11 Reasons Why Pool Running Doesn't Suck!

As a sports medicine podiatrist, I often encourage injured athletes to cross train and keep up their cardio fitness during their “rest period”. Pool running can be very helpful, but is frowned on as extremely boring and down right tedious by most runners and triathletes alike.

I also had to enter the conversation in our series “The Journey to Texas Ironman” with a shout out to everyone who has a little ache or pain in their foot or ,God forbid, a stress fracture, but still wants to join us at the starting line of the Texas Ironman in May. This was taken and liberally adapted from an article in the December 2010 issue of Triathlete magazine:

11 Reasons Pool Running Doesn't Suck
Completely stolen and altered from Holly Bennett, please forgive me….

1. It gives the barefoot movement a whole new angle -- and spares the wear and tear on your running kicks. Better than a pair of Vibrams!
2. You earn sympathetic looks from the cute boy-toy lifeguards. And at 40+, let’s face it – we like to look and dream, but would have a heart attack if they were serious!
3. Until now you thought breastroke was the slowest way you could possibly travel from one end of the pool to the other. Or my pathetic looking side stroke!
4. Hello, six-pack! Water running recruits those pesky, oft-neglected core muscles. Even your arms will exhibit extra buffness, strengthening with the resistance of the water. Let’s face it; most of us girls would be happy with a two pack after 4 pregnancies’!
5. If ever you long for a surrogate granny, there are plenty of gentle, smiling faces in the therapeutic lap lane. And most of them are my patients!
6. From your vertical vantage point, you can observe, admire and critique the swim strokes of the nearby lap swimmers. Maybe you'll learn something. And often times, you will realize your stroke is not so bad!
7. There are no rocks, stumps, curbs or other obstacles in the pool. In the water, you're no longer a danger to yourself. You can try running with your eyes closed. (Note: Resist the urge to fall asleep.)
8. One rarely encounters rattlesnakes while pool running. Or any kind of creature commonly seen while we practice open-water swimming on Lake Grapevine. And it’s not 60 degrees!
9. If you hop in immediately following a bike session, you get to call it a "P-run."
10. If you can mentally endure two hours of water running, your next Ironman marathon will feel short. I highly encourage a swim man IPod…..I could never even train for the Ironman swim without it.
11. And of course, the most important reason pool running doesn’t suck: Dr Crane won’t completely bust you when she or Janet passes you on the trail when you are still supposed to be in the walking cast!

Bottom line, pool running really doesn’t suck if you have the right attitude and tunes! Embrace the change and come out of the “rest period” that much stronger so none of us will be carried off by the ambulance come May!

Chronic Heel Pain Responds to Night Splint

Plantar Fasciitis a.k.a. Plantar Fasciosis (PF) is an extremely common foot injury usually described as heel pain. The pain is usually first thing in the morning and after rest. PF is by far the most common injury I see in my North Texas sports medicine clinic. PF is seen in most athletes, and is one of the most common running injuries. One study described PF as affecting 8% of habitual runners. 8%! When you calculate that approximately 2% of the US population runs on a regular basis (based on a survey of how many people ran a marathon in their lifetime). That is a lot of people. Actually the rough estimate is 6.2 million runners in the US alone with about a half a million suffering from heel pain. Wow! Oh my aching heel!

Why is there so much heel pain in runners? Too much, too soon, too fast syndrome. In other words, we want to be in shape way before our bodies are ready. The rule of adaptation states that our bodies become stronger with small incremental increases inn stress, but we break down with large incremental increases in stress. This is why PF is described as an overuse injury.

So how do we treat is? A protocol approach that starts with simple, stupid and follows a stepwise pattern that ends with 85% of runners having complete resolution with conservative therapy and 15% going on to move invasive surgical procedures.

Mainstays of treatment: orthotics, better and/or different shoes (that is an entire article in and of itself), lots and lots of stretching, night splint, anti-inflammatories, physical therapy, extracorporeal pulse activated treatment (EPAT), and in some cases, injection therapy (always a debate in athletes).

Simply reducing pain and inflammation alone is unlikely to result in long term recovery. Rest is usually not enough. The minute the runners gets back to activity, their pain is back! I find that most runners, especially over the age of 40, desperately need to stretch their Achilles tendon and plantar fascia. The plantar fascia tightens up making the origin at the heel more susceptible to stress. The best way to do this is a combination of dynamic stretching throughout the day (see my video on Youtube) and a night splint. A plantar fascial night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Why does a night splint work, especially in athletes?

The plantar fascia is the ligament that holds up your arch. It is a thick band of fibers that go from the heel of the foot across the bottom of the foot to the toes. Plantar fasciitis is considered to be an inflammatory process following micro tears in the fascia. Plantar fasciosis is a degenerative process that occurs after several months of chronic plantar fasciitis. The reason PF causes so much pain in the morning, is that during the night the foot is relaxed and drops so the toes are pointed downwards. In this position the plantar fascia is relaxed, healing of the micro tears occurs overnight, but when the foot is put to the floor in the morning the fascia has to stretch to a longer position and this tears the new healing. Think of ripping a scab off every morning! Ouch! The idea of a night splint is that the foot is held overnight with the toes pulled upwards and thus the healing occurs with the fascia in its stretched position.

Many research studies have looked at night splints and the treatment of plantar fasciitis. There have been some mixed results due to the construct of the studies, but overwhelmingly the whole body of evidence suggests that night splints can help ease pain and assist healing, and this is especially true for people who have been suffering from plantar fasciitis for several months or more (truly plantar fasciosis).

Night splints do generally have to be used consistently for at least one month or more before significant improvement is seen. If you are a light sleeper, just make sure your wear it at least 4 hours a night.

A number of good night splints are available, and the fit and comfort is important given you will be wearing it for at least 6 weeks AFTER your symptoms resolve. A dorsal night splint will allow you to walk to the bathroom in the middle of the night without taking it off. A posterior night splint usually is better tolerated long term.

Got an aching heel, seek out a running podiatrist to get you back on the roads in better shape than you left them!

EPAT Treats Chronic Heel Pain

EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.

The Top 16 FAQ’s About EPAT Therapy for Heel Pain:

1. What Is EPAT?

EPAT is an acronym for Extracorporeal Pulse Activation Technology. It is a highly effective non-invasive office based treatment method that accelerates healing of injured tissues.

2. How Does EPAT Work?

The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

3. How is the Treatment Performed?

Ultrasound gel is applied over the skin of the treatment area to enhance the transmission of the pressure waves. The pressure waves are applied using a special applicator tip. The tip is moved over the injured tissue using circular motions.

4. How Long Does the Treatment Take and How Many Treatments are Required?

Treatment sessions take approximately 15 minutes per site and vary slightly depending on the site to be treated. Generally 3 treatment sessions are necessary and are performed on a weekly interval. If you are improving, but not completely better; up to 5 treatments can be performed.

5. What Conditions Can Be Treated With EPAT?

EPAT can be used to treat many painful soft tissue injuries. Including: plantar fasciitis, Achilles tendonitis, tendon insertional pain, acute and chronic muscle pain, and myofascial trigger points.

6. Is EPAT Safe?

EPAT is a safe treatment with virtually no side effects. It was originally developed in Europe and is currently used around the world.

7. Is EPAT Safe for Pregnant Patients?

EPAT is a safe treatment, but has never been tested on pregnant patients. Patients are advised to wait at least 3 months post partum before treatment, as many foot pains subside after weight loss and hormonal equilibrium is reached.

8. Is EPAT FDA Approved?

Yes, the machine is FDA cleared for usage.

9. What are the Expected Results?

Most people will experience pain relief after 3 treatments. Some patients report immediate pain relief after the first treatment, but maximum relief can take up to four weeks after the last treatment to begin. Over 80% of patients treated report to be pain free or have significant pain reduction.

10. Are There Any Special Aftercare Instructions?

All patients receiving EPAT therapy should be off all anti-inflammatory medication for a minimum of 2 weeks prior to the procedure and 4 weeks after. This includes common over the counter medication such as, ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin. Your doctor will provide you with detailed after care instructions.

11. What are the Possible Side-Effects or Complications?

EPAT is a non-invasive treatment and has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. On rare occasion, the skin may become bruised or red after the treatment.

12. Who Should not Have EPAT?

EPAT should not be used in people who have deep venous thrombosis or malignancy. It is also best to avoid the procedure if you are taking blood thinners.

13. Why Consider EPAT?

EPAT has a proven success rate equal to or better than traditional treatment methods (including surgery) without the risks or lengthy recovery time. It is performed in your physician's office without the need for anesthesia.

14. Does My Insurance Pay For EPAT?

No, unfortunately insurance companies do not pay for EPAT, though the cost of EPAT can often be reimbursed from a qualified health savings account. Non-covered services and/or procedures without billable terminology are paid to the office by the patient at the time of service; a claim will not be submitted to the insurance, though our office can provide receipts for reimbursement accounts to consider.

15. How Much Does it Cost?

EPAT is an affordable alternative to invasive surgery, lengthy physical therapy and other costly treatments. The first 3 treatments are bundled at a cost of $500 for the procedure, but you are still responsible for any co-pays or costs associated with the initial and/or any follow up office visit. If a 4th or 5th treatments are deemed necessary, these cost $150 per treatment.

16. How Can I Get More Information About EPAT?

The physicians at FAANT all have experience in providing EPAT treatment and are the best people to speak with if you have additional questions regarding the procedure. Call or contact our office for a consultation.

There is also much more extensive information available at http://www.curamedix.com/