Sunday, July 29, 2007
Leg pain after turning ankle - Riley
I am training for my first marathon (in October)- I am running anywhere from 35-45 miles
a week. Before I started training (about 2 months ago), I was running about 20 miles a week and gradually increased. We (my
running group) run 2 easy days, one speedwork day, one tempo day and one slow long day. I also run one additional day on the
weekend- either a fast 5k, or a moderate 4-5 miler. Thursday I was running a tempo day and my right ankle hit the edge of
the sidewalk and turned inward. My ankle didn't hurt from it but I immediate felt a pull/stretch/little things tearing
or stretching a little too far in my right lower leg on the outside (closer to my knee than my ankle). It felt fine the rest
of the run but after I was finished and sat down (then tried to get back up), the pain was pretty intense. (I iced it). The
next day (friday), I decided not to run as my leg hurt everytime I took a step (it hurts to point downward and to flex). Today
(Saturday), I ran 5 miles- the first 3 miles it hurt every step but after that, it started to feel much better, hardly even
noticing it by 5 miles. However when I was done, with the time it took me to sit down and take off my shoes and stand back
up, my leg was sore as ever, tender to the touch and harder to walk on than before. Any suggestions? Probably just a pulled
muscle? Okay to keep running on it? Thanks!! Riley
Reply - Janet
I know you want me to tell you
to keep running on it, but that's not a good plan. There are several things that could have happened here, the least
of which is a muscle strain. Muscle strains take TIME to heal though and continuing to run on this will only prolong
that healing process and may also set you up for other injuries because you will inadvertently alter your gait pattern due
to the pain, thus setting yourself up for another injury due to the compensation! You're wise to just take 4 or
5 days totally off running and let this thing start healing. While you're off, you may be able to do an alternate
activity (biking perhaps?) or you may not... you have to listen to your body. If it hurts, take the day OFF. If after
4 or 5 days off you try a short easy run and it hurts, then it's time to see your physician and get some diagnostic imaging
done. You may have done substantially more than pull a muscle. Hopefully the short time off is all you need and you'll
be back on track for your marathon. Best of luck! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor
8:49 am edt
Saturday, July 28, 2007
Yoga with a Femoral Neck Stress fracture - Dawn
I was training for a 10k and I had been having pain in my groin that radiated to my hip. For about
4 weeks after symptoms, I tried to "run through the pain" but it was so bad that after a run I couldn't walk.
I finally went to the ortho and was diagnosed yesterday with a stress fx in my right femoral neck. The doctor said it was
mild and felt it didn't require me to use crutches, although he gave me the option. He told me to avoid activities that
cause pain in my hip, which I have pretty much been doing anyway. I don't run (obviously) and only walk as much as is
absolutely necessary. I have been doing yoga nearly every day and I wonder if that is ok. If so, are there any particular
positions I should avoid? Yoga doesn't make my hip hurt and I told the doctor I was doing it. He said it was ok, but I
thought it would be good to get a second opinion. What do you think?
Reply - Janet
if your physician
felt your fracture was stable enough to not require crutches, and he said the yoga was OK, then you're probably pretty
safe. I don't know all the various yoga poses, but I think if you'll listen closely to your body (rather than working
through pain as you did previously) you'll probably be OK. The more crucial question to ask yourself during this
"down time" from running is WHY did I get a stress fracture of my femoral neck? Were there flexibilty or strength
issues that needed to be addressed? Were there training errors (obviously running despite pain is one of those)?
Do I have biomechanical issues like pronation that's occurring too late or being sustained too long? How is my nutritional
status and bone density? Each of these factors can contribute to a stress fracture. You'll need to be very patient
as you heal from this and even more patient when you get clearance to run again. That process needs to be conservative
and you need to have addressed all the strength and flexibility issues or you're setting yourself up for another injury.
I'll be happy to help with this - rehabbing runners is what I do! See the services page for more info or e-mail
me directly (janet at runningstrong dot com). Best of luck to you - listen to your body! Janet Hamilton, MA, RCEP,
CSCS, RRCA-certified coach
1:53 pm edt
Wednesday, July 25, 2007
Numbness in hand - Brenda
I have been running off and on for over twenty years. I typically run about 3-4 miles 4 -5 times
per week. During my run I experience Numbness/reduced blood flow to my hands - expecially the left - it turns whitish colored.
I had an EKG and a stress test about a year ago during a routine physical and they did not find anything wrong. I am 45 years
old. Do you think that this is something to worry about? Thanks
Reply - Janet
The EKG will only
evaluate your heart function from an electrical standpoint, it doesn't really evaluate things like blood flow. Perhaps
you whould speak to your physician about being evaluated further - perhaps looking into blood vessel blockages? Another
possibility would come from muscle tension leading to compression of a nerve root in your upper back/neck. For example,
if you run with your shoulders hunched up, perhaps that's compressing a nerve which might lead to the numbness sensation.
