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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.
To find a certified specialist PT in your geographic region use the APTA specialist directory search engine or find a certified orthopedic manual therapist (PT) in your geographic region using the NAIOMT search engine or the search engine for the American Academy of Orthopedic and Manual Physical Therapists (AAOMPT)

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Tuesday, September 16, 2014

Knee issues and shoe changes - Malika

Hi. I was recently diagnosed with grade 2 patellar chondromaliasis. i've been running for about 2 months now. i gradually learned running 5k, started with walk/run sessions then i was able to run longer distances. after about (probably) 6-7 runs, i changed my shoes, i was wearing Skechers running shoes (with elastic sole) and switched to Mizuno Wave Creation. while running 5k everyday on concrete pavement (not now because my doctor told me to stop for a couple of weeks), my feet was feeling pretty stiff but i didn't care at all. (maybe i should've, maybe that was sign of a problem.) could this injury be caused by shoe change? i thought my new shoes weren't able to absorb the shock properly like how it's supposed to, because the cushioning wasn't fine for my feet and leg anatomy and passed the shock waves directly to my knees. Is it possible? What do you think? I really want to go back to running. But i'm so scared now and don't know which shoe to choose or what to do. and more importantly, i don't know what i did wrong, i thought i was running properly. what are your advices? Thanks in advance...

Reply - Coach Janet - Hi Malika, sorry to hear about the knee issues.  Shoe choices are about more than just cushioning -- the shoe needs to support your foot in a way that compliments it's natural structure.  And, you can't expect the shoe to absorb all the shock/forces... that's the job of the muscles!  I always say - the knee has two best friends:  a strong butt and a well supported foot.  In other words, the shoes need to be doing their job, but the hips are a key element as well.  Most people with knee issues benefit from working on getting stronger hips (some simple strength exercises can be really helpful in this regard) and working on improving flexibility in the calves and hamstring muscles.  The previous foot discomfort likely was an indication that things weren't as they should be.  It's not just the shoes though -- you have to consider other training errors like adding mileage too quickly, doing all your runs at the same distance, (no recovery time), training at inappropriate paces (doing all your runs at/near target race pace), running on concrete for every run, etc.   Running is a natural activity and as such it sometimes seems like it should be pretty simple to just lace up and start training... but there are things to consider that might make the difference between running well and getting an injury.  Start now with some flexiblity exercises and some strength work for your hips, ease up a little on pace and take the approach that not all days need to be 5k. Transition off the concrete and onto some dirt paths from time to time....  If you'd like more detailed help, check out the "services" page of this website and drop me an email and I can get you started right away.  Best of luck -- Don't just look to the shoe for solutions... remember that flexibilty, strength and training errors also have a role to play.   Hope this helps. Janet Hamilton, MA, RCEP, CSCS 

1:14 pm edt 

Monday, September 8, 2014

Torn meniscus - Robin

I recently had a MRI and the doctor said he could see a partial tear in the menicus. I read on line that sometimes it will heal itself. my dr. wants to do surgery to remove the part that is torn so it won't tear more. I haven't ran in 2 weeks. It tried to run yesterday and I was limping the whole 3 miles. It doesn't hurt like it did when I was running.am a long distant running who runs about 50 miles a week normally. Thank you for your help.

Reply - Coach Janet -  Sorry to hear about the meniscal tear!  The surgery to remove the torn portion is usually relatively uneventful - done through an arthroscope and the rehabilitation is usually really pretty quick.  I think you might be more confident going into the surgery if you get a second opinion though.  It makes no sense to continue to run when you're hurting - and running 3 miles with a limp not only makes the initial injury worse (the meniscal tear) but it also sets you up for a whole host of compensatory injuries because of your wonky gait pattern!  You can easily take one simple injury (the torn mensicus) and turn it into three injuries!  The questions I'd have are -- how did this meniscal tear come about?  Was it a sudden trauma or wear and tear?  If it was a wear and tear kind of injury - then it will be really important to work through a rehabilitation process that deals with the underlying imbalances or deficiencies that lead to the original injury.  If it was a sudden trauma, then the rehab can simply be to get you back to where you were before.  Either way -- get that second opinion and then make sure your orthopedist refers you to a good PT for some rehab guidance.  The PT's will give you a whole bunch of home exercises to rebuild you as quickly as possible.   You might find this article helpful - it's one I wrote many years ago about communicating with your medical professional 

