I've had a couple of cases of a sudden onset of ankle pain in the middle of a run. This has happened twice, the first during a marathon, and the second during a 5K race (they were about 2 months apart). Both occured half-way through the races, and were in the same location on the same ankle. The location of the pain in on and above the knob on the outside of my left ankle. I can't figure out why this happens, as during training runs, both outside and on a treadmill, I do not get any pain. The pain isn't enough to make me stop running and I have not had pain there in between runs, or any other time. The pain is similar to a "twisted ankle", but the pain doesn't last long and as far as I can see, there is no swelling. But I do get fairly stiff ankles when sitting for long periods of time, or have my legs stretched out while relaxing. Any ideas? Are there stretches or strengthening exercises I can do that could help?
Reply - Janet -
I wonder, do you get this pain at all when you do any form of speedwork or hill work other than in races?  You don't mention any precipitating factors like stepping on a pebble or something so I'll assume that's not it.  Do you do flexibility exercises? If not - some calf and hamstring stretches might be in order.  If you have some limitations in flexibility, perhaps what you're experiencing is some sort of pinching of a joint capsule?  Have you seen a Dr. to evaluate this? Might not be a bad thing to visit with your orthopedist or even see a Physical Therapist for an evaluation of your flexibility.  A gait analysis may also reveal some things - perhaps with an increase in pace (5K) or fatigue (marathon) your form starts to deteriorate and you end up being less well aligned biomechanically and something gets tweaked in the process.  If you'd like help with this and you're local to the Atlanta GA area, give me a ring! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Mike and Janet, Hello, I am 53, in good shape physically and have been running for about 18 months; currently doing about 25-30 miles a week mostly on pavement. I have participated in only a sprint triathlon, a 10 K and 10 miler over the last 4 months. I have a history of pain, soreness and injuries (last year)in the Achilles lower calf area. Running shoes for severe overprobantion eliminated the injury issue, but I recently had a physical therapist advise me that I have Achilles tendinitus. Its worse on the left side. I have been treating it with ice, rest, heel pads, reduced hill work, etc, Usually after a day ot two the tenderness/soreness is almost gone. I am training for a marathon in Nov. and recently there has been a slight pain in my left heel that bothers me for a mile ot two mid-run and then goes away. Is this a worsening of the tendinitus or a new issue? Prior to this heel pain the soreness in manageable. Anything that I can do to eliminate or reduce this soreness and what do you recommend? I am concerned about increasing my mileage over the next month or two. Any suggestions would be helpful. Kevin
Reply - Janet
Kevin your concern is well founded!  It does sound like the heel pain in mid-run is probably an indication of a worsening of the situation.  Is there any chance you'd reconsider the November marathon goal and take the time needed to deal with this injury and get it healed? Achilles tendinopathy is notoriously slow to heal and if you continue to train at a high level (i.e. building for your first marathon), I'm concerned that you'll slow it down further.  The shoes for overpronation make me wonder if perhaps you need something a bit more customized (an orthotic?)  The physical therapist who diagnosed your Achilles tendinopathy - did they do a gait analysis for you? Perhaps the shoe is enough at a lower level of training but the cumulative trauma of training for a marathon is more than a shoe alone can deal with?  Most rehab programs for Achilles tendinopathy focus on eccentric exercises for the calf/achilles, and gradual progressions - in addition of course to the standard heel lifts to reduce strain, stretching for tight muscles (BE CAREFUL of stretching the calves... you shouldn't feel it in the Achilles), and emphasis on core strength. If your PT hasn't done an evaluation for you - it might be worthwhile to have the gait analysis done and also have them do a full lower quarter biomechanical assessment.  Hope this helps, let me know if you have more questions.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi Janet, I wrote to you the other day asking about spondylolysis, and I had an MRI taken and just found out I have a bulging disc. Can you give me some information about this: like what sort of steps should I take for recovery, and things of that sort. Also, have you ever coached any runners with this problem? Will I ever be able to run again? Thank you for all of your info, I greatly appreciate it!
Reply - Janet
Hey, this is actually good news! What exercises are appropriate depends in part on which direction your disc is bulging.  No matter what direction it's bulging, you'll want to work on abdominal, lateral abdominal and lower back strength -- these muscles help support the spine.  The direction of bulge will determine what kind of spinal motion (flexibility ) exercises are appropriate. In addition to the core strength, it's almost always appropriate to do some flexibility exercises for your legs and to follow some sensible training progressions.  Have I ever dealt with this? Absolutely!  You should be able to get back to running if the herniation hasn't ruptured and with the right attention to careful progressions and covering your flexibility and strength issues - you should be able to run again.  Don't despair -- hope is not lost! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi, i am just curious of what a good long distance runner should be eating and drinking every day and how much of each.... I run about 7-8 miles everyday my schedule usually is oneday easy one day hard and some intervols are thrown in there.. i get about 2 days a week of rest because of weekands. What would be a good healthy nutrition plan i can go on that you know of and / or can referr me to? Thanks!
