In over two years of practice as an Athletic Therapist, I have not recommended foot orthotics to any of my clients.
The fact isn't that I consider orthotics to necessarily be a detriment and that they don't have their place; rather, I see other alternatives to attempt first, for a client's recovery, before going with the orthopaedic support route.
Orthotics went through a phase of being heavily over-prescribed for a couple decades, with any sign of a flat or stiff arch condoning their recommendation.
It is true that structural changes in the foot, such as a flat arch, might contribute to a higher rate of overuse injury in the lower body. However, it's important to remember that your arch is maintained by both ligaments and muscles, and so it stands to reason that exercise and strengthening can help to improve that arch support on its own. In fact, some studies find that exercise has a greaterbenefit than artificial insoles.
As well, it's important to point out that, like with any crutch or support, having the support of an insole can actually decrease the strengthand stability of your foot muscles due to lack of need.
What's more, if formal exercise doesn't work for you, minimalist shoes are also shown to have identical positive effects on the strength of those small foot muscles.
Again, this isn't to say that orthotics don't have their place. I will always attempt and monitor the effects of exercise on its own first, and so far all of my clients have had no need for anything further. But if an individual's foot structure, whole-body condition, and specific injury require the extra support, then it should absolutely be encouraged.
BUT (this is the last 'but') it's also important to highlight that expensive, custom orthotics are found probably be no more effective than off-the-shelf insoles, so for those looking into the arch support route, consider giving this a try before making the larger expense.
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Myself, I was never a huge fan of treadmill running. Mostly because I like nature and am a sucker for a nice waterfront view. But I digress...
Treadmill running isn't going anywhere. It's a staple in our gyms and a handy tool for being able to measure and control for our physical activity.
However, there have been some claims that treadmill running may pose an increased risk for overuse injuries.
The idea is based on the fact that overuse injuries stem from repetitive stress to a particular tissue, and this stress is greater when the variance in the movement is decreased. By this, we're referring to the fact that treadmill running strides will typically always be the same length, at the same speed, and with the same impact force. In contrast, running outside will have a much greater variability in the types of strides being taken, with the body needing to learn to adjust and adapt to the subtlest change in terrain.
While this claim is cited by several sources, few of them use hard, researched evidence. We do, however, have evidence supporting the general principle of low variance resulting in increased tissue stress. As well, while treadmill running has been shown to lower the rate of stress fractures, specifically, the same study found it to be less beneficial to bone strengthening than outdoor running. This might translate to decreased overall beneficial training adaptations from treadmill running and, thus, and overall increased injury risk.
I feel I must apologize for the inconclusiveness here, but hopefully it's good food for thought. Don't let this change your training regiment if treadmill running is currently working for you, but if you suffer from running injuries, it may be worth trying a modification in surfaces. And of course, if you're training specifically for running a race, the best training for you will be found outside.
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You'll be hearing me celebrate the return of running season for the next little while. Running is a fantastic exercise and sport, and I'm more than happy when I see both experienced and brand new runners partaking. However, is running a healthy activity?
It has generally been the common consensus that running is bad for your joints, whether it be for your knees, your hips, or back. Thus, it's often the reason (or excuse) for many people to not partake in any running. It makes sense; too much impact on the joints could totally cause some arthritic development or degeneration in the spine. As we understand it, this is basically the definition of how osteoarthritis onsets, right?
The research journal search was actually extremely easy here. As I was able to find out, between both old and new studies,long-term studies, and cross-analyses, running was almost always found to be unrelated to any development of osteoarthritis in the knee,hip, and spine. At the worst, some studies suggested it to be merely inconclusive.
In fact, one brand newpiece of research even found that, as far as intervertebral discs go, running actually promoted more strength and better disc health as opposed to contributing to degeneration!
So what's going on? What actually causes arthritis? Well, recent skeletal examinations are now suggesting that osteoarthritis development has more to do with alack of physical activity rather than too much of any particular type. This was strengthened by the fact that degenerative joints correlate highly with the morbid obesity seen in many modern-day skeletons.
Furthermore, there may even be mechanisms that actually protect runners from degenerative changes from their spot. While the overall impact and force going through the joints is higher during a running gait, there may be some evidence suggesting that the decreased contact time with the ground actually works to counteract any damaging effects.
All this being said, no, running is not the joint-destroying, pain-inducing activity that many out there believe it is, and there's even the possibility of being a runner if you already dohave arthritis. Keep in mind, running, like ANY other activity, can cause injury, whether it be from an accident, poor conditioning, or training error, so don't forget the importance of proper training.
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It's trail running season! Runners at the grade school, post-secondary, and recreational level are all out and gearing up for races. City marathons, cross country meets, and more will soon begin.
Many people assume that, to train for running, you simply need to run, but I've spoken at length on important weight-training tips for distance runners as well. After all, do you think that any other type of athlete - be they a wrestler, boxer, football player - only repeatedly performs their sport as training? No, I thought not.
Additional training, however, does not simply mean heavy lifts and explosive forces. The health of each joint of the lower limb needs to be considered in order to have longevity as a runner. There's an important balance of mobility and stability that must be maintained.
Take the foot. You've heard the importance of foot health for most of what you do in life, as it's obviously the first line of defence - so to speak - when it comes to impact forces as you walk and run. This doesn't necessarily mean it's as simple as wearing supportive shoes for good lower limb health, though.
The foot has 26 bones to it. That's a lot of joints! That being said, pliable mobility (allowing the joints to move, glide, and compress) is vital in allowing those joints to absorb shock and impact, as is strength of the muscles of the foot in order to prevent those forces from being too damaging to the tarsal joints.
Modern-day running - specifically, the footwear - has taught the Western world to bypass the majority of these impact-buffering joints by running heel-first. As a result, these forces are greater by the time they reach the knee, hips, and back than they would be if a forefoot strike was used, resulting in an increased injury risk.
However, with the birth of minimalist running, Western runners attempted to make a quick switch back to forefoot running in order to benefit their joint health and performance. This is all and good, but it needs to be remembered that the body takes time to condition itself to new mechanics and activities. After a lifetime of stiffer, highly-supportive footwear use, the joints of the foot are, conversely, going to be stiff and immobile as well. Furthermore, the muscular strength in the foot may be lacking due to years of disuse. As a result, while the foot may now be diverting much of the impact away from traveling up the chain in too-great amounts, the foot's own joints may not be durable enough to accept that force itself. This is why there was a spike in new and previously-uncommon running injuries as soon as minimalist running became popular.
The takeaway here is that, like the rest of the body that you train for performance, the feet must also be carefully conditioned for the uses you intend of it. Adequate mobility through the toes, forefoot, and midfoot as well as enough muscular stability are key if you want to prevent the high-impact of running from developing into pain. That being said, changes to running and training routine must also be gradual and progressive, just like a routine for training any other joint. You need some variability to shock the body into improving, but be kind with how quickly you introduce it.
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If you haven't had them yourself, you've at least heard of them. Shin splints: the bane of existence for many runners. This delightful condition involves stabbing pain in the inner shin region, exacerbation from running and impact, and can often include radiating pain traveling through the entire calf muscle.
Medial tibial stress syndrome is a condition so common that it affects nearly10% of all runners. However, surprisingly little is known about it. Often, people boil the pain down to muscle strains, tendinopathies, or stress fractures, but these internet diagnoses are inaccurate.
For the longest time, I, myself, considered MTSS to be something that it wasn't out of error. Among many professionals, it was thought to be periostitis of the tibia - inflammation of the top layer of the bone caused by traction from muscular tension. Unfortunately, upon a journal search for this article, this theory was quickly proven wrong.
As it turns out, science still hasn't completely agreed on the etiology of MTSS. There is one prevalent theory that just cropped up during the new century.
One pair of researchers was able to demonstrate a pathology to do with bone remodeling as related to shin splint pain. As you may know, bones are not a lifeless tissue. The body's cells are constantly breaking down bone and replacing it with new. Usually, this is done at a healthy, even rate, but in examples such as osteoporosis, the breakdown occurs more quickly than the regrowth, resulting in the frail-boned condition.
In the case of shin splints, the breakdown of bone tissue increases when the bone is subject to new and sustained mechanical stress, such as an unconditioned individual who suddenly starts to overdo the pavement running. This is done in order to remodel the matrix of the bone tissue and allow it to adapt to the new stressor, but in the interim of this remodeling being complete, the bone structure is unable to accommodate the stress. As a result, microdamage to the bone itself occurs.
It's like a highway that's in the middle of being converted into a traintrack, except the train has already started being run along the route during the construction. The structure is going to take a beating!
Yeah, something like that.
In terms of the recovery from shin splints, even though many practitioners may not have had the reasoning correct, many of the same rehab and exercise methods still stand. Weakness or excessive stiffness of the calf muscles still must be addressed in order to allow the muscle tissue to transmit forces properly, rather than directing them back into the bone. Hip muscle activation is still key to ensure the impact can further travel up the chain rather than remaining in the lower leg. Finally, gait and footwear should not be disregarded, due to improper loading through the foot and leg resulting in increased fatigue to structures that are needed to buffer impact forces.
So, just remember to be conservative when increasing your training volume, be mindful of your form, and change your shoes regularly. Keep all this in mind, and....
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It seems like every other client and athlete that I see has a complaint about their tight hamstrings.
The tension that a lot of people feel is relentless and just won't let go. They stretch and stretch all day long. Bending down to touch their toes, sitting and reaching, on their backs with a band, but nothing works!
Why are these things so tight and why can't we get them to be flexible?!
Hamstring Tension
I read this excellent article by Eric Cressey on the true reasons for hamstring tightness. One of the most enlightening points that it makes is the fact that your hamstrings are very unlikely to be truly shortened.
You see, the hamstring muscle group performs two major actions: knee flexion and hip extension. If our hamstring tension was really caused by shortening of the muscles, then that would essentially require us to be in both of those joint positions (simultaneously) on the regular. Do you spend every day on your knees for hours? (No jokes, please.) No? Then you probably don't have a hamstring lengthening/shortening issue.
So that being said? What causes hamstring tightness? There are three main things: Protective tension (compensatory tightness), neural tension (most significantly, sciatica), and an injury to the muscle (whether it's an acute strain or tendinitis).
Most of my clients who have this issue have it due to the first option; protective tension. More often than not, they're lacking proper activation of the glute muscles to initiate hip extension and stabilize the hip joint. As a result, the hamstring has to not only compensate for the ability to extend the hip, but it also has to increase in tension to try and make up for the lack of stability that the body senses at the joint. As the fix, I spend a lot of time reeducating the action of gluteal hip extension. Obviously, this isn't the only compensatory mechanism for why the hamstrings are tight, but it's the most common one that I find.
Similarly, if the reason for the tension is neural or due to injury, we need to fix the root of the problem in these cases as well before the hamstrings will truly be able to release their tension. If there's sciatic involvement from either the hips or the lower back, then some sort of intervention to relieve the stress on the nerve is required. If there's been an acute hamstring strain or built-up scar tissue, then time, manual massage, and proper strengthening will help accelerate recovery. If there's a chronic tendinitis, then that brings us back to the compensation issue which needs to be corrected.
Hamstring Stretching
In the meantime, is there anything we can do to help decrease hamstring tension while attempting to correct these mechanics?
Well, from my experience, I'm finding that static stretching for this area is less and less effective. Like I touched on before, if the hamstring isn't truly shortened, then why bother trying to truly lengthen it?
Instead, I'm starting to employ more dynamic stretching (even after exercise) in order to promote the muscle to neurally relax under tension and let go during repetitive stretch rather than prolonged. My clients have reported feeling that these methods have made them feel like the muscle is under decreased tension and have relieved pain more than holding the stretch ever did.
All in all, this goes back to my philosophy that simply stretching and mobilizing is never the answer to the problem. The base mechanics always need to be addressed before the issue is resolved. So, if you fall in this category of someone plagued by chronic hamstring tightness, take a moment to consider the reason for it.
I've been a running coach for several years now, training both long-distance runners as well as sprinters. I made a recent post about weight training tips for long-distance runners and I wanted to do one about sprinting. While there definitely is a lot of crossover between jogging and sprinting, it should be remembered that sprinting is not simply a jog put on fast-forward. There are very different mechanics and energy systems at work between the two activities.
1) Early Strengthening and Explosive Progressions
One big mistake that speed athletes make is training slow and heavy year-round. I agree that heavy strength training is vital to developing an early foundation, however, that type of training will only go so far. You may have heard the team "Train slow, compete slow", and it certainly holds true. You should absolutely do slower strength training in the early off-season of your sport, but if you don't transition your training towards more explosive plyometric and sprinting-specific training as you get closer to your competition, then you won't be ready to show up and perform.
