Returning to Running After Injury or Surgery

Returning to running after an injury or surgery is often frustrating to the runner, and also to their doctor! Most veteran runners start back too much, too soon and too fast. The opposite can also be true; newbie runners are often afraid to re-injure themselves so often are extremely cautious making themselves borderline paranoid in their return to sport. Which is better? Neither! Somewhere in between is the most prudent, and less frustrating way to return to activity; especially after surgery!

God’s basic rule of bone healing is that the average person takes at least 8 weeks to heal a fracture or a surgically cut bone. It is important to understand that it’s his rule, not mine - made up to torture my patients! It is also important to understand that age and extent of injury can make this 8 weeks longer! Yes, I said that bad word – age! Listen to your doctor and don’t try to run too soon, or you may cause yourself a set back laden with swelling and more pain!

So you’ve been cleared to return to running! Yea!!! But what does that really mean? Well, it depends. Great answer, I know J. The rate at which you can return to running is limited by your soft tissues ability to adapt to increasing stress. Gradual increase in running stress is paramount to this adaptation.

Here is a good basic plan to return to running after an injury or surgery:

Walk 5-7 minutes to warm up, run 5 minutes, walk one minute, run 5 minutes, and then walk 5-7 minutes to cool down. If you have no pain during this walking and running (Important tip! IF NO PAIN); then progress by one more interval each day. Day two would be walking 5-7 minutes, run 5 minutes, walk one minute, run 5 minutes, walk one minute, run 5 minutes, and finish with walk 5-7 minutes. You get the idea.

The next question is always, “When can I get rid of the walk breaks?” If you are under the age of 50 and a veteran runner, the walk breaks can be eliminated after you can walk:run with no pain for 45 minutes or so. In my opinion (and understand this is just my opinion), most newbie runners and those over the age of 50 should continue walk:run either forever (Yes, I love the Galloway method) or until they can comfortably walk:run for an hour.

Another good tip is also to start with a pace that is comfortable, even easy; then after you can walk:run for 45 min to an hour with no pain - then you can start increasing your pace. Long, slow distance is good for your adapting muscles, tendons and bones.

I know this seems very slow to many of my readers, but return from injury can be fraught with setbacks. This is a plan to continuously move forward in your fitness and avoid more time off! You will progress quickly through this algorithm if your body is healthy and sound - ready for the running challenge! Listen to your body and progress at your own pace!

Update on the Running 2,015 miles in 2015 Challenge: Art and I are still going strong! We reached 600 miles just before the end of April, and although we were slightly less than our target of 671; we are planning on doing quite a bit of racing this spring and summer, so I think we still can easily reach our goal! Next race is Ironman 70.3 Chattanooga next weekend! Full race report to follow!

Run Happy! Run Strong!

Strengthening Your "Foot Core" May Reduce Injuries

Running injuries are often caused by failure of the stabilizing muscles of your feet that make up your “foot core”. We all talk about how important “core” stability is in preventing injuries, but most of the focus is on our hips, pelvis and back. What about the tiny little “foot core”? There was a really interesting article in this month’s British Journal of Sports Medicine, which make the case that we shouldn't ignore our “foot core”.  In fact, the  authors challenge us to move beyond lifetime orthotic control; and after treating an injury with stabilization and rest with an orthotic, slowly wean the runner away from their orthotics by gradually stabilizing the “foot core”. Interesting paradigm shift! I'm not ready to get rid of my orthotics, but perhaps this is really not so new; but just another way to meet the demands of runners who want to go back to natural running style without the use of corrective orthotics or stabilizing shoes. Hmmm. Sounds like the exercises we presented years ago to stabilize your feet in order to introduce minimalism? I definitely see where this could be helpful in treating all of our runners that don’t have overwhelming biomechanical issues. It certainly can’t hurt!!

So what makes up the “foot core”?

Your feet have extrinsic and intrinsic muscles.  Extrinsic muscles originate far away from the joints that they move.  These are the toe muscles that start on the shin bones and turn into tendons that attach on the ends of the toes.  They can curl and extend the toes, but they do it by crossing over the many small bones and joints of the foot.

