Category: foot pain

3 tips to preventing running injuries

The ice is melting. The sun is shining. The warmer temps are calling our names.

Before you lace up your running shoes and inhale in your first deep breaths of spring air, stop to read these injury prevention tips for runners.

injury, runner, prevention

Buy the right shoes.

Who needs an excuse to buy new shoes? Not this girl. But if you’re looking for one, here are three.

Buy new shoes if…

1. There is any breakdown in your current running shoe (aka your shoes are old!)
2. You have been running on a treadmill all winter and are switching to land.
3. You have been using your running shoes for walking.

Make sure to choose the right running shoe for your foot. You can read about how to choose the right shoe here.

Ease into outdoor running.

Your first outdoor routes of the season should be on level ground, then gradually start working in inclines and different terrain. Trail runs (personal fave) can quickly bring on ankle injuries if you haven’t worked up to them.

Pay attention to what your body is trying to tell you.

Muscles aches the day after running are signs your muscles are changing and adapting in good ways. Localized pain, sharp pain, or joint pains are signs you should ease off a bit.

Check to see if your local physical therapy clinic has a “Running Clinic” where your run can be analyzed, and you can get pointers on how to improve your stride!

Happy running!

Return to Running After Pregnancy

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Postpartum has been a long road. And not the kind of “oh, what a journey…” road. The first days after Seton’s birth I didn’t so much want to roll over in bed. I was definitely not dreaming of tying up my shoelaces and going for a run. But eventually, albeit after many weeks, I found myself promising the exercise gods that I would never complain about working out again as I watched Netflix count down to the next episode of my TV marathon in utter disbelief that my current state of life existed on a couch. Being restricted from doing something just makes you want to do it, right? I longed for the feeling of my tennis shoes hitting pavement, my heart beating through my chest, and my frequent breath mixing with the fall air.

running after pregnancy

We may be anxious to return to running after pregnancy, but it’s important to make our comebacks gradual. Lots of changes just happened to our bodies and, as mothers, we now need our bodies to take care of our babies. Being injured isn’t an option.

To prepare for running, I encourage you to strengthen your abdominals and pelvic floor muscles through the abdominal progression and pelvic floor exercise progression I recommend. Having strong abdominals for running can reduce the risk of injury to our backs, hips, knees, ankles, and even should girdles and necks! The abdominals will work to stabilize our backs and pelvis to allow the limbs to generate movement for each step.

I also encourage you to strengthen your gluteals. You should do this the same way I recommended doing it throughout your pregnancy: by performing Hip Abduction with Lateral Rotation (“The Clamshell”). You can read through the steps in my post Top 3 Exercises Every Pregnant Woman Should Do.

When you feel as though your abdominals and pelvic floor muscles are strong enough that you can keep them contracted throughout the course of the day (even when going up/down stairs or getting up for the floor while holding your baby), you are likely ready to begin a running progression. Make sure your doctor has cleared you to exercise!

To begin, start with running and walking at one minute intervals, aka run a minute, walk a minute. Prior to pregnancy, I told my patients to do this for 30-minutes. But, now that I am experiencing the joys of postpartum first-hand, I recommend doing this for as long as you can up to 30-minutes. I started my progression (ahem, last night) and barely made it to 18 minutes. I walked that last 12 minutes telling myself, “whatever, I’m strong…I pushed a human out of my body!” as I somehow heard my heart beating the way you do after an insane workout.

Since you are only running one minute at a time, use the minute to focus on running with good form. After pregnancy, our bodies will forget we have abdominals and gluteals, so we will be relying on muscles like the tensor fascia lata (TFL, which is the muscle that controls the infamous IT band) that can lead to injury. Focus on contracting your abdominals. Review my post Improve Your Running Stride Part II: The Gluteals which will help you use your gluteals to improve your stride.

Once you hit this walk/run cycle for 30 minutes, start aiming for running 2-minutes, then walking 1-minute up to 30-minutes.

Add a minute to your running spurts when you feel ready (should be every three to five runs), and so on.

Keep in mind:

Do not push yourself too quickly. Your muscles need time to catch up to what you are asking your body to do.

Do not set time goals until you are confident you can run with good form.

If you’re having unusual aches, pains, or … ahem, dare I say leaking, talk to your physical therapist.

And, lastly, you may want to wear two bras. :)

This was my reaction to finally getting the green light from my doctor to exercise:

running after pregnancy

Hopefully you enjoy you first run back as much as I did.

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

A Guide to Abdominal Strengthening For Runners

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As technology becomes a greater influence, it becomes more common for me to hear from my patients that they previously looked up exercises to treat their injury on Google before they even get to me. Part of me thinks, Yes! People are taking ownership of their health! And the other part of me cringes in anticipation to hear what they read online. It’s a great thing that we have so many resources at our fingertips to learn how to take care of our bodies, but it’s really hard to know what to trust when reading through things online.