Good luck - hopefully you'll be on the other side of this very soon.  As for the meniscus healing on it's own - that's not usually the case but certainly a question to ask your surgeon.   Janet Hamilton, MA, RCEP, CSCS 

11:23 am edt 

Monday, August 25, 2014

Maintaining fitness through the winter - Jan

Hi Coach, This summer I focused on the 5k distance, and made great progress bringing my times down and learning to push into the "pain" zone. Do you have any tips for maintaining my gains over the winter? I run through the winter, and luckily own a treadmill, so I don't plan to stop training. Yet I know I won't be racing much (if at all) for about 6 mos. Any suggestions would be appreciated. Thanks!

Reply - Coach Janet  Although you mention a  treadmill, I'll recommend that you continue to run outside as much as you possibly can.  The treadmilll is a reasonable option if the weather is horrid, but it's not the same training load as running through the air over mother earth!  Ideally training should run in cycles so that perhaps the cycle you'll focus on through the winter months is one of base-maintentance or base-building. In that case the focus is primarily on easy paces for most runs, with some occasional (once a week?) runs that focus on hills (build strength) and perhaps some fartlek (maintains some of your running economy at faster paces).  The paces you use for these strength and economy workouts is based on the event you're trying to stay sharp for -- it would be different for runners focused on a half or full marathon versus those focused on 5k.  The most important part of this phase of training is that you focus on maintaing your overall fitness level so that when the "racing season" comes around you're ready to resume hard training. Look ahead at your planned race season and back up perhaps 2-3 months... that's when you would likely start back into more focused interval-type training.  The benefit of cycling your training like this is that you give your body some time to recover and build strength in the "non-racing" phases and this sets the stage for improved performance because you enter the "pre-racing" phase stronger than you were before!  Good luck.  If you'd like more detailed help with this, check out the "services" page on this website or drop me an email at: janet at runningstrong dot com.  Best of luck in your next race season.  Janet Hamilton, MA, RCEP, CSCS

5:36 pm edt 

Monday, August 11, 2014

Increased mucous production - David

Why do I produce mucus every time I run or cycle? I do not get colds or blow my nose normally but as soon as I start working out (running or cycling) I start produce mucus.

Reply - Coach Janet  That's a great question, and I'm not sure I have an answer for you!  Perhaps a wise pulmonologist doctor or respiratory therapist will read this and weigh in? I can only surmise that since one role of mucous is to moisten and protect the airways that the increase in production is due to the increased air flow and this is a way to keep things from drying out and getting irritated.  I think it's pretty normal.  I certainly experience this and based on the number of runner's I've seen on long runs blowing their noses at regular intervals... it seems pretty normal for most people.  Unless it seems excessive to you, I'd say chalk it up to normal physiology!   Coach Janet Hamilton, MA, RCEP, CSCS

9:45 am edt 

Saturday, August 9, 2014

Young runner with leg tightness - Melanie

My 14 yr old has begun training g for her first yr running high school track (2nd yr as a runner). She is complaining of leg cramps and a feeling of "not being able to stretch out her thighs enough" She is 5'6" and 100 pounds. What can you suggest to help her with this.

