Part 3 – Where Should a Runner Seek Help When Injured?

The next post in our series on types of healthcare providers is about sports medicine doctors. I have worked alongside sports medicine doctors for my entire career and they are amazing human beings. They are highly educated and they really understand the athlete mindset. They want to get you back to your sport but they want to do it as safely as possible so you are not at risk of further injury. 

For this post, I interviewed Dr. Dominique Stevens, a sports medicine provider for Northwestern University in Evanston, IL. My hope for this series is to help runners understand which healthcare provider to seek out when they are injured. According to Dr. Stevens, runners should see a doctor when they sustain an acute injury. An acute injury is something that happens suddenly – not an overuse injury which creeps up slowly over time. You will almost always be aware that you sustained an acute injury because you will feel or hear a pop and have a sharp pain. An example would be an ankle sprain.  You should also seek help from a doctor if you have an injury that has become so nagging that it is interfering with your everyday life. If you can not walk normally and nothing you are trying is making it better, you should call a doctor. 

Sports medicine trained physicians have additional training beyond that of your primary care physician. Primary care (also sometimes called family medicine) doctors are trained in managing all kinds of things. Everything from strep throat to blood pressure. Primary care doctors do receive some training in musculoskeletal injuries. Just like it sounds, those are injuries to the muscles or bones. Sports medicine doctors go on for at least a minimum of one more year of training in musculoskeletal injuries and they must be board certified. This means they have to pass a very thorough national exam on sports medicine issues. 

I asked Dr. Stevens if she could share a specific example of a time that an injured athlete sought out her help and she was the right person for the job. She described a time when an athlete was experiencing a nagging shoulder pain. He did not recall a specific acute injury, but gradually over time he could not throw properly and nothing he had tried for himself was helping.  Dr. Stevens performed a thorough history and physical exam and took an x-ray. She was able to correctly diagnose tendonitis and explain to this athlete the need to do a rehab program that was tailored specifically to his needs. He successfully returned to his sport. 

Thank you so much for reading and stay tuned for the next post in the series! 

Part 2 of Where Should a Runner Seek Help When Injured?

For this post, I interviewed Dr. Thomas Solecki. Dr. Solecki has a PhD in Health and Human Performance. He is an adjunct university  professor and a team chiropractor for collegiate athletes. 

CN:  My primary goal for the blog series is to help the running community understand the differences and overlaps between different types of providers and when they should see each type of person. Can you describe when a runner should reach out to a chiropractor?  

TS: A runner can reach out to a chiropractor for any neuromuscular/skeletal condition.  For example, plantar fascitis, shin splints, low back pain, hip pain, muscle spasms, sprains or strains. A sports chiropractor can help with stability and strength training by providing a rehabilitation program.

CN:  What type of education and training do you have? If someone has never seen a chiropractor before and they want to for the first time, what credentials/degrees should they be looking for?  

TS: Personally, I have a bachelor’s, master’s, Phd and DC degree.  Chiropractors will typically have a Bachelor’s degree and Doctor of Chiropractic degree.  If an athlete (runner) is looking for a chiropractor for the first time they should seek one that has post graduate training in sports medicine, rehabilitation or orthopedics.  These post graduate training programs are available and allow the chiropractor to specialize in a field of study leading to a diploma in the field.  For example, the American Chiropractic Board of Sports Physicians and American Chiropractic Rehabilitation Board offer diplomate programs leading to a speciality in sports medicine or rehabilitation.  The ACBSP offers additional training in concussion certification which can lead the chiropractic doctor to evaluate and manage concussion.  These types of specialties are helpful when runners are looking for someone who has advanced training in sports injuries and management of how to rehabilitate them.  I believe certifications such as a strength and conditioning specialist, corrective exercise specialist, performance exercise specialist or a degree in exercise science can be very helpful in treating the injured athlete.

CN:  Tell us a patient success story – a time an athlete came to you and you were able to help them return to their sport. 

