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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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Saturday, June 23, 2007
Lyme disease - JT
I am a runner and triathlete who was recently diagnosed with lymes disease. I had been training
10 - 15 hours/week but was told I should stop exercising for 4 -6 weeks. I am on the antibiotic doxycilin. I have been taking
them for 2 weeks and will be on them for two more weeks. My question is in regards to my return to training. When do you feel
it would be appropriate for me to return to training, and when should speed work and intensity begin to be added? I was doing
speed work and racing right up until my diagnosis. I am hoping to return to racing in August and am planning on a 1/2 Ironman
at the end of September
Reply - Janet
I'd say you should follow doctors orders and not
return to vigorous exercise for another 2-4 weeks (comply with the original instructions regarding stopping for 4-6 weeks).
When you return to running do NO speedwork until your weekly mileage is up around 30 per week. That basically means
you are starting the base building process all over again. If you ramp up mileage too quickly, you risk getting an orthopedic
(muscle, tendon, bone) type injury, so be conservative. Your body is doing what it needs to do -- fighting the Lyme
disease. Respect and appreciate that, and be gentle with yourself when you return! I think your idea of a 1/2
ironman at the end of September is pretty optimistic -- by my calculations you'll only have 10 weeks to train when you
return to running at the 6-week mark.That would give you only 6-8 weeks of base building and sharpening, and a 1-2 week taper.
That's too fast in my humble opinion. Hope you're well quickly! Janet Hamilton, MA, RCEP, CSCS, Running
Strong coach
6:25 am est
Friday, June 22, 2007
Pelvic stress fracture - Meredith
Stress fracture on bottom of left side of pelvis (ramus?). I am nearing the 6-month anniversary
of the injury date (ran 10 miles as part of a training plan; did fine the whole time; drove home and could barely walk when
I got out of the car). I've been off running but swimming and cycling, doing some elliptical stuff and some treadmill
walking, and a whole lot of pelvic stability and core strength exercises. I really thought I was almost finished with this,
but for the past 2 weeks have had an increase of pain--minimal, but after 6 months of being injured and having felt almost
recovered, it is very discouraging. The only thing I can think of as a possible cause is a long motorcycle trip that obviously
involves certain pressure on the area with the leg in a forward position. The only other thing could be some long hours at
work recently where I sit in a miserable office chair. Things feel best if I can sit more or less astride a stability ball
with my knees pointing down at maybe a 50-55 degree angle with the floor. My main goal is a half-iron in June of 08. So I
have some time here. But I'd just like to know if I just need continued patience here or if I should be concerned about
something else going on. Also, I'm fairly certain that the injury was caused by too much speed, too many hills, too much
distance, etc. too soon. I was cardiovascularly fit but relatively new to running, so I think my muscles gave out before I
did. Also, before I really start back, I am going to a very good local shop for shoes. But I'm wondering also if there
could be gait/stride/stance issues here (possible addressed by shoes/orthotics) that could also predispose me to that injury?
Thanks
Reply - Janet
Generally the closer the stress
fracture is to your core - the longer it takes to heal. For example, metatarsal stress fractures (small bones in your
foot) seem to come back pretty well after about 6 weeks, tibial strss fractures can take 8-10 weeks, femur stress fractures
12-16 weeks, and pelvic stress fractures even longer than that. With that said... 6 months is a reasonable time frame
for healing but you've also been doing a whole lot of cross training which works the muscles that attach to the pelvis.
One question always comes to mind when I see a female with stress fractures (especially pelvic stress fractures)... what's
your bone density like? Do you have any eating issues? Do you maintain enough body weight and calorie intake to allow your
body the right environment for healing? Even moderately disordered eating can interfere with bone healing, so just because
you still have a period don't think that your body isn't strssed. Also keep in mind that over the counter anti-inflammatory
drugs like ibuprofen may be interfering with the bone regeneration process. You've likely correctly identified the
overtraining issues that contributed, but have you looked into flexibility and/or muscle strength imbalances? Your gait pattern
and footwear also need to be examined. I'd be happy to help with this stuff. If you're interested, check
out the "services" page of this website. Regards - Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
Wednesday, June 20, 2007
PT for hamstring - Jamie
Basically when i go physio they massage both legs then use the machine thats sends pulses through
your leg then go through a range of stretches on both legs then tell me to keep stretching daily.I do have a blue and black
strengthening band plus a swiss ball at my disposal.Will been changing where i get my treatment because have not been satisfied
with my injury progress this time.I have also followed a recovery program from physio room for grade 2 injurys thats goes
ok untill the light jogging stage.Thanks again for your time
Reply - Janet
Jamie, I think
that the focus on passive treatment might not be what you need. Since you have therabands and a physio ball available,
I'm hopeful that the next PT you go to will be more focused on active rehabilitation. Tell them what you've
been doing and that it hasn't worked and that you want to try a different focus. Hope that works.
