Getting more than you bargained for…

I woke up this morning to my phone's usual angry buzzing, hit the snooze button as many times as I could get away with and then reluctantly rolled out of bed. There on my phone was a little white 1 in a red circle, resting quite happily on top of the little bird from my Twitter App. What might that be I wondered? A message from that Cat that tells jokes? A retweet from Jon the Pigeon?

I slurped a little tea and had a look. It wasn't cat or pigeon but @runblogger;

 

I read his blog and is it a little sad to admit that I was delighted?! Runblogger.com is one of the largest running blogs around and Runblogger – AKA Pete Larson – is an exercise physiologist who's even had an excellent book about running published. After taking a little bit of criticism for my blog this weekend it was great to see him complimenting the piece.

Pete is part of the reason this site has taken off, he gave me a foot up in the early days when for a long time a link on his blog was my largest referrer. Even today we've had well over double the normal traffic just from his article! So if you're aren't following him on Twitter, now is the time to do so and check out his book which is available to download on kindle or buy as an actual book!

And Pete if you are reading this, thank you, your blog and it's nice comments made my day!

 

Yesterday's run was one of my favourite of the year so far. There wasn't a cloud in the sky and I ran a hot 13.5 miles in 1:48:35. The scenery was so stunning I had to stop for photos and got a little more than I bargained for…I just wanted a photo of the light shimmering off the sea…imagine my surprise when I checked the photo after my run….

Click to enlarge

Oops. Won't be framing that one!

This one on the other hand…

What's nice too is my 'rehab days' are starting to pay off. Since Brighton Marathon I've had some issues with my left knee. It's part ITB tightness, part patellofemoral pain. I've been spending at least one evening each week working quads (with single knee dips) and glutes (with sidelying abduction) then foam rollering ITB, hip flexors and calf muscles. It seems to have really paid off. Minimal discomfort on the run and no problems today.

Strength and conditioning has its benefits, and if you're running 4 or more times a week it's worth considering replacing a run each week with a rehab day or just adding it in if you have time. I'll close today's blog with another photo… Nothing rude in this one, I promise!

 

 

Taping for the knee

You may have seen elsewhere on the blog the use of a modified McConnell taping for knee pain;

It's very useful for ITB issues and patellofemoral pain (often described as runners knee) – follow the links for more info on both.

Today I'm adding a more general tape for knee problems. It's designed to offload the knee a little and will help with most knee problems;

When you watch this second one, do bare in mind that a) FMG filmed it – somewhat reluctantly – and b) I was suffering from a Belgian beer hangover – for which I blame @Captain_Critic! Still the technique is there and easy to follow.

For both techniques I use Kinesiology Tape. Round the corners first with scissors to stop them catching on anything and peeling off. Make sure the skin is dry – use a towel to remove sweat or moisturiser (do women moisturise their knees? I have a male patient that does for some reason!) When applying the tape you first create an “anchor” of an inch or two under no tension, this helps it stick. Provide a gentle stretch to the tape as you apply, apart from the last inch or two which has minimal tension and is used as a second anchor. I know serious KT advocates use very different techniques with no tension, that's fine too you can find lots of those on YouTube, personally I find this method more supportive to the area you are trying to offload.

Tape can be left on for as much as 7 days! It will survive a shower, even a swim if it's good tape. It's not usually good after a long bath though. If you find it uncomfortable or have any redness, itching or reaction to the tape remove it.

Tape is good to use as a support/ offload strategy. Apply it at least 20 minutes prior to sport to allow it to stick properly, leave an hour if possible. You may just use it when running, or for longer periods if you have a very painful, irritable knee to help it settle.

Happy taping!

 

Top 3 solutions for common running injuries

So far with RunningPhysio we’ve written fairly lengthy posts on each injury with cause, solutions and rehab included. This post is a different approach, we are focussing much more just on what tends to help. So for each running injury we will offer 3 of the most effective treatments and a link to where we provide more info.

This stems, in part, from posting on Reddit, which has a great running Subreddit. Check it out here. It’s a running community where people post on a range of running topics. What I found people wanted wasnt necessarily lengthy explanations but solutions;

ITB Syndrome

1. Strengthen Gluteus Medius

  • Use sidelying abduction – 3 sets of 15-25 reps or to fatigue. Stop if painful. Rest for 1-2 minutes between sets. Can also be done with the lower leg bent. You should feel it in the side of the hip not down the leg.

Reproduced from Distefano et al. 2009.

2. Improve balance and eccentric quads control

  • Use controlled single knee dip. 3 sets 10-20 reps with a focus on control, rest 2-3 minutes between sets. Move the knee over the second toe. Only dip as far as comfortable.

3. Stretch the ITB

  • Use the “sofa stretch”. Hold for 30 seconds. 3-5 reps. Gradually work into the stretch. Don’t do if you have any history of dislocation of the patella or high levels of pain.

For more information on ITBS check here. This approach will often also work for patellofemoral pain.

Achilles Tendinopathy

1. Offload the Achilles

  • Use kinesiology tape. Can be used when running or for everyday use. Use it to help settle symptoms.

2. Strengthen the Achilles and calf complex

  • Use “heel drops” start on both legs, progress to single leg when comfortable. 3 sets of 15, twice per day.

From Alfredson et al. 1998

3. Stretch the calf muscles

  • Stretch gastrocnemius and soleus. 3-5 reps with 30 second hold. Once or twice per day.

From Roxas 2005

For more details on managing Achilles Tendinopathy check here.

Posterior Tibial Tendon Dysfunction

1. Stretch calf muscles (as above in Achilles Tendinopathy)

2. Offload Tibialis Posterior with orthotics to support the arch of the foot.

3. Strengthen Tibialis Posterior

  • Use “eccentric” exercise; 3 sets of 15 reps. Rest for 1-2 minutes between each set, twice per day.

More details on managing Poserior Tibial Tendon Dysfunction here.

Plantar Fasciitis

1. Stretch calf muscles (as above)

2. Stretch the mid foot over a cold or frozen bottle/ can (beware of ice burn doing this).

From Roxas 2005

Place a gentle pressure down on the can/ bottle stretching the middle of the foot and roll it backwards and forwards for approximately 5-10 minutes. Stop if too painful.

3. Specific stretch for the plantar fascia

From Digiovanni et al. 2003

Cross the leg of the affected side over the other leg. Grasp the toes and stretch the toes upward as shown in the photo. You can also feel along the plantar fascia with your fingers to make sure the area is under tension. The link above has more details on this. Hold the stretch for 10 seconds, repeat 10 times. Do 3 times per day, including before you take your first steps in the morning.

A more detailed plantar fasciitis blog will be coming to RunningPhysio soon.

The reps and sets described above are based on research but they are approximate. Stop if the exercises are increasing your pain.

If this approach doesn’t work for you, you may need to address the underlying cause. Check out the links for details on how to do this, and as ever if in doubt, get it checked out!