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Achilles_cropped

In March, we examine another common concern for many runners.  Dr. Adam Tenforde returns to discuss a problem that can trip up runners like himself (28:23 for 10,000m), as well as recreational runners alike.

FNF:  What is Achilles tendonitis?

AT: Achilles tendonitis describes a condition involving the tendon that connects the calf muscles (gastrocnemius and soleus) to the calcaneous (heel bone).  The condition can either result from an acute stress (such as increase in training) or develop over time from chronic stressors, such as biomechanical factors or poor footwear.



This month, we touch on a question that comes up over and over with brand new and experienced runners alike.

Form Tip:  Arms

Q:  What should I do with my arms when I run?



Ask the Practitioner - Sciatica

Written by Dena Evans January 30, 2012
sciatica_pointThis month, we sat down with Dr. Michael Fredericson, Director of the Physical Medicine and Rehabilitation Sports Medicine Service at Stanford Medical Center.  Dr. Fredericson has spent a career addressing the needs of athletes at all ages and ability levels, and here, he provides some insight on sciatica, one of the most common ailments for adult athletes.

 

FNF: What is sciatica and what are signs you might be suffering from it?

MF: For most people, it relates to a bulging or herniated disc in your low back that is pressing on a nerve.  You feel it through the sciatic nerve.  That nerve goes all the way down your leg, so you’ll feel it there as well.  Sometimes your back is fine, and the problem is pirformis syndrome.  Your sciatic nerve goes through the pirformis, one of your smaller backside muscles that helps rotate your hip. That muscle can get tight and it can compress your sciatic nerve.  The biggest reason to see a physician is that you want to make sure it is not a bulging disc pressing on your nerve, as this requires more aggressive treatment.

 

FNF: How do you typically treat sciatica?

MF: First, we try to figure out if there was something that got them into this situation.  A lot of people don’t realize that it isn’t from their activity, but from their work.  Maybe they sit too much or drive a lot, which can put increased pressure on their discs.   The piriformis muscle can also get tight from driving too much.  So a lot of it is getting them out of the activity, and then calming down the inflammation.  We’ll advise over-the-counter products like Aleve or ibuprofen, and then prescription anti-inflammatories and so forth, in combination with physical therapy.   If it is a bulging or herniated disc in the back, sometimes we recommend an epidural corticosteroid injection and very rarely, surgery.

 

FNF: What can we do to prevent sciatica?

MF: Everyone is typically given core exercises as a part of their physical therapy, so that is something we should do prophylactically as well.  It takes pressure away from the disc.  We also should take care with our back mechanics.  People don’t think about simple things throughout the day such as how you lift, or how you sit and stand. You should.   Also, it is wise to be careful with the downhill running.  It is easy to get out of control downhill running and put too much stress on the low back.  Likewise, overstriding [landing with your foot too far in front of your body] can lead to overstress on the back. 

 

 



Breathing on the Run

January 30, 2012

breathing

This month, we return to one of the basic types of questions we get on a regular basis - how to breathe while running.

 

We know breathing is important because we feel awful when it is ragged and shallow and we feel better when we are running easily enough that we hardly notice it at all.

 

The faster we run, the quicker we will reach a point where we will have to concentrate on our breathing in order to continue at that pace.  That is because the additional strain of the pace over time has caused our muscles to demand more oxygen on a quicker schedule.  All of sudden, you need more air and breathing begins to require your attention.

 

Usually when you get at the point where you must concentrate on your breathing, recalling long complicated lists of multi-step tasks is not something to which you are looking forward.   As such, we offer the following simple tips to remember when the going gets tough.

 

Straighten up

When we are tired, our running posture can often fall apart – our shoulders hunched over or bunched up to our earlobes, much more tense than is desirable.  When you need to get more air and right away, remind yourself to draw your shoulders away from your ears, but straighten up nice and tall.  This allows for your lungs to have the maximum room to pack in more air, and may be able to help ease symptoms of a side stitch by stretching out the afflicted area.

 

Breathe deeply

Often, whether it is the pure physical strain of the task at hand or the stress created by that strain, we tend to pant and take shallow breaths at the time we need to bring in the most air.  In the moment, it seems like the quickest way to gather as much oxygen as possible.  In reality, it is much more efficient to take a slower, deeper breath.  Imagine you are filling your stomach/ diaphragm first, from your bellybutton up to the tops of your lungs, rather than take a shallow breath.  Panting is like splashing some water over the mouth of your water bottle.  Some of what you want gets in, but the effort yields much less than the desired result.  A deeper breath is like sticking your water bottle directly under the faucet stream.  Fill up those lungs so they can do what they do best – get air to your screaming muscles!

 

Begin a slow and rhythmic breathing pattern

Breathing deeply almost certainly means you are slowing your inhaling and exhaling rhythm without necessarily focusing on doing so.  However, concentrating on your breathing rhythm can do two things:  distract your mind from the stressful running task you are continuing to pursue, and ensure you are taking in enough on each inhale.  When you are running or walking at relative ease, your breathing pattern may be 2-2 or 3-3, that is, it takes two footfalls (one landing of either foot) to inhale and two footfalls to exhale, etc.  However, when you are tired and air is at a premium, try to spend a bit more time on each inhale than you do on each exhale, for what might end up as a 3-2 rhythm or a 4-3 rhythm.  The most important thing you can do is to fill your lungs with each inhale, and it is harder to do that quite as quickly and as forcibly as you can exhale.  Take your time, try to relax yourself generally by the almost meditative counting of your breathing rhythm, and / or let a favorite song guide your brain through the pattern.  All of a sudden, you’ll be at the next mile marker or water station.

 

Everyone is a bit different, and all of us, from novice to experienced runners, need to practice techniques in low stress situations before taking them to the streets in the big race.   Listen to your breathing on easy runs to find out what your natural patterns are.  Try to maintain a tall posture and open your chest when the running is easy before forcing yourself to find that position when the running is tough.  Test out a 3-2 pattern or a 4-3 pattern on your next interval or tough workout and see what feels right.  With practice and the confidence of a few counteraction measures in your pocket for the next tough racing patch, hopefully the finish line will find its way to your feet just that much more quickly.



Toe_stretch_croppedThis month, we investigate Plantar Fasciitis with one of the nation's most well regarded podiatrists.  Caring for world class as well as recreational athletes in need of top-shelf care, Dr. Amol Saxena of the Palo Alto Medical Foundation has operated on some of the fastest feet in the world.  This month, he provides some information on one of the most common ailments presented by runners in his clinic.

 

For additional information on Plantar Fasciitis and other podiatry related topics, visit Dr. Saxena’s website.


FNF: What is Plantar Fasciitis?

AS: Heel pain accounts for over 20% of patient visits to foot specialists and a third of all patient visits I see. Over 50% of Americans will experience heel pain during their lifetime. The most common form of heel pain is known as Plantar Fasciitis or “Heel Spur Syndrome”. The Plantar fascia is a thick ligament on the bottom of your foot spanning from your heel to the base of your toes. It supports the arch and several muscles under the bones that support the foot. Over time, most people will develop some degree of calcification within these muscles on the bottom of their heel, which is called a “spur” but is entirely innocuous. Hence, the term “Heel Spur Syndrome” is a misnomer.

 

Plantar Fasciitis is a condition of irritation to the Plantar Fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness located on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run.

 

There are a few “Plantar Fascia-like” conditions one should be aware of. The most common occurs acutely: the patient continues to exercise despite the symptoms and experience a sudden sharp pain on the bottom of the heel, with the inability to stand on their toes and subsequent bruising in the arch. This is a rupture of the Plantar Fascia.

 

The Achilles tendon (the cord-like structure attaching your calf muscle to your heel) is another region where heel pain is common, either through chronic inflammation (Tendonosis), acute rupture, or calcification near the attachment.

