Category Archives: Running

Just Run Through It?

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Holly's beautiful running form at the end of the Mid-Mountain Marathon

Holly’s beautiful running form at the end of the Mid-Mountain Marathon

By Emma Maaranen

It is prime time running season with runners all over the Wasatch Front training for the Wasatch 100, Mid-Mountain Trail Marathon and St. George Marathon.  At Focus Bodywork we are often asked how to decide if a pain experienced during a run is okay to run through or not.  First, pain is your body’s way of letting you know that something is not okay and needs to be investigated.  Listen to your body!  I lump running pain into two categories: pain that develops while running and pain that develops after or continues several hours after a workout.

Pain That Develops While Running

Discomfort while running is part of the game; if you run you will experience pain now and then.  There are times, however, when you need to listen to your body and call it quits. When running pain causes you to alter your gait, it is time to call it a day.  Your compensated gait is a sign that there is a problem, and to run through it in this odd gait will most likely cause more problems and/or usher the painful site into full-blown injury status.  If the pain is not altering your gait, slow down for five minutes and focus on good running technique.  At the end of five minutes check in to see how the pain has changed.  If is the pain has reduced, pick up the pace and see what happens.  If is the pain has stayed the same, try another 5-minute technique period.  If at the end of this second test period the pain has increased or your gait has altered, it is time to walk home.

Pain That Develops or Persists Several Hours Post-Workout

You need a rest day! If the pain has subsided after a day of recovery try an easy run and see how it goes.  If you do not have pain while running and it does not return a few hours after rest, you can resume training.  If not, start with some good home therapy.

Home therapy:

1.)    Day 1 – Take a rest day- a real rest day!  Don’t even go to that yoga class.  RICE (rest, ice, compress, elevate) as often as you can.  Sit in a hammock (with your legs up and iced) and catch up on some reading (If you NEED to call this day a training day I recommend reading “The New Toughness Training for Sports: Mental, Emotional and Physical Conditioning from one of the World’s Premier Sports Psychologists” by James Leohr.)

2.)    Day 2 – If your pain is still hampering you, try a regiment of OTC anti-inflammatory, such as Ibuprofen.  Initially this will mask pain symptoms, but if taken as prescribed for 5 days you will reap the anti-inflammatory benefits of the medication.  RICE.  I know you are panicking about your fitness diminishing already (it is not, this takes two weeks), so try some cross-training, such as swimming or biking.  If your cross-training sport increases any of your pain symptoms, you need to try something else.

3.)    Day 5 – If your pain has not resolved, it is time to see a professional.  A sports massage therapist (like the ones at Focus Bodywork), a physical therapist or sports medicine doctor can help you develop a plan to get back to running pain free.

Endurance sports regularly require athletes to push through discomfort.  Should you “just run through it?”  It is important to evaluate your pain keeping in mind that cutting a training day short may save you several weeks of being side-lined.

One Of My Favorite Clients And Why

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By Emma Maaranen

I work with athletes of all flavors: a stay-at-home Mom  training for her first marathon to lose baby fat and carve out some time for herself, a professional Extreme skier trying to keep his spine healthy as he drops 80-foot cliffs, and a 14-year-old US Figure Skating Team member who trains more hours in a day than I am even awake for.  I love the variety of motivations my clients have to be athletes.  I am regularly introduced to new sports (like skeleton) and constantly dive into medical journals to learn how to meet each of these clients’ novel sport and injury needs best.  Recently I have met my biggest challenge.  Her name is Micah, and we can all learn a lot from her about injury psychology, trusting the healing process and the importance of “homework” to get back to the things we love.

Micah is a runner and, through some poor footwear decisions, developed pain in her feet.  Because she was unable to continue running, she saw several specialists to diagnose her foot pain.  Many doctors, MRI’s, and cortisone injections later, she did not have a diagnosis or relief.  She was recommended to rest and hope that the problem resolved itself; it did not.  It soon became painful for her to even walk.  Months of limping soon made her hip painful.  This is the point where I started working with Micah and her medical team.  An insightful podiatrist radically changed her footwear, which  changed how her heels interacted with the ground until finally she showed signs of improvement in her feet.  However, as her feet improved, her  hips got worse.  I surmised that all the gait alteration to escape the pain in the feet required new and novel uses for her hip joints.  I released the tight and overused muscles in her hips, stimulated the muscles that were not pulling their weight, did gentle joint gliding for the hips and lower back to encourage synovial fluid production (lubrication for joints), and introduced lateral movement into Micah’s rehab work to strengthen her atrophied muscles.  I was glowing as a therapist after this first session.  Micah was in the least amount of pain that she had been in for months, and she was finally hopeful she would return to racing on the trails again.