The runners I treat all have their own understanding of how to strengthen their abdominals. So I put myself in my patients’ (running) shoes and Googled “abdominal strengthening exercises” to see where they were getting their information.

I wanted to cry. None of them were exercises I would refer to the majority of my patients, and certainly none of them were exercises I would suggest to my runners.

When strengthening our abdominals (which is an important part of a good running stride), we have to consider what movements are happening during the exercise. We want the exercise to essentially mimic the movement of the stride. When does the movement of a sit-up occur during running?! NEVER! When does a “crunch” happen during a running stride?! NEVER! So why is the internet telling us to bend our backs repeatedly to strengthen our abs for running? Just because we feel a muscle burn does not mean the exercise is beneficial.

During running, we want our low back to stay relatively still. The movement we generate is coming from our limbs. I want to provide runners with a guide to abdominal strengthening that mimics the running stride.

This post will take you through 5 abdominal exercises, each progressively more difficult. You will notice that the low back does not move at any point in the exercises. Rather, the abs work to stabilize as the limb movement becomes progressively more challenging. To work through the exercises, you must first successfully perform up to 20 repetitions correctly before progressing to the next exercise. Therefore, you may be on one level for up to 2 weeks before you feel you are ready for the next. If you can not perform an exercise without moving your low back (arching it away from the floor, pushing into the floor, or allowing your abdominal muscles to “pooch” up toward the ceiling), you must go back down to the previous level.

Level 1

abdominal strengthening
Level I Abdominal Strengthening for Runners

Step 1: Lay on back with knees bent and feet flat on floor.
Step 2: Contract abdominals buy pulling navel toward your spine as you exhale.
Step 3: Hold 5-10 seconds.
Step 4: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 2

abdominal strengthening
Level 2 Abdominal Strengthening for Runners

Step 1: Perform abdominal contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees while maintaining abdominal contraction.
Step 3: Place leg back to starting position as in Step 1.
Step 4: Raise contralateral leg so hip is bent 90 degrees while maintaining abdominal contraction.
Step 5: Place leg back to starting position as in Step 1.
Step 6: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 3

abdominal strengthening
Level 3 Abdominal Strengthening for Runners

Step 1: Perform abdominal contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees while maintaining an abdominal contraction.
Step 3: Maintain position of Step 2 and raise opposite leg so hip is bent 90 degrees.
Step 4: Place one foot back to starting position (keep those abs contracted!)
Step 5: Place the other foot back to the starting position (keep those abs contracted!)
Step 6: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 4

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Level 4 Abdominal Strengthening for Runners

Step 1: Perform abdominal contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees.
Step 3: Raise opposite leg so hip is bent 90 degrees.
Step 4: Straighten out one leg, keeping heel close to the floor.
Step 5: Bring leg back to position in Step 3 (bent 90 degrees).
Step 6: Straighten opposite leg, keeping heel close to the floor.
Step 7: Bring leg back to position in Step 3 (bent 90 degrees).
Step 8: Continue alternating extending each leg (as if running!) while keeping abdominals contracted for 10 -20 repetitions.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling. If you cannot straighten your leg without moving your back, try sliding your heel on the floor. Progress to being able to straighten your leg with your heel just above the floor.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 5

abdominal strengthening
Level 5 Abdominal Strengthening for Runners

Step 1: Perform abdominal contraction as in Level 1.
Step 2: Lift one leg so hip is bent 90 degrees.
Step 3: Lift other leg so hip is bent 90 degrees.
Step 4: While maintaining your abdominal contraction, straighten BOTH legs so heels are just above floor.
Step 5: Bring both legs back up to being bent 90 degrees.
Step 6: Repeat straightening both legs at the same time for 10-20 repetitions.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling. If you cannot straighten your leg without moving your back, try sliding your heel on the floor. Progress to being able to straighten your leg with your heel just above the floor.

Perform exercise daily.

Want more running advice? Read these:

Improve Your Running Stride Part I: The IT Band

Improve Your Running Stride Part II: The Gluteals

Improve Your Running Stride Part III: The Running Shoe

Stretches For Every Runner

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

Improve Your Running Stride Part III: The Running Shoe

Forresyt

I have spent a long time looking for a running shoe that has firey blazes shooting from the back that miraculously make me run faster. My search continues to this day. I will not give up.

"Mama says they was magic shoes."
“Mama says they was magic shoes.”

In the meantime, it’s important to find a shoe that fits the shape of your own particular foot, promoting the best and most optimal relationship between your foot and the ground. A fitted shoe has the ability to lower your risk of injury.