TS:I have had the opportunity to help many athletes over the years in practice.  I have a very memorable story about an older athlete who was a triathlete and competitive cross country skier.  He was training for the Hawaii Ironman and suffered chronic bilateral shin splints with plantar fasciitis of the right foot.  I developed a treatment program for him that involved soft tissue treatment of the lower extremities, and fascial slings throughout his body.  I also utilized a stability and breathing program that involved DNS.  (DNS stands for Dynamic Neuromuscular Stabilization) Lastly, I developed a strength program for his lateral pelvic stability and trunk to enhance his stability and strength endurance.  He responded favorably and was able to return to training and compete in the Ironman without having any residuals after the competition.  

CN: Is there anything else you would like to share with the running community about chiropractors? 

 TS: Be diligent about your search for a chiropractor.  Use the criteria I have outlined above and make sure that treatments address all components needed to heal.  The body involves the poetry of the human frame and all the attachments that allow it to function, always be sure these structures all get equal attention.

Where Should a Runner Turn For Help When They Are Injured?

As a recreational runner, it can be hard to know where to go for the best advice when something hurts. Most high school, college and professional athletes are extremely lucky to have an athletic trainer (AT)  who works with their team who can assess, diagnose and treat their injury as well as refer them to other types of healthcare professionals when needed.  A good, ethical AT will be honest with you about what they can and cannot treat. We are highly skilled and trained in many areas but we operate under the licenses of physicians and must refer to them when necessary. 

Out in the “real world” it can be hard to find an athletic trainer who serves the general population. This is one of the primary reasons I started Superior Running Medicine. 

When I worked as an athletic trainer for a collegiate cross-country program, I would joke that I understood them because I was “the same kind of crazy.” I don’t mean that in an insulting way at all. Non-runners tend to think we are crazy and I was choosing to embrace the word rather than be hurt by it!  I do understand the types of training and workouts that runners do. I am very well versed in the types of injuries that commonly occur in runners and I have many years of experience creating training plans that bridge the gap from injury to full-volume running. 

I have been running long enough and working with runners long enough to know that the most devastating thing you can tell a runner is that they need to stop running. Running serves so many purposes in our lives. For some it is our quiet alone time, for others it is our social time with our running buddies. For some of us it is our sport – we train and compete to improve. For others, it is freedom and a release – a time to be outside in nature with no watch or cellphone or worries. Taking away this outlet can leave us stressed and irritable. 

The first time I was ever injured, I saw a primary care physician. These doctors are brilliant people who are trained to manage a wide variety of conditions. This doctor was able to narrow down my diagnosis to two things based on the location of my pain. He told me that it was either a bone stress injury or tendonitis. He advised that I not run for 6 weeks because both of those conditions can heal within 6 weeks time. Not. Run. For. 6. Weeks. 

That was not what I wanted to hear. 

I was an undergraduate college student myself at the time and I was taking my very first class in the field of athletic training. So I asked the AT teaching the course if he would look at my foot. He did some additional things that the doctor hadn’t done – asking me to move my foot in certain ways, apply pressure to his hand with my toes, etc. He was able to fine-tune my diagnosis and shorten my time-off sentence.  

I hope that this post will help you understand when to seek the services of an athletic trainer. Over the course of the next few days, I plan to profile other types of healthcare providers you may encounter and what their skill sets are in order to help you determine who to see and when! 

If after reading this, you would like to come meet with me, follow this link to my menu of services!

What is Cupping? Is it Good for Runners?

Photo from the National Center for Complementary and Integrative Health

Cupping is one of the treatment options provided at Superior Running Medicine and it was one of the most commonly requested treatments when I was working in collegiate sports medicine. Here is a look into what cupping is and what it can do.

Cupping was brought to the public eye in the 2016 Summer Olympics when Michael Phelps’s back displayed some bold cupping bruises. However, cupping was not new in 2016 – it has been a part of traditional Chinese and Eastern medicine for centuries.

The cups are typically made of glass, plastic or silicone and measure about 2-4 inches across. Different sizes are best suited to different body areas. The clinician treating you will use a small pump to attach the cups to your skin. The skin will rise and redden due to blood flowing in to the area. Your therapist might also glide the cups along your skin to create a massaging effect.

