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!

Should Diabetic Runners Use Sports Drinks?

I get a lot of questions from diabetic runners about the use of sports drinks during exercise. Should they drink straight water or a “diet electrolyte solution”? Can they mix in or use a regular carbohydrate-electrolyte solution for carbohydrate replacement and energy?

Great question! Drilling down a title further, most diabetics are truly concerned about spikes in blood sugar and bottoming out during exercise, which may cause fatigue symptoms and decreased endurance. There is some validity to these concerns, but studies show the benefits out weigh the risks as long as you are utilizing 5-8% carbohydrate solution. Higher concentrations will delay gastric emptying an actually slow rehydration which can lead to dehydration especially in our hot climates. A recent article actually explains this well: “Drinking carbohydrate-electrolyte solutions before exercise does produce, during exercise, rapid rises in blood glucose and insulin concentrations, followed by a sharp fall in blood glucose. However, as exercise continues, blood glucose concentrations normally return to pre-exercise values. It is interesting to note that, even on the occasions when blood glucose concentrations fall to hypoglycemic values during the early part of prolonged exercise, the subjects in these studies do not report any adverse sensations.”

Interested in learning more? Click here to take you to the original article.

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

Spring is in the Air in DFW...Time to Dust Off the Running and Cycling Shoes!

So Spring is in the air in the DFW area! Time to dust off your bike and running shoes and head outside. Forego the treadmill or the trainer for fresh air! Yea!

So if you are like me, it’s also time for new running shoes. The battered winter pair have had it! How long are running shoes good for? About 500 miles or six months, whichever comes first! Now an aside about the recent craze in minimalist shoes, just because they are “minimal control and cushion” does not mean that they last longer and don’t need to be replaced. In fact, I found my more minimal shoes seem to wear out faster.

So you haven’t reached the 500 miles or six month expiration date because you have been lazy the last few months of winter? Please at least decontaminate your shoes! Take a spray anti-fungal (my favorite is Mycomist) or use a shoe sterilizer (like Steri-Shoe) and get rid of the cooties that have been growing in those idle shoes. Don't have something to decontaminate your shoes? Stop by Healthy Steps and they can hook you up! This is especially important for cycling shoes that have been sitting in the closet or garage all winter. Cultures of these kinds of shoes show fungus among us, as well as, staph, strep and nasty pseudomonas bacteria!

Also time to take a look at the sock collection. Socks don’t last forever and tend to shrink. If your socks are too small, you can get black toenails and even lose toenails just from the pressure of the socks! If your socks are more than a year old, toss them and buy yourself a spring treat of new socks!

And last, but never least, it’s time for girls to take a long look at their jog bra collection. Just like socks, these bra tops need to be replaced about once a year if you expect any supports for “the girls”.

Enjoy this first taste of spring coming to Dallas-Fort Worth….who knows, next week it could snow; but my money is on spring is here to stay! Enjoy it before the sultry summer descends upon us!

Doctors Can Get Hurt Too!

Confessions of Myrundoc: Do as I Say, Not as I Do.....

Time to come clean. Yes, I too can fall victim to a running injury. And yes, of course it's a foot related issue. Turns out the old adage is true that doctors are the worst patients, just like plumbers often have leaky pipes at home :) in fact, I think doctors are the worst patients only trumped by pilots. Yes, it's a control issue!

Because I'm the local authority on running injuries I of course started to treat my injury when it was in its mild form....Not! No, I did like most of my patients and ignored it until my foot hurt so bad the day after a race that I could barely out my heel on the ground. Yes, I suffer from the dreaded and incredibly common plantar fasciitis in my left foot. Why? A combination of the perfect storm.

I would like to blame it on the White Rock Marathon, you all remember that glorious day.....45 degrees, pouring rain....but if I'm honest, it started way before that. I ran the DRC Half in November with bronchitis (also a brilliant move) then barely trained the rest of that month as I was getting over my upper respiratory infection. Couple that with an incredibly busy November and December in the office and the OR; you get poor training schedule, exhausted body and depressed immune system. Oh yeah, I also ran the White Rock Half marathon in the pouring rain and had to run the Bold in the Cold Half marathon because my running club was putting it on and the medal was cool.

