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!!

Advertisements

YELP me

Def: To utter a short, sharp bark or cry (i.e. to review)

Addendum/Update 10/18/12   It was reported on news-radio this morning that YELP is going to crack down on companies creating fake reviews to market themselves. There will be a “CONSUMER AWARENESS” label on the profiles of the businesses that have done that to let potential clients/patrons that they are guilty of this offense.

Never underestimate the power of a review.

Positive or negative, someone’s assessment of you can and will have an impact on how other people perceive you. The internet is an infinite source of information, posted by all walks of life and intelligence. For this reason, I always take what I read with a grain of salt because I understand that not everything that is published on the world wide web is absolute, unbiased TRUTH. In the field of social psychology, attitudes are an important factor in the evaluation of a particular thing. Our attitudes influence our beliefs and often, our behavior. We form our attitudes in a variety of ways. Personal experience, observation of others’ experiences, social expectations and societal codes of conduct all help to shape attitudes. Another important factor is conditioning, a process of behavioral modification where a person is made to associate a desired behavior with a totally unrelated stimulus. Example: Any commercial ad that shows a subject in an idealized state resulting from the shampoo they used, the drink they are holding or the perfume they are wearing, etc. This is classical conditioning at work and most of us are not conscious to the fact that the ads have worked in this way. Operant conditioning is a little more obvious. A behavior is associated with either a reward or a punishment. The reward, as in getting a bonus for working longer hours, increases a behavior while the punishment, like being asked to leave a restaurant to smoke your cigarette, is said to decrease the behavior.

Keeping in mind that other people’s experiences can form attitudes and thus, influence belief and behavior, you can understand how a review functions on a larger scale. As soon as it is published people will read it, comment on it, re-post or email it to their sites and contacts, tell their friends via social networking sites, “like” and “favorite” until the information has taken on another life altogether. One extremely popular and useful site for reviews is a place known as YELP, where ANYONE can review just about ANYTHING – from spas , to restaurants, schools and even the Department of Motor Vehicles. All you need is an email address to make or break someone’s career. Many businesses have started to realize just how much of an affect these reviews are having on their sales. As a result, some have started providing incentives for positive client reviews and discounts or complimentary services for negative ones. I have seen firsthand how a devastatingly negative review of a colleague led to the comping of the treatment provided and a gift card to use towards a future purchase down the line. Weeks later the same client wrote a second review thanking the establishment for taking such good care of the situation and noting that they would be back with friends soon. In this way, the business did not lose face or future client $$; however the downside is that my colleague’s professional reputation was negatively affected. Any future clientele that come across this review could potentially choose not to book their appointment with this therapist for fear of the experience happening to them. Case in point, I received a booking request recently based on the review another client of mine had posted, singing my praises. This new client’s positive attitude was influenced by another person’s experience of my skills and work.

Here are my thoughts: Before you rush to express your positive or negative experience via the internet, take a minute to assess the gravity of your words. If something truly feels relevant enough to be shared in this manner, I absolutely agree on posting the information. After all, I too YELP; however we all have to possess some level of accountability. For instance, if I am having a bad day and the barista behind the counter at the coffee shop messes up my drink order, that doesn’t mean it was done on purpose or that he/she is an idiot. Also, if I am just getting over a cold, the massage I am receiving may actually make me feel worse the next day. That isn’t the therapists fault; I should have said something. And speaking of sharing important information, an esthetician had a client who never wrote on her intake form that she had a heat sensitivity a.k.a allergy. After the wax treatment, the client claimed that the wax had scalded her. The esthetician, obviously concerned, addressed the client who then admitted her allergy. After pointing out that she never mentioned this to her before or during the treatment, the client proclaimed, “Well, it’s not like you asked me?” Again, accountability applies here. Very few people are truly “psychic” so if you know you have a problem, say something. If you sense a little attitude in what I am saying, perhaps it will influence you to be a little more scrupulous when sharing your TRUTH with others.

Give like a Rubberband

Within the lyrics of my favorite Kate Bush song, “Rubberband Girl” is the following statement:

“If I could learn to give like a rubberband, I’d be back on my feet…”

While we can’t all be Gumbi, the flexibility that we are born with can be conditioned further through exercise and a wonderful thing called stretching. Your joints are designed to move through space with the help of your muscles, tendons and ligaments (we all have these parts). The ability to take your joints through their entire range of movement and maintaining this range is an important part of injury prevention. Measured in degrees, flexibility diminishes with the passage of time and the amount of wear and tear on our joints and tissues that comes with aging.

That being said, there are very right and very wrong ways to stretch. The best route to go is to have a stretching program designed for you, much like a fitness program, that is based on detailed analysis of the activity/sport/conditioning that you engage in, your medical history and your injury risk factors. As a licensed massage therapist, prescribing stretches to my clients as part of their aftercare is within my scope of practice, but to design a stretching program I would consult with a personal trainer and physical therapist for input in tailoring the stretches to my client’s needs. Ideally, it is amazing to be able to work with these fitness and medical professionals as a team, much like you see in any professional athlete’s training entourage, to improve the performance and recovery time of the client.

Professional that I am, I am guilty of stretching incorrectly. I realized my folly after an especially intense set of yoga classes. I felt incredibly long and leaned out after each class, partly because visualization is a key part of really settling into the practice. I pictured my limbs extending beyond me to the front and back walls of the room, pulling my extremities ever further from each other like a yogic “rack” of sorts. At the same time, I was also working with my trainer twice a week doing a combination of weight training and Thai kickboxing. I believed that my leg strength would improve with my yoga practice. Yes, I could definitely kick my leg up to my face, but what I felt was a surprising weakness in my quads. The plyometric squats that I once could do 3 sets of 20 holding 15 pounders in each hand became impossible. My thighs shivered after only ten reps. After consulting with one of my professors, I realized that by overstretching my Quad muscles, I had made it a lot harder for them to contract. The demand I made on these muscles to perform the way I was used to in training was too much in this over-lengthened state. Even scarier than weakness, muscle fibers that are over stretched can sometimes rip, also known as a strain or “pull” which thankfully did not happen to me. Usually PAIN when stretching beyond the limit will indicate something has gone awry in there. I took a couple weeks off of yoga and within 2 to 3 training sessions, was right back at the level I had been prior to the overstretching. The experience was a cautionary one.

When designing a stretching program there are two types of stretching techniques to take into consideration – static and dynamic. A static stretch is when you take the muscle being stretched to the point where you feel tension (not PAIN) and hold it there. After a certain period of time (under 30 seconds) the hold tricks the brain into telling your tendons to let go, thus lengthening the muscle further and increasing your flexibility. Holding the stretch for more than 30 seconds was noted by researchers to have a negative affect on athletic performance, as it undermined explosiveness and power. Dynamic stretches take the muscle through its range of movement slowly and deliberately, gradually increasing the speed of the movement over a period of time.  Therefore, a combination of short term static stretches and dynamic stretches that mimic the movements of my sport have proven to be the most effective way for me to prepare and repair my muscles. Coupled with massage, my stretching program has rendered me injury free for sometime now (knock on some wood, please). Learn to properly let your body give like a rubberband, as Ms. Bush sang, and not only will you be back on your feet, but ready for action!