Hi Janet, I have struggled with piriformis syndrome off and on for quite sometime but now it seems to have taken a turn for the worst. In addition to having pain in my rear and upper hamstring, I now have pain radiating down my leg on the outside of my knee and into the belly of my calf. Getting out of bed in the morning or out of a chair is not comfortable nor is sitting on the stairs to put on my shoes. :( I am not sure why all of sudden I am having these new issues. Thanks for your insight!
Reply - Janet
Kristen, it sounds like you've got a nerve root pretty irritated - perhaps the sciatic nerve.  It can easily cause the pattern of symptoms you've got.  It could be irritated up in the low back area where the nerves exit the spine, or it could be irritated as it transits through the region of the piriformis muscle.  I think you'd be wise to see a good orthopedic physical therapist who is trained in manual therapy techniques and see about getting this resolved. The fact that you've dealt with the issue "Off and on for quite sometime" means it's likely to be a bit more complicated to resolve.  You can use the search engines I've linked at the top of this BLOG page to locate a good skilled PT in your geographic region.  If you use the APTA search engine - search for an "orthopedic certified specialist" (OCS) and put in your city or neighboring towns to narrow it down.   Read their credentials and area of practice focus... you want one that is focused on low back and manual therapy if you can find one.  The other search engine is for the North American Institute of Orthopedic Manual Therapists (NAIOMT) and in this search engine you're hoping to find a "COMT" - which is the higher of their two credentials and stands for certified orthopedic manual therapist.  The CMPT is the first level of credentialling, the COMT is the higher of the two. Either way - if you can find a PT that has more than the standard skill set from their education it's not a guarantee of success, but it does indicate a good bit of devotion to learning their craft since any of these designations (CMPT, COMT, OCS)  are difficult to attain.   Good luck!  Let me know if I can be of further assistance.  I don't think this is something you're going to be successful with self-treating...   Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hey, I have been having a terrible time with burning/numbness/tinglig on the balls of my feet while working out. This began happening when I bought new shoes. I have since changed shoes, even went to a place where they watch you walk and recommend the kind of shoes you should wear, and am still having issues. My concern is that, although the burning/tingling goes away when I'm done working out, my feet are starting to ache/tingle when I'm not working out.
Reply - Janet
It's hard to say based on this little bit of information - but perhaps you need to work a bit on calf flexibility? Are you stretching your calves regularly - if not - start doing gentle calf stretches several times a day.  Are you running on land or on a treadmill - if it's a treadmill are you putting it on an incline?  Run outside rather than on a treadmilll whenever possible, and if you must run on a treadmill, keep the incline flat most of the time, doing only shallow grades for short periods.  Are you running at appropriate paces? If you are trying to run too fast for your current fitness level, that might play into the mix.  Do you have any issues with your lower back? Sometimes low back issues can show up as numbness/tingling in the feet.   Hope this is some food for thought... Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Can someone run into foot issues when running a shoe too big/too wide for the foot? If so, what can some of those issues be?
Reply - Janet
I would think that too small or narrow a show would be far more problematic than one that's a bit too big - but if the foot is wallowing around in the shoe, then the shoe isn't able to offer the stability to the foot that perhaps is needed?  Also if your foot slides around in the shoe, perhaps this could contribute to blistering?  When you check the fit of your shoe - you should have about the width of your thumb between the end of your longest toe and the end of the toe box of the shoe - so generally speaking most runners wear a running shoe that is a size or two larger than their normal "street shoes". Hope this helps - Janet Hamilton, MA, RCEP, CSCS ,RRCA Coaching Instructor

Hi there, So I have been to a Biokinetist and a Podiatrist and still when I run down hill below the knee to the right I get a funny pain and my knee goes funny I have to stop what I am doing rest for 2 min then carry on running. Any advice???
reply - Janet
Perhaps you still don't have the strength in your muscle/tendon to tolerate downhill running? Recent research has been showing real promise with the inclusion of eccentric focused exercise to help stimulate collagen repair in damaged tendons and it sounds like perhaps that would be a good thing for you.  You might ask your Biokinetist about single-leg decline surface squats.  Hopefully they're up to date on the most current treatments for tendinopathy and will know what you're referring to!  Wishing you speedy recovery - Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

What is an approximate average heart rate a runner can sustain for a marathon?
Reply - Janet
There are too many variables for me to give you a single number but perhaps a "ratio" or percentage would answer your question?  In a well trained athlete who has the endurance base needed to "RACE" the distance - perhaps running it at 85% of "maximum heart rate reserve" is a reasonable prediction.  This takes into account maximum heart rate and resting heart rate.  It's commonly referred to as the "Karvonen formula".  Keep in mind that if you do a prediction of max (220- your age for example) that the error range on this is +/- 10-12 beats.  Hope this answers your question.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I am a 42 y/o guy, 5'11", 193 lbs. In the last 6 weeks I have run two half-marathons (1:57 and 1:53). I'm gearing up for the Chicago Marathon in 10 weeks and I need to lose 10-15 lbs safely without jeopardizing my training. Any suggestions? Thanks.
Reply -
Thom, this is actually a tricky thing to do... if you restrict calories while you're training a high level, you run the risk of not providing the metabolic capital your body need to repair tissue damage sustained in training.  Have you consulted with a Registered Dietitian who is sports-certified?  Keep in mind that someone who calls themselves a "nutritionist" may or may not have any college background -- but an RD (a Registered Dietitian) has the college background and the license to prove it.  If you find one who is sports certified (an additional credential that requires additional training specific to nutrition for performance) you've probably got a good person to add to your training team.  You can do a search for one in your geographic area by logging on to their website - http://www.scandpg.org  - they have a link on there somewhere that allows you to search for a SCAN member and I think you can do it by state or city.... go take a look and see what you can find.  In the absence of hiring a professional to give you expert and individualized guidance - you can pick up any number of books by sports dietitians (Susan Eberle, Nancy Clarke, etc) that have a wealth of information in them.  I recommend hiring someone for a few hours of consultation time -- it will probably net you a better result.  Good luck in Chicago!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor