RunDoc at DFW Sports Medicine Symposium

This morning I spoke at the DFW Sports Medicine Symposium in Arlington, TX. What a great crowd! Over 300 physical therapists, athletic trainers and sports medicine physicians from all over Texas gathered to discuss advances in the medicine of sports.

I spoke on running injuries and more specifically the need for a complete biomechanical exam to not only diagnoses, but to guide your treatment plans. This way the runner can return to running in much better shape than they walked into your office. I feel it is a missing link in a lot of offices due to the time involved. Dynamic gait analysis can actually help the clinician diagnose the root cause of an injury instead of just treating the symptoms. This will decrease the chance of a repetitive injury.

I also talked about the current barefoot running phenomenon and the fact that the average runner will most likely not benefit from barefoot running due to poor biomechanics and muscle imbalances. There is much more of a chance that they will actually hurt themselves. Those runners with fairly good biomechanics and patience can benefit from some barefoot running in a controlled environment. Lots and lots of questions still exist and more biomechanics research needs to be done in this arena.

The need for functional foot orthotics was also discussed. No! Every runner does not need orthotics, but almost 80% need some kind of biomechanical help. Most can be accommodated with shoes, stretching and strengthening programs. You would be amazed how much impact a core strengthening program can have on your running biomechanics. Recurrent, nagging injuries often require orthotic control to alleviate recalcitrant pain.

The last thing I discussed was the need for a gradual return to sport so there will be no more of the too much, too soon, too fast phenomenon that plagues so many runners!

A great question and answer session followed. I gave away a few copies of my book, If Your Running Feet Could Talk. I think we all learned something this morning. A good time was had by all and all the athletes in the Dallas-Fort Worth area and all over the State of Texas will benefit!

Running Too Much, Too Soon = Shin Splints

The last few weeks, lots of patients have been coming into my office in Grapevine, TX saying, “My shins are killing me after running". This is a common complaint of new runners or runners increasing their mileage or intensity. It has been estimated that "shin splints" account for approximately 15% of all running injuries and may account for up to 60% of leg pain in runners. Many terms have been used to describe exercise-induced leg pain, including shin splints, medial stress syndrome, tibial stress syndrome, recurrent exercise-induced ischemia, and chronic exertional compartment syndrome. "Shin splints" has been commonly used as an all-encompassing term for many disorders causing lower-leg pain so that’s how I’ll refer to it during this discussion.

So what is a “shin splint”? Shin splints are pain in the lower leg usually caused by a variety of overuse or chronic stress related fatigue syndromes. The root cause of most shin splints is chronic biomechanical imbalances of the lower leg and feet. What does that mean? Bad feet, muscle imbalance, bad shoes, or improper training. In Caitlin’s case, she was running too much, too soon, too fast like many new runners and needed better stretching and arch supports.

What can a “shin splint” represent? The underlying pathology of a shin splint can be a fatigue injury of almost ever tissue seen in the lower leg. This can include:
1.stress fractures
2.periostitis (irritation of the covering of the bone also known as medial stress syndrome)
3.Muscle fatigue or fascial herniation (compartment syndrome)
4.Tendonitis
5.Peroneal nerve entrapment
6.popliteal artery entrapment or intermittent claudication (decrease blood flow)
7.spinal radiculopathy (spinal nerve compression causing referred pain).
Wow! That’s a lot of things that can cause shin splints!

While every shin splint injury has its own specific biomechanical causes, most are rooted in tight calf muscles and relative weakness in the front leg muscles. What's going on is that your tight calves are pulling up on your heel, which in turn pulls the front of your foot down. This puts strain on the muscles in the front of your leg, which unfortunately are not strong enough to resist the pulling. This causes a big pain in the leg! This is very, very common in runners, since running tends to exercise the calf muscles more than those in the front. But fear not, a little rest and a lot of stretching and strengthening will fix you up and possibly make you a better runner, too.

How do we treat them? Early on in the syndrome, shin splints are treated with ice, relative rest (slow down and get off the hills and uneven surfaces), anti-inflammatory like ibuprofen, stretching, and arch supports. Take a good look at your shoes. These often need to be replaced or upgraded to a better pair for your foot type. (More discussion on that topic in a future article). Yo may even need a custom foot orhtotic.

After we address your shoes and overpronation or underpronation (your foot rolling in or out excessively when you run), then we move on to the muscle imbalances in your lower leg. Your calf muscles are too strong and tight, while your front leg muscles (anterior compartment) are too weak. This is easy to remedy but won’t happen overnight. Stretching your calf muscles with a simple wall stretch for your Achilles tendon many times a day( how many?) will help. Strengthening the front of your leg can be done by actually putting a small weight (or an athletic sock full of sand) on your foot and lifting it towards your shin. Hold that for a count of ten then relax. Repeat twenty five times. You will be amazed how tired those muscles are!

If your pain persists after two weeks of these simple solutions or is at any time pinpoint or severe in nature, call you podiatrist or sports medicine physician. Stress fractures can creep up on the overzealous new runner and can take 8 to 10 weeks of no running to heal!

Shin splints are common in today's active population. It is important to keep in mind that shin splints, like most running injuries, are basically an overuse injury. Listen to your body and back off when you begin to feel pain.

These are just a few tips to get you on the road to recovery! Run Happy!