Long story short, what started as a little tightness at the Phoenix Turkey Trot over Thanksgiving (oh yeah, ran that too, then climbed Camelback Mountain the next day), became a swollen, sore foot by the first weekend in January.

So what do I do? I stopped running. This wasn't really a choice since I could barely put my foot on the ground the day after Bold in the Cold. I started icing, taking Advil and lots of stretching. I looked at my shoes and realized I had five pairs I was working on and all of them were dead. My orthotics were 3 years old and needed replacing. I started wearing nothing but a brand new pair of running shoes to work and clogs on the OR. I even let my partner give me a steroid injection. And I got in the pool and on the elliptical and bike so I didn't gain a million pounds!!

A month went by and I was somewhat better. Maybe 50% but still couldn't run. I was now starting to get annoyed and my staff wanted me to get back to running so I would stop being cranky! Onto EPAT....why have technology if you aren't going to use it? What is EPAT. Yes, I had the EPAT procedure performed the first week in February and yes, it hurts like hell but way worth it. I was about 70% better after the first treatment and 80% after the second. I still did the night splint (incredibly annoying but effective for the first thing in the morning owie), had gotten a brand spanking new pair of custom orthotics and still wearing nothing but running shoes, clogs and a two inch heel when necessary.

I went for my first run in 6 weeks yesterday in Napa Valley, CA. I was in wine country for a conference and my foot was feeling so much better. I did 4 miles of walk run and did pretty well. Tight but not painful! I'm going to have my third EPAT this week and I think that should do it. Maybe I will let the staff video it so you can all join in.

What did I learn? Listen to my own advice. If I had started stretching, icing and looked closely at my shoes and orthotics at Thanksgiving; this whole saga probably could have been avoided. Stubbornness and the fact that when I close my eyes I'm 19, did not help me recover. Thank God for technology! The EPAT certainly saved the day for me. I'm sure two months of physical therapy would've had the same result, but time was short and technology available! Bring on the triathlon season! First race St. Pat's Sprint Tri in Keller on March 10th!

Are You Suffering From Excusitis?

Are you suffering from excusitis? Meaning you have way too many excuses of why you can’t exercise? Need some motivation to get back on the road? Here’s a good one: Exercise will improve your love life!

Often people think of exercise as something that will possibly make them look better and maybe live longer. But, it doesn't just stop there. Exercise can improve all aspects of lives, especially relationships with friends, family, and signifiacnt others.

Become a Better You. Exercise can make you feel better about yourself. How you perceive yourself is obvious to others around you. Every day that starts with a run always seem to be a great day!

Attract Positive People. When you feel better about yourself, you attract the right crowd. Attract others that are positive to be around. You really are the average of the five people you hang out with the most!

Be a Role Model. When you exercise, other aspects of your life improve. Your body wants to eat better, sleep sounder, and be more active. Your family will notice and your kids will be forced to eat better!

Meet More People. Exercise can help your fear subside. Your positive choices for your body will help your confidence; and therefore more inclined to meet others. My running club is my family away from home.

Good Relationships Become a Goal. With any exercise, creating goals help you succeed in every workout. It's the same idea with relationships. The more you create goals the more natural it becomes. Think of it as something you want work and improve on every day. A goal not written down is a mere wish! Once you start writing goals down its amazing how they happen!

Communicate Better. When confused about how you feel and what you want for yourselves can be difficult to share with others. Studies show exercise helps your brain think more clearly, which will help your communication skills with others. Who doesn’t want to communicate better?

Exercise cannot fix everything in your life, but it definitely can make you a better version of yourself! Want a better love life? It's important to work on you first and then show others what you're made of. You will be amazed with the results!

February is the month for love….I love running!

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.