 

One should also be aware that heel numbness can be the first sign of a back problem.

 

FNF: What are some common causes of plantar fasciitis?

AS: Plantar Fasciitis occurs because the tendon is not well-supplied by blood (which makes this condition slow in healing) and a certain amount of activity is needed to get the area to warm up.

 

Plantar Fasciitis can occur due to various reasons: use of improper, non-supportive shoes, over-training in sports, lack of flexibility, weight gain, prolonged standing and interestingly, prolonged bed-rest.

 

FNF: What are some simple steps we can take to address plantar fasciitis?

 

AS: Treatment initially is adding support to the foot, including better shoes and an over-the-counter arch support/insole, resting from the sport or activity exacerbating it, stretching the calf and arch muscles, and anti-inflammatories including ice and massage. The latter two can be accomplished simultaneously by taking a filled water bottle, freezing it solid & then using the now frozen ice cylinder, to massage your foot for 5-10 minutes by rolling it underneath at least two times per day.  This injury often takes time to resolve.  It is not unusual for symptoms of Plantar Fasciitis to persist for 6-12 months despite trying the myriad of treatment options.

 

 




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Can the Gym Help My Running?

Personal Best - January 2012


January is a time to set new goals.  Runners of every age and experience level often seek ways to improve performance and results outside of the time spent out on the roads.  As coaches, we are often asked if weight training, yoga, cross training, or other gym-based activities will assist an athlete toward their running goals.  This month in Personal Best, we consider the question with a few guidelines and tips.

Why not just run?
Certainly, the best way to improve your running is to run; however, moving your body in different ways can address various weaknesses that have built over time due to the repetitive nature of running. In addition, ancillary activities can help put the finishing touches on the fitness gains from a workout regimen begun in search of weight loss or aesthetic goals.

It all starts with the core....
If time and resources are limited, there are a number if ways to help your running with some simple core work.  Exercising the core helps strengthen the area from your chest to your hip flexors, allowing you to maintain good form and posture when at the end of a race. Your core stabilizes you not only when you're tired, but helps center your running form even when fresh, assisting in the achievement of good posture and range of motion in your stride.  We discussed the importance of one of these muscles, the transverse abdominis, in a previous column, along with a few easy and simple exercises to address it when you can steal a few minutes on the carpet after coming in from a run.

If you enjoy the social nature of classes they are a great way to stay on track with your core strength objectives.  In addition to stabilization, a strong core, and good spinal / pelvic alignment can help you maximize efforts spent on strengthening other muscle groups, another reason why it is a good place to start.

Flexibility is your friend

Activities like Yoga and Pilates are also tools used by many runners to help increase flexibility and strength when muscles are extended.  Greater flexibility can be a huge asset in the effort to stave off injuries, so if that is a big goal for 2012, these might be good options for activities to incorporate into your regimen.

Boost your metabolism and body composition
Along with general weight training, some of the latest trends in fitness include CrossFit, P90X, TRX, and a myriad of home and gym-based programs to challenge your body in a multi-directional, muscle-strengthening fashion.  Some of these also include a cardio component, and many of them build upper body fitness, demand lateral movement, and require more ballistic activities than a normal running routine.

These high intensity activities can complement your training by adding a new dimension of athleticism increasing your power.  However, anything along these lines should be carefully taken into account – some body composition changes are helpful, some are not, and anything that compromises your running by creating too much and untimely fatigue, may be more detrimental than it is worth.   Any of these activities are best safely incorporated with the help of a fitness professional at your local facility.


Ease strain on joints and muscles

Every runner occasionally requires a time of recovery or the need for a day or two of cross training.  Others enjoy incorporating spin classes, swimming, elliptical, or even a fitness activity such as Zumba into their regular routine.  If you are looking for a way to integrate in an additional day of cardiovascular exercise, but are concerned about the strain on joints and ligaments, one of these low or non-impact activities could be just the ticket to keep you headed in the right direction.

