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Ask the Practitioner: Back Pain

Written by Dena Evans September 17, 2012

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Dr. Waite holds a B.S. in Exercise Science from Creighton University and a Doctorate in Chiropractic Medicine from Palmer College.  She has treated the knees of professional cyclists, the hands of musicians, the backs of police officers, the shoulders of golfers, and the feet of marathon runners.  Dr. Waite is a certified Active Release Techniques (ART) and Graston Technique provider, and specializes in the treatment of all manner of soft tissue and repetitive strain injuries.  




rc: Many recreational athletes struggle with periodic back pain.  What
are a few of the most common problems you see as people seek treatment
in your office?


AW: Low Back Pain due to Psoas (long muscle along the lumbar region) tightness, Paraspinal Lumbar tightness (knots in the low back in muscles adjacent to the spine), and Sacroiliac joint pain due to ankle instability
rc: What are some common situational factors the average person can
avoid to in order to reduce the chance of developing periodic back
pain?

AW:  Common causes of low back pain include sitting for long periods of time and continuing to use your running shoes beyond 300 to 400 miles.  Since running is a repetitive motion exercise which can lead to repetitive strain injuries, don't put off making an appointment for myofascial release such as Active Release Technique.  Make sure you stay hydrated and don't over train!

rc: What can you do at home to encourage maintenance of a healthy back?

AW:  Simple things we can do include maintaining a daily stretch routine, getting up and moving around every 20 minutes if you have a desk job, going to a Pilates or Yoga class once a week, using your foam roller on the hamstrings, adductors, quads, and IT bands, and making sure you cross train as an increase in overall strength and core strength will give you a more efficient stride.


photoChef John Barone is a Michelin-trained private chef who is also in the midst of preparing for his second ING New York City Marathon in November.  With career stops at revered restaurants including the French Laundry in Yountville, CA, as well as Jean Georges and Per Se in New York City, Barone's cooking philsophy stems from his love of fresh and locally sourced ingredients and interest in healthy food for active lifestyles.  As he ramps up the mileage himself, here are a few of his tips for the rest of us trying to combine training and booked calendar with eating well.

rc: What are some prep tips for runners who are training hard and on the go?

JB: Revamp leftovers! Instead of looking down upon leftovers, turn them into new creative dishes. Grilled chicken from the night before can certainly be sliced and put into a wrap with fresh vegetables.
Plan Ahead.  After working a long day and then training, the last thing someone feels like doing is going home to sweat in the kitchen.  In the morning before work, get some of your prep out of the way,  e.g. chopping and marinating.  This may save 10-15 minutes before dinner is served, but it adds up!

On an off day from work, plan a day with time for cooking.  Prepare a few meals to last you 2-3 days. This way all you have to do is reheat!

rc: Fall is here.  What are some ideas for tasty seasonal dishes to prepare?

JB: When I think of fall, I think of apples! There are so many things you can do with them for a quick healthy snack. Cut the apple and drizzle on some melted dark chocolate.  if you feel ambitious enough, sprinkle with chopped walnuts and maybe a dollop of whip cream! YUM!

Soups are a great fix in the fall. There is nothing better to comfort you after that run on a cool fall day!  Pumpkin or squash soup is fantastic,  Cut either into small chunks then cover with chicken stock or water (to stay vegetarian)  Cook until soft, then puree in blender.  Season with salt, pepper, touch of cinnamon (and I always like to serve with a little creme fraiche)!

rc: What are the foods to avoid when eating out or night before a race?
 
JB: I would try and avoid fatty foods, shell fish, exotic foods or anything that one is not used to. Eat something that is familiar to you.  Stick with a meal higher in complex but with some simple carbohydrates, healthy lean protein, and not a lot of fat.  I always like to start with a healthy salad filled with lots of leafy greens and vegetables, and I usually have a piece of grilled chicken with some sauteed spinach and brown rice.


NEW iPhone app!

Written by Kate Tenforde August 21, 2012

perform iconNew name, new look, new feel!

The runcoach iPhone app is here!  Download it now!

Note: The latest version is called runcoach.  Version 1 was called
iRunning coach.

Now it's even easier to check and log your workouts on the go! 

This new enhancement is FREE for all runcoach members.  Once you download it, you can use the same username and password to access the mobile site.


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The first two weeks of August were filled with amazing performances, as well as the emotions that occur when things do not go according to plan.  When watching these breathtaking physical feats and (taped-delayed) moments of extreme anticipation, it can be hard to see a connection between the accomplishments of the world’s best athletes and our own everyday endeavors. However, there are several lessons these thrills of victory and agonies of defeat can teach us.  Here are a few:

1. Do not let a discouraging start prevent good things from happening by the end.

Early in the swimming competition, Michael Phelps barely squeaked into the final of the 400 IM, only to be assigned an outside lane and finish shockingly fourth and out of the medals.  For one used to the rhythm of “swim, win and repeat,” the walk from the competition pool to the warm down area must have been a long stroll without the interruption of the national anthem played in his honor.  However, by the end of the meet, almost no one looked upon his efforts as anything less than the coronation of the most decorated medalist ever.

