In this edition of Ask the Practitioner, we again connect with Mark Fadil, Clinic Director at the Sports Medicine Institute (SMI) of Palo Alto.  SMI is one of Northern California's leading orthopedic and deep tissue massage resources, assisting both world class and recreational athletes since 1996.  

RC: Tight and/or sore calves are one of the most common ailments for new and experienced runners alike.  What exactly is happening when one feels like his or her calves are tight and they have become sore to run on? 

MF: Sore/tight calves are a very common problem with runners.  Generally someone may experience sore calves when running for the first time, coming back from time off, during a period of increased speed work or during a period of increased mileage.  In each one of these circumstances the calf muscles are adapting to the stress from the increase in activity.

RC: When treating runners with sore calves, what are the most commonly reported practices that have potentially led to the problem? 

MF: There is normally some sort of change that precedes sore/tight calves.  In addition to the changes I already mentioned it can come from a change in running shoes (usually a shoe with a lower heel such as a racing flat will put more stress on the calf), a change in running surface or increased hill running.

RC: What techniques do you and your staff employ to address this problem and what can runners to do maintain the work at home? 

MF: I usually focus on three things: massage, stretching and functional strengthening.  Massage can be done by a professional therapist or at home using a foam roller or "the stick."  This can be done on a daily basis for 5 - 10 minutes.  Stretching should focus on both the upper calf (gastrocnemius) using a straight knee calf stretch and the lower calf (soleus and Achilles) using a bent knee calf stretch.  I recommend stretching after massage as well as an additional 2-3 times a day.  Each stretch should be held for at least 30 seconds.  Functional strengthening is one of the most important pieces in preventing sore/tight calves from occuring in the first place.  A great way to incorporate functional strengthening is doing heel drops off the edge of a stair.  These should initially be done on a daily basis and eventually shifted to two to three times per week for maintenance.

Few life changes will have a greater impact than the arrival of a newborn.  Both the physical challenges for mom, as well as the stark changes in family schedule and breadth of responsibility for both parents can justifiably upend priorities.  This can wreak havoc with the comfortable patterns of habitual runners.

Chances are, unless you have had a very quickly moving adoption, you have been well aware that changes in your running routine await the arrival of the new bundle of joy.  Very likely, transitions have already occurred for mom with the ups and downs of pregnancy.  Whether a quick return to work or flexibility for extended parental leave is on the horizon, here are a few tips and ideas for runners in the throes of new parenthood:

Consider how baby gear purchases, such as a stroller, can assist you in the eventual pursuit of a return to running. Yes, that sounds crass – you are about to enjoy one of life’s greatest blessings, and running should come to mind?  Well, if there is anything that you intend to continue doing on a regular basis after your baby comes, it probably saves time and money to anticipate how you can manage that practice within the context of your baby’s first few years at home.

For example, many running families use a jogging stroller (or a stroller with that capability) for their primary stroller.  Initially, it can be used for regular stroller duty, particularly now that many jogging strollers can attach baby carriers and inserts allow for extra padding with newborn babies.  When eventually jogging becomes appropriate with the little one, everyone is used to the new gear, how it fits in the car, the baby finds it to be a smooth transition, and more enjoyable / contented baby running might result.

Moms: set a completion goal, but no sooner than 6-12 months after giving birth.  Dads: choose flexible goals in the first year.

While the experience of every mother is different, having a goal to shoot for can often inspire (to lose weight, to re-grasp a feeling of independent personhood, etc) when life seems completely turned on its head.  Set a goal too soon, and it may become a needless stressor, both logistically, and physically, when the body is out of shape and sleep is minimal.  Set a time goal too soon after giving birth, and the unpredictable physical aftermath of motherhood can create frustration.  By a year, many moms are beginning to recognize their bodies again, and having a date to look forward to (as a return to the experience of being an athlete) can be a very motivational tool.  Just enjoy your first goal race after baby to celebrate how far you have come.  Use subsequent goal races to return to previous fitness and pace levels.