To Wave or Not to Wave? That is the Question

Sounds like a funny question, but what is the right answer? Is there a universal unwritten rule? Should you always wave so that other runners will see you as friendly? Or should you only wave at people you know so that a stranger won't think you are a potential stalker?

In Texas, it is typical to wave and even say hello to every runner you pass on your runs. Heck, I wave at runners, walkers, people's dogs, and even a few passing motorists who yell out the window. I figure they are either saying "Hi!", because they know me or they are admiring my sweaty derrière. Either way, a wave is indicated. I also talk nonstop while I run, so people either love to run with me or find me incredibly annoying. I was even told to shut up by another runner while running a marathon. Guess they were having a bad day. I know my incessant chatter can be distracting, but what about the wave?

To complicate the musing in my head, I also wonder about cyclists? Do you wave to everyone on a bike? After plunging head first into the triathlon world a few years ago and riding hundreds of miles, I still don't know the answer to the waving question when it comes to cyclists. The first few months I was learning how to cycle without falling down; a wave would've caused me to crash. I didn't even think about it! Now, I often wave or at least nod at the passing cyclists. You never know who is a friend or not with the helmets on.

Geography may also have something to do with it. I have come to realize, after running quite a bit while traveling, that the automatic wave is not the norm in other cities. I even started to think it was just a Texas thing, but remembered my childhood running in Rhode Island where everyone waved. Then again, everyone knew everyone else in my small town. Maybe it's a suburbia thing. In fact, while running in Chicago, people looked at me quite strange when I waved. No one actually returned my hello and I have to admit I was not feeling very welcome by the time I finished. My experience was similar in Pittsburgh. Not a lot of waving going on. I expected the same in New York, but was surprised when I received quite a few waves and even a passing grunt while running. Who knew New York runners may be friendlier than Chicago and Pittsburgh?

So, I embarked on a mission to answer the waving question. To wave or not to wave? After a very unscientific poll of over a hundred runners across the country, it turns out there are no hard and fast rules. There are however some loose guidelines:
1. It is always better to wave than not to wave unless you are running in a city. Wavers may be confused with muggers.
2. Wavers tend to be out for a recreational run, not a hard tempo run or speed workout.
3. There are more wavers in the South than in the North.
4. Woman wave more than men. In fact, one man felt a wave may be interpreted as a pick up line.
5. Non-wavers are often wearing an IPod and never even realize they are possibly considered rude and unfriendly.
6. Most cyclists have actually never even thought about waving, but feel a simple nod is recognition enough.

So, I guess there is no universal rule about waving, but I am going to continue to wave to ever and all runners to try to foster a community feeling while I run, but as for cycling; I think I will stick to the nod.

St. Patricks Day Tri Kicks Off the North Texas Triathlon Season

Keller, Texas was the home of the St Patrick’s Day Tri that kicked off the season for many an age-group triathlete. This year, the season actually started a little early on the Sunday before the great Irish-fest.

It is always a historically cold morning and was double whammy by being the morning of the great turn the clocks ahead tradition of the end of daylight savings time. Tired and cold, what a great morning! At 7:40am, just as the sun was coming up in the DFW area, the first swimmer hit the water. Almost 700 swimmers followed.

After a short 300 meter pool swim in the lovely Keller natatorium, it was off to T1. I cannot describe the feeling when wet feet hit freezing pavement. Picture it is 40 degrees and the cement between the natatorium exit and the parking lot where the bikes were hanging was hard and very cold. By the time I got to my bike, I could not feel my feet. I did don a long sleeve shirt over my dripping tri suit in transition or I thought I might be a popsicle by the time I hit the first mile. Thanks God for that thought!

Onto the bike I went. A brisk wind was my friend for the inaugural race on my new hot pink camo Quintanaroo Dolce bike. Yes, I said hot pink camo! Why not? I’m in touch with my inner princess ha ha. Love the new bike! It is a sports car when compared to my old Specialized road bike, but boy is it squirrely! I’m sure I will get more comfortable with its handling, but this morning I was a little unsteady. I’m sure a few people thought I had been up drinking green beer before the race. The ride was rolling hills and went uneventfully. I passed a few people and got passed by a few more. One guy turned to his friend as I passed them going up a hill and yelled, “Dude, we just got chicked!” Too funny, guess the pink bike bugged him ha ha. It was a smooth ride into T2.

Donned my hot pink Newtons (yes, they are obnoxiously pink as well) and it was off to the run. This is where I realized my legs were dead. The first mile I looked more like a jogging grandmother, but then my quads relaxed and I started to run. The adventure of triathlon is that you never know where or when the wheels are going to fall off (sometime literally). I finished in respectable style. Not my worst, but not my best effort.

The race was a good start to the new season. A little green beer and lots of laughter was had by all! A large group of first time triathlete’s were beaming and showing off their medals. Dallas Athlete’s put on a good show as usual and the triathletes of North Texas are at it again! Watch for cyclists and runners on the roads. In a month or so you will have to look for us in Lake Grapevine (still too cold for now). As for me, Run Doc is off to New Orleans to race the 70.3 in April. Get off the couch, it’s time to race!

Moderate vs Vigorous Activities

Study shows that vigorous exercise is better for your health than just moderate! Exercise junkies rejoice!

Moderate vs Vigorous Activities