Summer running
As several of my clients are keen runners and a number of others are planning to take part in 5k, 10k or the Royal Parks half marathon, I thought it might be helpful to look at some general advice around running and self care.
For the complete beginner, the best advice I can give you is to follow a training plan. If you want to start running and the most activity you normally do is run to catch a bus then a training plan will really help you progress. Typing in ‘running training plan’ on an internet search will reveal a whole range of listings from organisations such as Running World, BUPA, Cancer Research UK, MS Society that you can follow and they all have additional advice that is relevant, whether it is about clothing, diet, motivational ideas etc.
On the training plans, it will list different levels of training (beginner, intermediate and advanced) and for example on the BUPA website it has effectively given a definition of what this means. So, when you see Monday is an ‘easy’ run, what does that mean? Well, it’s between a brisk walk and light jog, enough to raise your heart rate and get you breathing slightly heavier but you can easily talk.
For a runner at any level, ensure you have a good pair of running shoes. Many specialist sports shops, such as Sweatshop, will provide you with a free running gait analysis so that they can advise you on the best pair of shoes for you when running. It is absolutely worth investing in these, to look after your feet, to reduce impact on the body at knee, hip or even further up the kinetic chain, such as low back or shoulder level! Your shoes should be your most expensive purchase but when you look at the cost per step, it is absolutely minimal.
Experienced runners may have read about barefoot running and be interested in developing this technique. Humans have run barefoot for centuries. However, when we run with shoes on, our gait has a significant heel strike. For barefoot running the impact is more midfoot and uses a lighter, springier step. So, if you want to take up barefoot running, work on stretching and strengthening your calf and foot muscles first to prepare them for the change in biomechanics when you run.
Running injuries
There are a few injuries that runners may experience in their chosen activity. These are listed below with a quick summary of treatment ideas to help. For any severe injury you should always seek medical advice!
All the ailments below can be treated by a clinical massage therapist or other appropriately trained body worker. They can also provide additional techniques to help with swelling, reduce trigger points or muscle tightness in the affected/associated area, or provide rehabilitation advice. So if you have tried self-help and you are still not recovered it might be time to seek assistance.
Plantar fasciitis
This is an overuse injury to the sole (plantar) surface of foot. The collagen fibres near the heel have broken down and not matured properly causing pain on movement, especially after being still for a while, for example getting out of bed in the morning.
Self-massage by rolling the foot on a tennis ball or a frozen bottle of water can gently stretch the thick plantar fascia. Gentle stretches such as pulling your toes up, and calf stretches to both the gastrocnemius and soleus can be helpful. However, all stretches should be performed within a painfree zone (up to 3/10 in terms of discomfort). If you have excessive pronation of the foot, orthotics may be helpful to provide support during your rehabilitation. A massage therapist will use myofascial release and soft tissue release techniques as well as the use of heat therapy and stretches to increase flexibility of the foot.
If you have plantar fasciitis, resist running until it has improved, try swimming or cycling instead to maintain fitness and cardiovascular activity. Once you can walk briskly for 30 minutes without pain then you are ready to gradually re-introduce running into your program. Remember you are checking that the collagen fibres have matured. If you overdo it then it could be back to the start of treatment again.
Ankle sprain
A sprain is an acute injury to a ligament. Generally speaking ankle sprains are caused when the foot rolls in on itself sharply during a movement. Usually the outside of the ankle is affected. This can overstretch the ligament affecting the integrity of the joint. Active and passive movements of the joint can cause pain and discomfort. Initial symptoms may include swelling or bruising of the ankle and foot depending on the extent of the ligament damage. Treatment is immediately RICE: rest, ice compression and elevation for 24 to 48 hours. Ligaments do not have a great blood supply and can take longer to heal, a severe sprain can take 12 weeks to recover!
Ligaments that have been more severely damaged may require massage. In the very early days this may be to help reduce swelling but later stages can include techniques such as cross fibre friction which encourages inflammatory cells in to the area to stimulate the healing process.
Providing some support to the joint will be beneficial. Initial gentle movements of the foot and ankle to reduce swelling should be performed frequently throughout the day, so ankle circles every hour, pointing foot up and down, outwards and a gentle inward movement should be done 10 times about five times per day. After a few days when swelling has decreased gradually start strengthening the joint with isometric exercises. This can be done by pressing the foot into the floor or against a wall or chair so that the joint does not actually move but you are activating the muscles. Then introduce exercises that load the joint perhaps using a theraband or similar. Walking is good and when painfree, exercises such as hopping and sprints with a change of direction or side-ways movements will challenge the joint.
Calf strain
This is frequently felt in the lower part of the leg around the Achilles and is usually felt after running for a distance. A strain is when some of the fibres of the tendon have been damaged or torn. Depending on the extent of the damage depends on whether it is a grade 1, 2 or 3 tear. Grade 1 is minor and recovery is within a few days, grade 3 could be a fully torn muscle, such as occurs at the Achilles tendon and may require surgery and long term rehabilitation.