New dads are also saddled/ delighted with the many transitions of fatherhood, but many times must navigate a tricky landscape of an initially supporting role in the physical sense.  Without the obvious setbacks of pregnancy and giving birth, it may be enticing to set a big goal, almost in celebration of the new family member.    However, in this particular instance, it is worth considering flexible goals.  Neither of you quite know how you will feel physically or rest-wise as these dates get closer, and the last thing needed is more stress.   One option to keep dad on track could be to pick a distance goal with three or four options in 60 day range.

Have patience with your body after baby (yes, dads too!)

For many first time parents, the adrenaline of new parenthood eventually wears off, but many nights of limited sleep remain.  Schedules change and keep changing.  Things like foam rolling, stretching, strength routines, and other ancillary activities may be cut out to preserve what little time remains to run.  Unsurprisingly, aches and pains might crop up, and the legs might not recover as fast.  Control what you can control.  Consider occasionally modifying your running routes and other patterns to avoid a fruitless comparison contest with your well-rested self.

For moms in particular, resist the urge to return to serious training until you are cleared to run by your doctor.  Be sure to progress incrementally.  Just like a marathon recovery that is too short, a postpartum running injury may not crop up immediately.  Rather it often surfaces after the premature progression has been established over several weeks or months.

Shop and prepare for running with body after baby.

One of the most common roadblocks to a successful return to pre-baby running fitness can be the first few efforts out the door.  For many moms, postpartum bodies feel like complicated new appliances with misplaced instruction manuals, what with the likely weight gain and the new demands and dimensions of various body parts.  All of us know better than to establish self-esteem from outside appearances, but without a couple running items that fit, it can be that much harder to get out and get started.  Having a high impact / supportive sports bra and shorts that fit your current size can make a difference, and are worth shopping for even in advance when you have more flexibility in your schedule.

When it comes time for stroller jogging, find the bike paths.

Just as parents at their wits’ end will drive a baby around the block, hoping to induce sleep, the stroller experience for your baby / toddler can vary wildly from soothing to disruptive, which in turn may have a direct impact on your ability to reintegrate running positively into your daily life.  Bumpy roads, streets with many stop lights, turns or undulations may be your only options, and by yourself, you might barely notice these parts of the route.  However, the stroller years might also serve as a chance to get to know the flat, off street routes in your region better than you might have before, and allow the jogging stroller experience to emerge as a positive parenting interactive time rather than a struggle of wills.

Here are a few tips to help keep up with nutritional demands in the midst of a hectic daily schedule:

Keep a full water bottle on the bed stand and drink first thing in the morning. We know we should hydrate.  We also know we shouldn’t rely on coffee or Diet Coke all day, but are inclined to do that in order to stay “up” for the various challenges in our path from 8-5 (or longer).  Water also aids in digestion, allowing our bodies to assimilate the good (or not so good) food we consume in a more efficient way.

The best way to ensure you act on good intentions is to eliminate the obstacles holding you back.  You may forget a water bottle at home and/or yet again arrive to the start of your run, under-hydrated. In an ideal world, you should hydrate systematically throughout the day, with sports drink as well as water.  Be sure that your blood has plenty of electrolytes and that you have replenished sufficiently from perspiration in your last training session.   Failing that scenario (and that scenario is often failed), make sure that you’ve at least given yourself a fighting chance by getting some H2O down the hatch before you do or eat anything else.

Buy a box of your favorite bars and stash them everywhere.

Fueling during, before, and after your strenuous training is key to recovery as well as to just accomplishing the task in hand without hitting the wall.  Many times we are coming from work or another commitment, heading out first thing in the morning, fitting in a run at lunchtime, or otherwise shoehorning our workout into the sliver of time provided by the rest of the day.  Many times, that means we don’t have handy nutrition.  As a a result, we end up waiting too long to eat after a run, crash during a workout, run out of energy to even start, or finish with less punch because we ran out of gusto midway through.

Next time you are at Costco, Target, the supermarket, or shopping online, instead of purchasing a bar or two for the current instance at hand, purchase a box.  (Added bonus - this is often less expensive per unit.)  Take a few and stack them in the glove box, your briefcase, your purse, your desk, your sports bag, and in any other household vehicle you might end up driving to a run.  You’ll immediately forget about these anyway, and probably still try to address your nutrition needs on a day to day, run to run basis.  However, when you inevitably find yourself on a day where you have nothing to eat before, during, or after a run, a light bulb will go off above your head and you will be very glad you have your secret stash.

