Have you noticed the well-defined calf of the runner ahead of you? You know the one, where you can clearly see the two separate parts of the calf or gastrocnemius. You might know that behind that muscle is the soleus which, along with the gastrocs, is responsible for plantar flexion or pointing the foot down toward the ground. Along with these 2 larger muscles in the back of the lower leg, there are two other muscles that help flex the foot down and two more that flex the toes. This month we’ll concentrate on just the gastrocnemius and the soleus which, together, form the achilles tendon which attaches the muscles to the heel. I’ll cover achilles injuries another month.
Tight calves can be the root of all evil. Remember when I mentioned tight calves as part of the problem in plantar fasciitis and also in shin splints? The reason is that ordinarily these lower leg muscles pass the shock of impact up through the body where this shock can be better, or at least more widely, absorbed. With a hard knotted calf the jolt of impact is much greater in the foot. Also the uneven workload between the back and front of the lower leg creates havoc.
You increase the workload of the calf when you run hills because the hill forces you to bend more at the knee which puts more stress on the soleus muscle. Not only hills can create problems for calf muscles, but also the long or hard run. As you continue to stress the muscle fibers, little tears form in the belly of the muscle, sometimes healing poorly leading to chronic problems.
Now that I’ve suggested some injury causes, what are the symptoms? Running and even walking can be uncomfortable, especially the part of the stride where the heel should, but hurts too much to, hit the ground. Warming up eases the pain, but expect to be sore during and right after your run. With a torn gastroc muscle, raising onto your toes with straight legs is painful, usually near the middle of the calf and nearer to the surface. An injured soleus, on the other hand, is a dull, aching pain deep and usually toward the top of the calf.
For self-treatment, you may want to temporarily use heel lifts (in both feet to keep from feeling lopsided) or shoes with heels an inch higher so you can stand and walk without pain. This will take the pressure off the torn muscle. Use ice, taking breaks to exercise the calf with alternate flexing and pointing while sitting with a slightly bent leg. As the injury heals, you should be able to straighten your leg during this exercise. Controlled movement during healing, in the same direction as typical movement, will keep the scar tissue aligned properly and help the muscle stay flexible.
Medical treatment is indicated if there is considerable tearing. Your sports physician may check your running mechanics and prescribe physical therapy or orthotic devices. Your massage therapist will treat the entire calf area with deep massage and friction massage to the specific injured area to promote faster healing and less scar formation. Palpation of the neighboring muscles will indicate weaker or other involved muscles. You might be made aware of compensating muscles and injuries ready to happen.
Should you run? If the strain is minor and there is no pain walking, try a short slow run on a flat easy surface. If the pain is insignificant, increase your mileage slowly, but keep it slow and flat until your calf has healed. Speed work and hills may bring you back to square one. A severe strain can take 5-8 weeks to heal.
For rehabilitation, continue with the seated point/flex exercise. When you have recovered, begin a few sets of bent knee (for the soleus) heel raises keeping your feet parallel and staying on the balls of your feet for a few seconds. Then do a set for the gastrocs with straight legs. Build slowly up to 50 repetitions.
In all cases with tears, be careful about stretching. I advise you to only stretch the muscle when it’s warm and healthy. Start all your activity slowly to avoid injury, stretch after you’ve warmed up and before intense workout. For instance, at the track do your warm-up easy, stretch, then do your hard workout.
Stay on the roads.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
INJURY OF THE MONTH: PREVENT INJURY BY CROSS-TRAINING!
It’s mid-summer; I’m going to RAGBRAI tomorrow, and I don’t want to write about injuries. Instead, I’d like to share a case history with you about how a runner tried cross-training after suffering her third stress fracture in 5 years. To simplify the research, the runner is me. No, I haven’t suffered from ALL the injuries I’ve written about in this column- most of them, but not all.
Last fall, after I ran the Portland Marathon and was diagnosed with my third stress fracture, I figured it was time to acknowledge that I was doing something wrong. Actually I knew what I did wrong each of the three times, but, suffering from the superwman/I-feel-great complex, I thought I could get away with it. “It” was racing on Saturday and running long on Sunday, or running long on Saturday and longer on Sunday, or anything involving “Oh, that sounds like fun, sure I’ll do that” when I would have been better off taking a rest day.
So, I realized that I couldn’t be trusted. If I was going to cross-train successfully, I had to be pushed (shoved, really) in that direction. The push came in late winter when Tim Sheehan, a Fast Tracks member, emailed a group of friends asking if anyone wanted to join him on RAGBRAI, the Des Moines Register’s Annual Great Bicycle Ride Across Iowa. “Sure, I’ll go”, I emailed him. Now if my Saturday running buddy asked me if I wanted to run Sunday at the Wissahickon, I would have to say, “No, I have to ride my bike.”
Now, the RAGBRAI isn’t a little ride. It’s 450 miles over 7 days, and they tell me that Iowa isn’t flat. I committed to the ride at the end of March, figured I’d buy a bike and do a long ride each weekend until the event in mid-July. Then the rains came. And buying a bike was more complicated than I thought. “Make sure to buy one that’s comfortable” I was warned. Did you ever ride a road bike? If you haven’t, let me assure you that none of them are comfortable! By mid-May I finally understood “comfort” and found a great bike. I was then invited to go to the “Mayor’s Midnight Sun Marathon” on June 21 in Anchorage Alaska. “Oh, that sounds like fun, sure I’ll do that.” I registered for the half marathon for which I was totally untrained. The biking was only slightly sidelined as I put in some running miles.
Alaska was wonderful!! When I got home, it became easy to say no to fun running dates when I realized I had only a few weeks left to get in some biking miles. I still was having trouble getting my feet out of the pedal clips, and I was going to ride with 10,000 cyclists across some mid-western state! A running/cycling friend taught me the ropes. I searched out bike clubs and rode. I became neurotically desperate. On the Fourth of July weekend, I forego a running race for the first time, maybe ever, and I cycled. That 3-day weekend I rode 150 miles, and I felt great! Maybe I can do this!
I leave tomorrow. I’ll let you know!
Stay on the roads, one way or another.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
INJURY OF THE MONTH: ILIOTIBIAL BAND SYNDROME
“My knee hurts, along the outside. It’s okay when I wake up, but then it starts to hurt again after I’ve run a couple miles.” I touch a spot on the outside of her knee; “Yeah, right there!” Then I dig
in a bit at the side of her hip. “Ouch!” The space between those two spots is the location of the iliotibial band (ITB). This long band of fascia (connective tissue) acts as a tendon, connecting muscle to bone. The ITB connects the tensor fascia latae (order a new one at Starbucks) and part of gluteus maximus to the tibia (shin bone). This muscle group flexes the hip and provides support for the knee, therefore becoming overworked from that forward stride, again and again and again. An increase in your running distance may contribute. If you sit all day, you’re compounding the problem because sitting is also an “activity” of hip flexion. When only one side is sore, think of imbalances: running one way only around the track, running on the sloping shoulder of the road. Perhaps at fault is a “longer leg” from a “high” hip or a tight hamstring or a tight calf that doesn’t allow for the heel to hit the ground, or pronation (flat feet). Look at your posture; a “sway back” (anterior pelvic tilt) can also contribute to ITB syndrome.
Why is your knee sore and what can you do about it? When the muscles are tight, they pull on the tendon which also shortens and tightens. The ITB may become inflamed and thickened with adhesions, the scar tissue. This tight ITB then rubs over the side of the knee, possibly pulling the kneecap to the side so it doesn’t track properly.
To test for ITB syndrome, stand with the outside of your injured leg against a wall. Keeping that heel in place, lift the toes on that foot and push the side of the front of that foot into the wall, hard. Feel the same pain?
Professional and home care? I recommend sports massage to both soften and work out the adhesions of the tensor fascia latae and the ITB. The therapist should also address the hamstrings, quads, calves and glutes as they may all be involved as I mentioned above. The therapist should then recommend homecare so you may continue to soften and lengthen the tight and adherent muscles. You can use a massage device like “The Stick”, try skin rolling where you ply away the skin from the underlying tissue, and use cross fiber friction to address the adhesions. Ice the area at the knee and anywhere else you’ve done this work. Try this stretch: Lie on the bed on the unaffected side with the lower part of the affected leg off the edge. Extend that leg like someone is pulling you off the bed while you rotate your knee (keep it straight) up toward the ceiling. Then try to relax into that stretch. When the pain has resolved you can strengthen those muscles by again lying on the unaffected side with your knees slightly bent. Slowly raise and lower your leg about a foot. To make it harder, resist the movement with your hand or a weight on the leg you are lifting. Build from 2 sets of 10 reps.
If the pain isn’t severe, continue running, but avoid hills and uneven or sloping terrain. I recommend that you minimize your distance until the pain is resolved. If you sit at work, get up as often as you can. Sleep on the unaffected side with a pillow under the affected knee. Massage, stretch, then ice. Check your posture and your running biomechanics.
If the pain is severe, or doesn’t easily resolve, see your sports physician. S/he may prescribe anti-inflammatories, a corticosteroid injection, physical therapy.
Stay on the roads.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
MASSAGE: WHEN TO GET ONE
I've been leading you all astray! I'm so sorry. Let me explain. Yesterday I got a call from a Fast Tracks member wanting a massage for a brand new injury, unfortunately just days before a major running event. I realized then that my injury of the month articles all suggest the benefits of massage for injury. Well, that's true. But the best time to get a massage is before the injury happens to prevent it, or at that very first twinge that you don't even want to acknowledge.
A competitive athlete trains on the edge. How hard can s/he push her/himself without injury intervening? How many times have you heard a runner say, "I was in the best running shape of my life and then I got hurt"? Massage will help you stay on top of that edge, whatever your edge may be. If you're no longer in your forgiving twenties, that edge leans a little more heavily toward injury. If you have a chronic problem (cranky knee, tight hamstrings, ongoing plantar fasciitis, etc.), your edge is even more slippery.
When is the best time for massage? To fight injury is a great time for massage. To prevent injury is the best time. If you're training heavily, for instance participating in weekly track workouts and/or running long runs each weekend and/or upping your mileage and/or racing, a weekly or bi-weekly massage will help you stay injury-free in several ways. For one thing, as your massage therapist goes over each muscle group, both you and s/he will find sore and tight muscles that you might not have been aware were potential injury sights. At the same time that the therapist feels these micro-tears and adhesions, s/he begins to smooth out the slightly damaged tissue and realign the fibers, stopping the injury process. Your therapist will also stretch your running muscles, again looking for and resolving adhesions. Your therapist can then suggest strengthening or stretching or self massage for the muscle in jeopardy.
If you are not currently "in training", as in the above example, but your injury scoreboard has its share of entries, I would recommend monthly massage to keep you off the sidelines. For those lucky souls thanking their folks for incredible genes that keep them from injury, birthdays are a great time to "give back" to that body that's been serving you so well. Besides feeling great, the endorphin rush lasts all day.
BTW-Therapeutic Massage (that's what I call my practice) always offers $5 off to running club members. Take advantage of the 4 massages for $195 special continuing through the end of September. Once bought, the massages can be scheduled anytime, even beyond September.
Welcome to this second column of good cheer enlightening you about common running injuries. I’ve selected muscle strains to discuss in April, the month we go back to track and racing and increasing our distances. To offer that subjective viewpoint, the muscle in question will be the quadricep, which I strained last fall. Please learn from my mistakes! Each month I will describe the symptoms, suggest the causes, and offer suggestions for healing including professional and home care.
A strain is an overstretch injury to a muscle or its tendon. It can occur from trauma, as in a fall or a car accident when your muscle is forced into a stretch, or from overuse such as too many hard workouts without adequate recovery or pushing harder and longer in a race than your training permits. Improper warm-up, muscle imbalance and inflexibility can all contribute to one’s susceptibility to a muscle strain.
The symptom of a minor strain (grade 1strain) is discomfort at the injury site during activity. If you’ve torn some muscle fibers (grade 2 strain), you may have swelling, bruising, heat and tenderness at the site of injury. Moderate pain with activity and loss of strength are also present. With a rupture or more severe tearing (grade 3 strain), you will experience severe pain, swelling, bruising and heat, with loss of strength and loss of range of motion.
When you first notice pain or tenderness, the treatment is RICE: Rest, Ice, Compression, Elevation. Evaluate your training. Did you do too much too soon? And the big question is: Should I take time off from running? Basically, yes. For a grade 1 strain, I recommend a couple days off, then an easy run to see how it feels. With a grade 2 strain, take, maybe, a week off, then try an easy run. If you keep running through soft tissue (muscle, tendon, ligament) pain, you will re-tear the adhesions (scar tissue) and impede the muscle from healing properly. With a grade 3 strain, walking will be difficult and you should seek early medical advice. Two years ago, I tore some muscle fibers in my quadricep while racing downhill, a particularly taxing movement for that muscle. I chose to continue easy runs while my strained quad healed. Even with no speed training, no hill running, and daily massage to alleviate internal scarring (adhesions), it took almost 3 months for complete healing. Had I stopped running for 2 or 3 weeks and weight trained to address any muscle imbalances, resting the quad, I could have gone back to racing that season. I chose easy runs rather than the time off. Last summer I strained the other quad (obvious muscle imbalance?) while training for the Portland marathon by increasing my long run distance too soon. I was scheduled to run 17 miles, but I felt great and ran 20. Stupid, I knew that at the time. The next weekend I biked 40+ miles, much longer than my usual ride and not exactly a quad rest, then I ran 17 the next day. Really stupid. I knew I was in trouble, but I made the choice to run one more 20 and then my marathon on my strained quad. I wanted to run that marathon, I did, and I paid the price. I ended up with a stress fracture of the femur and almost 2 months of no running.
What treatment plan is indicated beyond a few days of RICE and rest? See your primary care or othopaedic physician to assess the damage. S/he may recommend NSAID’s (Motrin or Naproxin), ice and rest; s/he may prescribe muscle relaxants and support (taping, wrapping, crutches); s/he may recommend surgery to repair the ruptured muscle. A physical therapist may address muscle imbalance and prescribe exercises for the associated muscles; s/he may suggest range of motion exercise for the damaged muscle to avoid shortening; s/he may use electric stimulation to bring blood and healing to the injured tissue. Your sports massage therapist will address the surrounding muscles which will tighten to protect the injury; s/he will address the developing adhesions (scar tissue) to alleviate loss of strength and flexibility; s/he will assist with range of motion stretching.
Home treatment includes RICE (rest, ice, compression, elevation), NSAIDS like Advil, and instruction from your health care provider including exercises, stretches and massage to the affected area. I would advise you to avoid stretching injured tissue unless it’s warmed up. Really consider where you are in your training and what it means to take a little time off from running now, instead of much more later.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic and sports massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
INJURY OF THE MONTH: PIRIFORMIS SYNDROME or OH MY ACHING BUTT
This month let’s move up. Enough about the legs already; let’s move on to the butt. A nasty injury that plagues many runners is piriformis syndrome, an ache you can easily point to in the middle of the buttocks, sometimes with radiating pain down the back of the leg. Although piriformis syndrome implies sciatic nerve involvement, that isn’t always the case. The piriformis muscle moves the hips laterally to the side; picture a dancer standing with her toes pointed toward the side walls. It is also a principal stabilizer of the hip joint, and in that function we runners overuse piriformis on successions of long runs.
ANATOMY: The piriformis muscle is strong and thick, running from the sacrum (tailbone) horizontally toward the very top of the leg in the hip socket. The gluteal muscles lie over it, and the sciatic nerve follows a path either behind or right through piriformis. For this reason, when the piriformis muscle contracts in spasm- pain, numbness or tingling can radiate down the leg following the path of the sciatic nerve.