Reply - Coach Janet - at that height and weight she appears to be a bit thinner than would be ideal -- her body mass index is sginificantly under weight.  So with that tidbit of info I'd want to check into her nutritional status and make sure she's consuming adequate calories and also make sure that she's taking in good quality nutrients and not overly restricting.  Electrolyte imbalance, dehydration, fatigue, etc can all play into the issue of "cramping" so start with the nutrition and hydration end of it.  She should be training at "easy" paces on most runs, with key workouts designed to work her a bit harder -- some running at faster paces is good, but if she's trying to do all her runs at a hard/fast effort she'll only succeed in breaking herself down and gettng injured.  There are lots of stretches, but the trick here is to not only maintain/improve general flexibility but also to deal with the underlying cause for the cramping/tightness.  I'd start with checking her training paces, and nutrition/hydration status and then move into a phase of working on strength and flexibility.  Perhaps she has a school coach that she works with that will give her some specifics?  Hope this helps -- feel free to reach out via email if you have more questions (janet at runningstrong dot com). Janet Hamilton, MA, RCEP, CSCS 

7:46 am edt 

Monday, August 4, 2014

Coach in Kanchippuram - k.chitra devi

My grandson want to join in marthan for 2014 IAM livi ng in Kanchipuram I am a retired tahsildar I want a coacher in kanchippuram

Reply - coach Janet  Perhaps you can contact your grandson's school and see if there are any coaches nearby?  I do coach athletes around the world but your grandson would need to be able to communicate in English and use a computer to communicate with me. I do not coach athletes younger than 16 for the marathon distance.  Janet Hamilton, MA, RCEP, CSCS 

9:18 am edt 

Friday, August 1, 2014

Building mileage - Bethany

I am a highschool runner and it's my first year doing cross-country. Next week, I'll be gone for church camp, so I'm missing practice. I am trying to improve by a mile a week. So by the end of the week, I want to run 5 miles without stopping. I am very limited there. I basically just have a road I can run. I'll be there Mon-Fri. What would be a good training plan if I can currently run 4.5 miles?

Reply - Coach Janet  In my opinion it won't hurt you a bit to hold steady for a week and not build.  Run what you're able to run - even if it's limited - and just take this coming week at camp as a "hold steady" week rather than a build week.  Your body may actually perform better the following week because it had a little more time to adapt!  Good luck with your first year of Cross Country!  Best wishes - Janet Hamilton, MA, RCEP, CSCS

4:11 pm edt 

Sunday, July 27, 2014

Question about coaching - Chithra

my grand son aged 6 want to join marathan runner for december 7th 2014. I want a coacher.I am a retired tahsilder and Iam living in kanchipuram

Reply - Coach Janet

I'm a little confused by your question.  If I understand it right, your grandson who is only 6 years old wants to run a marathon?  Do his parents realize how far that is?  It's 42 Km... a bit over 26 miles... and that's a really long distance for a 6 year old child! I would be happy to discuss coaching options with you but would strongly suggest that he (and you) consider doing shorter events - something in the 2-5Km range would be more appropriate for a child of that age.  Please feel free to reach out to me directly through email - send it to janet at runningstrong dot com.   

3:55 pm edt 

Friday, July 11, 2014

Tips on Pace
Though I don't agree with the part about using a treadmill for speedwork, this article on Fix.com has some good tips on how to work on improving race times.  Remember though, one size does not fit all! Generic advice here is solid but not appropriate for everyone.  Stepping up the pace
10:50 am edt 

Thursday, July 3, 2014

Coming back to running after 5th MT fracture - Richie

67 male running for 30 years (5-8 miles). This was to be my first marathon year (NYC 11/14)Broke right 5th metatarsal on 5/29 and should be off boot/crutches by 7/18. I know marathon is probably out this year and that's OK. Once I'm cleared for running how far should I go and what frequency? Thanks

