I am just wondering, of course i am a distance runner, if i should run barefoot and what your thoughts on barefoot running would be. I have been wearing shoes a lot when i run and never have tried barefoot running, but i am told it helps increase your posture, calf muscles, foot muscles, and much more. I am thinking of starting but i am not sure if i should or not. Any suggestions and input on this?
Reply - Janet
Barefoot running is a great tool -- but should be approached with respect and caution. In our society we generally are in shoes for most of our lives and the intrinsic musculature of your foot is not as strong as that of a person that walks barefoot all their life.  Using short segments of barefoot running on turf is one thing... trying to run lots of miles is another thing entirely.  You might want to consider it the same way you do any new strength building activity -- start with small volumes and build very conservatively.  This is just another tool in your toolbox...like hill work and speed work and strength training, they can all be over-done! Keep in mind that if you're biomechanically challenged - (excessive or poorly timed pronation) then you'll nee to approach barefoot running with even more caution.  Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

In January i had pain in the knee, which i, ignored because when i ran it eased. eventually it became unbearable and i went to a physio, who confirmed i'd torn my adductor and after treatment and 6 weeks of no running i slowly resumed training. everything has been going fine, running daily, x3 sessions per week, 50 miles a week, but in the last week, both adductors have been sore, although not at the same time and i have had to stop training. i cannot understand why this has reoccured, what is causing it and how i can prevent it ? please can you help.
Reply - Janet
it's hard to tell based on the info you provide.  If I understand your post correctly you're running daily? Why no rest days? Perhap you've been training at too high an intensity or doing too much running at/near race pace? Did you follow a sensible and slow build up to return to running? Have you kept with your PT strength exercises and flexibility exercises? Did the PT evaluate your gait pattern to make sure there's nothing going on there that might contribute? Has there been anything in the last week that has changed from your usual routine that may have set things off?  Lots of questions...   Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor
Follow up - Matt
Janet firstly.. THANK YOU for replying it is much appreciated. in response to your questions: i train everyday...over enthusiasm my running between training sessions is done at slow pace, no where near race pace after the initial injury i did build up slowly, but may have increased a little too much in the last 3 weeks ? my PT did not do a gait analysis or give me any strengthning exercises... this may be the problem?? 2 weeks ago i did some speed work.... main difference.... 10x300m in around 43 secs with 90 sec recovery... usually 49 secs with 60 sec recovery. i have been running for 3 years, but only training properly for a year, i do want to educate myself and want to understand why this has reoccured, what is causing it and how i can prevent it ?
Reply - Janet
Sounds like some big missing links to me. Strength work is super important when you're trying to recover from a "torn" muscle.  Speedwork is also likely an issue.  You did a high volume (3000m total) at a pace that was close to 30 seconds a mile faster that your usual (6 sec per 300 meter). It's likely that your symptoms recurred because you didn't fully rehabilitate from your previous injury and possibly because you introduced speedwork too soon, or perhaps too quickly ramped up the intensity of the speedwork.  The foundation of your training is the base building period... get solid with that foundation then introduce speedwork in a progressive and gradual manner.  If you'd like more help with this - please let me know via e-mail.  I have room on my calendar at the moment for a new athlete.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have had ITB issues for quite some time now. This began after a stint of not running for a few months and building mileage quickly. I realize I mad a mistake when he pain in my knee was severe. My knee would lock up while running. I consulted with a sports medicine doctor. He advised me to stop running and focus on only using the bicycle and stairmaster for six weeks. I stretch frequently and use a foam roller. I followed his orders and have begun running again. The doc advised me to start with 3/4 of a mile three times a week, building 1/4 of a mile per week. I have built to two miles, and I am experiencing slight twinges of tightness and pain in my knee and hip. I wear orthodics, I got a new pair about two years ago. I change my shoes more frequently than needed. I want to treat the problem, not just the symptoms. Please help! I would like to enjoy running in the beautiful summer weather! Any advise will be greatly appreciated! Thank you!
