Monday, April 30, 2007
Numbness in feet - Owen
Hi I have an intermittant problem with my left foot. Over the last 12 years I have started a regular
running training programme on 3 separate occasions, however the same annoying injury has held me back each time, and I eventually
give up. The problem is that after running for around 3 miles, my left foot starts to go numb - starting at the toes, and
working its way to the back of the foot, untill all my foot gets completely numb. On one run I tried to keep on running with
a numb foot, however this resulted in a very painful achilles/lower calf injury. I have since given up on running, however
this problem has recently returned while hiking - the same numbness. The problem seems to be helped by loosening my laces,
however they must be so loose that my trainers nearly fall off when running. Any advice would be greatly appreciated. Is this
compartment syndrome? A neuroma?
Reply - Janet
Your symptoms could be due to any number of things.
Let's start with shoes -- if your shoes are not correct for your gait pattern and don't support you well, then that
can contribute. If they don't fit will (longer than your longest toe by about 1/2" or so) then as your feet
swell a bit as you run, you'll find your feet going numb. On the other hand - there's a possibility it is not
shoes but is instead a circulatory problem. Have you discussed the symptoms with your physician? If you've got some limitations
in your circulation in your lower legs, then when the demand for blood flow exceeds the actual flow - you may experience some
numbness. Typically compartment syndrome presents as a cramping/aching sensation in the lower legs which comes on at
a consistent point in the exercise bout and continues until the exercise is stopped... at which point it resolves. If
that sounds like what you're experiencing then perhaps a visit to a good orthopedic foot and ankle specialist is in order.
Most of the time compartment syndrome doesn't respond to conservative care and requires surgery... but I'd sure try
the conservative route (calf stretching, shoe changes, possibly orthotics). Hope this provides some food for thought.
Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
5:27 am est
Thursday, April 26, 2007
Injury 3 weeks before marathon -Jerry
I'm 15 weeks into an 18 week marathon training program. Things were going well until my 18
miler a week ago. I ran the route on the highway against traffic in a very hilly location. I am not used to running hills.
Now I have a sharp pain below the outside ankle bone when I run and think that it is Peroneal Tendonitis. I have taken a week
off and got some arch supports for my shoes. With 3 weeks left what are my options? Will a cortisone injection solve the problem
and allow me to finish the training and race? Not trying to set any land speed records, just want to finish. I guess in Poker
they call it "pot committed", I've came to far to give up now. Any advice would be greatly appreciated!!!
Reply - Janet
With only three weeks to go - you're entering taper phase anyway. I do NOT
recommend any injection. Cortisone has the nasty side effect of causing tissue necrosis (death) - so although you may
get some symptom relief... you'll pay a price by potentially weakening your tissue. At this point your best bet
may be either to re-think your marathon plan or just taper and hope for the best. If this was your first marathon, 18
weeks is a VERY SHORT training peroid! Your primary focus at this point needs to be on rehabilitation. Rest, non-irritating
activities, and making sure that you're covering your bases with strength and flexibility exercises are about all you
can do. If you can walk without pain, perhaps that form of cross training will work for you. Make sure you're
being diligent with your flexibility exercises for all your muscles (hamstrings, hip flexors, quads, and calves). Make
sure your shoes are not fatigued. Do whatever form of alternate training you can to maintain your fitness level (biking?
walking? swimming? deep water running?). Decision time... do you run the marathon or not? I'm never a fan of competing
with an injury unless your paycheck demands you do that. If you're not making your living off your running, then it doesn't
make sense to beat your body up and potentially take away your gift of running forever by damaging your body further.