Reply - Coach Janet

Your long history of running will do you well as you come back. The type of tissue strength that you get from that many years of running is a wonderful gift!  I recommend that when you're cleared to be off crutches and the boot that you spend a couple of weeks (at least) transitioning through a walking program and make sure your foot feels 100% symptom free.  I like to have people accomplish about 10 miles a week of walking with no symptoms before they transition into running again.  The transition phase also should start conservatively - perhaps only including 1 minute of running every 4 minutes of walking at first.  As your body consistently proves it's tolerating the run segments (symptom-free during the workout as well as afterwards) then you can gradually bring the run segments up in duration and gradually shorten the walk breaks.   How quickly you move from one stage to the next really depends on your body's response.  No two training plans are created equal and this is especially true when we're talking about a return to running program.  When in doubt - hold stead and don't increase the run segments -- you'll never hurt yourself by giving your body a little moe time to adapt to the training load.  Good luck -- please let me know if I can be of assistance  - you can always reach out to me via email at janet at runningstrong dot com.   Janet Hamilton, MA, RCEP, CSCS

11:12 am edt 

Sunday, June 29, 2014

Sharp knee pain, training for first half - Melody

I just started training for my first half marathon ..up to only 41/2 miles but I am having sharp stabbing pain on the inside of each knee. I thought I could just shuffle but even that I can't do without pain. I what can I do? I've had my running mapped and have had shoes fitted to me. Help! And thank you :-)

Reply - coach Janet There are a few things to think about here -- first of all, how long have you been running?  Were you already running some solid mileage before increasing your training?  Second thought - are you training at the proper pace for your current fitness level?  It's important to realize that training is training and racing is racing -- and you shouldn't do all your training at race pace.  Third thought - what terrain are you traning on?  If you've added hills or perhaps transitioned from a treadmill to out door running then that may be factoring into it.  It's important to listen to the symptoms and not force things.  If you can walk without pain, then perhaps you can use walking as an interim activity while things settle back down.  Typically knee pain like you describe is related to the following:  lack of adequate hip strength, lack of adequate core strength, inadequate flexibility in the calf and hamstring muscles, lack of adequate support from your current footwear (even if it's been fit to you -- perhaps it's still not the right match?), adding mileage too quickly, adding hills too quickly, training at the wrong pace.    Look over that list and see if there's anything that rings a bell with you.  If you're not already doing it, get consistent with calf and hamstring stretches and also with some strength work for your hips and legs. Work in a pain-free range of motion on all exercises and gradually increase that range as your symptoms permit.  I'll be happy to help with more specific details but I'd need to know a lot more about your specific injury and training history as well as a whole host of other things.  If you're interested in that, check out the "services" page of this website or simply drop me an email to janet at runningstrong dot com.   Hope this helps!  Janet Hamilton, MA, RCEP, CSCS, RRCA certified coach 

6:30 pm edt 

Monday, June 16, 2014

Follow up to hip flexor question - Jan

Hi Coach, Thank you so much for insights about my hip flexor issue. When you mentioned the low back, I remembered that I hurt my SI joint this winter doing forward bends in yoga - perhaps it isn't completely resolved. I also remember doing the clam shell exercise and feeling a sudden painful pull in my inner thigh on one leg. Maybe that's partly to blame as well. I've incorporated calf stretches and the reaching lunge exercise into my routine, and am searching for a PT to check out my low back. Thanks again!

Reply - coach Janet  Glad to help!  Use the links in the information above to get to a couple of search engines that might help you locate a good skilled orthopedic PT.  The APTA search directory will let you narrow it by location (state and city) as well as certification -- you'll want to narrow it to "OCS" (orthopedic certified specialist) and then look at the stated practice focus of the therapist.  If you can find one that's focused on manual therapy and lower back issues, you may find you get a much better result with their expertise.  Good luck!  Janet Hamilton, MA, RCEP, CSCS 

3:43 pm edt 

Friday, June 13, 2014

Sore Hip Flexors - Jan

Hi Coach, For the past month or so, my hip flexors on both legs have been very sore after I run. When I do squats or lunges, I feel them in my quads rather than my glutes. I do isolated glute exercises (bridges, band walks, clams, leg lifts). It seems like I just can't get my glutes to take up their share of the work, even though I do the recommended strengthening exercises. Any suggestions? Thanks!