Reply - Janet
Well, the question that popped into my mind was: what sort of strength work have you done to deal with that part of the problem? You've stretched, but hopefully you've stretches something other than the ITB -- which is more often the victim and not the perpetrator. Hopefully you've been stretching calves, hamstrings, hip flexors and quads.  But you didn't mention any strength work.  Usually it's related to weakness in your core (lower back and lateral abs in particular) and lateral hips.  If you've not covered that base (core and hip strength) that would sure be a place to intervene.  It sounds like you've adressed the biomechanics issue with the orthotics and you've been relatively conservative on your build up.  Perhaps the strength work is the missing link?
Hope this helps.... Janet Hamilton, MA, RCEP. CSCS. RRCA coaching instructor

I've been having very specific hip pain as a result of overuse. The back of my right hip/butt hurts significantly when I pull my leg forward and to the left or push it back and to the right. It's also painful when I raise my right knee to my chest and when I lay on my left side and raise my right leg upward or to my chest. When I run it flashes a sharp pain every time my right foot is at full extension out in front of me. I believe it is some type of abductor or glute strain that resulted from overuse and very old shoes (went way to long without getting new ones - 900 miles or so). I'm about 155 pounds and like to usually run 20-30 miles a week. My shoes did wear fairly unevenly with the right side being much more ground down. I'd like to know how long I need to take off to rest it and if there are any exercises/therapy that would be helpful. Also could the problem stem from some type of bad alignment in my hips or back? I took a week off from running but substituted a good deal of biking. Though the bike was painless it clearly was a bad idea. I tried an easy run last night and could barely make a couple of miles. Looking for any answers I can get so that I can get back out there and run easy again.
Reply - Janet
Have you seen your doctor to rule out more significant injuries like a femoral neck stress fracture or a joint capsule injury (labral tear)?  If not - that might be a good first step.... just to insure that what you're dealing with is really a strain.  It sounds like you've pushed into the pain for awhile so I'd think that 4-6 weeks off running isn't an unreasonable prediction based on the way you describe the pain as being pretty significant and occurring even with non-weight bearing activities.  If you can cross train with some swimming or biking that might be one way to keep yourself from going nuts while you recover but it sounds like you might be off running for more than just a few days.  After you've seen an orthopedist and they've done what's needed to diagnose the problem then you can plan on how to proceeed.  A visit with a good orthopedic PT might help with teaching you some exercise, and might also be a good way to rule out any involvement coming from your lower back. I can't really recommend specific exercises based on the information you've provided... I'd need to know a lot more about you and your previous injury history before I could be of much help in that regard.  If you're interested in that - see the services page of this website and fill out the coaching questionnaire.  Hopefully you'll get good news from the orthopedist.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi, I have been training for FLM but am getting pains on the inside tibia of my left leg. About half way up. it has localised swelling and painful to touch. I started with this pain after I did a marathon over a year ago - I rested but it has never subsided - now I have been training for this marathon the pain has got worse. It can ache at night but not much but it has stopped me running shorter distances - although once warmed up I can run through the pain for longer distances with it only coming back once I have stopped! Do you think this could be a tibia stress fracture and also - what should I do about the FLM next week??? Really hoping you can help. Kerry
Reply Janet -
It makes absolutely NO sense to run injured and even less sense to try to run a marathon with an injury?  Are you making your living off your running? If not - then let the FLM go.  You obviously have a pretty substantial injury and it may well be a stress fracture.  You need to see your orthopedist to have diagnostic imaging (a bone scan or MRI) to figure out what you're dealing with. It sounds like you never really dealt with the underlying factors that contributed to this injury last time, because it's certainly come back in a big way! Rest is only part of the picture. You need to consider other factors like muscle strength issues, flexibility issues, biomechanical issues and of course - training errors.  It's quite likely that you'll need to deal with something in EACH of those arenas to get back to a healthy place.  Let go of the upcoming marathon and get healthy... it's way more imporatant than any race.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

There is one more thing: with these imbalances, and poorly shock-absorbing feet, and a previous injury (although training errors were there too)...am I crazy to want to keep running? I really love it but it's beginning to sound like I'm not made for it. If I do everything I'm told and be careful with training do I have a reasonable chance of avoiding serious injury? Can I ever do a marathon?