CAUSES: Besides overuse from running, stair-climbing or squats, postural concerns can overwork piriformis. Pronation (flat feet), lordosis (sway back) and pregnancy call on piriformis to stabilize the pelvis; sitting for long periods while driving or working act to shorten piriformis. An easily remedied priformis aggravation comes from sitting on your wallet in a back pocket. In addition to arthritis in the hip, trauma from a fall or car accident can inflame piriformis, the resulting scar tissue and adhesions creating ongoing pain and discomfort.
WHAT TO DO: To alleviate the syndrome, you must first decide what caused it. Look at the above suggestions and consider them. Pronation can be corrected with orthotics prescribed by your podiatrist or physical therapist. Orthotics may also help with sway back and better support your feet while pregnant. If orthotics aren’t indicated, more supportive shoes may be the answer. Whenever driving or sitting for long periods, the key to overall comfort and health is to move as often as reasonable. Standing and walking for as little as a minute every two hours will allow the spine to realign and the flexed muscles to relax.
After you’ve determined the cause, you may want to seek appropriate professional care. Your medical doctor can rule out disc and spine conditions and prescribe muscle relaxants, physical therapy and massage. Your physical therapist may show you exercises and stretches to alleviate the contracted muscle. Massage therapy will focus on manual therapy to relax not only the piriformis muscle, but also the surrounding muscles including the hamstrings and other muscles of the low back. Massage will also reduce scar tissue formation and existing adhesions. Sports massage will often include stretching and strengthening exercises. Chiropractic care might re-align the spine and the sacro-iliac, allowing the muscles being pulled by the rotated vertebra or joint, including piriformis, to relax.
HOME CARE: In addition to the earlier suggestions to avoid sitting for prolonged periods and examining your posture, also look at your sleep position. Sleeping on your stomach and on your back can exaggerate the curve to the low back. Sleeping on your side with a pillow between your legs (or well supported by spooning with your partner) helps to keep your hips stacked one on top of the other, releasing the involved muscles.
Contrast applications of heat and ice are effective treatments to increase circulation, bringing in oxygen and nutrients and flushing wastes. Try ten minutes of ice, then heat, repeated and always finishing with ice.
To relieve a piriformis spasm, lay face up on the floor with a soft tennis ball under your butt right at the area of tension. Hold that position until the muscle “melts”. If you feel numbness or tingling down your leg, stop the activity as you are compressing the sciatic nerve.
A good stretch is accomplished by lying face up with a rope around the affected foot which is raised in the air, the ends of the rope held in the opposite hand. Let the leg fall, with straight knee, down toward the opposite hip, keeping both hips on the ground. Assist the stretch with your rope. Hold for a few seconds then repeat the full range of motion. Another stretch starts laying down, feet on the floor, knees bent. Put the ankle of the affected hip on the opposite knee. Clasp your hands under that opposite knee and pull the knee (with the other leg on top of it) toward your chest.
WHAT ABOUT RUNNING? That’s a tough one. Rule out disc involvement! If the problem is muscular, take a few days off while you try some of the above suggestions to ameliorate the pain. Warm up well, then stretch well, then run a little, walk a little, run some more. Stretch well afterwards and use ice. Wait two days. See if you’ve exacerbated the condition. If not, run more and walk less. Take it slow; you don’t want to be side-lined for longer than you need by being too anxious.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
INJURY OF THE MONTH: PLANTAR FASCIITIS
This column discusses injuries common to runners. No, you needn’t experience an injury each month to read on. However, I will start the series with the first injury I suffered as a runner, plantar fasciitis. I will describe the symptoms, suggest the causes, and offer suggestions for healing including professional and home care.
Plantar fasciitis, how do you even pronounce that? I say planter (like the ceramic planter holding the flowering plant), fa (as in fabulous) she eye tis, accent on the eye. The plantar surface of the foot is the sole, and the fascia is the connective tissue throughout the body. –itis means inflammation. Plantar fasciitis is a common overuse condition which usually involves micro-tearing and re-tearing of the fascia at the heel of the foot, sometimes at the arch, and occasionally at the base of the toes.
Do you dread that first step out of bed or away from your desk because of the sharp pain under your heel? But then after you’ve been on your feet, or even after you’ve run your first mile or two, the pain diminishes or even disappears, possibly re-appearing at the end of a longer run? That’s a classic symptom of plantar fasciitis. You may experience this in one foot or both. Usually the onset is slow and without a specific injury. In other words, ignorable. Weeks after onset, I noted in my running log, “finally acknowledged pain in my foot”.