Intrinsic muscles originate and attach within the same body part.  In the foot, they originate on the heel bone or long bones of the arch of the foot and attach on the toes.  The intrinsic muscles are like the “core” muscles of the foot.  Because they are deep and don’t cross over too many joints, they can work well in stabilizing and protecting the arch and structures within the foot.  There are actually 11 tiny little intrinsic muscles in your feet, but they have a big job to do. When the foot intrinsic muscles are weak, the foot structures are more prone to increased stress and injury.  Strengthening the intrinsic muscles of the foot is good for people with foot injuries (especially plantar fasciitis) and of course those looking to prevent injury.

So how do we strengthen the “foot core”?

Here are some examples of foot intrinsic strengthening exercises.  They can be done either in sitting or standing, one foot at a time, or both together.  At first, the movement may seem impossible, but if you practice for a few minutes a day, you will start to see the toes working with better control.

1)    “Toe Swapping” – Start with your foot flat on the floor with equal pressure on your heel, the base of the big toe, and the base of the little toe.  Raise up the big toe while keeping the other 4 toes flat and pressed into the floor.  After holding a few seconds, try the opposite.  Flatten the big toe down into the floor and try to lift up the 4 small toes.  Try not to let your whole leg roll back and forth as you swap back and forth between the big toe and the 4 small toes.  You can start by using your hands to hold the toes in place to help your body learn how to isolate the toe movement.

2)    “Playing the Piano” – Start with your foot and all the toes flat with equal weight on the inside and outside of the foot.  Raise the big toe up by itself as in the previous exercise.  Keeping the big toe up, raise up the second toe to join it.  Then add the third toe, the fourth, and the pinky.  Try to make each toe come up separately.  Once all the toes are up off the floor, start putting them back down one at a time starting with the little toe.  Keep rippling them up, and then down, like someone playing scales on a piano.

3)    “Doming” – Start again with the foot flat on the floor.  Try and press the underneath side of the small knuckles of the toes down into the floor.  This should make the main knuckles closest to the foot raise up like a dome.  The toes need to stay long and straight.  When the toes curl under, it’s the extrinsic muscles working, not the intrinsic.

These movements will be a little frustrating at first, but they will strengthen the “core” muscles of the foot.  They also make good party tricks. 

There is a great video on strengthening your feet to prepare for minimalist running (by yours truly) that gives you 6 more simple exercises to strengthen your feet! Check it out! And of course, if you have any foot pain that is not resolving, consult your favorite podiatrist!

On a side note: The quest to run 2015 miles in 2015 is still moving forward! We hit 400 miles this weekend at the Dallas Athlete’s St. Patrick’s Day Triathlon! Fun Times…..Now 1615 miles to go…..See you at the Dallas Rock & Roll Half Marathon this weekend! 

There is Life After Running - Seriously!

There is Life After Running……Seriously

“When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has opened for us.” Helen Keller, author, political activist, and speaker

This is my profound thought for today. We often, as runners, feel like our world is coming to an end when we can’t run due to an injury; or even worse, a permanent disability. This often happens in older runners due to knee issues or chronic back pain. Foot and ankle arthritis or a torn tendon can also cause a premature end to a running career.

Instead of looking at what we can’t do, we often need to rejoice in what we can. When I turned 40, I realized that I needed to start cross training so I wasn’t beating the heck out of myself every day. I reinvented myself as a triathlete. I hadn’t done any swimming seriously in over 20 years and couldn’t remember the last time I was on a bike. I had always just run!

I had a goal: a sprint triathlon in 3 months! I made a list and borrowed a triathlete friend for a shopping trip to the cycling shop. A cute pink road bike later, I was on my way. A bathing suit, cap and goggles were procured and I jumped into the pool at the gym. Surprisingly, my swim form and bike balance were not all that bad. A conservative training program and lots of encouragement got me to my first triathlon. That was 2008.  I have done many sprint and Olympic triathlons; 6 Half-Ironman and 2 full Ironman triathlons since then. I’m a stronger but slower runner now, but honestly my body feels way better.

Many of my patients have had the same type of result with cross training. Some have given up running for cycling due to an old injury or two. Yoga, pilates, cycling, circuit weight training, elliptical, swimming, and even Zumba can be fun diversions form a chronic ache.

The world does not end if we can’t run. Often its not a "I can’t run", but perhaps " I should run less often" scenario for most people. Take it from me, find something fun that will get your heart rate up and sprinkle it into your running. Your body will thank you. Cross training (also known as relative rest) is not a death sentence but can be a door into a whole new you! Who knows, you may find yourself owning a pink bike!!