Reply - Janet
I'm not a registered dietician, but my recommendations are to follow a sound diet that includes about 60% carbohydrate, 15% protein and 25% fat. You would be wise to seek specific daily advice from someone more qualified to give it (an RD).  In addition you might also consider your training schedule.  Running the same distance every day isn't optimal -- it doesn't give you the best balance of overload and recovery. You might want to vary your mileage from day to day.  Hope this helps - Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have beeen for awhile and for some reason i get a good day where my hamstrings feel fine but than for like a month or so they feel like they are dead tired everytime i go out and run, thats what i am feeling right now. I drink accelerade to help them recover and i give them about 2 days rest every week, but i dont know why they feel horrible all the time. I stretch them a lot also. some advice would also be great.
Reply - Janet
There's no way of telling what's going on based on what info you provided but perhaps you should take a look at the intensity of running you do from day to day.  If you're going out the door too close to target race pace on every run, then your hamstrings have a right to be tired! Accelerade won't really help your hamstrings recover any better than a good balanced diet will -- And keep in mind, you can't "stretch away" an injury.  Perhaps some focus on core strength work would be something to consider? What about your shoes? Are they old or not correct for your gait pattern? What about your terrain -- are you always running hills or doing too much speedwork? Hope this is some food for thought.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have been running for about eight years now and last year, the right side of my lower back started having pain. I went to the doctor who said I just had a muscle strain and gave anti-inflammotories. I did a lot of research, and everything I read said to do a lot of stretching and core strengthening. Now just recently, I have begun having pain on the left side of my lower back. I immediately stopped running and have just been walking and doing some mild ab work. I went to the doctor, and he thinks I may have a stress fracture in my lower spine, which he said is called spondylolysis. I have been reading up on this and a lot of articles say surgery may be required. I am now getting very worried, because I do not want to have surgery, and I just want to start running again. I want to know if it is okay that I have been walking to get some sort of exercising, and also if I will be able to run again soon. Thanks!
Reply - Janet
Valerie, spondylolysis doesn't necessarily require surgery unless it progresses to something known as spondylolisthesis - which is a condition in which the fracture begins to displace.  If the doctor diagnosing you isn't an orthopedist, ask for a referral to one - just to get confirmation that what you're dealing with is indeed spondylolysis.  Next, ask for a referral to a good orthopedic Physical Therapist who specializes in back injuries and rehabiltiation.  There are certain stretches (like hyperextensions) that you should not do with a diagnosis of spondylolysis because it increases the risk of it progressing to a spondylolisthesis.  With the right types of strength training exercises and a sensible training program you may well be able to avoid surgery and still be able to run, but you need to get in contact with professionals who can really help you.  To find a good orthopedic PT, use the link at the top of this BLOG page and search the APTA specialist database.  You'll want to look for an OCS (Orthopedic Certified Specialist) in your state.  When the search results come back scroll through them and look at the therapist's stated area of focus.  You'd like to find one that specializes in lower back issues.  When you're cleared to resume training, get in touch with me and I'll help you through that phase if you like! Best of luck - get that second opinion and a referral to a PT -- that's your shortest path to recovery! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Janet, for the last 3 months I have been training for a half marathon to take place Sunday, September 23rd. I've never done a race this long, so my goal is to finish the race at my normal training pace (70-80% of my max). I don't want to race it. I just discovered that the Half is the day after Yom Kippur. There will be no water nor food from 6 PM Friday to 6 PM Saturday. Breaking the fast is a rather small meal, as no one can eat nor drink a lot at that point. Is there anything special that I should to do to adjust? Since I'm not racing the half, I'm not too worried, but still, it's my first long distance race. I will have two 12 mile runs under my belt and will also have tapered the week before. Thank you so much!
Reply - Janet
Wow, that's one that's never come up before! Let's see... you'll be able to eat up until 6pm on Friday, so a normal carbo loading process can take place up until then. If you're good about trying to keep your diet in the 60% carb range, just bump it to about 65-70% carb for the period from Thursday night to Friday night.  I'm actually more worried about liquid than I am food. When you break your fast on Saturday at 6 pm, make sure to eat right away, and start re-hyrating yourself right away.  Foods that are high in carbohydrate are normally digested easily and are stored with water -- so make sure you break the fast with a good 65-70% carbohydrate meal.  I'd also recommend trying to eat again around 10 pm, and arise early enough on race day to have time to hydrate a little and take in a light snack. If you can "graze" (nibble) on small quantities of food from 6pm Friday until about 10 or so, that might enable you to get a few more calories in without feeling bloated and full.  I guess this gets to the heart of "race planning" from the beginning of training doesn't it?  If we'd looked ahead from the beginning, you could have done a trial run of this on one of your long weekend runs and seen how you felt.  Since you're "running" the event and not "racing", you will probably do fine as long as you eat and hydrate as soon as you can break your fast.  Best of luck to you!  Have fun on that half!
Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I am a serious athelete that is prone to stress fractures. I had 1 metatarsal and 2 tibia stress fractures. I have an excellent Dr. and have recovered well from my injuries. I cross train, wear orthotics and don't run days back to back. My left calf has been tight and I have pain that mimics a tibia stress fracture. My Dr. and I are trying to take care of this without another MRI. He doesn't think I have a stress fracture. We did an x-ray and it looks ok. It has been 6 weeks since my first pain. What are your thoughts on accupunture? I am a skeptic but willing to try anything. Thank you so much!
Reply - Janet
With your history of stress fractures I'm kind of suprised at your physician's reluctance to use diagnostic imaging to determine for sure what's going on. The x-ray (as you know) is not really of much value in diagnosing a stress fracture.  Accupuncture works well on some people for some diagnoses.  It may help the pain but it doesn't deal with the underlying CAUSES for your injury. If you have a history of multiple stress fractures, there's pretty obviously something going on either biomechanically or musculoskeletally.  How is your bone density? You mention orthotics -- are they custom molded? Did the practitioner who made them assess your functional strength and flexibility?  Even though you don't run back to back days, if you're training at a pace that's too aggressive or doing too many hills or have built your mileage too quickly -- these can all play into another injury.  I think the first thing is to find out for SURE what you're dealing with (stress fracture or tendinopathy or what) and if you've not had your bone density checked, that would be a good thing to do as well.  I don't think accupuncture is your answer. It may help the symptoms but it won't deal with the cause!  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

My son was in his 2 week of Air Force basic training when he developed a stress fracture on his foot. He is 6'5" and weighs approximately 170 lbs. He is in the Air Force hospital hold unit till it heals, which looks like could be 8 to 12 weeks. He is in a removable splint. Do you know of any exercises that he could be doing to keep up his strength and endurance up? He is going to have to finish 4 more weeks of Basic Training when they feel he has recovered. The doctor has told him as long as he keeps the pressure off the ball of his foot he is O.K. to exercise. He does has access to a work out room but I am not sure what equipment is available.
Reply - Janet
The Air Force has a good medical system, including Physical Therapists.  I think your son would best be served by talking to his physician about a referral to one of the PT's on base.  Most people with stress fractures in the foot are allowed some level of weight bearing (soimetimes only in the boot) and with proper foot positioning on a stationary bike, that can be a possible form of cardio exercise. Another option is deep water running (no foot contact) or swimming.  As for strength -- pretty much all the upper body gym exercises are generally accepted, and the leg extension and leg curl machine won't put any pressure on his foot.  Unfortunately these forms of strength exercise won't really give him the strength he needs to tolerate the heavy workload of basic training.  One more thing... at 6'5" and 170 pounds he's a bit on the slender side... have they checked his bone density?  Two weeks into training is pretty quick for a stress fracture, it's more common to see them in the 4-6 week range.  Hope this helps, get him to talk to the Physical Therapist on base.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

My daughter is starting her third season of xc (senior yr) - Has seen several drs. for calf pain when she runs - md, chiropractor, etc. md had her stretching, stretching, stretching during summer because she couldn't flex her feet up more than 90 degrees - but she is still experiencing pain when she runs - usually occurs most of the time. One chiropractor thought she had poor circulation in her calves that would cause the pain -- (what would you do for that?) Help! It's her senior year and loves to run but it hurts!
Reply - Janet
the lack of mobility could very easily be an issue and if she's in the midst of a growth spurt all the stretching she's done may have just kept up with the growth spurt and not gained her much. Still... you're right to be concerned. The physician you need to see at this point is an orthopedist.  She may have something as troublesome as Chronic Exertional Compartment Syndrome (I think this maybe what the chiropractor was thinking?) or it may be somthing much more benign like tendinopathy. Either way - the doc with the diagnostic tools to help you is an orthopedist.  You can use the AOFAS website (American Orthopedic Foot & Ankle Specialist) to find some names in your area.  If there are none nearby, at least get her to an orthopedist. If it turns out she has CECS, the stretching would likely still be appropriate, but they may also want to refer her to someone for exercises to strengthen her hips, and perhaps to someone to fabricate a pair of custom orthotics to support her feet.  Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

For the last week, each time I run, I start out in a lot of pain in my lower right leg (shin and calf). I walk a little, stretch, run again, and then after about 3 miles I'm fine. After the run I am also in no pain. It is only the first 2 or 3 miles. I also have a pain in my buttocks on the same side of the leg. Any thoughts?