How did I get it? Quickly upping your mileage or hard workouts, and running on hard surfaces are primary causes of plantar fasciitis. Poor biomechanics such as “flat feet”, a hard foot strike or an awkward gait can predispose one to plantar fasciitis. Weight gain, tight calves, worn-out shoes can also be culprits.
What to do? Before you seek treatment for any ailment, question how you got it. After I found “finally acknowledged my foot pain” in my running log, I looked back to see my mileage had quickly climbed. I found an earlier notation of “tight calves”, and made an appointment with my physical therapist. She ordered orthotics to correct my pronation, prescribed massage for my tight calves, and she friction massaged the site under my heel where the pain was most significiant. Cortisone injections are an aggressive course of action, as is immobilization or surgery. Devices are available to keep the foot flexed while you sleep.
Home treatment can include non-steroidal anti-inflammatories like Advil. Ice, especially after exercise or after friction massage, is good to reduce inflammation. Rest is often recommended. The most important thing you can do is stretch the plantar surface well before you take that first step in the morning. If you roll your foot over a can or rolling pin, you will avoid re-tearing the fibers each and every time you stand on your foot after it’s been at rest.
Seek attention early to avoid adhesions from constantly re-tearing the fascia. At that point the condition can persist for many months. A podiatrist or physical therapist will diagnose, order orthotics if necessary and prescribe an anti-inflammatory drug. A sports or therapeutic massage therapist will assess and treat the injured tissue and the compensating muscles of the leg, and possibly the hip and back. I recommend you use aggressive home care and conservative medical intervention. Stretch your foot, check your shoe wear, get a professional assessment. Stay on the roads.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
NON-INJURY OF THE MONTH: POST MARATHON STRESS SYNDROME
CONGRATULATIONS! You’ve been planning and training for this marathon (half marathon, 10K) for months. Every weekend you’ve gotten up early for your long run, planned your life around track and getting in the miles, and you’ve adjusted your diet to get the best results possible for this race. You ran well (if your event hasn’t come yet, you’re visualizing this), you’re wearing your medal, and you’ve accomplished your goal. It’s over…
I’d like to offer you some personal thoughts on post marathon stress syndrome and also some education on the condition of your hard-working muscles and how best to treat them for this non-injury to stay a non-injury.
When I trained for my first marathon, I ate-drank-and-slept marathon. I read my Runners World cover to cover. When I met any marathoner, especially one who had run MY marathon, I encouraged him to talk endlessly about the event. Sound familiar? A month before MY VT City Marathon, several of those experienced marathoners began asking me what I had planned for after my marathon. “A massage!” I answered. “Actually,” my friend Paul said, “I was thinking a little further out than that.” Most Fast Tracks members are very busy people. I’m sure you’re looking forward to sleeping in on a Saturday, maybe even after 7am. You’re planning to spend more family time, prepare for the holidays. If you don’t have something after your marathon to focus on or look forward to, this is the time to start thinking about upcoming activities you enjoy. Post marathon stress syndrome is all about the physical and emotional let down after the long build-up. It’s a good idea to continue the camaraderie of those Saturday runs, or substitute another enjoyable activity like biking or hiking. Maybe you could focus on a future race. I’ve been told that your best 10K time comes 6 weeks after your marathon, that gives your muscles time to recover while your endurance is still strong.
What about running after the marathon? I like to go for a short jog the next day to move some blood into those muscles I worked so hard. Blood brings nourishment and fresh oxygen and also circulates out the cellular waste. Gentle movement of the joints alleviates the stiffness and prepares the tissue for healing. Many runners like to take time off after the marathon; I’ve heard anyway from a few days to a month. The main object is to keep moving to bring in fresh blood. A rule of thumb is to take off one day for each mile you raced before you begin training again. Almost four weeks might not be necessary before you visit the track again, but be aware that you risk injury if you push hard too soon after your race.