Like many of our races, Phelps’s schedule was a marathon, not a sprint, and given the opportunity to turn things around, he was able to refocus and end on several high notes, with individual and relay golds alike.  Next time some other early mishap threatens to derail your day, (ie your alarm doesn’t go off, the first mile or two feels harder than it should, you miss your first fluids, etc) keep in mind the confident mentality you had the evening before all that occurred.  You are still that person.  Your training hasn’t just evaporated instantaneously.  Plenty of positives remain to be had.  Giving up mentally only assures you that you will miss out on at least some of those takeaways.

2. “Normal” is oftentimes more than good enough.

During the qualification of the women’s team gymnastics competition, elder stateswoman Aly Raisman was seen looking Gabby Douglas straight in the eye, encouraging her with the admonition, “Normal, Gabby.”    With some of the most complicated and challenging routines in the competition, Gabby Douglas was obviously prepared to do what it took, both for the team and her own all-around competition.  She just needed to execute and not let the big stage take her out of her familiar rhythm.

Many times we expect race day to be a completely breathtaking day and we act like it,  We feel the need to don a cape and become some “super” version of the boring everyday person who does the neighborhood loop at 6am.  By the time the gun goes off, you have prepared your body to handle the challenges by working hard on all the days when there is no adrenaline involved.  The excitement of the day may indeed make the same pace feel little easier to start, and that’s in your favor.  However, be confident in the work you have put in, that your “normal” will be plenty to accomplish your goal.  Take pride in the execution of your plan, and let your faithful and consistent adherence to it herald the success of the day.

3. Let your resolve be strengthened by your training partners and / or immediate context.

Galen Rupp took silver in the 10,000 meters, earning the first U.S. men’s medal in that event since 1964.  Ahead of him was only his training partner, hometown favorite Mo Farah.  Immediately behind both of them were the Ethiopian Bekele brothers, with Kenenisa the two time reigning 10,000 meter champion and world record holder.  Rupp has been one of America’s best for the past several years, but how did he kick these guys down?

As reported in the USA Today the following morning, Rupp told the press that the last lap reminded him of practice back in Oregon, saying, “I knew if I could stay close to Mo, then good things would happen.”   Some of us have the luxury of training partners or familiar faces in local races we can use to help buoy us when things are getting tough.  “If they can do it, then I can do it,” we tell ourselves, and many times, it works!  The larger lesson here, though, is that when we break challenging and formidable tasks down into smaller, more recognizable, and less daunting parts, we can relax enough to use our energy only for the running rather than the worry.  Focus on the things you know and can control.  Draw confidence from that knowledge and let the unknowns go.

4.  Ability needs execution to produce a result.

After several years of frustration, dropped batons, tripping and falling, and various other mishaps, the United States track and field relay teams finally put together four clean preliminaries and four crisp finals.  The women won gold in the 4x100m and the 4x400m, while the men took home silver in each.  Sure, the men’s 4x100m was beaten by a world record-setting Usain Bolt and company from Jamaica, but their silver medal time equaled the previous world record and set a new US best.  The women absolutely crushed the world record in the 4x100m and scared the US record in the 4x400, winning by a country mile.

While there are several strong medalists and performers among the current relay pool, the United States has always had a strong sprint corps, deep in every event, and capable of putting on a show like that every Olympiad.  The only thing stopping them has been the seemingly small detail of how to get the baton successfully around the oval.

For us, it is instructive to remember how special a performance or an experience can be if we just execute the small details.  Did we remember body glide?  Did we tie our shoes with double knots?  Did we leave time to have a good breakfast and adequate fluids before heading to the line?  Did we follow our race plan and not get sucked out into a field of fool’s gold with several consecutive milesplits way ahead of pace?  We can’t control the weather or what others will do.  However, when we nail the basics, we can leave room for the special day to occur.  You may never run the backstretch like Allyson Felix, but then again, she may never run a half marathon or marathon, so in some ways (ok, in only one way) you’re even!



New Workout Descriptions

Written by Kate Tenforde August 16, 2012
We’re excited to announce our latest enhancement – new workout descriptions!

The content of your workouts will not change.  We are just making the workout descriptions easier to understand.  The new format contains an outline that reads like a cookbook and simplifies the times you need to run. Less thinking, more running!

 Your workout descriptions will change in 3 places:

  • Today tab
  • Training tab
  • Weekly/Daily workout emails

Here is an example of the enhancement in action:

 Before Enhancement                                                                                                      After Enhancement

 



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Claire Wood, Senior Footwear Product Manager (Performance Running) at New Balance

Claire Wood has spent a career working in running footwear design and sales.  After stints at industry sales powerhouses Mizuno and Brooks, Claire now works with New Balance in their Boston headquarters, leading the development of some of their most popular recent styles. 

rc: Sometimes when shopping for shoes, a salesperson will ask you to run a bit so he or she can analyze your gait.  What types of things are they looking for to help determine the best shoe for you?

CW: In this case, the salesperson is looking to identify any biomechanical tendencies – meaning what your body and mechanics by default are doing. This could include the popular overpronation, meaning to roll inward a significant amount that could lead to injury. Overpronation is very common, and a variety of stability shoes address this. Always tell the sales person what prior injuries or areas of pain you often experience. Pain on the inside of the knees or shins could be from rolling inward upon impact and can be easily remedied.

rc: What are the key aspects of a shoe that determine what kind of runner it is designed for? 

CW: Running shoes have gotten so elaborate that it can often be overwhelming to try to figure them out. Running shoes all fall within a certain category, Neutral, Stability, or Control. Neutral means that the footprint and basic design of a shoe is for a runner with a pretty efficient biomechanical gait. A stability shoe would have a higher density of material, found on the medial side of the shoe to bring additional protection to counter forces rolling inward. Control shoes are the highest degree of stability – and are less common than neutral and stability shoes. Always make sure that whatever you’re fit in feels comfortable, as nothing should hurt. In addition to the basic categories, running shoes offer a variety of heights which situate your foot in various positions off the ground. This is called “offset”, and is an important aspect of the shoe. Always make sure you’re never transitioning too rapidly from a shoe higher off the ground to a shoe much lower to the ground, also called a “minimal shoe”.

rc: What are some ways in which current shoe technology has evolved to better serve runners?

CW: The goal with any running shoe should be to make the experience better for the runner, and let the runner think about the run, not the shoe. Materials in the upper of the shoe have become much thinner and more pliable, allowing for a more secure fit with a much lighter feeling over the foot. The materials that make up the midsole – foams, rubbers, and plastics, are also significantly more innovative. The goal with technology in running shoes is that it improves cushioning, stability and the overall performance of the shoe. This could mean the protective element or the actual feel – be it bouncy or plush.

rc: What are the next frontier(s) for shoe design?  What kinds of challenges are you and other shoe designers looking to tackle over the next several years? 

CW: The next frontiers of shoe design are always focused around the goal of making the run better. Just as our iphones, laptops and vacuums are getting lighter – this is the goal of running shoes. It is important, however, to never sacrifice something in order to make a shoe lighter. For a runner logging a lot of miles or with an injury history – there is often a fine line. That said, the focus of footwear has shifted to not only include what is under the foot and on top of the foot, but the actual position the foot is in throughout the entire gait cycle. Having an awareness of this and helping runners better their overall form – feet, core and upper body included, is all part of what we believe is inclusive to footwear design. Thinking of the foot as an extension of the body, it is our duty to think of the footwear design as an extension of all elements that affect that foot.



Kick is a term used to describe an emphatic finish.  The final sprint is one way to talk about it, but many times, a kick can include a push that more closely resembles a tsunami rather than a crashing wave.

Whether you are running a one mile race or a marathon, sometimes a kick can help leave you with the definitive and lasting positive memory of a race that may not even have gone well otherwise.  So, what are some key things to remember as you prepare to unleash yours next weekend?



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Ask the Practitioner:  Barefoot Running - Why (or Why Not), What, How?


For this edition of Ask the Practitioner, we connected with Adam Daoud, an experienced runner and medical student, who while at Harvard worked extensively on research in the Skeletal Biology Lab.  His website states, "My current research interest lies in investigating the ways in which the human body is suited particularly well for endurance running and determining why Homo sapiens possess such incredible endurance running capabilities."  As a co-author of the studies cited below as well as work published in the journal Nature, Adam has narrowly focused in on the plusses, minuses, and implications of a growing trend among running enthusiasts, barefoot and / or minimally shod running.  Have you ever wondered if barefoot running would be good for you?  Read on for Adam's perspective......




rc: What are the potential benefits of barefoot running or running in minimalist shoes?