 

In short….the bottom line

Cross training and multi-dimensional movements can be beneficial for distance runners.  Consider some of the disciplines below to have an even better and more balanced 2012.

Core strength exercised, Yoga, Pilates:  At home, with an instructor, or in a class setting.  These primarily address needs for flexibility, core strength, and spinal / pelvic alignment.  Low / no impact, more meditative. 

Want to try a home-based core workout?  Check out Focus-N-Fly’s favorite whole body workout here:  

Weight / circuit training, CrossFit, P90X, TRX, etc:  At home, with an instructor, or in a class setting.  These require more dynamic, powerful movements, perhaps with greater intensity and resultant muscle development.  For those who enjoy an up-tempo addition to their week, and who are looking to add more power / speed.

Indoor cycling, elliptical, Zumba, swimming: At home, with an instructor, or in a class setting.  These activities can increase cardiovascular training time with minimal strain on joints and bones.  Could be used for variety or as a prelude to including an additional day of running into the schedule.


Focus-N-Fly Plyomterics and Warm-up Drills:  These can be run on a track, road, sidewalk, path or grass.  Even if you do not have time for an additional training session or two, these can be efficiently integrated into your already scheduled running to help strengthen your core and provide greater range of motion. 

Questions about the above?  Email us at info@focusnfly or tweet us a question to @focusnfly.

 




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Distance running and goal setting often go hand in hand.  While plenty of runners lace up each day for the enjoyment and the endorphins, it is often hard to train without a goal.  The large majority of our Focus-N-Fly trainees are focused on a particular event, many times with fitness, lifestyle, or weight loss goals as by-product.

Your training plans come built in with recovery cycles, designed to carry you safely to your next goal-setting point.  But how and what you choose to do next is a decision that remains squarely in your court.  Here are some of our ideas for choosing a new goal and re-lighting the fire that fueled you to your original goal race.

 

Take care to attend to your mental and physical needs

Some runners finish a big goal race and can’t wait to set a more challenging goal.  The thrill of success or the interest in re-doing what may not have gone well can be powerful motivators.  Others finish a race, rebound physically right on schedule, but don’t have the motivational itch to take on another challenge.

 

Work towards a goal race will require both physical and mental energy, so it is important that both aspects are attended to when making an appropriate goal for the next time around.  Your recovery cycle is designed to deliver you to a point where your body is ready for another challenge.  That point is usually after the immediate emotions have subsided from the goal race itself.  If emotions are high or you are unusually physically worn down, commit to setting a goal, but leave the actual goal setting until you are able to decide with a level head what makes sense.

 

Granted, many runners don’t have the highs and lows discussed above, in which case, there is not problem choosing another goal right away.  For those of us who require and enjoy more overt organization in our training lives, choosing another race right away doesn’t pose a problem and in fact can help keep you on track.  However, many new runners fail to respect the recovery period following a huge emotional and physical challenge.  Make sure you set your next horizon far enough away to take an appropriate recovery period and plenty of time for build-up into account.    It is true a few weeks of rest might leave you slightly less physically fit than race day, but that time for recharging will also prepare you to take on bigger challenges next time around.  Don’t rush it, or unplanned time off due to future aches and pains will likely be your result.

 

Take inventory about what you liked and disliked about your last goal race

Did you race for charity and find your cause to be a crucial motivator?  Did you enjoy (or not enjoy) any travel involved to get to your race site?  Were you enthused by the crowds or did you enjoy the solitude of a less populated and more scenic race route?  Pick the top three enjoyable aspects of your race experience as well as the three aspects that were most problematic to help narrow down what types of races will suit your preferences.

 

Researching races online can also prove useful to learn about the size and setting of potential races – sites like MarathonGuide.com provide a helpful clearinghouse for endurance events filtered or sorted geographically and/or by race date.

 

Learn from the daily life challenges that were present in preparation for your initial goal race.