Reply - Janet
without knowing more about your training prior to  your injury it's hard to speculate.  It sounds like you may have some tendinopathy going on in the lower leg, but the buttock pain could be related to lower back issues or could be a separate issue that's related to the same thing that's causing the lower leg stuff (namely probably biomechanical stuff like pronation that's occurring too late or to long).  Muscles in your butt help to decelerate the forces of pronation - so it's possible the two symptoms are related.  Have you tried doing a prolonged walk warm up? Perhaps walking for 5-10 minutes before you run your first step would be enough to warm things up a bit? Also - what about your pacing? Have you added mileage recently? Are your shoes old? Do you do your homework as far as stretching and strength exercises are concerned?  There are many possibilities here so it's hard to say for sure just what's going on based on the info you gave.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I just ran the San Francisco Marathon and experienced cramping in the hamstrings. Actually experienced cramping during my training at mile 21. I'm pretty sure it was not from dehydration and think that its from muscle fatigue. I'm back to running 3 miles or so. When I speed my pace up, I feel that my hamstrings want to cramp up again. Later in the day sitting at my desk I'll feel the same discomfort. I'm trying to hydrate as much as possible and eating somewhat healthy. This morning I ran 6 miles at a slower pace than normal. So far so good. Anyway, any ideas of my cramping? Should I see a doctor? Should I just stop for a while. I do want to run a half this October. Any information would be greatly appreciated.
Reply - Janet
Although dehydration is one cause for muscle cramping you're correct in that probably a bigger factor is muscle fatigue.  Obviously when you're running at a higher percentage of your capability you're going to fatigue faster -- hence the fact that you could run an easy 6 miler with no problem.  I'd suggest dealing with the underlying muscle strength issue - use functional training like balance/reach, lunges and squats rather than the silly leg curl machine at the gym. The carryover into your chosen sport (running) is much better that way.  In addition, since you mention some discomfort with sitting, you might want to have your lower back evaluated by an orthopedic physical therapist. The low back and hamstrings are intricately related to each other so dysfunction in one area can feed into the other.  Not sure if the low back issue caused the hamstring problem or the hamstrings caused a low back issue... but they're likely related. In addition to working on strength, make sure to cover your other bases: flexibility exercises (daily is a good plan), good shoes that are correct for your gait pattern, sensible progressions of training, and a sound approach to proper pacing on your runs.  Best of luck, let me know if I can be of further assistance! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Recently I was in training for the San Francisco marathon. During the first week of June, due to a business trip, I was forced to run of concrete in order to continue my training. During that week I increased my mileage and ran on concrete. I didn't notice any pain while running, but after about 5 weeks I started noticing a pain in my right ankle, mostly while resting. I have discontinued my running since mid June, but still feel some soreness in the right ankle. Soreness in the ankle is most noticeable when I straighten out the foot with the toe pointed to the maximum. Any thoughts on what this might be?
Reply - Janet
You don't give any clues about where on the ankle the pain is located so it's hard to say.  It is also odd that your pain is present at rest but not when running.  Are you able to walk without pain? If so, that lower level activity may help increase blood flow to the area, bringing nutrients in and carrying waste products away.  Activity is actually usually a good thing in the healing process and works better than total rest most of the time.  Perhaps you ramped the mileage up too quickly? Perhaps your shoes were old or not correct for your gait pattern? Perhaps you reached a level of mileage that your body had not yet adapted to and pushed beyond it too soon?  In any case, the fact that 5 weeks of rest has not alleviated your symptoms would make me think that seeing your doc for some diagnostic help might be a good idea.  You can search for a good orthopedic foot and ankle specialist on the AOFAS website.  All of the topics on the top right of the page have drop down menus and one of the choices is "find an orthopedic foot and ankle MD".  Hope this helps, Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I'm having some right medial knee discomfort. I'm certain that I have a knee tracking issue, b/c my knees just crack and snap and feel out of alignment when I extend them. Last summer, the left knee hurt me. I've been taking time off of running and crosstraining (b/c the crosstraining was exacerbating it, methinks.) My question is: everything that I read indicates that knee tracking issues are typically due to a week Vastus Medialis muscle. If that were the case, then wouldn't my lateral knee hurt? For me, it is my medial knee. The only cause that I can think of is that a few years back, I had a groin injury, and I may still have tightness in that area. Any recommendations for exercises to remedy this?