The next morning I received a panicked phone call from her mother.  Micah was worse, much worse! I reviewed the therapy I had done with her and was completely confused; at worst she should have had no change in her pain but be a little touch sensitive in the muscles I released.  We talked further and I learned that Micah felt so fantastic after my work that she promptly ripped around in the foothills with her friends that evening.  She believed that since she felt good she could go back to doing everything she did before, right away. Even though I explained to her during our session that she would feel better, a slow and methodical return to activity was essential.  This often is ignored by clients as the thrill of experiencing some improvement is seductive.  There are muscles to strengthen and movement habits to change that will take time and practice, plus some tissue healing that will take about six weeks to complete.  We set up an immediate follow-up session.

During our second session I spent considerable time with Micah teaching her the strength and movement exercises necessary to properly restore her hip biomechanics, showing her which tight muscles could benefit from self-massage, and some stretches to promote a full range of motion.  After our session I believed Micah understood the process to get her hips healthy again and a realistic time-line for returning to sport.

A few days later I received another call from Micah’s mom.  This time, Mom was laughing!  Mom shared with me that I must have gotten through to Micah as she was going out of her way to show her the exercises she was doing, and was doing them almost every chance she got.  Relieved, I saw Micah again to further therapy.  This time Micah had to show off.  She spun in circles demonstrating the lateral movement exercises I had asked her to practice; she did a forward fold placing her head between her legs to open up her hips, then went over to a piñon tree and pressed her hip into a knobby branch she obviously had pruned so she could do some self-therapy.  I was amazed;  Micah is a horse!

Micah Getting Therapy

It has been a bumpy road, but Micah is back to racing around the trails with the heard.  Even though Micah is a horse, her healing process from a frustrating injury is the same as yours and mine.  Injuries can be tricky to diagnose.  It often takes a few visits to various health care providers to figure out how to get an injury healed, and often there are multiple factors contributing to the pain. Often it takes a team of “experts” to come up with a plan.  When finally we see some improvement, it is difficult not to overdo it and set ourselves back.  Patience!  Being an active participant by doing your “homework” and becoming educated about your injury and healing process is essential.

Me, Teaching Micah Her “Homework”

Micah is my first equine therapy client, and it has provided an incredible learning experience for me.  I am available for other equine sessions; call Focus Bodywork if you would like to know more about my credentials, what is involved in a session and rates.

ITBS (Illio Tibial Band Syndrome) is not IBS (Irritable Bowel Syndrome), but it is Irritable

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By Emma Maaranen

ITBS is a repetitive stress injury common to both runners and cyclists.  If you participate in either of these sports, either you or your training partners have likely experienced this injury.  ITBS is characterized by pain on the outside of the knee.  Unless you have experienced knee trauma recently, ITBS is most likely the sports injury you are dealing with, not a torn meniscus or knee ligament.

What is the ITB?

ITB anatomyThe ITB (Illio Tibial Band) is a long tendon (rubber-band like structure that connects muscle to bone) that runs on the outside of the thigh from the hip the knee.  The Gluteus Maximus and Tensor Fascia Latta are the muscles that connect to the ITB.  These muscles make a fan shape between the outside top of your pelvis (if you put your hands on your hips, they span from your index finger to thumb), and they narrow to the bony spot at the top outside of your thigh.  (Insert image here) The ITB starts at the bottom of this fan shape and travels down the outside of the thigh.  It then crosses the knee and inserts just below the knee on the outside of the tibia (lower leg bone). The ITB separates the quadriceps (front thigh muscles) from the hamstrings (back of thigh muscles).  If you have ITBS, pain is felt just above the outside of the knee.

How did this happen?