Often a major goal race involves some reorganization of life as business as usual.  Some of those changes, such as daily nutritional improvements, or adherence to a more regular sleep schedule might be beneficial both for running and for good health.  However, the time and care required to train for a marathon or other long race might put additional strain on family or professional time.  Consider what has been good about that process and what probably needs to be avoided.  If the time to get in long runs was tough to manage, a 10K or half marathon might be a better fit – not because you couldn’t rise to the challenge, but because other goals might fit more seamlessly into your schedule if racing is becoming a regular occurrence.

 

On the other hand, if the specific challenges training for a long race provided the most enjoyable aspect of your training week, consider that as well.  We always encourage athletes to practice racing at a variety of distances, but the frequency of each requires personal inventory.

 

Keep seasonal differences in mind

If you live in a region where the winters are particularly cold or the summers particularly hot, or if you have become accustomed to doing long runs or challenging workouts during hours that can go from light to dark depending on the season, keep these in mind when scheduling your next race.  Even if your goal race is located in a temperate climate in March, if you live in Maine or Minnesota, your long runs will have to be managed through challenging conditions.  Likewise, for an early fall race when you reside in a hot and humid location.  These factors can be identified and can help guide you towards goals you are able to work toward without unexpected barriers to enjoyment or success along the way.

 

Stay focused on the affirmative

Challenging goals are, by definition, hard to accomplish.  As you may already know, things will undoubtedly come along and threaten to sway you from your path to the finish line.   Whether it is a cause, a personal performance goal, a basic commitment to finish what you start, or another motivator, remind yourself regularly what kinds of things draw you to them, what motivates you in other aspects of your life, what gets you up in the morning.  It is always much easier to run towards something than away from fears or difficulties.  Pick a magnetic goal, and you’ll benefit with a clear sense of purpose even when training is difficult.



High Hamstring Tendinopathy

Written by Dena Evans October 30, 2011
hammie_croppedThis month in Ask the Practitioner, we inquired about high hamstring tendinopathy with Renee Songer, Clinical Director of Agile Physical Therapy. 

Read on to find out more about one of the most common injury problems among runners.


Coach:  What is high hamstring tendinopathy? 

RS: Tendons connect muscle to bone. Tendinopathy is a degenerative condition of the tendon structure. High hamstring tendinopathy is a degeneration of the hamstring tendon at it's insertion near the buttock region.


Coach: What are the primary symptoms of this injury?

RS: Primary symptoms include local pain at the top of the hamstring. Often these injuries can be painful to the touch, painful with stretching and painful with forceful muscle contraction.

While running you may feel the pain as you are pushing off the back foot or as the leg is swinging forward.

A quick test is a Reverse Plank (see picture). Pain or weakness compared to your non-injured leg indicates possible problems with hamstring tendon.

Supine_plank_startSupine_Plank


Coach: What are some tips for addressing these symptoms or preventing their onset?

RS: If you see bruising in the hamstring it is best to get in to see your physical therapist or physician to assess the severity of the damage.

If you feel pain in this area acutely, it is often best to rest and ice for the first 24 hours. If pain allows, gently stretch the area and working on a foam roll or massage can help. Slowly return to activity over the next week avoiding activities that cause pain. If pain persists beyond a week see your physical therapist or physician to assess the problem.

This type of injury can also start with a gradual onset as a localized buttock ache, first noticed after a workout and with sitting on harder surfaces.

To prevent high hamstring tendonopathy make sure your glute muscles are strong through a full range of motion. Often we tend to avoid the last 20 degrees of hip extension (straightening) with exercise but we need it to be strong for running. Bowing, single leg bridge, and single leg curtsy squats are excellent exercises to maintain adequate glute strength for running.

Curtsy Video Version I

Curtsy Video Version II


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Personal Best - October 2011

Race Weekend Tips for Friends and Family

Every athlete must marshal the vast majority of effort needed to accomplish a big goal race.  However, many runners and walkers who embark on an ambitious training season must rely also on the help and support of family and friends.  Whether providing rides, fluid support, space in the family calendar, or just emotional support, oftentimes these individual can be difference makers, especially since they are often the motivation for the individual to keep trucking when things get tough on race day.