Whether you have one main sport season during the year or several shorter once spaced throughout, save the majority of the heavy lifts for the earlier period of training. As you progress and get closer and closer to your competitive season, you need to start adding more explosive exercises such as Olympic lifting, box jumping, and actual sprint training to the routine.
2) Target the Glutes and Mind the Hamstrings
The limbs amplify movement. They don't generate it. Therefore, like with long-distance running, the power generation is done by the glutes and assisted by the rest of the leg muscles down the chain.
Take the time to specifically target your glutes during training, through the slow-strength training as well as the plyometric training that we just mentioned above.
Also remember, however, that you do need to take very good care of those hamstrings as well. Being so prone to injury during exertion, preventative conditioning is vital. A balance between the strength to help and propel your body as well as the flexibility for stride-length and prevention of overstretch injuries will be crucial. Eccentric hamstring curls will be handy for protecting you from tendon strains. Heavier lower-chain exercises such as deadlifts will further the progress by training those muscles to be able to contract from lengthened positions.
3) Spend Time on One Leg
Again, like with jogging, sprinting has you spending time on one leg at a time only. Both feet are never in contact with the ground at time. It seems like a minuscule amount of time, but you need to train your body to stabilize the side-to-side shift of the load it's bearing.
Single-legged deadlifts, pistol squats, one-legged glute bridges, they're all handy. As long as you can train your muscles to fire in proper sequence, one side at a time. For those in the gym who only ever do frontal plane exercises on both feet, there's a significant difference in how effectively they're able to coordinate proper balance during activity.
Having poor hip mobility is going to be an obvious hindrance. Whether it's due to poor flexibility, capsular restrictions, or lack of muscular strength, adequate range of motion is a necessity if your stride length is going to be at all effective.
The other main area that I often see being a problem due to mobility restrictions is, surprisingly, the shoulders. If your shoulders are restricted and flexion/extension doesn't occur smoothly, then the tendency is to compensate for the lack of arm swing with torso rotation. If you ever see people running who aren't so much using their arms but rather just rotating back and forth at their chest, this is what I'm talking about. This makes for poor momentum and propulsion and is also a waste of muscular energy.
If you have these restrictions, does this mean you should be aggressively tractioning your joints with bands to try and increase range? Please please please no. It's so unnecessary to mobilize like an overeager Youtube Crossfitter if you're doing proper, conservative exercises that your body will more-willingly adapt to.
5) Remember Your Core
As always, we bring it around back to the core.
I remember the very first time that I did hill sprints as a teenager. The sorest parts of my body the next day were, understandably, my calves, but also, surprisingly, my obliques.
Remember that you're generating an enormous amount of force when sprinting at maximum capacity. Because of this, your trunk is required to do everything it can to resist torque and deformation that the limbs are causing.
For sprinting, however, it's going to take a little more than just planks and side-planks to effectively condition the core. Since sprinting requires such high amounts of plyometric activity, the core needs to be trained specifically against those types of movements. Essentially, we need to turn core exercise into a type of plyometric exercise of it's own.
6) Arms, Bro.
This is an often-overlooked area for runners, and many will skip arm day because, well, you don't exactly run on your hands. (Most of us don't, anyway.)
However, especially in my young runners that I coach, arm strength is lacking to a fault. When you sprint, your arms need to be driving back and forth to counter the movements at the leg. So often, I see sprinters who do not have the explosive tricep activity in order to drive their arms back with enough force. Because of this, the arms become unable to move with enough force to provide momentum to the run and can also slow down the entire stride rhythm due to not being able to keep up with motion at the legs.
The solution, fortunately, is simple. You don't need to adding three tri-and-bi days to your workout routine, but you should have a regular upper body workout with both strength and plyo work itself, just like you do for the lower body. Once you can push-press a significant amount of weight overhead with proper form, then you'll be able to drive the arms effectively when running.
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Sprinting is a highly-demanding and technical skill; therefore, training for it is as well. Simply walking onto the field and running as fast as you can will, unfortunately, not promote the improvements that you're looking for. It requires both the on-field training as well as a specific and targeted routine in the gym. And like anything, practice makes perfect.
As an avid long-distance runner myself, it seems about time that I publish some tips for my own sport.
I was a competitive runner back in high school and then continued on to longer-distances during college and beyond. Back in high school, however, I was under the impression that to train to run, you only had to run. Boy, was I wrong. I plateaued in performance and was bogged down with knee injuries and shin splints. Nowadays, I wish that I had the advice that I offer you here now.
1) Stop Training Like a Bodybuilder
I see this issue in my younger athletes, primarily. While the most common advice for weight training in general is typically sets of 10 reps, usually for 3-4 sets, revolving those parameters around running training won't be ideal. Those rep ranges are reserved for beginners to weight-lifting or for individuals wanting to increase muscle size. For long-distance runners, size gains will be counterproductive.
Instead, focus on strength parameters (3-6 reps) to condition your muscles to be able to withstand high impact, and power (2-4 reps) to be able to generate those explosive forces required to propel you forward. Mix in endurance ranges (15-20+) for good measure, but know that more than the occasional set of these isn't necessary, as the running that you're still doing should be close to enough from an endurance perspective.
2) Target Your Glutes
The way that your body works is that all of the strongest muscles are located near the center while the assisting muscles branch out. That being said, the main muscles you need to be targeting for strength are your glutes. During walking and running gait, those butt muscles are meant to be the main drivers of hip extension. When the glutes becoming weak or inactive and the knees and calves take over, this results in overuse injuries. (ie: the knee issues and shin splints that I formerly mentioned.)
It's common to assume that glute work is going to consist of high-volume squats and lunges. In theory, yes. However, the glutes actually tend to be inactive in a large chunk of the population with people being unable to initiate proper contraction of them in the first place during these exercises. Thus, exercises such as glutes bridges and hip thrusters will be vital to isolate the area.
A fair number of people, still, will have an inability to fire their glutes properly during the bridge movement, with the hamstrings being the dominant muscle instead. (If you feel the contraction occurring at the back of your knees, then you fall into this category.) Here's a quick video tutorial on how to deactivate the hamstrings for optimal gluteal activation.
3) Isolate the Glutes and Hamstrings; Leave the Quads and Calves Alone
As I just stated, isolating the glutes is important as they are the main force drivers while you run. The hamstrings are a good idea to target by themselves as well, mainly due to the fact that they're often much weaker than the quads and can be prone to cramps and strains when not strengthened properly.
As for the quads and calves, leave them be. You're constantly targeting those guys during the every single compound lift and while running. (On an average day, you're doing between 10,000-30,000 calf raises already.) Apart from that, isolation exercises to those areas can actually be damaging. I already talked previously about how calf raises can result in imbalances and shin-splint issues. As for the quads, it's been shown without doubt that the compressive forces going through the knees are maximized during the range of motion used when you use the knee-extension machine at your gym. In other words, "Oww, my aching knees".
4) Remember the Little Guys
Straying away from the big muscles that we all like to look at the most (figuratively and literally), we also can never forget to neglect the little muscles that keep them together. Specifically, the lateral stabilizers of the hips. (Glute medius, minimus, piriformis, etc.) Without proper activation of these smaller muscle groups, the biomechanics of walking and running break down and result in secondary compensations and complications.
These muscles are most active during unilateral (or single-sided) exercises. This is important for when you realise that, when you run, only one foot is in contact with the ground at any given time. (Believe it or not!)
With that being said, exercises using a single-leg stance, or with alternating legs (ie: lunges) are going to be your friend. Like with the big glute muscles, however, you may need to think about isolating them if they are not activating properly. That takes us to more of the rehab realm, which I'll touch on another time.
5) Core!!!
Ahh, you thought that we were gonna get through a post without me mentioning the core. Keep dreaming.
During any type of running activity, there are high-volume stresses being placed on the spine. Whenever you swing your arms and legs, physics demands that your spine twist as a result. When you strike the ground with your foot, impact shock is travelling up your legs and into your back. When you push the ground away from you and extend your hip behind you, the spine wants to follow your hip movement and moves into repetitive hyperextension.
As you can guess, these stresses can wreak havoc on your back health and are the reason why so many runners struggle with lower-back pain. Thus, it's vital to train the core with isometric exercises that will prevent these deformities from occurring by stabilizing the trunk against these external stimuli.