 

AD: I think that the biggest potential benefit of the barefoot style of running is reduced injury. The barefoot style of running that habitually barefoot and minimalist runners tend to use is a forefoot strike, landing on the outside ball of the foot before easing the heel down under the control of the calf muscles. This style of running minimizes the forces experienced at impact, which may help to avoid injury. Notice that this focuses less on what is under a runners’ feet and instead considers how footwear affects how runners use their feet and how this changes their style of running. My recent work looking at foot strike and injuries in collegiate runners found a nearly two-fold reduction in running injuries among forefoot strikers, none of whom were barefoot runners (Daoud AI et al. Foot Strike and Injury Rates in Endurance Runners: a retrospective studyMSSE, 2012.). This was a study about running form, more work especially prospective work needs to be done to look at the interplay between footwear, running form and injury. A singular focus on what runners strap to their feet can easily lead a runner into danger.

Another potential benefit would be financial savings. Since forefoot strike runners do not use the cushioning of a shoe to reduce the impact, shoes can be worn for many more miles before being replaced. As a forefoot strike runner, I usually wait until the upper is pulling off the lower before tossing shoes.

Studies on running efficiency have gone both ways. Our lab recently found that running in minimal shoes is more efficient regardless of foot strike and that there was no difference between heel striking and forefoot striking in terms of running efficiency (Perl DP et al. Effects of Footwear and Strike Type on Running EconomyMSSE, 2012.). While Rodger Kram’s lab has found that barefoot running is less efficient than running in lightweight, cushioned shoes (Franz JR et al. Metabolic Cost of Running Barefoot versus Shod: Is Lighter Better? MSSE, 2012.). But in general, a less injured runner is a better-trained, fitter runner so even if forefoot striking is not more efficient there may be performance gains by avoiding time off due to injury.

rc: What are the risks?

AD: While the major benefit of the forefoot strike running is injury reduction, the greatest risk is increased chance of injury during a runner’s transition from their current running form to forefoot strike running and possibly doing so in a more minimal shoe. Forefoot strike running puts very different stresses on the lower limb compared to heel striking. The muscles of the calf and foot have to do more work each time the foot strikes the ground while the bones of the foot incur impact and bending forces that are different than those experienced in heel striking. In addition, running barefoot or in a more minimal shoe will require increased muscle force to stiffen the arch of the foot and the bones of the foot may be subjected to less evenly distributed forces. Recent case reports have described instances of metatarsal injury in runners transitioning to barefoot running. Though if case reports were written up for all of the injuries sustained by “normal” runners, sports medicine journals wouldn’t have room for anything else.

Other risks are quite obvious such as injury to the sole of the foot due to surface conditions if a runner chooses to run completely barefoot. Though these risks can be greatly reduced by using your eyes and choosing smooth surfaces that are free of jagged debris. A hard surface such as a road or sidewalk can be a good surface.

 

rc: What are some sensible ways to experiment with barefoot / minimalist running to explore whether it is appropriate for you?

AD: The first thing to do is to decide whether or not your current form is working for you. If in your years, possibly decades of running you’ve found shoes that fit your running form and you’re not plagued by injuries then why change? But if you’ve struggled with injury as a heel strike runner then you might want to consider trying out forefoot striking. Unless they ask, my running friends don’t hear a word from me about running form until they get injured. This not only gives me a chance to figure out how much they’ve been injured in the past, but also transitioning to forefoot strike running can line up perfectly with returning from injury since you’re already running at a reduced volume and intensity. Transitioning should be done slowly and in accordance with what your body is telling you, just as you would any other new training technique such as weightlifting or plyometric exercises.

Concerning form, jump straight up in the air. Where on your foot did you just land? You should do the same when you run. Try out running completely barefoot on a track or smooth paved surface to try to get a feel for what it should feel like. Your bare feet will encourage you to run correctly as it will hurt to do otherwise. Don’t run barefoot on overly soft ground to learn good technique since the cushioning of the ground will allow you to run without good form. You can find more information including videos of forefoot strike running in various footwear on my past lab’s website.

The biggest mistake a runner could make would be to buy the newest, coolest pair of minimalist shoes and then go out and continue running in the same way they always have – heel striking – in their new minimal shoes. The heel cushioning of a standard running shoe will no longer attenuate the large impact forces of heel striking. Another mistake would be to consider the barefoot style as a panacea and to suddenly switch 100% of your running to forefoot striking. Your muscles need time to grow stronger and to learn the new firing pattern of a new gait pattern. And your bones need time to strengthen and remodel to adequately deal with the new loading patterns of forefoot strike running.



Our philosophy is to train at current fitness level to race at peak performance.  For that reason, we don't use goal times.  Instead, we use your past race performances to generate your pace chart and training schedule.  This is the safest way to progress to the next level. 

With that said, we encourage you to consider running a shorter distance race prior to your goal race (for example, a 5K or 10K).  We expect that as you start to condition, you will run an equivalent faster non-goal race.  The system will then update all your training to match your new fitness level.

To enter your new race time, follow the steps below:



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