Forresyt

Finding the right running shoe requires an understanding of foot mechanics. To simplify foot mechanics, think of two different foot movements: supination and pronation. Both of these movements are very complex and involve multiple joints, but for the purpose of this post, pronation is when the arch of the foot moves toward the floor and supination is when the arch of the foot is raised.

In a static standing position, you may have a supinated foot defined by a raised arch. This type of foot is classically more rigid.

A pronated foot has a collapsed arch and is classically more flexible.

To decide what type of shoe is best for you, the first step is to figure out if your foot is pronated, supinated, or neutral. To figure this out, I recommend having someone trace your foot while you are standing. Look at the tracing and determine if it is more pronated, supinated, or neutral. It is important that you are standing so the you are fully weight bearing.

This is an example of a pronated foot with a notable rectangular shape:

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This is an example of a neutral to supinated foot with a larger curve on the inside:

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Ideally, the bottom of the ideal shoe should match the shape of your tracing. If your foot is pronated (or flat), the bottom of the running shoe will look more like a rectangle. If your foot it supinated, the inside of the running shoe should curve inward.

It is also very important to consider what happens to the arch of your foot when you move. Some people may stand with a very high arch, but once they walk or run, their arch collapses. If you feel as though you fit in that category, I would recommend finding a local running store that has a good reputation. They should be able to watch you run and recommend a shoe for you.

So as we wait for rocket shoes to be invented, make sure your current running shoe is the right shape for your foot–and if it’s not, be sure to invest in a new pair to prevent injuries.

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

Improve Your Running Stride Part II: The Gluteals

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My favotite beach run ever!
My favotite beach run ever!

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In my previous post Improve Your Running Stride Part I: The IT Band, we discussed how runners typically have stiff IT bands. A stiff IT band has the potential to lead to hip pain, knee pain, foot pain, and back pain. Simply stretching the IT band will not solve the problem; rather, a runner has to change how he uses his muscles when he runs to prevent the IT band from tightening up.

As mentioned in Part I, the key to reducing the use of the IT band lies in increasing the recruitment of the gluteals during runs (a stronger booty!)

Changing your running form can be a daunting task and may require increased energy expenditure at first. But with these three basic tips, you will be using your gluteals—which are some powerful muscles—in no time.

On your next run, practice these three things:

1. Think of yourself as one of two types of runners: a runner who pulls himself forward with each step, or a runner that pushes himself forward with each step. To use your gluteals, you need to be a runner that pushes yourself forward. Give the ground a good push to get to your next step.

2. With respect to number one, make sure your foot hits the ground directly below your body as opposed to reaching ahead of your body. If your foot reaches too far forward, you will likely have to pull yourself to the next step. When you think of placing your foot directly below your body during your next run, you may feel as though you are leaning forward. Strangely enough, that’s okay. Leaning forward a little puts your gluteals in a position in which their contraction will much stronger.

3. As your leg is swinging through, but before it contacts the ground, raise your knee a little higher. Colleagues of mine commonly use the cue, “pretend you’re riding a bike down a hill and your legs are trying to keep up with the pedals.” Raising your knees up will bend the hip more, allowing the gluteals to work through a greater range of motion. Another benefit of bringing your knees higher is that it allows more time in the air and less time on the ground. Research shows that faster runners spend more time airborne than slower runners. Therefore, this little clue may get you to the finish line quicker.

Changing the way you run in even the smallest way will initially make your runs more fatiguing. I encourage you to practice these three things in two minute intervals until you feel like you are getting the hang of it. You’ll feel funny running this way at first, and you will be sore the next day. But no worries; keep practicing, and it will become second nature.

Now you can spend more time running and less time stretching your IT band.

Are you curious about which running shoes are the best for your foot? Part III will discuss how you should go about choosing a running shoe based off the shape of your foot.

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***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

Improve Your Running Stride Part I: The IT band

Image source: http://blogs.bmj.com/bjsm/category/children/

Are you a runner? Or, in my case, are you an inconsistent light-jogger that moves at a slightly faster pace than speed walkers?

Whatever your speed is, you probably have a stiff IT band and have tried a gazillion stretches to loosen it up. Maybe you have even tried one of those foam rollers that just hurts so good. But after all that, is your IT band still “tight?”

Probably.

Maybe you aren’t sure if your IT band is stiff. In that case, I want you to ask yourself if you have any bothersome pain while running or after running, like knee pain, hip pain, back pain, or foot pain. Your IT band may be contributing to these frustrating symptoms that affect your runs.

So how can you get that annoying band to loosen up?

First, let’s discuss what the IT band is. God is clever, and He didn’t put tissue in our bodies to hang out there. It all serves a purpose.

