and her left hamstring is also starting to hurt. Her back, hip and hamstring will all feel distractingly tight when she tries to go to sleep at night and stretching just doesn’t seem to help. She is losing sleep, shortening her runs and feeling slower.

Sally is also running 25-40 miles per week. She starts to feel a tightness in her left hip that she doesn’t know how to fix so she reaches out to an athletic trainer (AT). The AT assesses Sally’s range of motion, strength and does some functional tests. She determines that Sally’s issues could be fixed with some very easy corrective exercises that Sally can do with the supervision of the AT until she feels confident doing them on her own. Sally’s hip tightness is gone in a day or two and her training continues to progress.

Now, of course, there will be some injuries that can’t be fixed in a few days with exercises. Sometimes we might think we have a terribly tight muscle that we just can’t stretch enough and it turns out to be a stress reaction. Unfortunately the way we feel pain isn’t always crystal clear. But wouldn’t it be nice to not have to worry about making that determination on your own?

After the Marathon

The 2022 marathon calendar is underway. The Tokyo marathon took place in early March and Boston is just over 3 weeks away. When I was preparing for my first marathon (and even 2nd and 3rd) I would read just about everything I could get my hands on to make sure I was preparing well. I carefully selected a training plan every time that promised to help me achieve my goals. I remember that as the day of my first marathon approached, I started to realize I didn’t know what to do afterwards. I knew I was going to have to recover, but for how long? Hours? Days? Weeks? I tried searching for advice in the same way I had searched for training plans. Instead of a plethora of information, I found one article. Just one. And it didn’t go very much in depth. It told me to rest one day for every mile of the race. So I assumed I was going to have to take 26 days completely off of running. Spoiler alert – I didn’t last and ran again 10 days later. That run went terribly for a lot of reasons. It wouldn’t have gone terribly if I had been able to find the correct advice. So, for you I have compiled an E-booklet of the correct advice. “After the Marathon” explains what is happening to your body when you run a marathon and how to recover intelligently so you can return to running again. (If you choose to return. And I hope you do!)

You can purchase the book here. Full disclosure, I am new to the world of selling online and I am sure that the first 2-3 people who purchase might need to reach out to me to ask me to send them the PDF.