I Survived Injury and You Can Too!

Surviving Injury With a Twist!

Let’s face it….there will be a day when all of us get injured. Just like the fact that there are two kinds of cyclists: those who have fallen and those that will fall!

In a recent survey 90% of runners revealed some kind of injury in the last 12 months that resulted in the loss of more than one day of training. Some of us are just more hardy than others. I have several ultra-marathon running patients (yes, they embrace the fact that most of us think they are crazy) who train like maniacs and think that running a 50K on Saturday and then a marathon on Sunday is just a fun weekend in Texas! These people and their considerably more sane counterparts, a group of which I have been fortunate enough to consider myself a member, almost never get injured unless we fall off a curb, get hit by a car, or fall in a pothole. I define those as the “shit happens” injuries and these always seem to happen at the most inopportune time. There are also runners who tend to be injury prone. Those frustrated souls who seem to be in my office or with my physical therapist on a regular basis who often follow the letter of the training programs and still seem to get hurt.

Injuries suck…and often make us borderline psychotic! (My husband and children will attest to this fact) So, how do we survive this down time and come back from injury even stronger? Cross-training a.k.a. relative rest is the key! Unless you are in a full body cast from a severe accident, there is an alternative exercise that should at least keep your endorphin addiction under control. Yes, you need to seek permission to bike or swim or core train, light yoga, etc., whatever your doctor says you can do even if it is only upper body, you need to move! Everyday! Sitting on the couch eating chips and singing woe is me will not cut it! And you will lose all the cardio fitness you have built with your running program. A good rule of thumb is to try and keep to your program by performing the alternate exercise for the planned amount of time you were going to run. This may require some circuit training, because if you are anything like me, the first time I tried to swim I lasted all of 15 minutes without thinking I was going to drown; but then I got out of the pool and attacked the stationary bike to finish my planned one hour workout. Flexibility and a willingness to try something else will get your through any injury. The best part is that you may find you even like some of the cross training (remember I did my first tri after breaking my foot).

The power of positive thinking is also relevant in this topic. Stop sitting on the couch feeling sorry for yourself and instead make a new plan, a new goal and a new training program. There is always a light at the end of the tunnel (and no, it is not a train). Cross-train, plan and conquer your injury. You will survive and often times be in better shape afterwards!

RunDoc Does Her First Triathlon

RunDoc Eats Humble Pie!

I did my first triathlon today...just a sprint...and I'm eating humble pie...I blasted through the swim in 6:42 for 300m, then ran to my bike (barefoot on freezing pavement), had a good transition then off to bike 12 miles....turns out I am a slow cyclist (who knew!) I rode 12 miles in 47:21 then practically fell off my bike....almost screamed out "my legs, my legs, who took my legs" as I got off the bike, then tried to run....pathetic...for a person who normally does about a 21 minute 5K or less, I ran a 24:00 and was happy to have that time! I finished 3rd in the old lady 40-year-old age group and was thrilled not to come in last! I know have an enlightened sense of awe for all those triathletes I used to make fun of :) Bottom line...I had fun (and I beat my brother - he had a flat - I'll take it, first time I beat him in over 20 years!)....Next time I'll be better prepared...I think I have the bug....gotta try again....



Run Happy...and try a tri for fun!

Got Heel Pain?

Heel pain is of epidemic proportions in the United States! It is the most common complaint we see in our office. The pain is greatest usually when you get up in the morning, but continues to worsen over time – until it hurts with every step you take and can even ache at night when resting.

This syndrome is most commonly caused by several factors, including, but not limited to: -Tight calf muscles-Increase in body weight-Sudden change in the amount of intensity of exercise-Improper or worn out shoes-Abnormal foot biomechanics (excessive pronation or supination)Due to any of the above factors, the plantar fascia (the ligament that holds up your arch) is pulled or strained so that a portion of this very strong ligament starts to tear or fray like a rope at its weakest point (where it attaches to you heel bone). This tearing causes microscopic internal bleeding in this area. Your body reacts by causing inflammation, which in turn causes irritation to the nerves, bursae and muscles in this area. As the inflammation occurs, the body tries to heal itself by depositing calcium in the area of the tear. This creates the “spur”. Not everyone will have a visible spur on x-ray, especially in the early stages. The spur is not the cause of the pain! It is just a tangible sign that extensive tearing has occurred. The tearing and straining is the cause of the pain and then the nerve becomes inflamed which makes the pain more sharp and long-lasting. The straining must be stopped, along with the inflammation, in order to resolve this problem.

Diagnosis of plantar fasciitis is made with a physical examination including a biomechanical exam. X-ray are recommended to rule out a stress fracture or tumor in the area. Shoe gear is also evaluated. (Don't forget to bring your running shoes to your appointment!)

Treatment initially includes all of the items listed below. If any of these treatments increases your pain, please call or contact the office. It has been estimated that 85% of heel pain can be eliminated by non-surgical treatements; but these take time and effort on the part of the patient and doctor. BE PATIENT! Your heel pain did not appear overnight, and it will take a while to totally eliminate the pain.

Conservative therapy can include:
1. Ice (at least 15 minutes twice a day);
2. Stretching (your doctor will give you calf and arch stretching);
3. Anti-inflammatories (either orally or in an injection); and
4. Arch supports/Taping/or orthotics.
Remember that treating the biomechanics of your feet treats the underlying cause where the other treatments are only treating the symptoms! Some people need physical therapy, night splints, and casting for relief. Conservative treatment often takes 4-6 months to eliminate plantar fasciitis.


Surgical treatment is the last alternative, after conservative therapy has been exhausted. Extracorporal shock wave therapy (ESWT) is a relatively non-invasive surgery that is quite effective, but deemed experimental by many insurance companies. If you are interested in more information about ESWT, click on the word underlined above.

There are two common surgical approaches to heel pain: the traditional approach (removes the spur) and the endoscopic approach (lengthens the ligament to reduce the strain and therefore reduce your pain). If your pain is not eliminated by conservative treatment after 4-6 months, we will discuss which approach is best for you.

Remember, the earlier you seek medical help for heel pain, the faster it will go away! If you have pain more than 5-7 days in a row in the same spot, call or contact our office for an appointment.

Need help with stretching? Go to our video Donnie and Dr Crane amatuer video heping you stretch your way to pain relief on YouTube! You are not allowed to make fun of our amatuer photography!

It Happened to Misty May-Treanor, Don't Let it Happen to You!

It has been a rough early fall for Misty May-Treanor, Olympic Beach volleyball champion. She was in the preliminary rounds of "Dancing with the Stars" when she ruptured her Achilles tendon in practice. She had successful surgery on her tendon and hopes to be back to competition soon. Many people have asked "If such a terrible injury happened to such a conditioned athlete, how can I prevent it from happening to me?"

The Achilles tendon is the largest tendon in the human body. It is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping. An Achilles tendon rupture is a complete tear through the tendon, which usually occurs about 2 inches above the heel bone.

The Achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses and medications can also increase the risk of rupture.

Rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are racquet sports and basketball, but any forceful push off can cause a rupture. Most ruptures are obvious and the person experiences a sudden and severe pain may be felt at the back of the ankle or calf—often described as "being hit by a rock or shot." The sound of a loud pop or snap may be reported. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear.

Tendon strain or tendon inflammation (tendonitis) can occur from tendon injury or overuse and can lead to a rupture. Most likely, although not reported, Misty May-Treanor had a minor chronic tendonitis from her volleyball competitions and then aggravated it with the strain of dancing. "Dancing with the Stars" training has been reported to be significant and quite taxing even to the athletes that are competing!

How can I prevent this happening to me? Treat any tendon symptoms before they lead to rupture! Call your doctor if you have any signs of minor tendon problems including pain with activity, swelling and problems with standing on your toes. Tendon strain or tendon inflammation (tendonitis) can occur from tendon injury or overuse and can lead to a rupture. Prevention centers on appropriate daily Achilles stretching and pre-activity warm-up. Maintain a continuous level of activity in your sport or work up gradually to full participation if you have been out of the sport for a period of time. Good overall muscle conditioning helps maintain a healthy tendon.

What should I do if I think my Achilles tendon is injured? Any acute injury causing pain, swelling, and difficulty with weight-bearing activities such as standing and walking may indicate you have a tear in your Achilles tendon. Seek prompt medical attention from your doctor or emergency room. Do not delay! Early treatment results in better outcome. The majority of people return to normal activity levels with either surgical or nonsurgical treatment. Most studies indicate a better outcome with surgery. Athletes can expect a faster return to activity with a lower incidence that the injury will happen again. Return to running or athletics is traditionally about 4-6 months. With motivation and rigorous physical therapy, elite athletes may return to athletics as early as 3 months after injury.

Remember that your Achilles tendon is needed for almost all activities! Treat it right and see your podiatrist if you have any symptoms of Achilles tendonitis to avoid an Achilles tendon rupture like Misty May-Treanor!

Larry: My Ultimate Ironman at the Ironman World Championships

Ironman World Championships, Kona, Hawaii

Here's a big cheer that goes out to my friend Larry Branigan!

Larry competed in the Ironman World Championships in Hawaii this weekend. He didn't win, but was a winning example for all of us. Larry is a 62-year-old colon cancer survivor who really can't run any more, but didn't let that stop him. He swam, biked hard, and ran as fast as his body would let him.

He finished in 14:38:33, 25th in his age group and 1494 overall.

Not bad for someone who is just over a year past surgery and nasty chemotherapy. Cancer slowed him down, but never killed his spirit.

So the next time you don't feel like getting up in the morning to run, think of Larry. If he can do it, so can you!

Knee Pain Slowing Your Run to a Crawl?

Patellofemoral Pain Syndrome in Runners

What is patellofemoral pain?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”.

Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

Run Happy!

15 Injury Prevention Tips

There are general rules for injury prevention that must be followed to avoid loss of training due to injury. Consistency and gradual incremental increases in overall athletic stressors are the key to any successful training program.

Causes of injury

Probably the main cause in distance running is the volume of training, especially if there is insufficient rest between sessions. This is the classic “too much, too soon, too fast” syndrome. Research has indicated that there is no link between speed and injury in distance runners, unless of course an appropriate warm-up routine has not been followed. Don't overdo it! The amount of training you actually carry out plays a key role in determining your real injury risk. Studies have shown, for example, that your best direct injury predictor may be the amount of training you completed last month. For example if May is a heavy training period, watch out in June! This relationship may seem strange at first, but it simply reflects the fact that vigorous training produces tired muscles which may not be able to stand up to further training stresses. Fatigued muscles also do a poor job of protecting their associated connective tissues, increasing the risk of damage to bones, cartilage, tendons, and ligaments.

Many injuries occur due to weak muscles or muscle imbalance. Assessment of muscle strength and balance and regular sports massage can be an integral part of a sports injury preventative strategy.

Resistance strength training can make muscles less susceptible to damage. This can be achieved in the gym or at home in your living room with a few dumbbells and a core ball.

It is important that any exercises are specific to your sport. In distance runners, adding hill training to your strength program can be a valuable tool for injury avoidance if carried out properly. Core stability exercises are an extremely useful tool in preventing muscle imbalance, especially in woman.

Top Tips For Injury Prevention
1. Avoid training when very tired. Or hung over!
2. Do not run if you are still stiff or fatigued from your previous run. Get out your bike or swim instead.
3. Avoid peer pressure into running too fast or too long when you are due for an easy day.
4. Pay attention to nutrition and hydration, increase carbohydrate consumption during periods of heavy training.
5. Increase in training should be matched by an increase in resting. Don’t increase yours by more than 10% per week.
6. Treat minor injuries immediately to prevent them becoming serious.
If in pain when training, STOP.
7. Keep to soft surfaces wherever possible. If you must run on the pavement, keep switching sides of the road especially if there is an appreciable curve to the asphalt.
8. Introduce new training techniques and activities very slowly and carefully.
9. Be religious about warming up and cooling down. Adopt a dynamic warm-up and stretch after a session.
10. Wear appropriate running shoes that are not excessively worn. Have two pairs that you rotate.
11. Listen to your body! Monitor daily for signs of fatigue.
12. Have a sports massage on a regular basis.
13. Incorporate core stability exercises into your daily routine.
14. Remember that strength training is great cross training for runners, especially woman.
15. Remember that to achieve your running goals, you need months and years of successful running free of injury and illness.

Pay attention to your body and all of these tips to ensure that you’ll continue to pound the pavement injury free for years to come!

Run Happy!