“Runner’s Knee”

Runner’s Knee is the commonly used name for Patellofemoral Pain Syndrome (PFPS). Patellofemoral is the anatomical term for the part of the knee joint where the kneecap comes in contact with the thigh bone. The phrase “Runner’s Knee” came about because it is one of the most common issues in relatively new runners or those who are significantly increasing their mileage. If you think you might be suffering from Runner’s Knee, read on to see if your symptoms match the description.

Signs and Symptoms

Typically there will not be anything visibly wrong. You should not notice any swelling or discoloration on the affected knee. It might not even be tender to the touch at all. You will likely only notice pain during a run or when taking stairs. The pain will also likely be hard to pinpoint. It may feel like it is the entire knee, or a “C” shape around the knee. This is different from patellar tendonitis which may cause your tendon to look swollen and is painful if you push on it.

So, What’s going on? And how can it be fixed?

Runner’s Knee is not a case of internal damage to your knee. It is a biomechanical issue that is likely caused by running gait or movement patterns that can be corrected! If you seek treatment for it, your clinician will first rule out other issues such as a meniscus injury.

At Superior Running Medicine, I will do a through physical exam including tests for other common knee problems. I will assess your movement during some common, easy exercises like squats and lunges and test your strength and mobility. We can also evaluate your running gait to see if that is contributing to your pain.

The Treatment

The gold standard treatment for Runner’s Knee is a therapeutic exercise (rehab) program that addresses the movement patterns that are causing excessive stress on your knee joint. If you schedule an appointment at Superior Running Medicine, we will tailor your rehab program specifically to your needs so you don’t have to waste time on exercises that are not the most beneficial to you.

5 Reasons to Visit Superior Running Medicine

“The meaning of life is to find your gift. The purpose of life is to give it away.”

– Pablo Picasso

When I was preparing to go to college, I did not yet know what I wanted to be when I grew up. All I knew was that I wanted to do a job that helped people. Over the course of the next few years, I would discover athletic training. After several years of practicing as an athletic trainer, I would realize that my experience in distance running made me well suited to treat runners as a clinician. I started Superior Running Medicine in order to bring my gifts to a larger number of people – not just those who are fortunate enough to run at a Division 1 university. Below I will highlight the top five gifts that Superior Running Medicine can give you!

1. Personalized Injury Prevention

Let’s face it, we are all pretty busy. As much as we love running, sometimes it can be hard to find time in our day to get out for a run. The #1 excuse I hear for not doing preventative exercises is not wanting to take the time. At Superior Running Medicine, we perform a movement analysis to determine which prevention exercises YOU would actually benefit from. I will never ask you to waste your precious time on things that won’t give you the best results.

2. Video Gait Analysis

Do you tend to get the same aches and pains any time you try to increase your running mileage? Have you been struggling to improve your race times? Or do you simply want to ensure that you will be able to run throughout your whole life? The special insights you can gain from a video gait analysis will help with all of those things. I can help you find out whether something about your running gait is leading to those pains. A gait analysis can also find areas where you can become a more efficient runner which will make you faster. To learn more, read this previous blog post on gait analysis.

3. Healthy Runner Treatments

Taking good care of your body while it is healthy is key to preventing problems down the road. One of the mottos I live by is “Listen to your body’s whispers before it has to scream.” At Superior Running Medicine, we utilize a variety of techniques that improve mobility and reduce discomfort caused by muscle tension or fascial adhesions. You and I will work together to determine which treatments will most benefit you, but options include cupping, tool assisted massage (scraping) and Active Release Technique. More will be coming in 2023!

4. Customized Training Plans

Are you getting back into running after some time off? Have you “graduated” from physical therapy but aren’t sure how much or how often to run? As a running athletic trainer, creating or modifying training plans to fit your needs is one of my areas of expertise. If you have a plan or training methodology you are interested in using, we can definitely work with that!

5. The LightSpeed Lift

Superior Running Medicine operates out of the LightSpeed Lift Movement Center in Duluth, MN. The LightSpeed Lift is an amazing bodyweight support system that is incredibly comfortable and easy to use. The weight reduction is an incredible tool for progressing back from an injury, reducing load to prevent injury, OR facilitating speed training to improve your performances.

I would love to share my gifts with you if you see a service above you could benefit from! Click here to schedule a visit.

SI Joint Pain

Our bodies have two sacroiliac (SI) joints, just above the coccyx (tailbone). Unlike our shoulders or elbows, SI joints don’t have a very large range of motion. They move a small amount to allow for activities like walking, running, or pitching a baseball. SI joint pain can occur if over time after lots of repetitive motion. These small rotations can add up and the two sides may not be perfectly symmetrical. We can often feel this in the form of an ache, pain or the sensation that our hips are not in the proper place.

At Superior Running Medicine, I will address this by evaluating your hips and legs to see if you are rotated. I will work with you to perform a muscle energy technique to correct the rotation and I will teach you some ways you can self correct in the future. I will also develop and stability and strengthening plan that can help minimize the occurrence of this issue.

A more serious form of SI joint pain can occur if the sacrum develops a stress fracture. Stress fractures are caused by a very high volume of training that is out of proportion to the runner’s rest and caloric intake. These injuries are often missed by healthcare professionals who don’t have experience evaluating a lot of them. If you are experiencing low back pain or a “pain in the butt” with running, I encourage seeing an athletic trainer, physical therapist or sports medicine physician.

Plantar Fasciitis

Plantar fasciitis is common in athletes as well as in professions that require being on your feet for a very long time. As with most injuries ending in “itis” it begins as an inflammation of the body part but can progress to a more difficult, chronic problem. Inflammatory injuries that are not treated properly early on can cause changes to the body tissue that are much more difficult to get rid of.

How can you tell if you have plantar fasciitis? The classic symptoms are:
– pain along the bottom of the foot, especially the bottom part of the heel.
– that is worse with the very first few steps in the morning
– and gradually improves throughout the day.

However, those are the symptoms that you will notice early on. As the condition worsens, the pain might not get better throughout the day.

Plantar fasciitis is “invisible” and you won’t really see anything if you look at the bottom of your foot. It won’t appear bruised or swollen. However if you use one hand to bend your toes upward, you may notice an increase in your pain. An athletic trainer, doctor, or physical therapist will know just the right places to press on the foot in order to make the official diagnosis.

If you suspect you have plantar fasciitis, I recommend getting seen by a professional, but if it has just recently started, here are some things you can do for yourself to see if it will resolve:
– set aside a “treatment time” that begins with warming up your foot. I recommend soaking the foot (or feet if it is both) in comfortably hot water and moving your feet and ankles around.
– roll the bottoms of your feet on a ball and roll out your calves with a foam roller
– stretch your calves on a wall
– give yourself a little foot massage with intention – hold your thumb in one spot on the bottom of your foot while flexing and extending your toes. Do this for a few seconds and then move on to another spot.
– at the end of the day, roll your feet on a frozen plastic water bottle.

Don’t worry yet if all of these recommendations do not make perfect sense – photos and videos will be coming soon to our social media channels! Or make an appointment to get a plan that is customized for you and a treatment session so you don’t have to do it yourself!

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 have “good running 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.