Onward and Upward

Today I had a celebration of sorts.  A little personal victory party.  After spending the latter half of 2016 dealing with a stress reaction in my foot, I can comfortably say I am not injured anymore!  As a physio, I often advise my patients to mindfully avoid falling into a long term "disability mentality" when they are injured.  There comes a point when your body is healed, but it's easy to still think of yourself as "damaged," and remain fearful of moving normally, living normally.  Although it's still healthy and wise to be cautious post injury, consciously leaving that "injured runner" mentality behind is necessary and so liberating!

Today I completed my first 4 week training block after coming out of my boot.  I started slowly, so slowly, painfully slowly.  First I started replacing some of my bike time with walking on the treadmill.  Then I started moving into run:walk intervals, and then finally short steady runs.  Once I was able to run 4 miles with no walk breaks I moved outside, because I was then moving enough not to freeze to death!  My mileage has slowly increased and I'm feeling the need to hold back to stay in zone 1, which is a great sign. Finally.

All along the way, I gave my body small tests I strongly felt that I could pass. I was not interested in self-sabotaging this whole process and wasting all that valuable healing time I had spent resting. This is the criteria I give my patients, and I made sure to apply it to myself each and every day.

Before Running:
Pain-free walking before running. My personal test was 60 min on the treadmill.

During Running:
1) No obsessing about your injury. If you are aware of your problem with each step and you can't relax and forget about it for whatever reason, that's a sign that maybe you shouldn't be running that day.
2) No limping or altered gait allowed.  I constantly monitored my gait with the metrics from my Garmin, which meant wearing my HRM for all runs.  If my ground contact time R/L balance spread by more than 2% over the course of a run (L 51% R 49%) then I knew I needed to adjust my plan for the next few days.

After Running:
1) No lasting discomfort > 2 hours.
2) No increased morning stiffness or discomfort the next day.
3) Overall healing trend - each week is better than the last.

I just had a 3D Gait Running Assessment completed where I work at The Running & Gait Centre.  I can happily say there is nothing  biomechanically precluding me from running - no red flags.  In fact, my gait is better than it was last year! I'd highly recommend any recovered runner consider having one of our assessments done before starting to increase mileage, if for nothing else than peace of mind.  I'd be lying if I said that I am 100% pain free, but the vast majority of the time I am and each week is better than the last.

So it's time to leave that injured runner mindset behind and move on towards my next race goal.  I am finally confident enough to say that I'll still be toeing the line at the Zion 100 in April.  Very excited. Onward and Upward!

A Strong Body is Rarely a Painful Body

When you're not running, do you spend more time stretching or strengthening?  In my work as a physiotherapist at the Running & Gait Centre at the Pan Am Clinic, I have had the opportunity to perform many running gait assessments since we launched in November.  We have been performing assessments on injured athletes and on those who simply want to identify any “red flags” within their running biomechanics that could lead to injury in order to prevent any down time.  Already, I am starting to see some patterns and themes develop that confirm what many coaches and successful runners already know.  A strong body is rarely a painful body.

I have been known to say that if runners would spend as much time strengthening as they do stretching, I would see a lot less running injuries in my practice.  Coincidentally, lately I have found myself prescribing far more focused strengthening than stretching exercises to the keen runners who have come to our centre seeking solutions to their running injuries. Don't get me wrong.  Spending time stretching is good, but we can't forget strengthening as well.

Strength needs to be balanced and it needs to be functional.  A joint needs to be supported on both sides, side to side and front to back.  Multiple joints need to be able to work together as part of the whole lower kinetic chain in order to produce the desired motion for any sport.  Strengthening exercises for running need to replicate the desired muscle, joint or lower kinetic chain function as closely as possible to result in optimal biomechanical function and performance.

As your running season progresses and you find yourself spending more and more time logging miles, it’s easy to neglect your strengthening regime.  However, even a few short strengthening sessions per week can create better balance in your body and protect you from injury.  Here are some suggestions when choosing your strengthening exercises:

1. Make it functional.  Always ask yourself, ‘why am I doing this exercise?’  Keeping in mind this article is intended for runners, try to do most of your exercises standing up.  Better yet, consider standing on one foot as much as possible, as 100% of running is spent with either one foot or no feet on the ground.  You will improve not only in strength, but neuromuscular control, balance, proprioception and your ankle and foot cannot help but get stronger.
2. Go minimal while strength training.  As long as it is safe and allowable to do so, wearing minimal shoes or going barefoot while doing your functional strength training encourages your foot and ankle muscles to work more.  You will be able to sense fine adjustments needed to stand stronger on one foot while barefoot than you will with your running shoes on.  Try to keep your arch engaged (pretend there is a pebble or tack under your arch) and your toes relaxed, while avoiding rolling onto the outer edge of your foot. This encourages the deep muscles in the sole of your foot to work optimally. 
3. Work multiple muscle groups at once.  Not only is this more functional, but it is more efficient and every runner knows that time is precious.
4. Don’t neglect eccentrics.  The eccentric or negative function of a muscle is a controlled lengthening contraction.  Running is essentially a controlled fall with every foot strike and your muscles need to slow the impact force of your body weight as each foot hits the ground. This happens eccentrically for most muscle groups and is where breakdown of the body and injury most often occurs.  For each exercise you do, try a 2:1:4 tempo, where you shorten the muscle on a 2 count, hold for a 1 count, and lengthen or return to the starting position on a 4 count.
5. Optimize your core for running.  We all know that having a strong core is important and there are dozens of great exercises out there.  Generally, while running the core functions to control rotation and derotation as we transfer energy from one limb to the other with our arms swinging in the opposite direction.  While you will be generally working your core if your workouts are functional, you should incorporate specific core exercises that involve reciprocal motions similar to running, such as mountain climbers, reverse mountain climbers, and the bicycle.

Bicycle

Mountain Climbers

Reverse Mountain Climber

Reverse Mountain Climber - TRX

If you have very little experience with strength training, consider asking for help from a professional such as a coach, personal trainer, or physiotherapist.  If you know your body is a little bit complicated or cranky, and you want a tailored plan to address your specific weaknesses, consider visiting us at the Running & Gait Centre for a comprehensive biomechanical and physical assessment. We’d love to help!

Kim Sénéchal is the lead physiotherapist at the Running & Gait Centre: Foundation Rehabilitation Services at the Pan Am Clinic.  She is also an ultra marathon runner and run coach.

**This article was originally published in the Manitoba Runners Association February newsletter, On The Run.

Pay Attention

Two weeks ago today I was rear-ended at a stop light.  Had a sore neck for about a week, but last week felt "fine."  Two days after the accident I went to hot yoga after a run and struggled with poses that I'm usually rock solid in.  Hmmm.  Must be tired.

Then I ran an easy 10K in the COLD and felt my L iliotibial band starting to tighten up.  I blamed it on the cold, but it scared me because 10 years ago I had the same thing happen and it sidelined me for months.

A week later I finally got back to the gym for the first time since the accident and during my usual single leg stance balance and lunge exercises I could NOT stand on 1 foot for the life of me, especially the R foot.  I was struggling and looked like I was standing on quicksand.  It had been too long since my last workout and I left feeling weak.  I hate feeling weak.

Then yesterday I did my long run and after only 5K I felt the peroneal tendons in my L ankle start to ache.  After the run my L achilles seized up.  As I hobbled up the stairs to get food I wondered if I was falling apart a mere 3 weeks into my year long training schedule.

Then I looked in the mirror.  Those constant hunger pains had left me with some nicely developing abs.  No I do not spend long hours gazing in the mirror at myself.  But the trained physio eye in me did note that my abs were not symmetrical.  My R abdominals were more active, my L abs underactive, my hips were sitting at different heights.  A light switch came on.

My pelvis was out!  I did a few quick landmark measurements on myself and all of a sudden things made sense.  I was NOT falling apart.  I was just not quite together.  In my pelvis that is.

Way back in 2004 I struggled during my first marathon training season through severe left IT band syndrome.  I had tried EVERYTHING to treat it, but it only resolved when I discovered that my left sacroiliac joint was totally locked which made my pelvis dysfunctional.  Once that was treated, I ran the marathon (relatively) pain-free.

I could tell the same thing was happening again.  And it all started a few short weeks ago after being rear-ended with my R foot on the brake.  After a quick check-up by a coworker this morning here's a summary:

1) L leg longer 1/2"

2) L side of pelvis rotated forward

3) L SI joint very stiff

4) R SI joint very mobile (unstable)

5) hip flexors totally locked down

It is notable that since the accident I have not felt ANY low back or pelvic pain.  Upper back and neck pain yes, but no pelvic pain.  But there was a waterfall effect down my legs that started to create a mess all over the floor given enough time.

Result: A quick treatment at Foundation Rehabilitation Services @ The Pan Am Clinic where I work, and a lot of focused stretching and self muscle releases and I worked out today feeling like a rock.  Solid and stable on one leg and very much relieved that I had paid attention to the warning signs that something wasn't quite right.

My warning sign:  I know that I am rock solid in the single leg squat or stridder (click for video).  All the time.  After 2 workouts where I could not control my knee over my ankle I knew something was wrong.  This is a great self-check for any runner, as long as your strength is good and you can do a single leg squat during healthy times with no difficulty!

Moral of the story: Know your body.  Pay attention to your body.  React when you can tell something is not quite right.  I have the luxury of a trained eye and years of running experience to guide my instincts, but if you are not sure what's going on, get professional help.  I sure hope this is the last of my pelvic instability issues.  If not, my car insurance will hear from me :)