Get in the habit of always ordering salad on the side.

More than ever, Americans eat meals out of the home.  Social, work, athletic and other commitments leave us in need of quick meals or require us to socialize over a meal.  We all have been told since childhood that vegetables are an important part of our diet – after all, they provide crucial vitamins, minerals, fiber, and digestion regulation.  There will be plenty of times when a healthful set of options is not available.  When the opportunity is presented, always order the salad (and eat it without heavy doses of dressing).  Many times, salad is an option instead of fries or chips, vegetables are negotiable when ordering a sandwich, or a salad is possible to add on the side of an entrée for a nominal cost.  Always take this option, and you will mitigate the effects of the unavoidable bad nutrition situations you must navigate the rest of the day.

Have a healthy snack before you go

If your schedule requires you to eat out, if your office seems to have donuts or somebody’s birthday cake lurking in the break room more than once a week, or even if you are headed to the movie theater or a sporting event, have a piece of fruit or a healthy snack beforehand.  Chances are, what you have at home is less processed and better for you than concessions, party food, or sheet cake.  It is often very difficult to avoid over-consuming foods that are not helpful to your athletic goals.  By taking the edge off with a healthy snack beforehand, you increase the chances that you will make sane choices and employ appropriate portion control.

Of course, many non-runners lead busy lives and have a hard time staying on top of good nutrition.  Undoubtedly, running a session of mile repeats or a 20 miler on the weekend adds a layer of complexity and urgency to your nutrition needs, while further eroding your discretionary time to take in the appropriate food.  While none of us will be able to keep a perfect record on this front for any extended period of time, celebrate the wins when you make a good choice.  Don't dwell on the bad choices when you fall short.  If you have figured out a path to accomplishing success one time, you can find it again.  This will transform a single occurrence into an important habit.

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.

Ask the Practitioner:  Blisters!

For this installment of Ask the Practitioner, we connected with Michelle Toy, Assistant Athletic Trainer at Santa Clara University.  Michelle has worked with the cross country teams at Santa Clara, as well as high school athletes as the Strength and Conditioning Coach at Woodside Priory school.  This summer, Michelle will again serve as a trainer for the Bay Area Running Camp.  In short - she's seen some blisters!


RC: Why do runners typically get blisters?

MT: The most common reasons that runners get blisters are: their shoes don't fit right, they aren't wearing thick enough socks, they are running with improper mechanics, they are running on uneven surfaces, or they are running in new shoes that haven't been broken in long enough.

RC: What can you do if you develop a blister, but still need to get out there and run?

MT: If you have a blister, you can help protect it by wearing a band-aid over it or wearing a gel pad called second skin or skin lube.


RC:  What are some good ways to prevent blisters before they occur?

MT:  Good ways to help prevent blisters are to wear shoes that fit properly, wear thicker socks, run on even ground, break new shoes in over the period of a week, or wear skin lube over hot spots.

FNF: What is sciatica and what are signs you might be suffering from it?

MF: For most people, it relates to a bulging or herniated disc in your low back that is pressing on a nerve.  You feel it through the sciatic nerve.  That nerve goes all the way down your leg, so you’ll feel it there as well.  Sometimes your back is fine, and the problem is pirformis syndrome.  Your sciatic nerve goes through the pirformis, one of your smaller backside muscles that helps rotate your hip. That muscle can get tight and it can compress your sciatic nerve.  The biggest reason to see a physician is that you want to make sure it is not a bulging disc pressing on your nerve, as this requires more aggressive treatment.

FNF: How do you typically treat sciatica?

MF: First, we try to figure out if there was something that got them into this situation.  A lot of people don’t realize that it isn’t from their activity, but from their work.  Maybe they sit too much or drive a lot, which can put increased pressure on their discs.   The piriformis muscle can also get tight from driving too much.  So a lot of it is getting them out of the activity, and then calming down the inflammation.  We’ll advise over-the-counter products like Aleve or ibuprofen, and then prescription anti-inflammatories and so forth, in combination with physical therapy.   If it is a bulging or herniated disc in the back, sometimes we recommend an epidural corticosteroid injection and very rarely, surgery.