Are these tips the secret to a gold medal in your city's next marathon? Of course not. But they're a tool to use and modify your training to help move yourself past a plateau and prevent injuries. I've gone through quite a bit of research as well as trial-and-error to come to these philosophies which, indeed, I'm sure some may argue. Minds constantly change, however, and I'm sure my methods of training will continue to change in the years to come.
Shin splints suck. When they come on, it's so difficult to get away from them. It's no broken arm, but when they get bad, it's that kind of aching pain that just makes basic function agonizing, like a cavity.
"Shin splints" is considered to be a catch-all term that encompasses injuries such as muscle tears and stress fractures. However, in my practice, I stick to calling those things "muscle tears and stress fractures". As far as I'm concerned, shin splints (or medial tibial stress syndrome) involves tightness and restriction of the calf muscles muscles to the point that they pull strongly enough on the tibia (shin bone) to cause inflammation. This effect occurs when the outermost layer that covers the bone - the periosteum - is lifted up due to this tension, allowing the inflammation to develop underneath. Oftentimes, there are microtears throughout the calf muscles involves as well as pain referred through the entire medial calf. Sounds awful, huh?
Here's where I start to get more general and provide a list of the go-to-reasons why you may have MTSS and what you can do about it. Keep in mind, this training advice, not medical. If you have a real problem, seek help from a medical professional in person.
1) You're a Heel Runner
If, when you run, you strike the ground heavily with your heel, the hard impact could be a likely trigger for the inflammation beneath your periosteum if you've already been prone to it. The strike of the heel allows all the force to travel directly up your leg, causing impact-related problems all the way up to the back. Retraining of your running gait, switching to a softer running surface, or wearing a flatter running shoe that promotes more midfoot running are excellent places to start for your recovery.
2) You're a Pronator and/or Flat-Footed
If your feet have very little natural arch of if you have an exaggerated inward-roll of your feet while walking and running, this could be putting excessive strain through the medial calf muscle. Often, improper shoe support is the cause, and you may need more added to support the arch and stop the pronation. You may also need less as well. I, myself, self-corrected once I switched to minimalist shoes and no longer had an artificial arch causing my foot to roll in. Foot exercises can also help to lift the arch in your foot naturally as well, to an extent.
3) Your Butt is Asleep
If your glutes are inactive during gait (they should be the primary muscle moving you along), then the hamstrings and calves tend to take over. If you're getting your calves to take on the workload that your much stronger gluteal muscles should normally be handling, then you'll definitely see tightness and restriction through the muscles occur as a result.
4) You're Doing Calf Raises
Firstly, I hope that no one save for bodybuilding and fitness competitors are doing calf raises. Your calves were designed to run for hours, not lifting a heavy weight ten times. So that's your first problem
Secondly, most-often when someone does a calf raises, they are pronating and favouring the medial calf overall, causing it to become more stronger - and tighter - than the outer as a result. If you really have to do calf raises, try squeezing a tennis ball between your heels to help distribute the load.
5) You're Stretching Improperly
If you're stretching your calves to try to relieve your pain but are getting no results, recheck your technique. If you're doing the traditional runners stretch by lunging against a wall, pushing your toes up against the wall, or dropping your heel off a step, you may very well be moving into pronation again. Try doing the runner's lunger, but with the foot flat on an incline to keep the leg and foot properly aligned.
Furthermore, are you stretching your entire calf? When stretching, you need to do both a straight-legged stretch for the more superficial gastrocnemius muscle (which crosses the knee) and one with a slightly bent knee to get the deeper soleus which crosses the ankle only.
6) You're Not "Born to Run"
Finally, maybe you just have anatomy against you. I don't care what some people say; we're not all naturally built to run long distances. Yes, we all did it when we were cavemen, but do you really think that our anatomy hasn't at all changed since cro magnons walked the earth? If you're naturally (or unnaturally) heavy-set and have short legs relative to your weight and height, it may just be too much for your legs to handle running a marathon without extensive and specific training. I'll never say that there's a physical feat that anyone can't accomplish, but without a doubt, it's going to be a much harder time for some than others.
Take from this what you will. Everyone's body is different though, so the reason for your pain may very well not have been mentioned. Use it as a starting point. It may take trial and error, but no one is meant to suffer without a solution.
