Why Do My Shins Hurt After I Run?

I ran the Lake Grapevine Runners and Walkers Double Trouble 5K/10K duo this weekend. Fun! Crazy weather! It started out at 78 degrees and was down to 52 when we finished the 10K portion.  Got to love a good cold front! A good time was had by all, and it’s great to see everyone out at the lake.

My funny story for the day was that one of the runners sidled up next to me and asked, “Why do you think my shins hurt after I run?” and “How come they don’t hurt when I’m running?” Of course, my first reaction was “It depends….”, and “Good question. Let me catch my breath and I might have an intelligent answer for you.”

Here was my answer:

Your shins can hurt after running for a variety of reasons. The most common is a shin splint. This is actually a term commonly used to describe medial tibial stress syndrome.  What? Yes, stress causes pain along your shin bone and can even cause a stress fracture. In the early stages the painis actually myositis (irriation of the muscle that runs along the shin bone) and this will “warm up” when you run. Stress fractures don’t “warm up.”

Why does this happen? Most common reason is either worn out running shoes or inappropriate shoes to start with. If you have a very high arch, you need a more cushioned shoe. If you have a flat or low arched foot, you need a more stable shoe. Lots of times you just need to part with your old beloved super worn-out running shoes.

Other reasons can be a change in surface like going from the treadmill to concrete. Or a rapid increase in training mileage or increased speed.

When is it time to stop the home remedies and go to the doctor?

Pain 5-7/10 or in a pinpoint spot can indicated a stress fracture!

Pain that has lasted more than a few weeks with rest, ice and over-the-counter anti-inflammatories.

Lastly, if you have changed shoes, tried stretching and icing and still have pain daily….time to come in for a visit.

Some people need help buying shoes, some people need functional foot orthotics to re-align their gait and some people need to rehab their injury with physical therapy.

So the take home point is that your shins shouldn’t hurt after you run!! If they do, you should take a look at you shoes and training patterns! When in doubt, give us a call so we can take a look and make your shin pain go away!

FAANT gave away cute little Body Glide buddies for your gym bag at the race! Adorable!

Got Ball of Foot Pain?

Can Compression Socks Make You Run Faster?

Podiatrists have been prescribing compression socks for years to treat things like chronic edema, lymphedema, varicose veins, and to prevent deep venous thrombosis; but recently they have started showing up on perfectly healthy runners. Yes, sometimes compression socks are used to treat shin splints, but do they make you faster? Can you run longer in compression socks? Many runners and triathletes swear by wearing compression they feel faster and recover better. Do they really work? Is there any scientific evidence that they really work? Or is this just more running lore?

In 2007, one study showed no increase in endurance or speed, but they were shown to stimulate blood flow, helping legs recover faster from a hard run. OK, so they help recovery, but can they make me faster? That early study didn’t think so, but that’s why we kept looking.

Most theories about how compression socks improve running performance focus on the physiological and biomechanical support of the lower legs.

It is assumed that compression socks may enhance venous return to the heart through a more efficient calf muscle pump, leading to increased endurance capacity. And there is the notion that because muscles are kept more compact, balance and proprioception are improved and muscle fatigue is minimized. Sounds reasonable, but again, what does the research show?

It wasn’t until 2009 that a German study clearly showed that they enhance performance during hard runs. And research done in South Africa and New Zealand both show that knee-highs also improve recovery by boosting blood flow in the extremities. In fact, even compression socks (not your Grandma’s TED hose) have been shown to increase resting arterial circulation by 30% and 40% under physical strain. Many compression sock companies even tout that they have studies that shoe an increase in running efficiency by 5%, which can equate to taking 12 minutes off a four-hour marathon. Crazy? Maybe not?

Yet they still aren't for everyone. One German study conducted on super-fit elite athletes (not most of us in the back of the pack) reported no performance payoffs from compression. According to the study, the socks work better when they're squeezing more performance out of non-elites (you and me).

Lots more studies to come, but if donning some hot pink knee socks will take 12 minutes off my marathon time, bring them on!

New Study: Foot Orthotics Can Prevent Running Injuries

The top three questions runners ask about custom foot orthotics are:
1. Should they use orthotics in their shoes while running if they don’t have an injury?
2. If they have fatigue in their legs while running or a jacked up gait, they often wonder of orthotics will help?
3. Should they wear orthotics forever after an overuse injury?

The answers are yes, yes and yes!! A new study showed that orthotics have a significant benefit in reducing running injuries as prophylaxis. It makes common sense, that if you have an underlying biomechanical deficit, orthotics give you better alignment so therefore should reduce overall abnormal stressors and subsequently injuries. Now there is a new study that shows just that! Piggy-back that on years of biomechanics research and the answers get much more clear.

This study demonstrated that the subjects who wore orthotics had "a significantly reduced rate of exercise-related lower limb injury across the training period". The authors emphasized that participants were not treated for an injury with orthotics, but were prescribed orthotics to prospectively reduce the risk of injury. In addition, they believe that these "preventative results can be cautiously extrapolated to a recreational running setting and should be considered by sports and exercise medicine professionals."

We generally prescribe foot orthotics to treat specific injuries. This study indicates that orthotics can be a valuable prophylactic tool for injury prevention, supporting orthotic use in at-risk populations (e.g. runners) for medial stress syndrome, iliotibial band syndrome and Achilles tendinopathy. Considering the results of this study and the results of a previous study on the use of orthotics in runners by Mundermann, it is recommended to use at least a pre-fabricated Powerstep orthotic which incorporate a medial heel skive and rearfoot post, as a cost-effective means of providing prophylaxis with corrections proven effective in runners. Runners with a previous history of these injuries and/or those that develop symptoms would be good candidates for custom orthoses based on the results of these two studies.

Franklyn-Miller A, Wilson C, Bilzon J, et al. Foot orthoses in the prevention of injury in initial military training: a randomized controlled trial. Am J Sports Med 39(1):30-37, 2011

Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech 18(3):254-262, 2003

11 Common Sense Tips to Run Injury Free!

My patients in my Grapevine, TX office are always asking me: “Why do some runners always seem to be hurt and others can run forever and never sidelined?” Great question!!

Amby Burfoot tried to answer that question in an article in Runner’s World in March 2010. He states that George Sheehan, MD, the medical editor of Runner’s World in the 1970’s, felt that one in 100 people were “motor geniuses” and never got hurt. The rest of us were destined to be injury plagued from time to time.

Ralph Waldo Emerson stated “that there is a crack in everything God has made,” meaning that nothing is perfect and that can be translated to runners as well!

An extensive review of the medical literature by Burfoot reveals a great number of papers on running injuries, but no conclusions. It turns out that running injuries can be caused by being female (funny), being male (more likely), being old, being young, pronating too much, pronating too little, training too much, training too little, having new shoes, having old shoes, and it goes on…..

So what can we conclude? Most of us will get hurt at some time during our running career! So what can we do to prevent major, career threatening injuries?

1. Know Your Limits. This is a hard one. Some people cannot tolerate long distance running year after year. I’ve seen this in my office all too often. Some people try again and again to get to the marathon distance, but just keep getting hurt. Everyone has a threshold. Learn yours. Follow the rules and avoid too much, too soon, too fast syndrome! If you get to 15 miles and get hurt every time, maybe your body is trying to tell you something. Work on your 5K time instead of trying to attempt a marathon yet again.
2. Listen to Your Body. I give this advice every time I talk to a group of runners. Many do not listen. If you get out of bed feeling like you got run over by a train, perhaps a little rest in is order; not a long run! Most injuries do not spontaneously occur; they start with little aches and pains. Ironman triathletes are the worse! Do not “train through the pain”. That’s just plain stupid (and yes, I’ve tried to do it too!)
3. Consider Shortening Your Stride. I have to admit, I hadn’t really thought of this advice until I read Amby Burfoot’s article. It makes sense. Overstriding increases stress, so shortening your stride will soften the landing when you run. I think this is also why the recent “barefoot” or “minimalist” craze has taken a string hold. It’s hard to overstride in minimalist shoes!
4. Strength Training Can Help. One thing that has been shown to decrease running injuries is strength training. This is especially true in women. Core strength training twice a week can really help you avoid the doctors office and prolonged time on the couch.
5. Ice is your Friend! See my video on first aid for tendonitis, rest and repeat every time you have an ache or pain. A little rest, ice, compression and elevation goes a long way!
6. The Surface Makes a Difference. Here’s great tip: Don’t always run on the right side of the road facing traffic! It allows you to see the cars coming at you, but here in Texas, it means you always run on a slight slant that causes a functional leg length discrepancy. (And don’t try to make up for it by putting a lift in your left shoe- that’s stupid too!) Also try to vary your surfaces, one day on the road, one day on the track, perhaps a treadmill day or a day on the golf course. Trails are also a good thing to put in the mix. The same thing, at the same speed, on the same surface all the time can quickly add up to an injury.
7. Too Hard, Too Often is a Recipe for Disaster! When I was younger (about a thousand years ago) I used to “race into shape”. Not a great plan unless you are a gifted teenager! Too much speed work or too much racing beats the heck out of your body. Always follow a hard day with an easy one, or two if you are over 35!
8. Stretch. I’m not going to debate the value of stretching. I’ve done that in other articles. I know there are some people who think stretching is bad. I’m not one of them! All I know is that runners that are tight get hurt a heck of a lot more than those that are flexible.
9. Cross training is not a Bad Word! When I turned 40 (yes, about 5 seconds ago), I took up triathlon. Why? Because I knew as a thin female runner, getting older, I needed to cross train to keep up my aerobic fitness and decrease the stress on my body. This lead to a love of swimming and eventually an Ironman. Who says you can’t evolve as an endurance junkie? Seriously though, swimming, biking, the elliptical, circuit weight training….These all help to maintain your fitness and change up the stressors n your body.
10. Shoes Make a Difference! Find the shoe that works for you. Your podiatrist or a good experienced shoe sales person can help you, but bottom line….get a shoe that fits and is the correct type for your foot type. The reason there are a million shoes are on the market, and growing, is that there is not one perfect running shoe (although this doesn’t stop people from asking for it!)
11. Orthotics Can Help! I realize that many people are shying away from corrective orthotic and trying to embrace the minimalist wave. Not everyone can run barefoot and not everyone needs orthotics. If you continue to have similar injuries over and over, what’s the definition of insanity? Doing the same thing over and over, yet expecting a different outcome! If you are one of those biomechanically perfect gazelles, more power to you! But most of us could use a little help in that department. In many cases, you can correct some biomechanical problems with strengthening and stretching, but let’s face it….most of us are too lazy to do the work to correct our biomechanical imbalances. Orthotics can help. Think of them as eye glasses for your feet. The majority of us could benefit from a tire realignment!

Best advice I can give: listen to your body, increase slowly and have a plan! If you are one of those oft injury plagued runners, take a look at these tips. Are you following the guideline? If so, take a spin in triathlon! It has saved a lot of weekend warriors…….

Thanks to Amby Burfoot and his crew. I have liberally borrowed from their content and just put in my two cents worth. If you want to read his article, “The 10 Laws of Injury Prevention” you can find it in the March 2010 edition of Runner’s World.

Video Blog: Does Running in the Rain Make You Sick?

You asked for more video blogs, so here is the beginning of a new series :)



So enjoy running in the rain! Jump in puddles!! Have fun!

Does Running in The Rain Make You Sick?

It’s one week after the cold, wet rain permeated the White Rock Marathon. Lots of people, including my mother, have asked me if I caught pneumonia from running “The Rock”?

So, does running in the rain make you sick? This is one of those questions that seems to be doomed to getting inconclusive answers forever. Especially when it comes to the opinion of Mom!

People usually do get sick more when the weather is rainy. That's because they stay indoors more, and indoors is where cold and flu viruses spread because of increased contact between individuals. On a sunny warm day, everybody goes outdoors, where there is (obviously) more space, better ventilation, and less physical contact with large numbers of other individuals.

Catching an infectious disease such as the common cold requires direct exposure to the pathogen (virus). Exposure comes in the form of close contact with an infected individual. Going into cold and rainy weather will not make you sick unless you also get colonized by the pathogen while you're out there.

There have been reports that cold temperature itself reduces the effectiveness of our immune system, but even that's not sufficient alone - you'd still need exposure to the virus.

Bottom Line:

"I'll get sick if I stand out in the rain or go out into the cold without a hat on" - Fiction

"Cold and rainy weather causes virus infections to spread more rapidly than usual" - Fact, due to people staying indoors more

Prevention:

Wash your hands, stay away from people who are sick, and feel free to run and play in the rain, just like we did last Sunday at the White Rock Marathon. Run Happy....and remember to jump in puddles after the 6th mile when your feet are already soaked!

Do NSAIDs Inpair Fracture Healing?

Do NSAIDs Impair Fracture Healing?

There has been a theory that comes from looking at animal studies that NSAIDs like ibuprofen or Naproxen inhibit bone healing and may cause delayed unions or non-unions in fracture patients. Some doctors even go so far to say that you shouldn’t use NSAIDs in postoperative orthopedic case; but what is the truth?

A recent article in the Journal of Family Practice by Yates, Shah and Blackwell, showed NO, ALTHOUGH THE EVIDENCE VARIES. Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t appear to impair clinical fracture healing. Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

Evidence summaryNSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their antiprostaglandin properties delay callus formation and subsequent healing.1 However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results.

BOTTOM LINE
The majority of physicians agree and recommend using NSAIDs temporarily along with other measures—such as rest, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free.

For more info on this retrospective analysis, click here.

Knee Woes From Running: Iliotibial Band Syndrome

I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?

Let’s talk about ITB syndrome.

The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.

Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.

Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.

Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.

During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.

The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.

The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!

Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.

Really? Invisible Shoes For Running

I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)

I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!

A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!

The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

Black Toenails are Common in Distance Running

Over my 30+ years of distance running, I've had many black toenails. In fact, I suffered one at Ironman Texas last weekend! A few of my friends, who also participated, stopped by the office this week for black toenail treatment. The following is my advice in trying to avoid and treat this common problem.

Almost everyone who runs will eventually get a black toenail. Getting your first one is a sign that you are now part of the endurance club. Its kinds like cycling. There are two types of cyclists; those that have fallen and those that will fall. While most runners blame a shoe that is too small, this is often not the main cause. Mine was from the well-meaning volunteers who soaked my running shoes trying to cool off the triathletes with their hose! Squish, squish, squish for 26.2 miles equals blisters and black toenails!

If a toe is under pressure from the shoe or a sock that is too tight or too thick, the sustained pressure, step after step, produces an impact or a friction problem between the toenail and the tissue surrounding it. When the tissue gets damaged, fluid accumulates. This is known as a subungual hematoma. The red or black color is the result of a few blood capillaries that become broken in the process. The more fluid that accumulates, the more pain. The extra fluid, colored by some blood, accumulates below the toenail. When the pressure gets too great, the existing toenail will be separated from the nail bed.

Really, most of the pressure that results in this "toenail injury" is produced by the regular action of the foot coming forward, thousands of times every mile. Each time your foot swings forward, a little extra blood is pushed into the toe region due to the force of the foot coming forward. If you increase your distance regularly and very gradually, your toes will adjust to each new maximum distance and only complain when you extend farther. In a marathon training program, almost everyone gets at least one black toenail. Running faster too soon and too long will increase the chance of this injury.
Hot weather also improves your odds of getting one. When it's warm, your feet swell more than they would on cold days. Because there is more pressure, and more fluid, there are more black nails generated during the summer months. This is especially true when it is humid!

How do I prevent black toenails?

You'll reduce the chance of a black nail if you ensure that you have enough room in your toe area when you fit your shoes. At least half an inch is needed, when you're standing in the prospective shoes (in the sitting position, the toes aren't all the way forward). If you've had a history of black toenails and summer is approaching (or here), you may want more toe room. When you add more room at the end, ensure that the arch of the shoe matches up with your arch. Also, run in the shoe before you buy it to make sure that the shoe isn’t too big and that your foot doesn't slide forward as you're running, which can aggravate the toe more than a tight toe box.

Do all black toenails need to be treated?

Leave black toenails alone and allow them to grow out if they are not painful. About 70 percent of the black toe problems are best treated by ignoring them. The damaged part of the nail is gradually pushed out, and the foot slowly returns to normal. If they are painful, red, or swollen; time to see your podiatrist.

Can I just stick a needle in it to drain it?

Do not attempt bathroom surgery! Many runners will heat up a needle and drain the fluid under their nail. Often this introduces bacteria and now you have a painfully infected toe!
Take any sign of infection seriously. If it continues to hurt or the pain increases, this is a bad sign. Toe infections can lead to cellulitis (blood poisoning), gangrene, and worse, especially if you have diabetes. See your podiatrist first, not last!

Will I lose my toenail?

The short answer is - yes. It will take a few weeks or months, but as the toenail continues to grow, eventually it shoves out the damaged, blackened toenail. The black toenail is raised off of the toenail bed, and underneath it is often the healthy remainder of your toenail. Your black toenail will gradually loosen from the sides and you will be able to trim it away.

When will my toes be pretty again?

If pretty toes are important to you, you can paint the black toenail or even the thin new toenail, or the bare skin. You can also stop by Healthy Steps and have a prosthetic nail put on by our licensed medial nail technician. Most people won't notice the difference if you use a darker shade of polish. Full replacement of your toenail takes about 3 to 6 months, and the new toenail will often be a bit wavy, thin in some areas and thicker in others. After 8 to 10 months your toenail should be back to normal (unless you get a side infection of fungus….another topic).

Black toenails are part of distance running, but take them seriously or they can stop you in your tracks!