Reply - Coach Janet 

There could be a couple of things going on but the first thought I had was - I wonder if something is going on in her lower back?  One of the two dominant hip flexor muscles attaches to your spine - and so if there's any dysfunction going on there it can certainly contribute to a sense of tightness there. In addition it's not unusual for people with low back dysfunction to have inhibition of the gluteal muscles.  Even if your back doesn't hurt, it might be worth checking in with a good PT to have an evaluation.  Another thought -- do you stretch your calves on a routine basis?  If not, that might be something to work on. It seems unrelated but it's not -- when your hip flexors are being stretched to their longest length in your gait pattern is the same time that your calves are being stretched to their longest length (the push off phase of gait) so tightness in one often results in tightness in the other.   Final thought I had was: Are you training at the right pace?  If you're running at a pace that's a bit too fast for your current fitness level, you may be taxing your muscles a bit too much.  I think you're doing a lot of good isolated gluteal exercises but you might try to incorporate some balance and reach exercises.  See this page for a picture of a diagonal backward balance & reach exercise that targets the gluteals.  Good luck, hope this helps!  Janet Hamilton, MA, RCEP, CSCS

7:24 pm edt 

Wednesday, May 28, 2014

Competitive racewalker with Left side issues - Karl

As background, I am a semi-competitive racewalker (8 half marathons since May 2012, plus a lot of 5K, 8K, 10K, 15K races, etc. I try to train, race, or work out 5 days a week, unless I am tapering for a long race (or recovering). MY PROBLEMS: I have noticed that my left leg (and the left side of my body, generally) doesn't even seem to be "engaging" at all when I walk. My right side seems to be doing all the work. I don't know if these other symptoms are relevant, but I have battled with an elevated right hip, plantar fasciitis in the right foot, a fallen left arch, and shin splints in both shins. Any ideas - either from a posture/alignment standpoint or a stretching standpoint? (Or any other "standpoint" you think might be helpful!)

Reply - Coach Janet  If you have an elevated right hip, perhaps you have a leg length discrepancy?  In my experience, the long-leg side (in your case perhaps that's the right leg?) tends to be more likley to get plantar fasciitis.  There are two types of leg length discrepancy:  Structural and Functional.  Structural leg length discrepancy is when one set of leg bones (femur and tibia) is longer than the other side.  In cases like this, the only "solution" is to use a small lift in the shoe of the short leg.  What's more likely the case is a Functional Leg length discrepancy caused by a spinal/pelvic misalignment.  This can be resolved with spinal mobilization and then follow up with exercises to strengthen the area so that the proper alignment is held.   If it's an issue that's been going on a long time, it may take awhile to realign and to get your strength back.  I'm thinking with your sense of "lack of engagement" on your left side that this is what you're dealing with because if your back is out of alignment it can cause nerve root impingement which would result in a decrease in strength on the involved side.  If you have any symptoms in your butt or down your left leg, this would be even more likely to support the spinal alignment theory.  If you can get in with a good orthopedic PT that has manual therapy skills, or perhaps a Chiropractor who has skills in not only manipulation but also exercise prescription -- you should be able to get this resolved.  Good luck, hope this helps! Coach Janet Hamilton, MA, RCEP, CSCS 

9:36 am edt 

Saturday, May 24, 2014

Help for a 100m sprinter - Juliette

My daughter is a spinter and runs flat footed her feet ankles lean inwards. She rounds a fast 50 m and than last 50 slower. Can you help?

Reply - Coach Janet   

There's a lot going on in that short distance of 100 meters but the quick answer is that the stronger your daughter becomes the faster she'll be in that last 50 meters.  Sprinting success comes from being able to produce a lot of power, so perhaps you could consult her track coach about helping her with some strength training exercises.  The second piece of the puzzle is stamina.  That comes with aerobic training -- which comes from training distances much longer than the 100m.  Hope this helps? Coach Janet Hamilton, MA, RCEP, CSCS

8:24 am edt 

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