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On this page, we'll try to answer your questions
and provide some nuggets of wisdom. Keep in mind that diagnosis of injury is the responsibility of your physician. Comments
posted here should not be misconstrued as medical advice! Please refer to the
publications page of this web site for informative articles on flexibility and strength exercises, common injuries, and other
useful tips.
Ask the Coach
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Thursday, August 31, 2006
Knee Pain - Bill
I have been running for the last 6 months logging in about 40 miles per week on different terrains.
Lately,I have been having pain on the inside of my left knee just below the knee joint I have had three knee surgeries on
this knee but this is a pain that I'm not familiar with. Tears on the meniscus and ACL I know very well. This particular pain
will come and go throughout the day with an occasional sharp pain hitting once in awhile. I haven't had any swelling and very
little tenderness. Now the interesting part when I first start to run it will hurt for the first quarter mile then the pain
will be completly gone for the remainder of the run except for onoccasional sharp inclines(pain is still on the inside part
of the knee not the back of the knee) I have tried a variety of things rest, ice, lower mileage etc. Any thoughts on what
to do? Could it be the shoes? (I run with a new pair of Saucony Trigon Guide and this is the only thing that I have changed
during this little adventure) Any little help would be appreciated. Thanks Bill
Reply - Janet
Bill it's hard to tell based on the information you gave, but if I've got my shoes right the
Saucony Trigon Guide seems better in the cushioning department than it is in the stability department. Perhaps a change
to a more stable (less cushioning) shoe would help? The way you describe the symptoms (comes on early, then resolves
as you continue) is pretty classic for an irritation of tissue (some people call it tendonitis but this isn't really physiologically
correct most of the time - usually it's a degenerative process "osis" rather than inflammatory process "itis").
The previous surgeries on that knee (torn ACL and torn meniscus) quite likely affected the specific
biomechanics of the joint and although your body could compensate initially for the biomechanical differences - with higher
mileage the repetitive stress may have taken it's toll. Building to 40 miles a week in 6 months is pretty fast -- if
you did this without adequate attention to maintaining adequate flexibility and insuring muscular strength balance then you
may have missed some key peices to the puzzle. Some things to consider adding to your program:
1. Make sure you're doing flexibility exericses on a daily basis -- nothing hard or aggressive...
just be consistent. Key areas are calves, hamstrings, hip flexors and quads.
2. Make sure you're doing functional strength exercises to get your core and hips as strong
as possible. Simple things like balance & reach exercises, lunges, squats, etc work well.
3. Back your mileage down and make sure you're running at an easy pace. A common
mistake is going out the door too close to target race pace on every run.
4. Consider experimenting with a more supportive/stable shoe.
5. Give some consideration to hiring a good coach to guide you through this process --
it usually helps speed the recovery. Check out our services page and read about us on the "about us" page.
Hope this helps - Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
Wednesday, August 30, 2006
Calf pain in Cross Country runner - Jerry
I have a 12 year old daughter who just started running with a 7th grade cross country team. Previously
she has played soccer in the fall - other than that she doesn't get a lot of hard physical activity. She is thin and has long
legs relative to her torso - is running in new shoes that she says are very comfortable. She has been experiencing strong
calf pain that sometimes occurs only after running - during practices she runs around 1.5 miles. Her calves may not bother
her while running at all. Overnight or after a day or 2 of rest they no longer bother her at all, but the pattern will continue
again when she runs again. This seems strange to me (I am a old-seasoned runner) since normally when I strain a muscle while
running, I know it right away and it takes a while for me to heal. My guess is that my daughter's legs are just not used to
the stress and are overly fatigued, causing pain, but is not significantly damaging the muscles. We have been doing calf,
hamstring and other stretches most nights. Her hamstring are very tight, always have been, which may be a major cause of the
problem. This pattern has been going on for a couple of weeks.
Reply - Janet
Jerry I think you may be on to something with your theory of tight muscles contributing to the
problem. Although her symptoms appear in her calves, the hamstrings can play a significant role so it's good you're
having her stretch hamstrings AND calves. It might be good to have her do stretches several times a day. I also
agree with your theory that perhaps she's just not used to the stress of running. If it were compartment syndrome -
the symptoms would come on DURING the activity and subside when the activity were stopped. If she were having night
pain, I'd suspect a stress fracture. It sounds to me like she's just adding activity too quickly and her body isn't
ready. Is there a way she can back down a bit and re-build a little slower? Is her cross country coach pushing
speedwork or hill work? If so - those would be the first things I'd have her back off from. Build endurance first,
and then hills (strength) and then finally speed. Unfortunately, many school cross country teams don't take time for
base building - they assume that the kids have established a base of endurance (foolish assumption) and jump right in to the
hill drills and intervals.
One other thing to consider is to have her see a massage therapist. Perhaps a skilled pair
of hands can "feel" what's going on in those calves. It may be nothing more than what you've suspected - a bit of overuse.
But if the symptoms persist despite backing off training and doing the stretching and getting a massage - then it's time to
see the doc and get some real clear guidance on a diagnosis.
Hope this helps!
Janet Hamilton, MA, RCEP, CSCS, Running Strong Coach
Thursday, August 24, 2006
How much mileage for an 8 mile race? - Kortney
Hi, I have a question. I have been training for an 8 mile run on 9/9 (in Mackinac Island) and I
live all by rolling hills (M.Island is flat). I have run 6 miles and people tell me that I don't have to run the full 8 before
the race- I'll be able to do it fine. Is that true? I have an ankle injury (torn Atfl that required extensive surgery in the
end of 2004) that has been consistently bothering me after 4 or so miles and then nags the rest of the day, so I don't want
to push the miles if I don't have to. Also, after the 8 mile run, I plan to tone my workouts/runs down to 3-4 miles per day.
Do you feel that only running 3-4 miles per day is still a good workout to stay in shape? Thank you
Reply - Janet
Kortney, it's true that if you just want to be able to finish
the race that you don't have to have actually accomplished the distance before race day. HOWEVER - if you intend to "race"
the race and not just do it as a friendly fun run with a bunch of people... then you'll be better prepared if you have run
at least that distance (and preferably more) in training. BUT - you're on short time now (only a little over 2 weeks
to race day) so the best bet is to NOT try to do the full distance but just continue your training and taper back your mileage
during the week of the race. Go into the race well rested, and be willing to take short walk breaks and keep your pace
reasonable and easy. Look at this as a fun run - a chance to test yourself a little... but don't overdo it or you'll
get injured. As for your previous ATFL injury - it could be that you're not in the correct shoe for your gait pattern
or perhaps you didn't fully regain all your flexibility and strength in key muscles after your injury. Perhaps after
your race when you're just in "maintaining fitness mode" you can take some time to chekc into what's keeping the ATFL irritated.
It may just be that a few simple exercises and some moderation of your training is all it takes. As for how much running
is needed to maintain fitness... most researchers put the number at about 2000 kcal per week (which is roughly 20 miles a
week at a 10 min mile pace on level terrain for a 135 pound person). So bottom line - 3-4 miles a day is fine for maintenance!
I'd recommend alternating distance more than that though - some days do 2, other days do 4, and one day a week do a long one
(perhaps 6). This will allow for recovery, and will also encourage the maintenance of a higher level of stamina and
endurance. Best of luck in your upcoming event! Janet Hamilton, MEd, RCEP, CSCS
Friday, August 4, 2006
Possible ITB - Marie
I have been running 20+ miles per week for several months now, and have had a pesky pain on the
outside of my left knee. As I have increased my long run from 6 to 9 miles (one mile per week max, over the course of several
weeks), the annoying pain has become more severe. I did a nine mile run yesterday and the knee hurt by the time I was done,
and continues to hurt today when I walk up or down stairs. It's a fairly local pain low on the outside of the knee and when
palpated feels a bit bruised. I am thinking about seeing a physical therapist because I think it could be ITB related. Your
web site used to have some info about finding an appropriate PT, and am wondering if you could provide some guidance. (I live
in Omaha, NE)
Reply - Janet
Marie, I think you've hit the nail on the head... it does sound like ITB issues. You can
find the link for how to find a good PT at the very bottom of this BLOG page -- in the bottom margin (perhaps I need to make
it easier to find eh?). Biggest issues with ITB in my experience - weak lateral hips, excessive or poorly timed pronation
that's not being controlled adequately by your shoe or shoe/orthotic combination, and lack of flexibility in the calves and
hamstrings. Note that a tight ITB isn't something I find as a causative factor near as often as those other things!
Let me know if I can help. Janet Hamilton, MEd, RCEP, CSCS
Wednesday, August 2, 2006
Running on Blisters - Shawn
I have been running over the last week despite having two badly infected blisters on each of
my feet. My doctor is a long distance runner as well and he said that it was ok to run through the pain but to watch out for
stress fractures. Well, all of a sudden I now have some pain in my upper left leg, on the outside close to my buttocks, the
hip area i guess. Could this be a stress fracture or just the overuse of certain muscles due to the fact that I have been
running through pain in both of my feet? I forgot to mention, I'm 11 weeks into a 20 week marathon training program I just
don't want to have to give us this training if I don't have to. Thanks,Shawn
Reply - Janet
The pain sounds like it could be an irritation of a muscle due to an altered gait pattern.
If your feet hurt, you run in a different (and usually unnatural) fashion, which leads to a whole host of biomechanical effects...
usually ones that get you injured. My question is: why continue to train on an obvious injury? Why not take 4
days totally off, let things get started on healing, and then take it from there? Why take the risk of turning one injury
into 3 or 4 different injuries as a result of an altered gait pattern? Did your doc discuss with you why you might have
gotten the blisters in the first place? Was it shoe related? Was it related to training errors (adding mileage too fast),
was it related to running in wet (sweaty) shoes/socks? Was it related to flexibility or muscle strength imbalances, or perhaps
excessive pronation? Seems like a reasonable course of action would be to take a few days off now -- so you don't have
to take several weeks off later! Best of luck in your marathon training. Janet Hamilton, MEd, RCEP, CSCS
Tuesday, August 1, 2006
Peroneal Tendon pain? - Diane
Hello- Well, I have been out of running commission for nearly a year. Previously pro runner,
then top master. Diagnosed in October with torn plantar faschia - subsequent surgery in April. Seems to be healing ok. My
major issue now is what they are saying is an injured peroneal tendon. Intense pain on the outside of my foot, down between
the ankle and the bottom. It is literally keeping me from running a step. I am on the elliptical, and it doesn't hurt to do
that. But running even for 5 minutes is intensely painful. Any suggestions.
Reply - Janet
There are two factors that are common to both a plantar fascia tear and peroneal tendinopathy:
excessive or poorly timed pronation, and limited mobility in the calf muscles. The tight calf muscles can make the pronation
issue more pronounced - so one kind of feeds into the other. If you were immobilized for a time after your surgical
repair of the plantar fascia, then that can make the muscle tightness issue in your calf more pronounced. If the shoes
you're wearing are either too stiff or too cushioned -- that too can play into the mix. If you've not been real consistent
with calf stretches in the recent year (daily) then perhaps that's one avenue to try. Log on to the publications page
of this website and go to an article on "Flexibility" - a free download. There's a photo and description of how
to properly stretch your calf muscle with your arch in a protected "neutral" position. This will insure that when you
stretch your calf, you don't simultaneously stretch the plantar fascia. Hope this helps - if you'd lke more detailed
assistance, please log onto the services page and read about our coaching services.
Janet Hamilton, MEd, RCEP, CSCS
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Running Strong* 191 Crossing Dr* Stockbridge, GA * 30281 Phone/Fax: (770) 957-0986 Or 678-357-6406
Contact coach Mike Broderick in Gaithersburg MD * (240) 338-2210
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