Being willing to admit that getting well is more important than training and way more important than any single event is tough
to do, but vital. If you'd like more specific guidance on how to rehabilitate this and perhaps train for a future
marathon, I'd be happy to help you out. I still have a couple of spaces open on my schedule right now to take on
some new athletes. Let me know if you're interested. Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
6:56 am est
Monday, April 16, 2007
Numb feet - Jackie
I have been a runner now for sometime and I have been struggling with the fact I get numb
feet after about and 35-45 min run. I am not sure why this happens and not sure what to change. I am really wanting to be
able to run longer but I don't know if it is bad to keep running when they are so numb? Thank you
Reply
- Janet
It's probably not a good idea to run through those symptoms. Have you experimented with different
makes and models of shoe? If the shoe you're wearing isn't appropriate for your gait pattern (too soft or perhaps
too stiff?) or if it's too old and worn out then that can contribute. Do you have any symptoms in your calves
when the foot numbness comes on? That might indicate an issue like peripheral circulation problems or even Chronic Exertional
Compartment Syndrome (though 35-45 minutes into a run is pretty late for those type of symptoms to be coming on...)
Are you consistent with your stretching exercises? If your calves or hamstrings are tight, that may be playing into things.
Do you do a walk warm up? Do you have any problems with your hips or back? Usually the numb feet issue is shoe related
so that's where I'd start. Best of luck, let me know if I can help. Janet Hamilton, MA, RCEP, CSCS, Running
Strong coach
5:03 pm est
Heavy legs & breathlessness while training - John
Hi, I'm worried I'm going about my training all wrong. I'm 32 76kg and 168cm tall
and in pretty good shape and have played soccer all my life. i train very intense 5 times a week doing running, ball work,
weights and bike for upto an hour and a half with each session getting my heart rate close to max every time. All this and
I still struggle with fitness as when I'm playing my legs feel very heavy and I am very breathless, to the point where
I can't run. This has been a problem of mine for about 5 years which I thought would go away with all the training I put
in, however I just battle on with my training, it's very depressing not getting the results with all the work I'm
putting in. Do you have any ideas of why I would be struggling with heavy legs and breathlessness after so much training?
Reply - Janet
I think your worries about "going about training all wrong" are well founded!
In other words I think you might be on to something with your suspicion. Your body needs some level of overload to adapt,
but if your overload exceeds your ability to adapt, you just continually break yourself down. Have you ever considered
training with a little more moderation? Perhaps alternate some 45 minute workouts with the 90 minute ones and consider NOT
going to max every time you lace up your shoes. It sounds like you're turning every workout into a "race"
or major competition. Train at 70% some days, maybe up to 80% some days... but leave the max effort stuff for short
sessions or better yet - for competitions! Sounds to me like you might be overdoing it and breaking your body down even
though you're trying to build it up. A bit of moderation might be a good thing to try for 8-10 weeks... see if it
helps! Best of luck to you. Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
4:47 pm est
Sunday, April 15, 2007
Cramping Calves - Elizabeth
I have been running for about three months now and was walking for the past year. Everytime I
walk fast or run my calves get extremely tight. I try to stretch them often while I am out but sometimes they just keep getting
tighter. Usually by the end of a 45 min run or walk my feet are then numb and my calves are tight for two days after which
is when I am suppossed to run again. It is begining to discourage me from running because I don't know how to make it
better and I don't want that. I am planning on doing a half marathon in september and at this rate with my feet going
numb and calves so tight not sure how I am going to last for two hours. Any sort of reasoning behind this might help. thanks
Reply - Janet
A couple of things come to mind: Have you had a gait analysis done to see
if the shoes you're wearing are appropriate for your gait pattern? If they're too stiff, or not supportive enough
- either way this could contribute to overuse issues in the lower legs. Do you do calf flexiblity exercises at times
other than in conjunction with your run or walk? If not - perhaps doing stretching several times a day every day would help?
The cramping sensation at first sounded like it might be related to blood flow through those muscles - a condition known as
Chronic Exertional Compartment Syndrome -- but the fact that you say the cramping lingers for a couple of days kind of rules
that out because in CECS, when you stop the offending activity - the cramping sensation usually resolves within a few minutes.