There continues to be a lack of solid scientific research that really outlines the benefits of cupping. You will find claims that it can treat everything from arthritis to fertility disorders with very little to back up those claims. What we do know is that it is quite safe for most people when it is performed by a health care provider with appropriate training. The most common side effects are a pinching sensation while the cups are in use and bruising afterwards.

At Superior Running Medicine, I use cupping to treat tight, tense muscles caused by the repetitive nature of running. The areas I most commonly treat are the shoulders, back, quadriceps, hamstrings and calves.

Do you have any specific questions about cupping? Please feel free to leave them in the comments section below!

From Worst to First – the Three C’s

Recently, a friend suggested I write a blog post about my own race plan for an upcoming 5k. At the time I didn’t want to do that. I thought I had 2 very good reasons.
1. I want my blog posts on this site to stay focused on the healthcare that I can provide.
2. I provide those services for you! I want the focus to be on others and not on myself.

However, the following afternoon I went for a small run in preparation for that 5k race, and I realized that maybe writing a small post about my racing journey could help me tell you a little about the perspective from which I approach my own running and how that carries over into the care I provide for others.

When I started running in high school I was terrible. I don’t really have any doubt that I was the worst kid on the team. I would typically struggle to run the entirety of a race and a good day for me meant coming in second to last. Despite my lack of talent, there was something I liked about it and I kept running. Throughout college and early adulthood I would run 3 miles most days. The story of how I got involved in running marathons is probably best saved for another post, but the fact remains that I improved from struggling to finish a 2.5 mile race to finishing 26.2 miles multiple times.

The timeline of my improved endurance coincided nicely with my increasing experience in the world of sports medicine. I learned about the importance of strength training for preventing injuries and I learned about corrective exercises to address movement patterns that could cause injury. A welcome side effect to more strength training was that I got faster. The first marathon I ever ran took me more than 5 hours. A few years later I ran a personal best of 4:14. The collegiate student athletes that I used to work with would be shocked when I told them that I did all of this without ever having a major, time loss injury. Sure there would be aches and sore muscles here and there, but no stress fractures, no plantar fasciitis, nothing.

Oh, and that 5k race I ran recently? I took 1st place in my age group and won a prize. Overall I was the 6th woman out of 28. I’ve come a long way from finishing dead last!

Here are my three pearls of wisdom. The Three C’s.

Consistency, Correctives and Cross Training. I will keep the description to one paragraph each, this post is already getting long!

Consistency – Take care of your body in a way that allows you to follow each day of your training plan. Consistency does not mean “run every day”. If your plan calls for a day off, take it off! If a run is supposed to be easy, do NOT run it fast and hard. Save that for your speed workout days. You’ve probably heard the cliché “Gains are made on rest days.” Well it is actually true. When we do a hard workout, our body freaks out a little but but then it adapts in case we ever try to make it do something like that again. We don’t improve from the training itself, we improve when we allow our body to adapt to what it just did.

Correctives In a recent post I went over this in more detail. Corrective exercises help us run more efficiently so we don’t waste energy and they protect us from injury. I strongly encourage you to be assessed and find out what your weaknesses are so you can improve upon them.

Cross Training – These are the other exercise we do outside of running and correctives. Often times training plans will call for one day per week of cross training. If your plan doesn’t call for a day of cross training…you might want to find a plan that does. When we do something different, we become a more well-rounded athlete. Using an elliptical trains our running muscles with lower impact. Riding a bike reduces the pounding on our bones. Weight lifting improves our bone density. I could go on and on.

This might be one of my longest posts so I will stop here, but I encourage you to leave a comment or ask a question! Happy running!

Crossing the finish line first in my age group!

Movement Screens and Corrective Exercises

When I was early in my career as an athletic trainer, I took the National Academy of Sports Medicine’s Corrective Exercise Specialist Course. It laid an excellent foundation for identifying potentially problematic athletic movement patterns and determining how best to correct them.

As a special added bonus, almost all corrective exercises also make runners faster. Compensatory patterns result in wasted movement and make us less efficient.

Today I will eat a slice of humble pie and use myself as an example.