Reply - Janet
I'm of the mind-set that most anybody can run and be healthy with it.  I'm troubled by the trend I see these days among runners who subconciously (or consciously) believe that in order to be a "real" runner you need to be doing marathons.  It's almost like you're not a member of the right clique if you're not doing a marathon.  Frustrating... as much as I like marathons, they're not the right event for everyone.  Doing a half marathon or 10K doesn't make you any less an athlete.  With all that's going on with you, perhaps a year or so of shorter distance events like 10K and half marathons will help you determine what your body is best suited for.  If you tolerate the training for those events and remain injury free... then you'll be much more confident taking on the volume of training needed to succeed injury-free at the marathon distance.  Just keep in mind - running is a gift and it should be used to maintain life-long health... not squandered away on the egotistical pursuit of an artificial distance just so you can say you did it.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

follow up - Grainne
Thanks for that! I'd be more than happy to stick to 10Ks and half marathons. Think the half is a great distance really. And nothing is worth being off for half a year with an injury and doing no running at all! It would be nice to do one marathon at some stage but I can definitely wait. It actually occurred to me recently that when you read the bios of many of the elite athletes they tend to have years and years of shorter racing behind them before tackling the marathon distance...yet there's almost a pressure on non-elite runners to do it quickly! Think I'll train like a slow elite...by respecting my body and the distances :-) Thanks Janet!

Thanks again for all your advice on rehab of my pubic ramus stress fracture. Have been doing max 3 runs a week and all going well so far. Took your advice and had my biomechanics looked at. Opinions vary! Was at a talk on biomechanics and had to walk up and down in front of the class...to show them what a supinator looks like. A private physio said not a typical supinator, but tight calves and left adductor longus, heel whip and weak left external rotators (prob from limping). Saw a physio in the hospital where I work today...who said supinator, scoliosis, slight leg length discrepancy (left longer)...and still has to look for more next Monday. Trying a heel raise to begin with. Am more inclined to believe the more negative news actually. She's the only one to pick up the scoliosis (it was on my MRI but I didn't tell her until afterwards!) and am less surprised to find I have a LLD than to be told I'm normal...after left calf pain, left peroneal tendinopathy and a left sided stress fracture. Physio at biomechanics talk recommended trying Vomeros for cushioning and throwing out the Pegasus I had been wearing-she thought my pair seemed to have a bit of medial wedging. I threw a pair of shock absorbing insoles into them too for good measure! So, it seems like there's lots to work on but I'm hoping it will all be worth it. Thank you for giving me the push to get it all checked out. I could (and probably would) have run into exactly the same problems (or worse) again otherwise if I hadn't modified things. Just one silly question: is there any value to rotating brands of trainers-e.g. spending most of my time in Vomeros but doing some runs in Gel Cumulus or something? Just wondering if it might help to distribute forces slightly differently? I may be overthinking my shoes though!
Reply - Janet
The second PT may have more in common with the findings of the third PT than you thought.  A scoliosis and mask a leg length difference and a LLD can cause a scoliosis... so they both may be right.  In addition, the muscle imbalances the second PT found may be contributing to the "medial wedging" that the third PT found.  Very complex case!!!  Anyway - to your question of shoes... There is a school of thought that says two different models of shoes rotated on a regular basis, will result in more stimulation of muscle function.  I wouldn't recommend doing a switch between a stability shoe and a cushioning shoe... but switching between a couple of pairs of one category of shoe (for example two different cushioning shoes) may be beneficial.  Also keep in mind that shoes are only one small piece of the puzzle.  Muscle imbalances,tightness, training errors... they all contribute to the big picture.  Injuries are rarely caused by just one thing and almost never fixed by just one intervention.  Glad you got things looked at!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hello Janet! I was recently diagnosed with Ehlers-Danlos Syndrome and recognize that I'm more prone to dislocation and early osteoarthritis (we think it's Hypermobility type). I have been running about 30-35 miles per week for a few years now, and last fall I did something to my L calf; not sure exactly what, but stayed off running for 6 weeks, built up a base very slowly, and came back strong and fast afterward. I was near the end of a great 9-miler a few weeks back and think I did the same thing again. It was fine on and off, consistently RICEed it, anti-inflam., lots of rest, all that good stuff, until 2 days ago, when at mile 5.5, it was agony. Shooting pains up and down the back of the calf, some up through the hammy, and it hurt more to walk than run. My reward: a world-class limp (this weekend's half is out), swollen lower calf, pain of 7 on a 1-10 scale. My PT thinks I pulled the posterior tibialis both times and this time is just worse. More RICE, some stim., some massage, and eventually foam roller. What else can I do? Do you think I'll be able to do Chicago (my first full) this fall?