At the onset of calf strain, stop running! Don’t continue as all you will do is increase the extent of the damage. RICE is important but gentle movement (no more than 3/10 in terms of discomfort) during the initial stages will help reduce muscle stiffness and tightening.
Massage can be particularly helpful for muscle strains to encourage scar tissue to form correctly, to reduce trigger points in the affected muscle and associated muscles, and to reduce tension and swelling in the area.
The exercises suggested above for plantar fasciitis are equally important for calf strain as they activate the muscles of the calf. Gentle self-stretching in early stages of rehabilitation should be performed frequently before moving on to a stretching and strengthening program. Static stretches for the calf against a wall help to remind the body to lengthen the muscle fibres and help you realise what is a comfortable stretch so that you know your own range of movement and don’t overdo more active techniques until you are healed. Exercises such as standing on a step, raising up on to tiptoes and gently lowering so that heels are below step level at the end point help both strengthen and eccentrically stretch muscle. Start with both legs working together and when this feels comfortable, then progress on to performing this one leg at a time. Standing on a pillow and doing single legged squats adds some gentle instability into the muscle and joint to stretch while weight bearing. Gradually resume training by starting with a walk and jog routine until you are confident that injury has resolved.
Shin splints
Bones are covered in a protective layer called the periosteum. In shin splints, the muscles around the shin exert too much stress on the periosteum during movement and pull it away from the bone. This can lead to sharp pains, feeling of bumps along the bone, redness and swelling or even a stress fracture of the shin bone, the tibia.
The two key muscles involved are the anterior and posterior tibialis. These muscles are involved in dorsiflexion and plantarflexion of the foot and help the foot to curl medially (inversion). These are all crucial movements in running, which is why any imbalances in these muscles can contribute to shin splints. However, other factors include incorrect footwear, different running surfaces and/or over pronation/supination of the foot.
Immediate treatment is RICE. Gentle movements of the foot to start the initial phase of recovery will help to keep the muscles moving and reduce tightness. However again keep well within your individual comfort levels. No more than a 3/10 in terms of any discomfort. Massage can help to strip the entire musculature and reduce tightness, especially when combined with soft tissue techniques. Direct myofascial release techniques will be of benefit as the intention would be on helping alignment of any scar tissue. Exercises to both strengthen and stretch the calf muscles including using a band to invert and evert the foot whilst it is pointed up and then pointed down will ensure both anterior and posterior muscles are strengthened and stretched.
Taping, orthotics and checking footwear are also measures that can be taken to see if they help the myriad of factors that can contribute to shin splints.
Knee pain
Knee pain is rarely a simple issue! From a therapist perspective, if you have knee pain it is really helpful to know what brings it on: is it distance or going uphill or downhill? Is it anterior, posterior, medial or lateral? For runners, is it lateral knee pain that comes on after running a certain distance? If so it could be ‘runner’s knee’ caused by a tight IT band, is it a wear and tear injury perhaps due to patellar or cartilage problems. Is it due to poor biomechanics, perhaps a rolling of the knee inwards when running?
The movements of the knee are quite limited, so sometimes there are knee problems because of inefficiencies in the musculature that crosses the hips and attaches to the femur (thigh bone). Assessment by a therapist will help provide specific information to help improve the situation. Tight muscles pulling the patellar out of position will benefit from massage so that tension and trigger points can be eased and full range of motion stretches incorporated into your routine. A tight IT band can be helped by massage, myofascial release techniques and stretching. Ligament or meniscus problems can benefit from a strengthening program. Biomechanical issues can resolve with taping, orthotics, appropriate footwear and appropriate massage, stretching and stretching of muscles.
General stretches for improving the knee include quad and hamstring stretches. In severe cases this might start in a seated position and flexing and bending the leg, then adding a weight or using a theraband to add resistance. Once comfortable, standing or using the gym to stretch and eccentrically load the hamstrings and quads can help build up stamina. Incorporating work for the glutes and lateral rotators of the hip will be additional areas to focus on, perhaps if there is a biomechanical imbalance. So activities such as lunges for hip flexors, or using a band around the thighs to activate hip abductors can be beneficial. Stretches should be performed to a 3/10 in terms of discomfort and any strengthening should be varied and kept to just below the onset of symptoms so tolerances can be built up.
Identifying the factors that contribute to knee pain and then providing a treatment program to redress these imbalances takes time and requires commitment from the client to resolve. This is just like any rehabilitation program where you need to reduce muscular tension and develop a new habit to learn correct patterns of movement.
Obviously this is just a brief overview and summary of running injuries but hopefully it provides you with an idea of the scope of work that a clinical massage therapist could help you with. If you would like more bespoke information then please feel free to book in for a session.
However, the evidence for stretching post event is inconclusive. What is highlighted is how people perceivestretching helps them: it is part of their cool down, enables individuals to feel they are getting rid of muscular tension from their chosen activity; helps them to feel realigned, it is part of their psychological de-stress from the activity; it has meditative effects; it prepares them to calm down the autonomic nervous system, etc.
Many people who complain of low back pain are told that they lack core stability. They then embark on a series of exercises with varying degrees of success. However, core exercises alone do not always lead to improvement in low back pain. So what else could be implicated?