Take a look at me on the right side and my friend Earl on the left. Now take a look at my left leg and Earl’s left leg. The anatomy of my left hip has been a disadvantage for my whole life. If I am not conscientious about my corrective exercises it becomes problematic. I can have symptoms like tightness, aching, IT band symptoms, gluteal pain, etc. My running life is really a lot better when I take the small amount of time needed to do my corrective exercises. And my running photos are less embarrassing!

Without telltale photos of ourselves or a professional to help us identify our patterns, it can be hard to know where to start. Reach out to me and I will be happy to perform a movement screen for you!

What is the Ideal Cadence?

Running “cadence” or step rate is the total number of steps a runner takes per minute. Cadence is one of the most controllable risk-factors for injury yet it seems to me to be one of the most often overlooked. In my post on Video Gait Analysis I touched on the topic of how many steps a runner may take in a run and how running so many steps with faulty mechanics could lead to injury. For that reason, you might be thinking to yourself “more steps must mean more impact and therefore a greater injury risk”. However, the opposite is actually true!

A 2012 study by Heiderscheit et al in the journal Medicine & Science in Sports & Exercise examined the relationship between cadence and loading of the hip and knee joints. They found that small increase in step rate actually reduced the amount of load on these joints. How can that be? Imagine that instead of running with your feet, you are clapping your hands. Actually go ahead and try it – clap your hands to a steady beat for one minute. Then for the following minute, try to fit in 10 more claps. You will notice that in order to fit in more claps, you have to decrease the amount of time your hands are in contact with each other. When a runner increases their cadence by 10 more steps per minute, they reduce the amount of time that their foot is actually in contact with the ground per step. Decreased ground contact time leads to less loading on the joints.

In a live presentation Dr. Heiderscheit gave this fall at the Mountainland Running Summit, he taught that a cadence of 166 steps per minute or less was linked with a much higher risk of shin injury that a cadence of 174/minute or greater.

If you are interested in finding out your current cadence, try this method: Settle into a comfortable pace on a treadmill for about 5 minutes. Keep your eye on the clock for one minute and during that minute, count the number of times your right foot hits the treadmill. Double that number and you have your cadence! If you find your self in that 166 or lower range, try increasing your cadence by an additional 10 steps per minute.

For a more comprehensive evaluation, in addition to assessing your cadence, reach out to Superior Running Medicine today to book a Video Gait Analysis.

What is Training Load? Why Does it Matter?

Raise your hand if the following scenario sounds familiar. You have just signed up for a race. Maybe you signed up because you needed the motivation to be active. Maybe you like the structure of a training plan. Or maybe you run cross country and track and you didn’t so much “sign up” as arrive back at school for the start of indoor season. Now that the race date is on the calendar, it’s time to train, but maybe you haven’t done the greatest job of maintaining a base fitness. (That’s the part where you should raise your hand).

I am not here to pass judgement on taking time off and in fact I enthusiastically support taking time off from hard training to let your body heal. However, it is very important to properly build up from resting to training.

You can think of “training load” as the sum of everything you do to train (running, weight lifting, cycling). Imagine that you are actually loading a cart full of bricks and each day’s training is a brick. But all bricks do not weight the same amount. Not all activities contribute to load in the same way. A hard interval workout, hill workout or long run “weigh” more. This is why training plans will have 1-2 easy days in between the hard workouts and an appropriate training plan should always include days completely off. Sometimes life happens and we need to move runs around on our calendar. This is perfectly fine as long as when we move things around, we maintain that structure of easy days after hard days and we don’t give up our recovery day.

Why does this matter? Because the best way to get injured (i.e. break your cart full of bricks) is to take on too much training load. So what’s a runner to do? I have two suggestions.

  1. Color code your training plan. This can be an easy, visual way to make sure you are getting in enough easy runs to recover from your hard training days. Find 3 crayons, colored pencils, or markers and after a run, color that day red, yellow or green. Red for hard, yellow for medium and green for easy. If you really like coloring, you can add blue for your off days.
  2. If you’d like to get a little more high-tech you can use a spreadsheet to calculate your Acute to Chronic Workload Ratio (ACWR). I will explain ACWR in a separate blog post. As a special treat, I have done the work of creating a spreadsheet that calculates this and I will be including it for all new clients who sign up for a service in January or February.