 

While athletes get a great deal of advice and tips on how to manage their training and race, friends and family can be left empty handed when wondering how best to support their runner or walker.

 

Here’s a road map for every support person or team to take into consideration (since we wrote it – you don’t have to feel selfish about handing it out)!

 

Designate a czar of logistics

One common situation is that the decision for a large group of friends and family to come to the race creates additional stress for the athlete.  Everyone definitely means well, but numerous calls to ask about where to stay, when they can visit with the athlete, where they should watch on the course, and so forth, can increase the perceived pressure when nervousness may already exist.  Designate a family member who will serve as the traffic cop for this type of planning, someone who will coordinate flights and airport trips, hotel stays, dinner reservations, and various rendezvous with all those who wish to be included.  This person should be well versed in the details available on the race website for the course, the expo, and the post-race reunion area.  If a new person pops up who wants to support the athlete, the athlete can then confidently connect them with the logistics czar, who can walk them through the plans already in place.

 

Consider the Athlete

It is not uncommon for friends and family contingents to begin to build a life of their own as race day approaches.  Interest in various sight seeing expeditions, brunch or dinner locations, matching t-shirts, expo shopping trips, and more ideas may continue to grow and expand.   There is absolutely nothing wrong with making plans that don’t include the athlete, respecting the runner’s need for rest and calm before (and rest and recovery after) the race.  However, keep in mind the race that your runner has trained for and the needs they have in final preparation.  For example, if everyone wants to eat dinner at 9pm at an exotic restaurant, but the athlete expresses a desire to eat simple pasta at 5pm and go to bed early, consider compromises and alternatives (such as having one person from the group have dinner early with the athlete).  Race weekend isn’t a democracy; it is a narrowly focused time period with one specific and very demanding aim..  Be proactive, and ensure the physical and psychological needs of the competitor are paramount.

 

 

Determine a simple post-race plan, including a fall back plan if things haven’t gone well

At smaller races, athletes are easy to connect with after they finish.  However, at many large races, the post-finish process can be very crowded, and may take some time.  Cell phones have been left at home, at the hotel, or in the race baggage, so old-fashioned methods of communication must be relied upon.   Races often offer reunion areas, but it may make sense to pick an alternate landmark or process to find each other as the reunion areas may be clogged.  Friends and family need to be patient with post-race logistics.  Oftentimes races require a lengthy cool down area, and the competitor may not feel especially perky after running a 10, 13 or 26-mile race. If more than one person is racing, they may also want to greet each other within the finish area before heading out.  Determine a plan for reunion if things go as planned, and an option if things do not.  The runner should have a plan if forced to withdraw mid-race (read the race materials), and the czar of logistics should be well versed in this process as well.  The same goes for brunch, lunch, dinner or whatever is the first item of business after the race.  Consider that the athlete may not be in a position to eat a large meal, walk a long distance, or sit in the car for an hour.  Try to plan accordingly and be prepared to be flexible.

 

Marshal the energy of the support group into loud and visible demonstrations of support

Make a plan to provide an inspirational boost to the competitor or competitors in the race.  Large signs, strategic course placement, and clear visibility can be a huge boost, but require an organized plan to account for pacing and transportation variability.  Don’t miss out!  Think through how the group will get from point to point and how the problems that might occur can be addressed.  HOWEVER, again also consider the athlete’s needs.  Should they prefer a lower-key approach, respect their wishes and support as requested.  It is their day!

 

Race weekend can be an intense, but significant and memorable weekend on many levels.  Everyone involved wants to provide support, but the greatest energy must be saved for the actual task itself.  Keep that focus in mind at all times, and hopefully your athlete can look forward to a happy and unified reunion when the finisher’s medal has been finally placed around their neck.



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