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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Trigger Points – the baggage our muscles hide!

Is this your back?

If the above image gives you the impression that a group of assassins  are ready to fire on you, stay with that feeling.  No one is immune. They hide in your muscles and sinews waiting for something or someone to activate them. Some gather in groups while others migrate to new territory, but more often than not they refer their pain elsewhere to trick you. They are trigger points.

A trigger point is defined as a hyper irritable spot within a taut band of skeletal muscle that elicits pain locally when compressed, but can also refer it elsewhere or be accompanied by muscle spasm. When touched, these spots can feel like hard nodules ( i.e. the “knots” we so often refer to in our backs and other body parts). It was Dr. Janet Travel, physician to the late president John F. Kennedy, that first came up with the term when she noticed that these points of pain tended to happen in predictable patterns that could be mapped out on the body. Her maps can be found in the 2 Volume book she wrote with David G. Simons, “Myofascial Pain and Dysfunction: The Trigger Point Manual.”

How do you know if you have one or more of these bad boys lurking in your tissues? There are a few characteristic symptoms which include sensitivity to pressure in a muscle, stiffness accompanied sometimes with a pulling sensation emanating from a particular point in the muscle, pain that refers from the point compressed to another area of the body and pain that has a dull, aching or burning quality to it.  Other symptoms sometimes experienced are various autonomic phenomena like dizziness, sweating and fever as well as headaches, numbness, loss of range of motion and dysfunction of the muscle involved. While the cause of trigger points remains a much disputed medical topic, it is safe to say that they most commonly occur when muscles are chronically overloaded, as in the case with occupational and exercise overuse, injury and poor posture. Also, chilling of a muscle (i.e. catching a draft or having an air-conditioner blow on you) and the position in which you sleep can also create these points. Sometimes these points are even triggered by emotional and stress related events.

Any qualified massage therapist (ME!) possesses the skills needed to deactivate these points and treat the surrounding tissues. In my opinion, your first course of action should be massage therapy. Thereafter, if the points do not resolve within a few treatment sessions, you should be referred to a chiropractor, osteopath or physical therapist, all of whom employ more aggressive treatment measures. The protocol used to address trigger points via massage is a combination of sustained compression of the point followed by cross fiber friction and deep strokes in the direction of the muscle fibers to clear out metabolic wastes and encourage the flow of blood into the affected area. I am a huge fan of a myofascial technique known as skin rolling. It literally involves me picking up your skin and rolling it along different angles between my fingers, almost like cookie dough. This is an important diagnostic tool for me to find these stuck points, especially if a client is unsure of the location of their discomfort. The sustained compression of these points temporarily stops the pain signal coming from the brain and the flow of blood to the area, so that when it is released, blood literally floods the point and washes wastes away. The first compression is always the worst because the pain level will be greatest then. It is super important to breathe through the 8-10 second count, as the point is held. On a scale of 1 to 10, the pain/discomfort should be around an 8. With each subsequent sustained compression (about 4 in total) the pain level will dissipate while the force of compression stays about the same. During these compressions, many clients will break into a sweat or become hyperemic (flushed) in the area of the trigger point. Sometimes there are twitches in the muscle or surrounding tissues near the point being worked on. Even stranger, the point can move while I am compressing and I literally have to chase it through its migratory path until I shut it down. Once the compressions are finished, the point is rubbed vigorously in a cross fiber pattern between 1 to 5 minutes and then all the fibers of the muscle get treated to a nice and slow, deep rub down. I like to then apply a bit of heat in the form of a heated dry towel (no more than 10-15 mins on) or a topical irritant like Tiger Balm.

Best case scenario, trigger points will get resolved in one intense session, but more often than not, multiple sessions are needed to deactivate years of evil. It’s extremely important to assess what is going on or has happened in your life, both physically and emotionally that, although your brain might have dismissed, your muscles and tissues beg you to notice. This awareness will help you focus your attention back onto yourself and deal with the baggage at hand because trust me, your muscles have better, more productive things to do than carry the weight of the world in their nooks and crannies.

Additional reference available at:

http://en.wikipedia.org/wiki/Trigger_point

NOTE **Read personal trainer, running coach and kayak instructor, Jeanne Andrus’s post about her experience with Trigger Points. I think it to be a helpful read:

Trigger Points