Happy Running!

What Is An Athletic Trainer ?

When I decided to become an athletic trainer, I often had to explain what that meant. Most people thought I was going to be a personal trainer. They would ask me if I could help them lose weight or if I “liked to work out a lot.”

It’s easier to explain an athletic trainer to sports fans. If you watch a football game and see staff members wearing fanny packs run onto the field to help an injured athlete, you have seen an athletic trainer at work!

Athletic trainers (ATs) are health care providers who manage athletic injuries. The profession has grown immensely in the 12+ years since I became certified. We ATs are found, of course, in professional sports, high schools and universities, but you will also find us in hospitals, clinics, at the rodeo, backstage at Cirque du Soleil or at FedEx. Really, ATs are anywhere that people are being physically active.

So, how can an athletic trainer specifically help treat a runner?
I have experience with video gait analysis. Gait analysis can help you identify parts of your running gait that may cause injury. Gait analysis is often combined with other assessments to identify problematic movement patterns. I can evaluate an existing injury to provide you with a diagnosis and a treatment plan. I know when an injury is beyond my scope of practice and requires a doctor. Athletic trainers are also trained in injury rehabilitation and can return you to running pain free.

Take a look at the Services page to read more about these skills and to book an appointment.
Happy Running!

“Shin Splints”

23 years ago when I decided to join my high school’s track team, I ran happily for a couple of months before being blindsided by a painful case of shin splints. I remember one of my teammates at the time telling me, “Oh no! Shin splints means your muscles are pulling away from your bones!” Let me tell you, that’s a terrifying diagnosis. Thank goodness it is not true. Sadly I still hear a lot of runners say that phrase.  

“Shin Splints” is a term that gets used a lot to describe any pain in the front of the lower leg. The actual cause of the pain can be one of a number of things. Most commonly the pain is actually a condition called Medial Tibial Stress Syndrome (MTSS). MTSS occurs when the amount of stress we place on our legs increases too much too soon. This is why we often see it in brand new runners or in runners who have begun to train for a longer race distance, like a marathon, and increase their weekly mileage too quickly. 

It is very possible to prevent this injury from occurring and prevention is wonderful because it means you won’t have to run through pain or take any valuable time off from your training. Here are the 3 key rules for preventing MTSS. 

#1. The 10% Rule – Only increase your mileage volume by 10% per week. If right now you run 3 miles, 5 days per week, that is 15 miles. 10% of 15 is 1.5 miles. That means that when you are ready to increase your training volume, you can safely begin by increasing to 16.5 miles the following week. This can be done by distributing that extra distance throughout the week or by adding a longer run of 4.5 miles to just one day.  If you are planning to start training for a longer race, it is very important to find a training plan that doesn’t begin at a weekly mileage that’s significantly higher than what you are used to. 

#2 Keep Calf Muscles “Loose” – Invest in a foam roller, lacrosse ball or any massage tool that you will use. And then use it before runs, after runs, or while you are hanging out watching Netflix! Tight calf muscles are almost always closely linked to shin splints. Our calves work hard when we run and they deserve a little TLC to prepare them for movement as well as to help them recover after a run. 

#3 Work Your Glutes – “Really?” You might ask. “Work my glute muscles to prevent shin pain?” Absolutely. Our gluteal muscles control the motion of our hips. And our hips control the motion of the rest of our lower bodies. Weak glute muscles lead to instabilities that can place unnecessary amounts of pressure on our shins.  If I were to recommend only one exercise for every single runner to do, it would be the clamshell exercise. If I were to recommend more than one, it would be the many variations of the clamshell that increase the strength, endurance, and stability of the Gluteus Medius muscle. 

These same 3 rules are also instrumental in rehabilitating a runner that is treating or recovering from MTSS. If you adjust your mileage, work on massaging your calf muscles and strengthening your glutes but do not feel your pain resolving, please contact me for further evaluation!

 Happy Running!