Do you notice any patterns of occurrence related to speed? Is it worse with faster running? Do you have any history of headaches
or neck problems? Another referral might be to a neurologist. They can do nerve conduction tests to see if there's
an issue there. You're wise to continue to try to troubleshoot this. Janet Hamilton, MA, RCEP, CSCS, Running
Strong Coach
8:28 am edt
Tuesday, July 24, 2007
"Sportsman's Hernia" - Jamie
I have just change my PT because of my chronic hamstring problems as i have said before theres
no sharpe pain when they go its just 1 or 2 days after they just go really tight.It was my 2nd session last week and they
checked all my biomechanics and my feet the result was essentially normal.Then i was told that they can'nt do anything
for me and said she suspected it could be a sportsmans hernia?I had never heard of this before so any information would be
great.Having read the symtons for a sportsmans hernia i dont seem to show many signs that problem.Thanks
Reply
- Janet
Without knowing a lot more about your history, training and symptoms Jamie I can't be of much help
on this. I think you're doing what you need to do by seeking local input. My understanding of a sports hernia is
that it is related to the connection of the abdominal and groin muscles to the pelvis and pubic bones. If your pain
is not in the region of the groin, and is more localized to the hamstrings - then perhaps the sports hernia isn't the
right diagnosis? When in doubt, get another opinion. Have you seen an orthopedist to get some diagnostic imaging?
If it is a sports hernia, I'd suspect they could see something on MRI. Best of luck to you. Janet Hamilton,
MA, RCEP, CSCS, Running Strong coach
11:06 am edt
Thursday, July 19, 2007
Heart Rate -- Bill
Forgive my ignorance if I don't articulate this question very well. I've been running
since January 2007 and am now averaging 13 miles per week. I've been using a heart rate monitor since day one but for
whatever reason, I cannot lower my heart rate. I am 38 years old and I know my upper limit should be around 140 but I normally
peak out at around 170 and barely feel winded. I recently tried to run at 140 for well over an hour and didn't break a
sweat...it felt like I was walking. My resting heart rate is 72 if that makes a difference. Any suggestions?
Reply
- Janet
well if you go with the standard calculation of 220-age= predicted maximum heart rate, I get your predicted
max as 182. If we then follow the Karvonen formula for figuring your target training zone it looks like this:
182
- resting heart rate = heart rate reserve
182 - 72 = 110
heart rate reserve multiplied by your target effort
-- say for example 80% and then add back in your resting heart rate and we've got your target.
(110 * .80) + 72
= 160
So.... following that calculation, I'd say you should be running your easy pace runs somewhere in the neighborhood
of 155-165. Keep in mind that this whole calculation is based on the premise that your max heart rate CAN actually be
predicted from your age. That's statistically true, but the standard deviation of this is 10-12 beats in either direction
which means your max may be really 170 or perhaps it is really 194? You can see that with that amount of wiggle room
in the calculation, it's hard to get a pinpoint value. One option is to do a 2-mile time trial at max effort and
see what your max sustained HR actually is, then use that instead of 182 to pull together the rest of the calculation.
Hope this helps. Janet Hamilton, MA, RCEP, CSCS, Running Strong Coach
11:18 am edt
Baxter's Nerve - Tom
I've been a runner for over almost 30 years,I been running a marathon a year the past 7
years, My current training is 5 days a week from 5 to 7 miles with a long weekly run from 10 to 15 miles with weekly speed
work and hills.Two weeks ago about 4 miles into a 10 miler I started experiencing pain in the area between my right arch and
heel and with in a mile I was walking because of the pain, 2 to 3 days after the bottom right side of my foot went numb and
still is. The sports Dr.diagnosed Baxters nerve he ordered orthotics and physical therapy he also said surgery might be needed
and that I will probally never be able to run at the level I am now even with surgery. Are there any other treatments or options
available. Currently I've been icing my foot and stretching but I still can't run around the block before the pain
gets to intense.
Reply - Janet
I'm stumped on this one -- I've never heard of Baxter's
nerve and can't find anything in my resources about it. I know about "Boxer's Nerve", its a hand injury
though so that won't help you much. I'd say you're in good hands though if the doc is recommending therapy
and orthotic support that's a good sign-- conservative care should be the first step. Make sure the PT you're
going to is a foot and ankle specialist if possible. Go to the link at the top of this BLOG page and click on the link
for how to find a certified specialist PT. When you get to that search engine, search for an "OCS" (orthopedic
certified specialist) or "SCS" (sports certified specialist) and put your geographic area in there. When that
spits out results, narrow it further by looking to see if any of those listed in your area specialize in lower quarter biomechanics
or foot and ankle.Sorry I'm not much help. I'd appreciate you checking back in to let us know how you fare with
the conservative care. You can also get in touch with me directly via e-mail. (janet at runningstrong dot com).
Best of luck to you - Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
Monday, July 16, 2007
Posterior Tibial Tendonitis - Wendy
I think I have posterior tib. tendonitis. I was going to try and find someone to tape my ankle
(or learn how to do it before a long run or track work), but would an ankle brace suffice? It doesn't bother me all the
time. I was going to try Superfeet in my shoes, but they make it worse! Thanks.