Most of us do sports that move forward and have little side-to-side motion with the legs.  Over time forward only motion weakens the muscles of the ITB.  To walk, run or to pedal these muscles work in a small range of motion, which trains the muscles to be strong only in a small zone and causes a loss of flexibility.  Sudden increases in training distance or intensity, as well as adding steep hills into run training, can overtax these muscles and tighten them.  This creates excessive tension in the ITB and begins to cause friction at the lateral epicondyle (the bony knob at the outside bottom of the thigh bone).  When you bend your knee about 30 degrees the ITB normally glides over this bony knob, but if it is too tight the ITB grates over it and gets irritated.  Once inflamed, the ITB becomes swollen and will grind over the lateral epicondyle more, making the condition worse as you push through the pain!

You have pain at the outside of your knee; what do you do?

The first time you experience pain at the outside of the knee it is important to end your workout.  Go home and ice the painful area.  Rest and ice for three days (no running/hiking/biking; avoid stairs and other activities that involve repetitive bending of the knee).  After three days, see how it feels.  A minor one-time irritation of the ITB should recover after this rest period, but be on notice that you need to strengthen and lengthen the muscles of the ITB.

If, however, three days of gentle care for your inflamed ITB does not alleviate the pain, you most likely have ITBS.  ITBS is a fancy tendonitis.  For it to heal, you will not only have to address the inflamed tendon, but you will have to address the cause of the excessive tension in the ITB as well.  The cause is often a combination of weak/tight ITB muscles, adhesions along the ITB to the quads and hamstrings, muscular or structural imbalances in the pelvis/hip complex, and foot/ankle biomechanics. Cyclists need to make sure they are not in excessive toe-in position when clipped in and runners should replace their running shoes if they have over 250 miles on them.

At Focus Bodywork we can help you sleuth the factors in your ITBS, address adhesions in the ITB, treat the associated muscles and recommend self-care practices.  Occasionally ITBS is stubborn and needs a physician’s care.  In these cases you may need a cortisone injection, orthotics or a regiment prescribed by a physical therapist.  We are happy to recommend some fantastic practitioners for you to work with and be a part of your return-to-play team.

In our next post we will cover self-care for ITB health.

I Love Being Called This, But It Gives Me Big Shoes To Fill…

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By Emma Maaranen

“The Leg Whisperer”

In this blog post (click on the blue link above) are some very kind words from Jay Aldos, a gifted ultra runner and Focus Bodywork client about how sports massage has become an essential part of his training. Thank you Jay!

PS – Jay went on to win the Zion 100 last weekend.

“Running will ruin your knees” – maybe not so…

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By Emma Maaranen

Today the Wasatch 100 ultra marathon started and many of the Focus Bodywork community are running or pacing for this event.  Over coffee this morning I overheard some ladies mocking the competitors, stating, “They are ruining their knees, none of [them] will be able to walk when they are in their 70’s.” Let’s debunk this notion. When comparing the knees of seniors over a 10-year period (age ranges from 50-80, in 10-year increments) who live a sedentary lifestyle, who run an average of 20 miles a week, and those who live active life styles (elevated heart rate for an hour at least five days a week), it was found that the most degeneration of knee joint tissues were in the sedentary population.  As one would expect, mild changes were seen in the active group, but surprisingly the running population showed increased health of their knees over the 10 year period!  Source: Long Distance Running and Knee Osteoarthritis When researchers looked at seven marathoners over a 10-year period, they found only one study participant who experienced significant degeneration of his knees, which lead him to quit running during the study.  However, he had a significant preexisting knee pathology prior to the study and quit running mid-way through the 10-year study period.  The other six runners showed no signs of new damage to their knees during the study period.  Source: Knee Joints of Runners These are just two recent studies, and more data is needed to confirm that running is, in fact, good for your knees, but as a runner myself this gives me and my knees hope.  The message here is that if your knees are healthy, there is no reason to expect they will deteriorate under thoughtful run training over a lifetime.  An active knee is more likely to stay healthy as you age than a sedentary one.  And maybe, just maybe, running will reduce your chances or severity of osteoarthritis as you age.  Of course, if you have significant knee history, running may not be the best choice for you. So cheer on all the ultra marathoners out there tonight running up and over the Wasatch Mountains who inspire our athletic spirits and may be adding to the well-being of their knees while they do it.