Have you seen your internal medicine doc for a general check up? How about an orthopedist to rule out other things like bone
injuries etc. I like to suspect horses when I hear hoofbeats (shoe and flexibility issues, or training errors) rather
than zebras (CECS or some bizzare bone issue) but you always want to rule out the odd things just in case and that's best
done by the physicians. If you want assistance with a gait analysis or training program, feel free to get in touch with
me or check out the services page of this website. Best of luck to you - Janet Hamilton, MA, RCEP, CSCS, Running
Strong coach
10:22 am est
Hip Flexor Pain - Ingrid
About a month ago I mysteriously developed pain in my groin / hip flexor. I've rested and
had active release therapy, both of which are helping, but have not totally eliminated the problem. The pain radiates towards
the inside of my knee from my hip area. I haven't been able to get a diagnosis. Running irritates it, so I've holding
back. Other cardio seems fine, such as biking, elliptical etc. Any thoughts or recommendations?
Reply - Janet
Depending on the type of diagnostic imaging that has been done, I'd be suspicious that a femoral stress fracture
might be an issue. If they've done good tests (bone scan or MRI) to rule that out, then perhaps consider looking into
your lower back region as a possible contributing factor. The fact that your pain radiates down your leg is consistent more
with either a bone injury, or perhaps a nerve issue related to your lower back. The fact that ART and rest seem to be helping
is a good thing and makes one think it is more related to lower back and muscle imbalance issues than stress fracture... but
I'd want some conclusive diagnostic imaging tests from the orthopedist to confirm that. When you're ready to
ease back into running, make sure you're conservative in your build up - and make sure you've discussed things with
your ART therapist - what issues could have contributed to the original injury and have we addressed them all? Best
of luck, let me know if I can help. Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
10:14 am est
Thursday, April 12, 2007
Racing on an injured hip - Shannon
I trained and ran my first half marathon in Phoenix in January. I am signed up to run again in
Nashville April 28. The problem is that I've been out now for a month with a hip injury. Other than overuse, I have no
definite diagnosis and it is still hurting. I REALLY want to run in Nashville but am not sure whether or not I'll injure
myself worse, or if I'll even be in any kind of shape to make it! I was running 35-40 miles a week prior. Have I not given
my hip enough time to heal? Should I attempt the race, knowing that I may have to walk some?
Reply - Janet
I know you don't want to hear this, but I am pretty much never in favor of racing on an injury. Even
if you do it as an "event" rather than a race... you still impart some serious stress to a tissue that is not functioning
at 100% -- and you run a serious risk of making things much worse. If you've been off for a month, and your race
is in 2 weeks... you're not in any condition to participate. I'd say bag this race and get serious about finding
out what is going on in your hip! Have you seen an orthopedist to rule out the nasty things like stress fracture?
I would be happy to try to help train you properly so that you can complete another half marathon, but we need to figure out
what's injured first and deal with the causes for that injury so you don't get it again! Let me know if I can
be of assistance -- you can check out the coaching services available on the services page of this website, or you can e-mail
me directly for more info if you like (janet at runningstrong dot com). Best of luck -- Janet Hamilton, MA, RCEP,
CSCS, Running Strong Coach
3:19 pm est
Wednesday, April 4, 2007
Mysterious muscle strain - Teresa
I have a mysterious muscle strain that I've never experienced before. It is extremely painful
to sit in a straddle and lean forward. However, my adductors don't hurt when I do this, nor does it hurt if i lean forward
with my feet together (i.e. my hamstrings don't feel tight). Is this a hamstring strain? Or something else? I am pretty
flexible and have had sore muscles plenty of times in my life, but nothing ever like this. It's been sore for four weeks
now and I still can't figure it out! Thanks so much!