Reply - Janet
Chrissy, though it's common to blame the medial quad muscle (the Vastus Medialis) for knee problems, I find it's more commonly an issue with weak hips. Either way, the biomechanical chain of events is as follows: the patella is supposed to track in a groove in the femur and the quadriceps muscle pulls on it from both sides and from above, and if these pulls are even then the patella tracks as it should.  However if the hips are weak, (which is likely since you have a history of groin injury), then pronation at the foot is not being adequately controlled from above.  The poor fella in the middle of this chain (the knee) gets beat up - and the area most commonly involved is the medial side of the knee because of the direction of forces involved in pronation.  Long story short - you may want to work on hip strength and balancing muscle inflexibilities, rather than trying to focus your attention on the vastus medialis muscle.  I'll be happy to help with specifics, if you're interested you can e-mail me directly, or check out the services page for more information. Hope this helps -- Janet Hamilton, MA, RCEP, CSCS, RRCA-Certified Coach

Hey guys, I am a distance runner (5k-marathon). My daughter has taken to running and I ended up helping coach the local youth track team (distance runners) ages 8-15. Will help coach the local xc kids and the track team next spring. My question: Where can I find reliable resources for training these kids? Don't want to shorten my old HS and college work-outs for them, but use specific age-appropriate training. Thanks
Reply - Janet
not sure if this is totally specific to that age group, but this is one book that's been recommended by others. I'm not a cross country coach - so can't vouch for the book but it's worth looking at the table of contents.  It's available on Human Kinetics Publisher's website http://www.humankinetics.com/products/showproduct.cfm?isbn=0736050914 .  Hope this helps. Janet Hamilton, MA, RCEP, CSCS, RRCA-Certified Coach

Lately when I run, my right calf hurts like crazy, but only my right one. I suspect I may be overcompensating for a troubled left knee. But perhaps not. I run in stablizing shoes with orthotics, and I am a 41 year old male. My last good run was on July 19. After that, it's been all run/walk and the running part has been quite painful, so I've stopped. Any thoughts?
Reply - Janet
the first thought is "good for you - listening to your body and backing off due to the pain!".  Seriously - you may be correct in suspecting that you're compensating for a left knee issue.  It could also be that the same factors that lead to the knee pain are involved in the calf pain. One more thought... have you been on antibiotics in the recent past? Specifically, some of the newer antibiotics can cause musculotendinous problems in some people.  Look back at your training log and investigate some things - have you been diligent about your flexibility exercises? what about strength work? Have you been smart about your training? How old are the orthotics and shoes - if they're a new combination perhaps it isn't a good one? If the shoes are old, perhaps they're no longer providing the support they once did? I suspect that the biomechanical issues that lead you to the left knee injury (and presumably the orthotics were for that?) may still be a factor.  Hope this is food for thought.  I'll be happy to help with specific stretches, strength work and/or gait analysis - see the services page for more details.  Janet Hamilton, MA, RCEP, CSCS, RRCA-Certified Coach

I have been running for about a year now but still am having problems with my shins. Have used gel insoles and now using gel heel cushions. This have made a big difference but my right shin is only just beginning to get back to normal nearly 3 weeks after a 10k run. Is there anything I can do to avoid shin splints in the future.
Reply - Janet
The most common factors I find involved in lower leg injuries are:
Lack of adequate flexibility - especially calves and hamstrings.  Stretch often (several times a day) but not hard.
Lack of adequate strength - usually it's the lateral hips and core region that are weak.  Use functional strength training for this rather than that silly "inner/outer thigh" machine. 
Lack of adequate support from the shoe or shoe/orthotic combination - my guess is that you've used the gel insoles because you thought you needed shock absorption.  You may or may not be correct in that assumption.  If the shoes you wear are cushion shoes and your gait pattern indicates you need stability more than cushioning, then you may be off on the wrong tangent with the gel soles.  If you can get to a good technical running shoe store, sometimes they can help by watching you run in your shoes and seeing if the support is correct. 
Training errors - this is usually the biggest factor.  Common ones include: adding mileage too quickly, doing too much hill work or speedwork, or simply going out the door at/near race pace on every run.
I'd be happy to help with more details but I need to get to know more about you. If you're interested in more personalized help, check  out the services page and feel free to send me an e-mail directly if you have questions.  Best of luck to you.  Janet Hamilton, MA, RCEP, CSCS, RRCA-Certified Coach