Reply - Janet
Certainly
taping is one short term option to help diagnose the problem, but it's not a long term solution. There are several
things to consider when looking at what factors you can deal with to resolve this issue. First - if it IS a medial tibial
stress syndrome, there's a pretty good liklihood that it's tendinosis rather than tendinitis... so if you're taking
anti-inflammatory drugs you might want to reevaluate that decision. Second - if you are injured it makes no sense to
push through to continue your long runs and high intensity runs (speedwork) on that injured tissue and risk making it worse.
Getting well is more important! Deal with the underlying factors that caused the problem, then work your way back up to your
current state of fitness and get back in the game healthy. Factors to consider: muscle flexibility issues - usually calves
and hip flexors, but also check the hamstrings; muscle strength issues - usually lateral hips, but don't forget the lower
back and abs too; training errors - too much mileage too quickly, running too many hills, too much speedwork, or simply going
out the door too close to race pace all the time; and last but not least - shoe and biomechanical issues - if your shoes are
not correct for your gait pattern then perhaps additional support and/or a change in shoe would be a good idea. I'll
be happy to help you with specifics - if you're interested, check out the services page of this website for more details.
Best of luck - get WELL, then go run! Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
Tuesday, July 3, 2007
Femoral Stress Fracture - Emily
At the beginning of June i started getting pain in my hip to the point where i could not walk.
It took 3 weeks to find the problem but finally i was diagnosed with a stress fracture, which is in the femoral neck. The
doctor told me to use crutches for six weeks (i am half way through, though it is difficult to use tem 100% of the time).
The trouble is he has told me very little else. For example, when i do come of crutches what is an acceptable level of pain?
I have to go back to work - and its a phsical job (waitressing) - but surely i have to expect some soreness after not walking
for so long. The other thing is i don't know how to approach exercising again - i am petrified, and he didn't refer
me to a PT or anything. I should also let you know i have struggled with anorexia for five years or so, duing this time my
periods have been either completely absent, or v. sparse. I did have a bone scan, would it have showed up if i problems with
my bone density? My orthopedic dr. has never even asked me these questions. I am taking supplements and also started on an
oral contraceptive. Will this help? And my last question is will this heal completely? Or will this area always be weak? Will
i always be prone this reoccuring?
Reply - Janet
Wow... where do we start?
A femoral
neck stress fracture is a very serious injury and will likely take longer than 6 weeks to heal. It must be in a location
that the doctor feels you are at risk for a full break if you weight bear without the crutches. Depending on exactly
where in the femoral neck your fracture is located, some are able to repair without having to resort to crutches.... that's
apparently not the case for you. Your anorexia is a significant part of the puzzle. Oral contraceptives may help
you regain some normal menstrual function, but they will not assist in regaining your bone density. If you aren't sure
about your bone density, ask the orthopedist about it directly! He/she probably has no idea of your past eating disorder (hopefully
it's past) and if your bone density is low, he/she may want to put you on medication to help stimulate regeneration.
Your physical job will not be easy to go back to when you're off crutches. It is hard to say how long you'll take
to get back to comfortable walking, but I'd not be surprised with 10 weeks. Obviously you'll need to resume
activities very carefully, and when it comes time to resume running, let me caution you that you would be wise to do a walking
program first and gradually introduce short running segments only when you're able to tolerate walking 12+ miles per week.
I'll be happy to assist in your return to activity process -- check out the services page for more details and please
feel free to e-mail me directly if you have questions (janet at runningstrong dot com). Wishing you speedy recovery
- Janet Hamilton, MA, RCEP, CSCS, Running Strong Coach
8:52 pm edt
Knee and foot pain - Jennifer
After I run a longish distance- over 6 miles- my left knee becomes stiff and I feel some tenderness
on the ball of my foot around the second/third meditarsal. Knee and foot appear a bit swollen. During the winter I did a speed
workshop and probably pushed too hard because my knee became really inflammed then and my orthopod suggested I had tendinitis.
I rested; it got better bu tis gettign stiff agaqin. I think this is caused by imbalances in my muscles. What should I do?
I have been trying yoga and biking and swimming more. I think I should try to strengthen teh appropriate muscles. (I am 57)
Any advice would be wonderful.
Reply - Janet
you're on the right track to suspect that
these issues are related to each other and share a common set of contributing factors. Muscle strength is a key issue,
but not the only one. Other things to consider include: footwear, lack of adequate flexibility (especially calves
and hamstrings), training errors like adding mileage too quickly, or trying to run at too fast a pace, or doing too much hill
work or speedwork. As for which muscles to strengthen, it's hard to say for sure without knowing a lot more about
you, but you can probably safely work on the lateral hips and core muscles of your lower back and abs. I'll be happy
to help with more details if you like, but I need to know more about you - if you're interested you can check out the
services page of this website or just drop me an e-mail at "janet at runningstrong dot com".
Regards,
Janet Hamilton, MA, RCEP, CSCS, Running Strong coach
8:43 pm edt