Reply - Janet
You don't indicated
where exactly you experience pain when you do this movement. It isn't in the adductors or hamstrings - is it in
the hip joint area? the groin? the low back? Do you know of any incident or movement or exercise that set this mysterious
strain in motion? You mention it's not resolved in 4 weeks - have you continued to try to do this straddle sit stretch
throughout that time? If so, you may be just re-injuring whatever is injured every time you do that? Have you rested?
You don't mention if you're a runner or walker, or what your chosen sport is... does it hurt when you do your chosen
sport? Perhaps with a little more info I can help a little. Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
3:22 pm est
Monday, April 2, 2007
Bone bruise - Andrea
Hi Coach, I injured my knee sledding 1 month ago (I was mid marathon training--big bummer.), and
had an MRI with diagnosis of minor MCL tear and a "fairly severe" bone bruise to my lateral tibia and lateral femur
(basically they smacked together). After 3 weeks of limping around, I'm now much improved: walking fine and recently went
back to the gym, doing stairs and elliptical without pain. Trouble is--both my doctor and my PT are really vague about how
long the damage from the bone bruise will take to heal and when I can return to running and at what level. I know I should
be guided by how I feel, but I was wondering if you could offer general advice about how long such injuries usually take to
heal completely, and how soon it's safe to start running a little, then my normal amount (20-25 MPW). Also, what's
the likelihood of damaging it further if I try to start too soon? Thanks very much!
Reply - Janet
Your
PT and your physician will be your best source of advice. The reason they're being vague is that the recovery from
a bone bruise like that is pretty variable. I've seen some people do OK with as little as 4-6 months, and a gradual return
to walking and then some easy walk/jog before progressing back to running a limited distance. Others I've seen have
taken a year. Your liklihood of slowing the healing process by pushing ahead too soon is pretty high. It's not worth
it. Continue with the rehab exercises, and gentle addition of weight bearing training (walking, elliptical, etc) and
listen to your body. When it whispers a warning, don't ignore it! Ask your PT about getting a gait analysis done
to see if your shoes are supporting you well, and make sure to let the PT and the doctor know that running is a big part of
your life and you'd like to return to it (gradually) as soon as it is safe and healthy to do so. I'd be happy
to help with that transition when the time comes and your formal PT is done. Let me know if I can be of further
assistance.
Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
7:39 pm est
Sunday, April 1, 2007
Coming back from an injury - Sam
After quite a few years off from running and contact sport, I tried to make a come back a couple
years ago and gave myself 3 months to get fit. In my first match I tore my hamstring and have battled with my left leg ever
since. This year I am making another/final come back in competitive sport as I am still fairly young and in o.k shape (could
be better) and hoping to condition the body as to prevent another serious injury. I'm not off to a great start as I now
strained my quad, on the same leg, and have been off for 4 weeks. I am seeing physio regularly and regular deep tissue massages
on my lower back and legs as well. I am now doing all kinds of stretches, but worried another injury is imminent....I'm
running again, but not at 100% yet, just 10-20 mins at a time....how do I know when I can really push to the max without constantly
having injury in the back of my mind...which limits my performance..
Reply - Janet
Without knowing
your particular sport - it's hard to say what's going on. If you're doing tennis, that's far different
than basketball, which is a very different sport from ice hockey. Bottom line though, you need excellent core strength,
(abs, low back, hips), good muscle balance (between opposing muscle groups and from right to left side), and a consistent
and progressive training program. If you just look at the running aspect (I'm assuming you're using it for conditioning
only?) then I like to have athletes doing a minimum of 20 miles a week of easy paced running before adding in any form of
speedwork or sprint drills. Your PT should be focusing on strength exercises that will help you acheive the core strength,
muscle balance, and agility you need for your particular sport. Make sure that the PT is clued in to your goals to return
to competition. If not, get another PT! Sounds like you're on the right track, but you may just be trying to rocket back
to competitive condition and form too quickly. Your body needs time to undergo the physiological changes to make it
stronger. Be patient and conservative and you'll probably have better results. Let me know if I can be of further
assistance. Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
2:45 pm est