FNF: What can we do to prevent sciatica?

MF: Everyone is typically given core exercises as a part of their physical therapy, so that is something we should do prophylactically as well.  It takes pressure away from the disc.  We also should take care with our back mechanics.  People don’t think about simple things throughout the day such as how you lift, or how you sit and stand. You should.   Also, it is wise to be careful with the downhill running.  It is easy to get out of control downhill running and put too much stress on the low back.  Likewise, overstriding [landing with your foot too far in front of your body] can lead to overstress on the back. 

Although we earn a small reprieve from the early morning darkness with next month's time change, many runners are just settling in for a long winter of running in the dark.  Whether you rise early to beat the rush before the workday begins and the kids wake up, or fit in a run at the end of the day, nighttime running is a fact of life for many athletes.  Here are a few tips for staying safe and maximizing these workouts until the sun reappears.

Avoid risk-taking

While running the same route again and again might seem unappealing, or stopping your awesome tempo run briefly to make sure a passing car sees you, it is always worth it.  Stick to routes where lighting can help provide safety and mark your path, even if that means doing multiple loops around a few block radius.  Head to a local track and run while kids are playing soccer or lacrosse under the lights in the evening.  Put off exploration of that new trail until the weekend when you can run in the daylight.  Set aside the headphones so that you can be alert to your surroundings (yes, you can do it).

Choose routes for the presence of sidewalks away from the roadway.  Consider places of business where early morning activity takes place in a typically safe manner, such as a gas station, bagel shop, or Starbucks and include them on your run.  Check for daily sunrise and sunset times so you can safely estimate when you will need to be in spots that are safe for those times of day.  In short, give yourself at least one more measure of safety precautions than you would ordinarily take.  That may mean boredom and repetition, but is always better than not being able to run at all or risking adverse events

See and be seen

Many running apparel companies and specialty brands have introduced reflective clothing and devices to help runners stay safe in the dark.  Sometimes we focus on being visible to cars and others by wearing reflective gear, and other times we focus on keeping our path lit with headlamps and other illuminating devices.  In reality, both are important at all times.  A hard fall because of an unseen root or sidewalk crack is dangerous, and of course it is crucial to be visible to vehicular traffic.   It isn’t always possible to be completely visible in the dark, but taking care to be seen and to seeing where your feet will travel can be a crucial safety precaution.

Keep others in the loop

Whether you live with others in your household or reside independently, leave a note, a text, or other word where you plan to go every time.  If you encounter any trouble on an evening run, it may be until daylight before anyone is aware of your extended absence or be able to see you in distress alongside a road.    Particularly if doing something strenuous or extended, such as a long run for a marathon training cycle, estimating a time of return can help ease the mind of others who aren’t used to the length of these runs, as well as determine when you are indeed overdue.    Whenever possible, try to meet others for nighttime runs.  Both as a safety measure and as added encouragement when the winter is at its darkest and coldest point, a partner or group willing to meet you at a nighttime hour can make all the difference.

Be creative

Roads and outdoor tracks may not be the only venues for getting in runs.  Enclosed walkways, indoor public spaces, the perimeter of a well-lit parking lot, and even a circuit of long hallways in winter-affected cities might provide occasional safe locations for runs when things are truly awful and dark.    Consider a short-term gym membership, even if just to break up the workout by running there, doing some miles on the treadmill, and running home.  If winter is really getting the best of you, consider sampling some indoor cross training disciplines you have been waiting to try, or investigate the possibility of all-comers indoor track meets in your community as a way to get in a good hard effort inside.

While nighttime running may not be pleasant for many, runners across the country and around the world have thrived with a schedule comprised primarily of workout times before dawn or after dusk.  The good news is that sunlight is likely around the corner as spring returns, and the challenge of darkness is an opportunity to exercise the type of commitment and persistence that will serve you well when faced with a rough patch in your next goal race.  Embrace the challenge, stay safe, and keep up the good work.