What Are You Running For?

After the runner’s high fades…ouch!

It’s marathon season in the Northeast. Thousands of people participated in the ING NYC Marathon on November 3rd . For those who may not know, the race traverses all corners of New York City’s 5 boroughs covering a distance of 26.2 miles (never forget the .2). Three years ago, I volunteered to provide post marathon massage to members of the FDNY; all of whom took part as a charity effort, competing against the NYPD‘s team. I think the firefighters made the better time that year – gotta love them!

Outside of marathon training, many New Yorkers whose favored form of exercise is running describe themselves as runners and only runners. I found this fascinating, for as much as I train in Thai kickboxing, I never call myself a kick-boxer. Other people I know who incorporate Olympic lifting into their workouts also will never call themselves Olympic Lifters. So why do people who run become so defensive about their running. When told, Oh, so you like to run? their immediate reaction is No, no…I’m a runner. I run (insert mileage/distance covered) every day, such and such times per week followed by accolades like and I’m about to do my third marathon.

After the initial defense, to which you nod and note their determination and dedication, they begin to list their assorted musculoskeletal injuries. This is where my mind really gets blown. Is it normal for a thirty four year old non-athlete to have had multiple knee and a hip replacement surgery? Answer is no; however their injuries  are worn like metals of honor. What I have also come to realize is the more they are able to run through the pain, despite their cartilage and tendons fraying to strands, the prouder they are. The only way you would know that something was off would be by observing their running gait (professional eye helps in that department) and the appearance of their knees and hips post run.

A little self massage of the Plantar Fascia…

Since many of my clients in the last two weeks have been runners, I decided to share with you all some of the more popular injuries experienced amongst this group. Blisters, weakened toe nails and callouses aside, feet suffer from the manner in which the individual runner pounds the pavement. Plantar fasciatis is an inflammatory condition that affects the connective tissue sheath that covers the sole of the foot. This inflammation leads to heel pain that radiates to the center of the foot. We test for it by pressing a thumb into the base of the great toe and extending the entire foot.  Most clients that I have had with this condition feel it more acutely in the belly of their arch into the medial/inner side of their foot. In normal walking gait, our heel strikes the ground first followed by a rolling out of the balls of our feet from left to right to push off for the next step. Running gait sends the strike further up into the middle part of the foot. In the case of plantar fasciatis, the runner is usually putting too much roll/strike into the inner arch of the foot, which leads to the inflammation they experience and related pain pattern.

Sharply related to the bottom of the foot is another condition known as Achilles Tendinopathy. The achilles tendon is a thick band of connective tissue that anchors the calf muscle’s two heads into the heel of the foot. Constant wear and tear from activity leads to degeneration and a weakening of the tendon, which makes it vulnerable to rupture. The areas that are weakened often feel tender to the touch and the tendon itself appears thicker looking. Much like with the plantar fasciatis, it is believed that an over rolling/striking into the inner arch of the foot can cause the achilles to become over strained, thus leading to the tendinopathy. The only way to heal both of these conditions is to reduce activity to allow for the collagen fibers to rebuild/repair themselves. Also, the wearing of insoles and a correction of one’s striking gait can help. However, many runners do not allow themselves this rest and repair time. At some point, it will become impossible to take even walking steps, let alone to run.

Achilles Tendinopathy in the left foot is clearly delineated by the black marker – thicker, misshapen and you bet, painful!

Moving further up the leg we have a condition that affects both the knee and hip known as Ilio-Tibial Band Friction Syndrome. Stats say that over 10% of runners will experience this condition at some point in their running life. Much like the other two overuse conditions mentioned, this one occurs from excessive training/activity. The locus of pain is on the outside of the knee over a bony prominence where the IT Band passes over each time the knee flexes and extends. It can radiate down into the shins or up into the hip, where the IT Band originates. It is super painful during activity and for some, even at rest, depending on how aggravated that huge strip of fascia is.  Stretching the glutes, especially the sides which encompass your little kickboxing muscle behind the pelvis known as the TFL, definitely helps as well as correcting, like the other two conditions, running gait and posture. But again, these conditions stem from pushing one’s limbs to their limits. In tandem with Ilio-Tibial Band Friction Syndrome, there is also “Runner’s Knee” or Chondromalacia Patellae. This condition is an inflammation of the underside of the patella or knee cap which leads to Patellofemoral Pain Syndrome.  This area is covered by smooth cartilage that normally allows the femur to glide easily when the knee is bent. However in runners, the constant friction causes the cartilage to get irritated which leads to thinning and softening, hence the moniker chondro (cartilage) and malacia (softening). Also, if one’s gait is out of alignment, the patella will not track properly and will also irritate the cartilage. A tight IT Band also relates to this condition as do the Lateral and medial quad muscles. Knees will crackle audibly with pain often felt in the front of the knee and on the condyles of the femur slightly above the knee.

If you wear all your cartilage away, surgery is the only route you will be covering.

Outside of physiotherapy, anti-inflammatory medications and icing one’s painful parts, taking the time to properly heal tissues, which should include massage to break up adhesions (i.e. knots or stuck points in tissues), clear toxins, build up the blood supply and elongate taut fibers will extend one’s running “career.” Let’s face it. If you are going to call yourself a runner and wear your battle wounds proudly, you should also invest in the care necessary to make your mileage count!!

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Gouri, 2013

It’s a New Year and with that come the flood of resolutions, made with good intention, to have a fresh start of things. What often tops these lists are changes in diet and exercise. Gym memberships notoriously surge in the beginning of the year, while kitchens are cleaned out of their sundry contents to be replaced with all kinds of leafy greens and organic snacks. After a few weeks, the novelty of the fresh start wears off and for many, old habits die hard.

One of my New Year’s day clients joked that massage should be at the top of his list for 2013. In fact, all the clients I saw on that day expressed wanting to begin their year on a relaxed note. Many of them had received these massages as gifts. The Greeks call this gouri, a gesture or gift of good luck typically given to family members and friends for the New Year. Honestly, it’s a brilliant commitment to oneself to reduce stress and bring balance to the body on a regular basis. Think of all the cumulative affects of a chaotic lifestyle, rife with packed schedules, inhaled meals and little sleep and the investment of one massage per month becomes feasible. This is what I tell clients when they cannot fathom the cost of such a “luxury.” If you can spend $80 to $100 on frothy coffee drinks per month, then you can afford one massage. 

It’s pretty and smells delicious, but doesn’t last very long.

I could post heaps of statistical data supporting the benefits of regular massage on health, immunity, mobility, recovery and performance, but I won’t. What I want readers to keep in mind is a word I mentioned above – commitment. Many of us have a problem honoring commitments made to ourselves; moreover, the list of resolutions we make at the beginning of each year to change this, that or the other is a bit of a joke when we have no intention of doing anything. Why even make a list at all? If you can commit to just one thing at the start of each month, I am positive you will enact more self change then tackling an entire list in just January. Here are a few to pick and choose from:

  • Commit to one massage a month.
  • Commit to one session of strength training per week.
  • Commit to five minutes of deep breathing and/or stretching before bed every night.
  • Commit to taking the stairs at some point during your day.
  • Commit to 20 minutes in the steam room at the gym.
  • Commit to juicing one morning per week.
  • Commit to making your day off count for you!