 Image: Netter FH. Iliotibial band friction syndrome. Image Source: http://www.netterimages.com/image/iliotibial-band-friction-syndrome.htm

Image: Netter FH. Iliotibial band friction syndrome.
Image Source: http://www.netterimages.com/image/iliotibial-band-friction-syndrome.htm

IT band stands for iliotibial band. By its name, it is a band of thick fascia that connects the ilium to the tibia. The connection to the ilium, a part of your pelvis, is by way of the tensor fascia latae muscle, aka the muscle that tenses your fascia a-lotta!

When the tensor fascia latae contracts, the IT band tenses. If this happens repeatedly (a lotta!), the IT band gets tight, or as I like to describe it, short or stiff.

So the answer to the age-old question of stiff IT bands across running circles all over the world…

Image source: http://blogs.bmj.com/bjsm/category/children/
Image source: http://blogs.bmj.com/bjsm/category/children/

If you’re a runner whose IT band is stiff, it’s because you contract your tensor fascia latae too much.

Contract a muscle too much? Is it so? Can it be possible? Yes. It is possible to contract a muscle too much if it means you are neglecting the muscle’s counterpart, therefore altering the joint’s balance. In the case of runners and IT bands, a stiff IT band usually signals that the runner does not use his/her gluteals enough. This muscle imbalance commonly leads to pain because it alters hip and knee joint mechanics.

You may think I am going to tell you to do gluteal strengthening exercises and bippity-boppity-boo, you’re healed.

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I wish it were that easy. While strengthening exercises can be useful, I am going to suggest that you change the way you run.

It is incredibly difficult to change your running form, but in my next post, I will give you 3 simple clues to think about when you’re running so you use your gluteals relatively more than you use your tensor fascia latae and IT band. With these 3 tips, you will rely less on your tensor fascia latae and IT band, therefore it won’t get so stiff! And word on the street is, these tips will help you run faster…

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

Save heels for the weekend

carrie_bradshaw_tutu

Here’s a riddle for you.

Who owns 200+ pairs of high heels and suffers from low back pain?

This girl:

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“Who, me?”

I LOVE high heels. I NEED high heels. (side note: my husband tells me I use the phrase “I need it” too much. Don’t know what he’s talking about). I feel like high heels were MADE for girls like me. God blessed me with short, stubby legs and a torso long enough to make me think I have extra vertebrae. I NEED the length that high heels offer my short legs.

But let’s talk about what high heels do to our bodies from a mechanics stand point, and how that can result in pain in strange places (not just our toes).

First, we need to think of our bodies in terms of lever arms, joints, forces, and vectors. Remember physics? Remember Newton? His third law stated, “For every action there is an equal and opposite reaction.”

Let’s keep this in mind.

There’s a million and one ways high heels change the orientation of our posture and movement, but I am going to focus on 3 for today.

1. Due to the upward force of the actual heel (aka the stiletto), the posterior part of our pelvis is raised. This is awesome for the booty. This exact effect is what I believe inspired Sir Mix-a-lot’s song, “Baby Got Back.” If Newton’s third law is correct (which it is), then there must be an opposite reaction from our upper body so we don’t get thrown forward. We have to lean back to keep our shoulders over our hips. This causes an extension force on our low back, and subsequently pain if this position is maintained for long periods of time. You can see this happening to Kim Kardashian when she tries to figure out how to pump gas.

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2. Keeping in mind that the posterior part of our pelvis moves UP due to the force of the heel, the front part of the pelvis must move DOWN. The muscles on the front part of the pelvis that connect the pelvis to the femur (thigh bone) are subsequently placed in a shortened position. No big deal if this is for one night, but over time, shortening of these muscles feeds into pulling the pelvis forward even when we are just in our slippers at home! Pulling the pelvis forward causes that extension force in the low back we talked about in #1. Ouch.

kim_kardashian_mintgreen_jack-ant tilt

3. The third and most obvious consequence of high heels is that they shorten our calf muscles. Again, this is pretty awesome when we feel inclined to wear heels after that killer calf workout so we can show off the definition we worked so hard for. Thank you, heels, for making my stubby legs look fake-muscular. But once we take those heels off, the shortened calf muscles pull our knees backward, likely causing hyperextension. Do you know a female over the age of 50 who has had a knee replacement? You can tell her to thank her knees for all that hyperextension in her youth. At least now her new metal knees give her an excuse to avoid the metal detectors in the airport. Oh, but unfortunately that results in an awkward pat-down. It’s a lose-lose.

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Photo from lotusimprints.com

So there you have it. High heels cause our backs to extend, our hip flexors to shorten, and our calves to pull our knees beyond where they should be.

But, if you’re like me, you can’t give up heels completely. We NEED them, right? So wear heels in moderation and live by my mantra: Save heels for the weekends.

Cheers to being female.