Anatomically, the effort of hard, long running on your muscles creates micro-tears in the muscle fibers. Often swelling occurs at overworked joints. Ibuprofen will help reduce swelling, heat will increase swelling. As tempting as that hot tub looks, ice is the better choice for a day or two. Because of the micro-tearing, be very careful of stretching if you’re not warmed up. A gentle jog or a hot shower will warm the muscle allowing you to stretch. I recommend holding the stretch for no more than 2 seconds, working the joint through its range of motion, then stretch again. Repeat until you feel a good comfortable stretch. Static stretching with compromised muscle fiber will encourage re-tearing; you don’t want that!
Enjoy the proud glow from your accomplishment. Plan a fun activity for some time after your race. Schedule a well-deserved massage! Congratulations.
Stay on the roads.
Bobbi Kisebach, licensed massage therapist and 14-time marathoner
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
INJURY OF THE MONTH: SHIN SPLINTS
When I hear the lay term “shin splints”, I picture a boy scout version of a splinted lower leg, thick cut maple branches protruding from the ace bandage. In fact, shin splints refers to pain felt near the tibia, the prominent bone in the front of the lower leg. It is most often an inflammation or tendinitis of the muscles on either side of the tibia. Tibialis anterior is the muscle just to the outside of the tibia and responsible for flexing your foot up. Tibialis posterior lies behind the tibia and also to the inside of the front of the lower leg. Its action is to point the foot down. Both muscles act to invert the foot, the movement a healthy foot makes inward after the heel lands on the way to toe-off. Periostitis, inflammation of the tissue surrounding the bone, can also be involved when a person complains of shin splints. Periostitis in this location comprises up to 18 per cent of running injuries, affecting more women than men according to John C. Richmond and Edward J. Shahady. If left untreated, periostitis can progress to a stress fracture. So, listen up!
Those most likely to encounter shin splints are new runners or those who are increasing their mileage or running fast on hard surfaces. Beware, spring and the return to long runs, track and racing is the time for shin splints! Causes include too much too fast for your level of training, running on hard or uneven surfaces, ill-supported pronation (flat feet), tight calves, worn out or improper footwear.
Pay attention to the symptoms. At first there is an ache in the morning and shortly into your run, decreasing as you warm up. Then the ache returns further into your run and continues after you’ve stopped. You’ll feel it more as you begin to swing your leg forward during your stride. You may feel it anywhere along the front and sides of the tibia, particularly 2/3 of the way up on the outside by the bone, 1/3 of the way up on the inside by the bone, or just behind the bony prominence (medial malleolus) at the inside ankle. If you feel pain while pushing directly on the bone, your doctor may prescribe a bone scan to check for a stress fracture. As you ignore the symptoms, the pain will decrease less as you warm up and continue through more of your daily activities. Running uphill is particularly painful.
What to do? This isn’t a good pain to “run through”. Rest and ice and build up the strength in those tibialis muscles. Flex and point the foot of the affected leg (often it is both legs) for a minute, rest for a minute, repeat a few times. When you can do this pain-free, try a short run on a flat forgiving surface. If there is no pain, try it again in 2 days. Return to your regular running slowly and with great patience. If you have flat feet, you may need orthotics to prevent the return of symptoms. Deep friction massage done by your massage therapist or physical therapist will eliminate the adhesions in the muscle tissue and bring blood to the area to encourage healing. Your massage therapist will also treat those tight calf muscles and compensating muscles in the low back, gluteals and hamstrings. Your physical therapist will determine muscle imbalances and prescribe exercises and stretches. Your sports physician may test for stress fractures and prescribe orthotics.
Pay attention to your aches and pains. A few days off when you first notice symptoms can spare you months of pool jogging while you read about Marathon 101’s adventures.
Stay on the roads.
Bobbi Kisebach, licensed massage therapist
My training as a therapeutic massage therapist includes ongoing study in anatomy and physiology, pathology and clinical practice.
Please send me feedback on this series. Do you want more info than I offered? Do you want more case history? Less? Do you have an injury you’re curious about? Let me know at BobbiVT2PA@aol.com