Janet Hamilton,
MA, RCEP, CSCS,. Running Strong Coach
4:13 pm est
Tuesday, June 19, 2007
Lingering Hamstring Issues - Jamie
Thanks for your advice on my previous questions re hamstrings.Unfortunately still having problems
not through any form of rehab exercise it can just happen when walking or lifting things such as the dog into the car.Its
been 10 months since they tightened up and i have spent alot of time at physio plus reading about how to recover from this
problem to little avail.so any more advice would be much appreciated!thanks.
Reply - Janet
perhaps
your PT exercises haven't gotten to the strength issue yet? Hopefully you're doing more than just leg curls
and straight leg raises. Is your PT having you do balance and reach style exercises? Have they emphasized the "controlling"
type of contractions? If you've been reading a lot about this, I'm sure you've read how important eccentric type
muscle actions are to the rehab of hamstring injuries. If all you're doing is stretching and generally living your
life -- you may be missing the strength issue entirely! Janet Hamilton, MA, RCEP, CSCS, Running Strong Coach
3:53 pm est
Friday, June 8, 2007
Strained Hamstring before a race
I strained a hamstring on Monday (I would call it mild) and am running the Dipsea race this Sunday.
Used ice and rest for 48 hours, but the pain kicked back in at mile 1 yesterday, even with a slow pace. I plan rest until
race day -- so questions are (1) anything else I can do besides rest; (2) what's best morning of the race and (3) other
than just going for it on Sunday, any way to evaluate before the race whether it has healed?
Reply - Janet
I'm not sure I'd call it mild if you rested for 48 hours and then felt it within the first mile of easy
paced running. Dipsea is no minor race -- have you considered that you might be better off not racing if you're
injured? I know you didn't want to hear that, but I couldn't stop myself....
Your questions - is there
anything you can do besides rest? - yes and no. You can utilize the services of a reputable massage therapist to enhance
circulation in the area, but you can't massage away a strain. In fact, tissue that's damaged will take a certain
amount of time to heal - physiologically... and you can't really do much to speed it up - however you can do a lot to
slow it down! Number 2 - what is best the morning of the race? I'd say use a walk warm up (perhaps a mile or more
of easy walking and then throw in some walk/jog towards the end. You might want to reconsider trying to race something as
strenuous as Dipsea with an injury.... Wait, didn't I already say that?  Question 3 - how to evaluate before the race if it's healed... I can tell you the answer to that one - a muscle
strain usually doesn't heal in a week. It is highly likely that it won't be healed before the race but if you
want to "test it" to reinforce that to yourself, you can go out and do some walk/jog and then easy running and see
how it feels. Depending on the original mechanism of injury - there may be factors you can address to help insure that
this doesn't happen again. Items to look into for future include - flexibility (especially calves and hamstrings),
strength (especially lateral hips and lower back/abs) and training errors (adding speedwork and hill work gradually) as well
as biomechanical issues (make sure your shoes are correct for your gait pattern). If you want some help with this, I still
have room on my coaching schedule to take on one or two more clients - e-mail me for more info if you're interested (or
check out the services page of this website). Hope this helps a little - Janet Hamilton, MA, RCEP, CSCS, Running Strong
Coach
12:44 pm est
Saturday, June 2, 2007
Cuboid syndrome - Chris
It was just determined that I have cuboid syndrome. What are some treatment suggestions and how
long before I will be able to run again? The podiatrist also gave me some orthodics, b ut they make the area more painful.
Should I discontinue wearing them?
Reply - Janet
I don't think I'd recommend discontinuing
the orthotics, but it does make sense to see the podiatrist that made them to have them adjusted. Sometimes orthotics
need to be tweaked a little to get them just right. Also keep in mind that if you didn't break yourself into them
gradually (an hour or two a day), then perhaps just backing up and trying a slow break in process will help. Finally
-- if your podiatrist hasn't taught you exercises to regain flexibility in tight muscles (calves and hamstrings especially)
then that could be an avenue to pursue. Most authors associate cuboid syndrome with a foot that is undergoing excessive
pronation. If that's the case with you - then shoes and orthotics to control the pronation, along with stretching
exercises for the calf muscles (which when tight will make the pronation issue worse) should both be pursued. Some have
gotten additional relief from massage tot he calves and lateral lower leg muscles (peroneals). Hope this helps -- don't
give up on the orthotics just yet. Janet Hamilton, MA, RCEP, CSCS
3:59 pm est
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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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