Reply - Janet
Clearly I'm no expert on this - had to go look up Ehlers-Danlos Syndrome.  If I understand it correctly it's a syndrome that affects collagen integrity. Collagen is a major component of tendons, and as such - your injury is not surprising.  Keep in mind that anti-inflammatory drugs may not be your best choice, since they may affect the healing process (which needs inflammation to get started!).  Talk to your doctor about that one.  Is your PT pretty well versed in your syndrome?  Hopefully yes.  If they're right and this is indeed a second rupture or tear of the posterior tibialis muscle, then you definitely may want to re-evaluate your plans for the Chicago marathon.  The tensile strength of a healthy tendon is drastically reduced when it's been injured multiple times and if I understand your syndrome correctly, your body's ability to make good strong collagen (the major component of tendons) is impaired - so your ability to heal and regain adequate connective tissue strength for running a marathon is in question.  Perhaps doing 10K events or maybe half marathons is a better choice?  Your doctor will be much more able to advise you on this.  IN any case, you've a long rehab in front of you - tissue needs to heal, then regain strength, then get strong enough for the task at hand... this will take time.  I don't think it's wise to target a fall marathon.  Hope you heal quickly... Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi there. I recently went to an ortho for what turned out to be a stress fracture in my pubis ramus. Frustratingly, the pain started two weeks before what was to be my first marathon, so the disappointment is pretty intense. Anyway, I've been laying off the running and the pain is practically gone. The twist is that while x-raying and MRIing me for that, they found a tension-side femoral stress fracture that is giving me no pain at all! I had some pain 10 months ago during a half marathon but with 2 weeks off running all pain went away. Am I really in danger of this turning into a full-fledged fracture? One doc is telling me elliptical and cycling are ok but no yoga (?), another is telling me anything but running is fine. My question, I guess, is have you seen dangerous stress fractures with a patient who is pain-free in that area? I understand my recovery is at least 3 months but I'm baffled and frightened by this potential time bomb in my hip!
Reply - Janet
Wow... good thing they found that other stress fracture!  Tension side stress fractures are generally considered more troubling than compression side - and often doctors recommend non weight bearing on crutches for several weeks to reduce the risk of it going to a full blown displaced fracture.  I think it's odd that your two docs gave you different guidance... are they both orthopedists?  If not - I'd get a second opinion from another orthopedist who is experienced with stress fractures of the pelvic/femoral region. The fact that you've got two is very serious and makes one wonder about your bone density.  You mentioned you didn't have any symptoms from your femoral stress fracture but keep in mind that sometimes the pain from a femoral neck stress fracture can present as groin pain which you could have easily attributed to your pelvic stress fracture!  Your recovery will be long and slow on this.  Its not unusual for it to take a good 6-9 months before running... though you may be allowed to do some walking and other forms of exercise in 3-months.  Get clarification from your orthopedist about what's "legal" to do and if needed, get a second opinion to make sure you're erring on the side of caution. This is an injury you have to respect and take seriously!  Wishing you speedy healing... Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Update to Runner's Knee - i guess things were too good. I dont have pain but i do feel a little bit of potential stiffness. . .just an inkling. The way i would describe it - it feels like there is some muscle/tendon which is thin and which i can feel is tight but goes across my knee after starting diagonally from my outer leg (left knee/leg). I have moved to elliptical now. Is the treatment same? lots of stretching and strengthening? ONe factor before as i thought i cured it earlier was yoga which probably ended up acted like my strength training. Thoughts on my symptoms?
Reply - Janet
I think your symptoms sound a lot like the early stages of patellar tendinosis or "runner's knee".  Without knowing more about your specifics, all I can do is give you the generic advice that says core and hip strength are absolutely crucial in rehabilitating this.  In addition, if you're tight - flexibility exericses would be good.  Also - if you have biomechanical issues like excessive or poorly timed pronation perhaps a more supportive shoe or even an orthotic would be good.  Really to get the best guidance, I'd need to know more about you.  If you're interested in this, log onto the services page of this website and download the coaching questionnaire.  You can also feel free to e-mail me directly if you have questions.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor