We have gathered answers from Sports Medical Professionals to some common questions that runners have - covering topics such as injuries, nutrition and running tips.
This information is intended to only be used as a reference. We recommend consulting a medical professional should you incur any injuries or are looking to make any major changes to your training and nutrition.
Foot Injuries/Pronation
Q: I have pain on the bottom of my foot and heel when I get up in the morning and also after I sit for a period of time and then stand up. At first it didn't hurt when I ran but it is starting to hurt all the time. What is it and what can I do?
A: This is one of the most frequent questions I hear from customers in the store. It can happen to anyone. It sounds like it might be Plantar Fasciitis.
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Definition
- An inflammation of the connective tissue on the bottom of the foot (plantar fascia)
- The plantar fascia supports the foot and holds the arch
- It attaches to the bottom of the heel and connects across the ball of the foot
Symptoms
- Pain on the heel or along the arch
- Most painful first thing in the morning or after prolonged sitting
- May be swelling in foot and along heel
Contributing Factors
- Flattening of the arch which is called over pronation (#1 reason)
- Wrong kind of shoes for your activity, not enough support in the arch area from the shoes or the inserts in the shoes.
- Sudden increase of activity when on your feet (standing for long periods or increased walking)
- Change in your training (increase in toe running, speed of running, hill running or distance of running)
- Increase of body weight
- Decreased flexibility in the body (occurs with age as well as other things)
Treatment
- Stretch the calf, achilles tendon and foot
- Strengthen the muscles of the foot and ankle will help to avoid these problems
- Support the foot with proper shoes and inserts
- Rolling a frozen water bottle under your foot for 5 minutes-which can also help with decreasing the symptoms
- And of course, rest will always be beneficial
- But as always it is good to check with your doctor to confirm that you indeed have Plantar Fasciitis and for specific instructions
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Q: When I run I have burning on the ball of the foot and it hurts between the third and fourth toes. What is it?
A: It could be a number of things. But one of those things is a Neuroma.
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Symptoms
- Pain in the area of the ball of the foot, usually between two toes
- Burning or tingling sensation in the ball of the foot
- Callous formation on the ball of the foot
Definition
- The tissue surrounding a nerve in the ball of the foot becomes enlarged - thickened
- An inflammation of the nerve between two toes (many times between the 3rd and 4th)
Contributing Factors
- Flat feet
- Wearing tight, poorly fitted shoes that are too narrow or high heels with pointed toes
- Prolonged standing
- Increased stress on the ball of the foot such as kneeling or up on ladders or running on the ball of the foot
- Flattening of the arch which is called over pronation and causes increased pressure on the ball of the foot
Treatment
- Stretching the foot
- Gentle massage of the bottom of the foot with your hands
- Ice bottle roll for 5 minutes
- Make sure the shoe has enough room in the toe box. (Remember that when running or walking the feet may swell due to increased activity)
- Support the arch of the foot with proper shoes and inserts
- Additional metatarsal support to take pressure off the ball of the foot
Contact your doctor to rule out diabetes, fractures and other conditions, which may have many of the same symptoms
Carolyn R. VarndellHaving a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Q: I was told recently that I need orthotics. I am concerned because I know some runners that have tried orthotics and found them to be painful. How do I know if orthotics are right for me?
A: It is true that some runners find orthotics uncomfortable, and even painful to wear. Two broad issues need to be addressed. First, the 'break in' period is extremely important. If new orthotics are worn too much, and too soon, the feet can become painful as they adjust to the new forces and pressures under the feet. Similar discomfort can be noted in the leg muscles. This soreness can further decrease your tolerance to orthotics.
The second broad issue in relation to orthotic tolerance is that muscle and joint inflexibilities actually contraindicate wearing these devices. One reason not to wear rigid orthotics is a lack of movement in the ankle joint caused by either tight calf muscles and/or bony blocks at the front of the ankle joint. Tight calf muscles can be stretched, but when this is not possible rigid orthotics are contraindicated. Bony blocks, small protrusions of bone, at the front of the ankle joint can usually be noted on x-rays and can occur after trauma to the ankle such as ankle sprains. Even if the calf muscles have enough flexibility, the block to movement in the ankle joint contraindicates wearing orthotics. Some other issues for runners who may be considering orthotics include instability in the knee joint and limited motion of the first metatarsophalangeal joint, the joint at the ball of the foot. A podiatrist can and should assess, among others, these factors that test your suitability for orthotics. All this noted, in some cases, a podiatrist might actually prescribe orthotics to correct some of the limitations mentioned above.
Another important point on orthotics is that orthotics can be flexible or rigid and inflexible. The type of material from which orthotics are made should be based on your running needs, foot type, biomechanics, … and the list goes on. If your feet and legs are suitable for rigid orthotics, they can be very comfortable and help correct abnormal biomechanics, which in turn can treat injuries. If for example, you have limitations in joint motion but still need some improvement to your biomechanics, more flexible orthotics may work well for you.
Finally, shoes make a difference to orthotic comfort. Typically, orthotics are prescribed based on the shoes you normally run in and if orthotics get uncomfortable with new shoes, you should get the orthotics checked and modified (or try different shoes).
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
The second broad issue in relation to orthotic tolerance is that muscle and joint inflexibilities actually contraindicate wearing these devices. One reason not to wear rigid orthotics is a lack of movement in the ankle joint caused by either tight calf muscles and/or bony blocks at the front of the ankle joint. Tight calf muscles can be stretched, but when this is not possible rigid orthotics are contraindicated. Bony blocks, small protrusions of bone, at the front of the ankle joint can usually be noted on x-rays and can occur after trauma to the ankle such as ankle sprains. Even if the calf muscles have enough flexibility, the block to movement in the ankle joint contraindicates wearing orthotics. Some other issues for runners who may be considering orthotics include instability in the knee joint and limited motion of the first metatarsophalangeal joint, the joint at the ball of the foot. A podiatrist can and should assess, among others, these factors that test your suitability for orthotics. All this noted, in some cases, a podiatrist might actually prescribe orthotics to correct some of the limitations mentioned above.
Another important point on orthotics is that orthotics can be flexible or rigid and inflexible. The type of material from which orthotics are made should be based on your running needs, foot type, biomechanics, … and the list goes on. If your feet and legs are suitable for rigid orthotics, they can be very comfortable and help correct abnormal biomechanics, which in turn can treat injuries. If for example, you have limitations in joint motion but still need some improvement to your biomechanics, more flexible orthotics may work well for you.
Finally, shoes make a difference to orthotic comfort. Typically, orthotics are prescribed based on the shoes you normally run in and if orthotics get uncomfortable with new shoes, you should get the orthotics checked and modified (or try different shoes).
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: My doctor told me that I need support for my arches because they are "falling". Should I get orthotics and if so, do I need to wear them all the time or just for running?
A: Falling arches is better known as over-pronation or excessive pronation. When you put weight on your foot and the arch flattens to a degree, it is the body's way of absorbing shock and helps your foot adapt to different surfaces. However, if the arch flattens more than normal for it is called excessive pronation.
This can cause your ankle to be out of the normal position and the Achilles tendon to curve instead of being straight. Using an orthotic can help to keep your foot in a neutral position and not put stress on the Achilles tendon or the ankle.
Running places more stress on the foot, ankle and leg than walking. However, over long hours of standing, walking, shopping, and all other daily activities, similar stresses can occur. Therefore, if you need orthotics you should try wearing them all the time and not just while running.
Make sure that any over-the-counter orthotics are thin enough to fit in more than just your running shoes and also firm enough to hold your arches in a position that takes the stress off the ankle and leg. Many over-the-counter orthotics can be enough for helping to correct for overpronation. But if you would need custom orthotics your doctor will have to give you a prescription. So take several shoes to see if the inserts/orthotics will fit in most of your shoes.
Carolyn R. Varndell
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
This can cause your ankle to be out of the normal position and the Achilles tendon to curve instead of being straight. Using an orthotic can help to keep your foot in a neutral position and not put stress on the Achilles tendon or the ankle.
Running places more stress on the foot, ankle and leg than walking. However, over long hours of standing, walking, shopping, and all other daily activities, similar stresses can occur. Therefore, if you need orthotics you should try wearing them all the time and not just while running.
Make sure that any over-the-counter orthotics are thin enough to fit in more than just your running shoes and also firm enough to hold your arches in a position that takes the stress off the ankle and leg. Many over-the-counter orthotics can be enough for helping to correct for overpronation. But if you would need custom orthotics your doctor will have to give you a prescription. So take several shoes to see if the inserts/orthotics will fit in most of your shoes.
Carolyn R. Varndell
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Q: I recently went to a sports medicine specialist who told me I have "os trigonum syndrome". Could you tell more about this?
A: Runners who have pain in the back of their heel with stiffness and swelling must be checked for this condition. Os trigonum syndrome is caused by an 'extra' bone in the back of the heel bone. A lateral X-ray of the ankle is needed when this diagnosis is suspected and at times a bone scan or MRI is ordered to confirm the anatomic detail of the area. During the foot's skeletal development sometimes a separate area of bone develops in children usually between the ages of 8-13. This separate area normally fuses with the remainder of the heel bone within 1 year of its appearance. However, an os trigonum, an accessory bone, forms if this secondary bone center fails to fuse after skeletal maturation.
The foot may have up to 21 accessory bones. The prevalence of the os trigonum has been reported from 2-20% (of the known accessory bones). The bone is usually triangular in shape and about 1 cm in diameter. Many runners who run downhill often and have this extra bone may become symptomatic from this.
The initial treatment of the os trigonum syndrome is conservative and includes anti-inflammatory agents, a relative rest period, weight bearing modification, and formal physical therapy. If conservative measures fail we recommend arthroscopic removal of the os trigonum which results in good outcomes most of the time.
The foot may have up to 21 accessory bones. The prevalence of the os trigonum has been reported from 2-20% (of the known accessory bones). The bone is usually triangular in shape and about 1 cm in diameter. Many runners who run downhill often and have this extra bone may become symptomatic from this.
The initial treatment of the os trigonum syndrome is conservative and includes anti-inflammatory agents, a relative rest period, weight bearing modification, and formal physical therapy. If conservative measures fail we recommend arthroscopic removal of the os trigonum which results in good outcomes most of the time.
Q: I was told that I pronate and that I need a shoe with good stability for walking. I am not sure exactly what to look for; do you have any suggestions on where to start?
A: Almost every athletic shoe company makes shoes for over-pronators. Brooks is a great company for finding a shoe that fits your foot and will decrease the pronation when you walk or run. Within the Brooks line, you may want to try on the Beast (men) or the Ariel (women) - the most supportive. Next would be the Addiction IV and then the Adrenaline and then the Vapor. These are all running shoes that may be ok for you to walk in. As far as walking shoes, I would recommend the Addiction Walker. All of these shoes with the exception of the Vapor come in widths.
Features to look for when looking for a stability or motion control shoe:
· Firmness along the medial aspect of the midsole (arch side of the shoe). A dual-density midsole means that the rear part of the shoe (usually gray in color) will be firmer to control pronation and the front part of the shoe (usually white in color) is softer for toe-off
· A shoe with a broader base of support
· A shoe with a higher midsole wrap along the arch (should not be cut away)
There are many things that go into making a shoe supportive. It is best to visit a local specialty account (see store finder on the home page) in your area and get properly fit.
Carolyn R. Varndell
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Features to look for when looking for a stability or motion control shoe:
· Firmness along the medial aspect of the midsole (arch side of the shoe). A dual-density midsole means that the rear part of the shoe (usually gray in color) will be firmer to control pronation and the front part of the shoe (usually white in color) is softer for toe-off
· A shoe with a broader base of support
· A shoe with a higher midsole wrap along the arch (should not be cut away)
There are many things that go into making a shoe supportive. It is best to visit a local specialty account (see store finder on the home page) in your area and get properly fit.
Carolyn R. Varndell
Having a strong interest in both medicine and sports Carolyn is a Certified Athletic Trainer and Board Certified Pedorthist.
Carolyn R. Varndell bio
Q: I went to a good running store recently to buy new shoes, and after watching me run, the sales associate told me that I pronate. What is pronation?
A: In simple terms, perhaps over-simplified, pronation is the rolling in of your feet when the foot impacts the ground during running or walking. Pronation is really a complex three-dimensional motion of the joint located just below the ankle – the subtalar joint. This three-dimensional movement is what allows you to rotate your ankle in circles.
Pronation is a normal movement, just like flexion and extension of other joints. When talking about pronation, runners are usually referring to over-pronation or compensatory pronation. That is, your foot pronates more than normal and/or pronates to compensate for a position or motion of your leg. A good example of how limb position affects pronation is the compensation for knock-knees. The foot will pronate to compensate for the knock-kneed position of the legs and the amount of pronation will be greater than normal, or over-pronation.
Over-pronation can also be a normal amount of motion, but motion that happens for too long. By the time the foot is preparing for the push-off phase, the time when the heel lifts and you move onto your toes, pronation should have stopped and even reversed. Thus, if your foot is pronating into the push-off phase, you over-pronate.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Pronation is a normal movement, just like flexion and extension of other joints. When talking about pronation, runners are usually referring to over-pronation or compensatory pronation. That is, your foot pronates more than normal and/or pronates to compensate for a position or motion of your leg. A good example of how limb position affects pronation is the compensation for knock-knees. The foot will pronate to compensate for the knock-kneed position of the legs and the amount of pronation will be greater than normal, or over-pronation.
Over-pronation can also be a normal amount of motion, but motion that happens for too long. By the time the foot is preparing for the push-off phase, the time when the heel lifts and you move onto your toes, pronation should have stopped and even reversed. Thus, if your foot is pronating into the push-off phase, you over-pronate.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: My running partner told me that I pronate. Is this normal and should I be concerned about it?
A: A small amount of pronation (inward roll of the foot) is actually normal during walking and running. Just after the foot strikes the ground, the foot will roll in about 5 or so degrees to assist the body in absorbing ground impact forces. However, this normal pronation happens so fast (a fraction of a second) and the movement is so small (think about 5 degrees in a protractor) that it would be difficult to see as you run along with your running partner. I am not saying that your running partner is wrong, just that if they can see you pronate, then you probably pronate more than normal and/or continue to pronate for a period considered longer than normal.
If you are pronating too far, that is, over-pronating, then this can be problematic. However, pronation alone is not a cause of injury. With the correct shoes, good training practices, and good stretching habits most runners can stay away from injuries even if they over-pronate. If you do suffer an injury, over-pronation could slow recovery. You might also consider a shoe for an over-pronator. Brooks has a range of running shoes for over-pronation such as the Beast, Ariel and Addiction 4. For walkers the Addiction comes in brown, black and white leather.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
If you are pronating too far, that is, over-pronating, then this can be problematic. However, pronation alone is not a cause of injury. With the correct shoes, good training practices, and good stretching habits most runners can stay away from injuries even if they over-pronate. If you do suffer an injury, over-pronation could slow recovery. You might also consider a shoe for an over-pronator. Brooks has a range of running shoes for over-pronation such as the Beast, Ariel and Addiction 4. For walkers the Addiction comes in brown, black and white leather.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: I am a 5'5" woman that weighs 160lb. I have fairly normal feet that over-pronate slightly. Should I buy a motion control shoe for a heavy runner?
A: Not necessarily. For example, your weight of 160lb is not considered heavy for a male runner, and men at this body weight do not typically need stability shoes based solely on their body weight. The selection of a shoe is based on many factors, including body weight, but your weight alone does not warrant an overly sturdy stability running shoe. If you are a mild over-pronator, you will most likely benefit from a shoe with a combination of motion control and stability such as the Brooks Adrenaline GTS. This shoe has a firmer density foam on the medial side (inside of the shoe) with good cushioning on the lateral or outside border. This difference in foam density may provide the support you need without purchasing an overly sturdy, or heavy shoe.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: The wear on my shoes is to the outside border of the heel. Does this mean I under-pronate?
A: First, let’s start with some semantics. Under-pronation is somewhat a misnomer because what most people are usually referring to is supination. Supination is the opposite motion to pronation, (just as flexion is to extension). Since under-pronation implies a lack of or less pronation, these terms are not really equivalent.
Back to the question – Does shoe wear on the outside of the heel mean you supinate? Probably not. Very few runners actually supinate, that is, land on the outside of the foot and then continue to roll to the outside. Landing with the foot in a supinated position is common which is why most runners will find excessive outsole wear on the outside heel area of their shoes, However, after heel strike, majority of runners roll to the inside. The amount they roll inward is the amount they pronate.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Back to the question – Does shoe wear on the outside of the heel mean you supinate? Probably not. Very few runners actually supinate, that is, land on the outside of the foot and then continue to roll to the outside. Landing with the foot in a supinated position is common which is why most runners will find excessive outsole wear on the outside heel area of their shoes, However, after heel strike, majority of runners roll to the inside. The amount they roll inward is the amount they pronate.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: I sprained my ankle running today. What should I do?
A: Use R.I.C.E. therapy as soon as possible, that is, Rest, Ice, Compression and Elevation. Do this even if the injury doesn’t seem serious. For example, the sprain was painful when you initially did it, but after a few minutes you were able to walk and even finish your run. Ice it as soon as possible because the more inflammation you reduce in the first 24 hours the quicker you recover.
The grade or severity of ankle sprain is usually related to the degree of tissue (ligament) damage, and the resulting instability of the ankle. Early assessment of your ankle sprain should always be a priority and should be undertaken by a qualified medical professional. See your Doctor.
Ankle sprains on the outside of the ankle are far more common than on the inside of your ankle. You should also try and assess what caused the sprain. You doctor or therapist can also help you with this. For example, in the extreme case where a shoe is worn down to the outside (laterally), ankle sprains could be related to this lateral instability.
Did I mention to seek medical advice?Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
The grade or severity of ankle sprain is usually related to the degree of tissue (ligament) damage, and the resulting instability of the ankle. Early assessment of your ankle sprain should always be a priority and should be undertaken by a qualified medical professional. See your Doctor.
Ankle sprains on the outside of the ankle are far more common than on the inside of your ankle. You should also try and assess what caused the sprain. You doctor or therapist can also help you with this. For example, in the extreme case where a shoe is worn down to the outside (laterally), ankle sprains could be related to this lateral instability.
Did I mention to seek medical advice?Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Leg Injuries
Q: I have been running for many years without injury. Recently however, I have had a series of injuries including sore knees, shin splints and even some heel pain. Why am I getting injured so much now and not before?
A: Injuries are multi-factorial and particular to each individual. The multiple factors contributing to musculoskeletal overuse injuries include (1) training errors, (2) abnormal biomechanics, (3) incorrect equipment, (4) flexibility and muscle strength, and (5) underlying injury or disease. These are not listed in a particular order. That is, training errors are no more or less important than incorrect equipment or muscle flexibility. Your recent series of injuries is most likely related to a recent change in one or more of these 5 factors.
When a runner makes a training error, this usually means they made a sudden increase in running distance, intensity or speed. Intensity can relate to running speed, but doing more hill work for example, will also increase running intensity. Another common training error relates to being consistent, not skipping runs and trying to make up your weekly mileage on the next run. Adhering to a well-structured running program usually controls the training errors quite well.
Abnormal biomechanics can also lead to overuse injuries. The "big" one is over-pronation of the foot, but this alone usually does not cause injuries. Many people run with over-pronated feet without injury, mainly because they were the correct shoes, have good flexibility and train consistently. Abnormal biomechanics becomes more of a problem when trying to recover from an injury, or when you make training errors or wear the wrong shoes. Abnormal biomechanics can also be improved with the correct footwear and in some cases, shoe inserts such as orthotics. This brings us to incorrect equipment. Equipment equals shoes in running. Simply, the correct shoe for your foot and lower limb biomechanics and structure can reduce the risk of injuries. The wrong shoe can increase the risk.
Perhaps one of the more important factors listed, is the influence that muscle flexibility has on overuse injuries. Most of us don't stretch consistently or even correctly. Tight muscles, particularly in the calves and thighs can lead to foot, ankle and knee injuries. Finally, some overuse injuries can be related to underlying disease processes or injuries. Ligament damage in the knees for example, can alter stresses on the knee and lead to running-related overuse injuries.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
When a runner makes a training error, this usually means they made a sudden increase in running distance, intensity or speed. Intensity can relate to running speed, but doing more hill work for example, will also increase running intensity. Another common training error relates to being consistent, not skipping runs and trying to make up your weekly mileage on the next run. Adhering to a well-structured running program usually controls the training errors quite well.
Abnormal biomechanics can also lead to overuse injuries. The "big" one is over-pronation of the foot, but this alone usually does not cause injuries. Many people run with over-pronated feet without injury, mainly because they were the correct shoes, have good flexibility and train consistently. Abnormal biomechanics becomes more of a problem when trying to recover from an injury, or when you make training errors or wear the wrong shoes. Abnormal biomechanics can also be improved with the correct footwear and in some cases, shoe inserts such as orthotics. This brings us to incorrect equipment. Equipment equals shoes in running. Simply, the correct shoe for your foot and lower limb biomechanics and structure can reduce the risk of injuries. The wrong shoe can increase the risk.
Perhaps one of the more important factors listed, is the influence that muscle flexibility has on overuse injuries. Most of us don't stretch consistently or even correctly. Tight muscles, particularly in the calves and thighs can lead to foot, ankle and knee injuries. Finally, some overuse injuries can be related to underlying disease processes or injuries. Ligament damage in the knees for example, can alter stresses on the knee and lead to running-related overuse injuries.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: I have recently developed knee pain. Can over-pronation in my feet be related?
A: Very possibly, but it depends on what is causing your knee pain. A common knee injury in runners is related to the kneecap or patella. Called, among other things, ‘runner’s knee’, chondromalacia patella or patello-femoral pain, it is associated with incorrect tracking of the patella on the thigh bone (femur). A number of factors can lead to incorrect tracking problems of the patella including quadriceps (thigh) muscle balance, pelvic instability and pronation.
As the subtalar joint (foot) pronates, the leg internally rotates. This reflects the screw like property of the foot joint and also the close relationship between the position of the knee and foot. Try it yourself. Standing comfortably, try to role your feet inwards, into a pronated position. Note that your knees turn in as your feet do. Some inward role is normal during running, but if over-pronation occurs, excessive internal knee rotation can also be evident. When the knee turns in too far, the patella tends to track improperly on the femur and knee pain can occur.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
As the subtalar joint (foot) pronates, the leg internally rotates. This reflects the screw like property of the foot joint and also the close relationship between the position of the knee and foot. Try it yourself. Standing comfortably, try to role your feet inwards, into a pronated position. Note that your knees turn in as your feet do. Some inward role is normal during running, but if over-pronation occurs, excessive internal knee rotation can also be evident. When the knee turns in too far, the patella tends to track improperly on the femur and knee pain can occur.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: How much force is really going through my legs when I run?
A: Forces on the body from ground impact can be considered in two parts: those associated with initial foot strike on the ground, and those related to pushing off. These 'ground reaction forces' have been calculated using sophisticated force measuring called "force plates". The ground reaction force is the force associated with the equal and opposite force of reaction between your foot and the ground.
The ground impact associated with initial foot strike during running can be up to 3-4 times your body weight. A quick calculation will show that even for a 100lb runner, each limb experiences up to 400lbs of force during each step. Another important feature of ground impact is the rate at which the force is applied because ground reaction forces that peak very quickly can be more damaging than those that peak slowly. Imagine for example, hitting your thumb with a hammer while driving a nail. Even with a 1 lb hammer the force on the thumb can be very large and we all know the damage that this can cause. But if a 1 lb weight (like a hammer) is placed very slowly onto your thumb, just rested there, you experience very little force and there is probably no damage. What this shows is that the rate at which your foot and leg experiences force is very important, and if the rate can be reduced, your body experiences less shock. With the correct type of shock absorbing material under your heel, both the magnitude and rate of ground impact can be reduced.
In the later case, the forces of push-off also exceed your body weight. This force is not from impact, but from muscular effort trying to move the body forward. To move the body, to accelerate it up and forward, you push against the ground, and the ground pushes back. Because these forces are large, it is important that your leg is aligned well and has a good platform to push from.
Question: The wear on my shoes is to the outside border of the heel. Does this mean I under-pronate?
Answer: Let's start with some definitions: - Under-pronation is somewhat of a misnomer particularly because what most people are referring to when they say under-pronate is actually supination. Supination is the opposite motion to pronation, (just as flexion is to extension). Since under-pronation implies a lack of or less pronation, supination and under-pronation are not equivalent.
Your question - "Does shoe wear on the outside of the heel mean you supinate?" Very few runners actually supinate, that is, land on the outside of the foot and then continue to roll to the outside. Landing with the foot in a supinated position - outside of the heel striking first - is common to most runners, but the majority of runners then roll to the inside, that is, they pronate. If your shoes wears on the outside border of the heel, than you have a better chance of being a pronator than a supinator. Really what this statement means is that if you land with your foot rolled to the outside, there is a strong likelihood that you roll in - pronate - to compensate for the strike position.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
The ground impact associated with initial foot strike during running can be up to 3-4 times your body weight. A quick calculation will show that even for a 100lb runner, each limb experiences up to 400lbs of force during each step. Another important feature of ground impact is the rate at which the force is applied because ground reaction forces that peak very quickly can be more damaging than those that peak slowly. Imagine for example, hitting your thumb with a hammer while driving a nail. Even with a 1 lb hammer the force on the thumb can be very large and we all know the damage that this can cause. But if a 1 lb weight (like a hammer) is placed very slowly onto your thumb, just rested there, you experience very little force and there is probably no damage. What this shows is that the rate at which your foot and leg experiences force is very important, and if the rate can be reduced, your body experiences less shock. With the correct type of shock absorbing material under your heel, both the magnitude and rate of ground impact can be reduced.
In the later case, the forces of push-off also exceed your body weight. This force is not from impact, but from muscular effort trying to move the body forward. To move the body, to accelerate it up and forward, you push against the ground, and the ground pushes back. Because these forces are large, it is important that your leg is aligned well and has a good platform to push from.
Question: The wear on my shoes is to the outside border of the heel. Does this mean I under-pronate?
Answer: Let's start with some definitions: - Under-pronation is somewhat of a misnomer particularly because what most people are referring to when they say under-pronate is actually supination. Supination is the opposite motion to pronation, (just as flexion is to extension). Since under-pronation implies a lack of or less pronation, supination and under-pronation are not equivalent.
Your question - "Does shoe wear on the outside of the heel mean you supinate?" Very few runners actually supinate, that is, land on the outside of the foot and then continue to roll to the outside. Landing with the foot in a supinated position - outside of the heel striking first - is common to most runners, but the majority of runners then roll to the inside, that is, they pronate. If your shoes wears on the outside border of the heel, than you have a better chance of being a pronator than a supinator. Really what this statement means is that if you land with your foot rolled to the outside, there is a strong likelihood that you roll in - pronate - to compensate for the strike position.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Q: I have a long history of running injuries and have noticed that one of my legs is longer than the other. Should I put a heel lift into my shoe to balance this out?
A: Leg length differences can be due to congenital factors, a previous fracture in the lower extremity, a misaligned pelvis, poor foot mechanics (pronation etc.), or numerous additional factors. It has been noted that between 2/3 and 3/4 of humans have a difference in leg length.
Differences in leg length can result in biomechanical stresses and muscular imbalances affecting ones running gait. Problems such as sciatic pain and hip discomfort are more common on the side of the long leg, while problems associated with the short leg are often foot pronation (inward roll), medial knee stress, and general muscle weakness.
Simply inserting a lift into your running shoes is ill-advised. The underlying cause of the leg length difference should be determined and addressed. Adding a lift to a shoe can create tremendous problems as your body attempts to adjust to the changes in your gait. Additional reasons to abstain from putting a lift in your shoe: 1) It changes designed function and performance of shoes (mechanics, support, etc.). 2) Unless being used all waking hours your body will be forced to re-adapt to gait with and without lift. 3) Lift may create unleveling of the pelvis and associate spinal complications.
Leg length differences can lead to dynamic problems with ones gait, predisposing them to numerous running related problems. Finding the cause of the problem is the key. Solutions to the problem may involve custom orthotics, specific Chiropractic adjustments to address pelvic unleveling and related problems, changes in footwear, and other clinically necessary changes.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Differences in leg length can result in biomechanical stresses and muscular imbalances affecting ones running gait. Problems such as sciatic pain and hip discomfort are more common on the side of the long leg, while problems associated with the short leg are often foot pronation (inward roll), medial knee stress, and general muscle weakness.
Simply inserting a lift into your running shoes is ill-advised. The underlying cause of the leg length difference should be determined and addressed. Adding a lift to a shoe can create tremendous problems as your body attempts to adjust to the changes in your gait. Additional reasons to abstain from putting a lift in your shoe: 1) It changes designed function and performance of shoes (mechanics, support, etc.). 2) Unless being used all waking hours your body will be forced to re-adapt to gait with and without lift. 3) Lift may create unleveling of the pelvis and associate spinal complications.
Leg length differences can lead to dynamic problems with ones gait, predisposing them to numerous running related problems. Finding the cause of the problem is the key. Solutions to the problem may involve custom orthotics, specific Chiropractic adjustments to address pelvic unleveling and related problems, changes in footwear, and other clinically necessary changes.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Q: I am a high school cross-country runner and was recently diagnosed with a "plica band" in my left knee. What is this and can I continue to run?
A: There are 4 different "plica bands". The classic presentation that we often see with a "symptomatic synovial plica" or plica band is anteromedial (inner knee pain) pain with running or other activities requiring repetitive flexion and extension of the knee. This syndrome is more common in teenagers. Symptoms include snapping, buckling, and pain with prolonged sitting. Most individuals do not experience locking or recurrent swelling of the knee.
Most patients will respond well to conservative therapy designed to decrease inflammation. This may include physical therapy modalities such as phonophoresis and iontophoresis or intraplical steroid injection. However, there are those who have had the plica longer. These chronic conditions often lead to fibrosis, which may need arthroscopic resection via an orthopedic surgeon. Removal of the plica band via arthroscopic laser sugery can affect the way the knee cap tracks within the knee groove.
Most individuals with plica bands will respond to conservative treatments and be able to resume running.
Dr. Greg Coppola
Greg has run more than 10,000 miles and cared for thousands of athletes at the high school, collegiate and professional levels.
Dr. Coppola bio
Most patients will respond well to conservative therapy designed to decrease inflammation. This may include physical therapy modalities such as phonophoresis and iontophoresis or intraplical steroid injection. However, there are those who have had the plica longer. These chronic conditions often lead to fibrosis, which may need arthroscopic resection via an orthopedic surgeon. Removal of the plica band via arthroscopic laser sugery can affect the way the knee cap tracks within the knee groove.
Most individuals with plica bands will respond to conservative treatments and be able to resume running.
Dr. Greg Coppola
Greg has run more than 10,000 miles and cared for thousands of athletes at the high school, collegiate and professional levels.
Dr. Coppola bio
Q: I am an avid distance runner, running about 35-40 miles per week. Recently I have been experiencing increased pain down my left leg into my calf. What is this, and what can I do to get rid of this discomfort?
A: Sciatica is a commonly used term for pain originating from the low back that is felt in areas such as the buttock, hip, thigh, hamstring, calf, ankle, or foot. Sciatica is secondary to an underlying problem. Sciatica involves compression or irritation of the nerves exiting from the lower spine. Each of the two sciatic nerves is formed by nerves branching off the spinal cord and running down into the legs to the toes. The sciatic nerves are the largest and longest nerves in the body. Pain can be felt throughout the nerve.
Sciatic pain can range from pins-and-needles sensation, throbbing, numbness, sharp shooting pain, burning, to a dull ache. Pain may be localized or widespread in both legs and feet.
Sciatic pain is most often caused by pressure or irritation of the nerves as they exit the spine in the low back. If a vertebra of the low back is out of its normal position this will cause irritation and inflammation on the exiting nerves. Associated complications can include biomechanical spinal problems, muscular imbalances and tightness, leg length differences, and spinal disc problems.
Patients with sciatic complaints often have discomfort in the morning, sitting, sitting to standing, lying in bed, and with bending/ lifting. Pain may decrease while walking, running, and staying active, unless the condition has progressed to a more acute state.
Treatment
In the past treatment has involved pain and muscle relaxing drugs, physical therapy, and even surgery. Chiropractic has proven to be a very effective approach for many cases with carefully controlled specific adjustment to the areas involved to remove the nerve pressure and irritation at its origin. Removing the pressure on the sciatic nerve may help the body heal itself and relieve symptomatic complaints through restoring mobility, proper circulation, and decreasing inflammation.
Helpful Hints
Ice- helps to decrease inflammation caused by irritation on the nerves. (Heat will create more inflammation)
Stretching- helps decrease muscle tension and increase mobility.
Walking and staying active- helps prevent onset of inflammation and muscle tightness.
Running - Avoid running on hard surfaces and pounding down hills. Proper footwear will also be beneficial to decrease compression forces with foot-strike.
Avoid
Pain and anti-inflammatory drugs (or use very sparingly)- depressing symptoms may allow the problem to progress.
Prolonged bed rest- this will allow muscle tightness and inflammation to progress.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Sciatic pain can range from pins-and-needles sensation, throbbing, numbness, sharp shooting pain, burning, to a dull ache. Pain may be localized or widespread in both legs and feet.
Sciatic pain is most often caused by pressure or irritation of the nerves as they exit the spine in the low back. If a vertebra of the low back is out of its normal position this will cause irritation and inflammation on the exiting nerves. Associated complications can include biomechanical spinal problems, muscular imbalances and tightness, leg length differences, and spinal disc problems.
Patients with sciatic complaints often have discomfort in the morning, sitting, sitting to standing, lying in bed, and with bending/ lifting. Pain may decrease while walking, running, and staying active, unless the condition has progressed to a more acute state.
Treatment
In the past treatment has involved pain and muscle relaxing drugs, physical therapy, and even surgery. Chiropractic has proven to be a very effective approach for many cases with carefully controlled specific adjustment to the areas involved to remove the nerve pressure and irritation at its origin. Removing the pressure on the sciatic nerve may help the body heal itself and relieve symptomatic complaints through restoring mobility, proper circulation, and decreasing inflammation.
Helpful Hints
Ice- helps to decrease inflammation caused by irritation on the nerves. (Heat will create more inflammation)
Stretching- helps decrease muscle tension and increase mobility.
Walking and staying active- helps prevent onset of inflammation and muscle tightness.
Running - Avoid running on hard surfaces and pounding down hills. Proper footwear will also be beneficial to decrease compression forces with foot-strike.
Avoid
Pain and anti-inflammatory drugs (or use very sparingly)- depressing symptoms may allow the problem to progress.
Prolonged bed rest- this will allow muscle tightness and inflammation to progress.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Q: I have recently increased my mileage and have noticed that the front of my shins have become extremely sore even to the mildest touch. I have done some reading on shin splints but am not sure what I should do now?
A: The most common area involved with the generalized term of "shin splints" is the medial or inner side of the lower leg. Discomfort associated with this problem is most often located on the inner aspect of the tibia (shin bone). This area will be tender to the touch as structures involved become irritated and inflamed. Onset of discomfort is often gradual. Pain in the involved area can range from sharp stabbing to a dull ache.
Stress fractures are also common to this area and presenting complaints are often similar. Shin splints often present a broader area of discomfort vertically along the inside of the shin while a stress fracture may present a focal or pinpoint area of pain.
Contributing factors:
Several factors often associated with shin splints are: increases in running mileage, training on hard surfaces (pavement) or overly soft surfaces, excessive pronation (inner roll of the foot), running on slanted surfaces, lack of footwear support or motion control.
Home care:
Stretching the front and back of the lower legs will help to decrease muscular tension in this area. Stretching should be performed during warm up and cool down routines. Apply ice to the affected area after running (1-3 12 min. intervals) to decrease inflammation and discomfort.
Chiropractic care will ensure associated physical components are functioning properly. Massage to the area may also help decrease tension in the lower legs. Anti-inflammatory drugs may be helpful in relieving symptoms but may also allow you to over abuse the injured area.
Chiropractic Care:
Pronation is the primary mechanical factor leading to shin splints. Pelvic alignment and leg length discrepancies are key factors affecting foot pronation. Abnormal mechanics of the pelvis and lower back can significantly affect ones gait- affecting leg length, foot flare, foot strike, your ability to adapt to stresses and recover, along with numerous other factors. The ramifications of such changes are increased dramatically when running.
Misaligned spinal and pelvic segments known as subluxations can be detrimental to your health. Removal of subluxations through specific Chiropractic care is essential for all individuals, but especially those undertaking such physical stress as running.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Stress fractures are also common to this area and presenting complaints are often similar. Shin splints often present a broader area of discomfort vertically along the inside of the shin while a stress fracture may present a focal or pinpoint area of pain.
Contributing factors:
Several factors often associated with shin splints are: increases in running mileage, training on hard surfaces (pavement) or overly soft surfaces, excessive pronation (inner roll of the foot), running on slanted surfaces, lack of footwear support or motion control.
Home care:
Stretching the front and back of the lower legs will help to decrease muscular tension in this area. Stretching should be performed during warm up and cool down routines. Apply ice to the affected area after running (1-3 12 min. intervals) to decrease inflammation and discomfort.
Chiropractic care will ensure associated physical components are functioning properly. Massage to the area may also help decrease tension in the lower legs. Anti-inflammatory drugs may be helpful in relieving symptoms but may also allow you to over abuse the injured area.
Chiropractic Care:
Pronation is the primary mechanical factor leading to shin splints. Pelvic alignment and leg length discrepancies are key factors affecting foot pronation. Abnormal mechanics of the pelvis and lower back can significantly affect ones gait- affecting leg length, foot flare, foot strike, your ability to adapt to stresses and recover, along with numerous other factors. The ramifications of such changes are increased dramatically when running.
Misaligned spinal and pelvic segments known as subluxations can be detrimental to your health. Removal of subluxations through specific Chiropractic care is essential for all individuals, but especially those undertaking such physical stress as running.
Dr. Jeffrey P. Metcalf
Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care.
Dr. Metcalf bio
Q: About 6 weeks ago, in a quest to train for a marathon, I started experiencing pains in my achilles tendon after a faster than normal run. I have been training on the elliptical machine every day except the day after long runs. My Achilles feels great, until I have to get back on the pavement and then, it starts to hurt again. It does not appear to hurt that badly if I stretch it. What should I do now?
A: It sounds like you have inflammation of the achilles tendon or some form thereof. The cause is difficult to identify in this context, but the factors contributing to, or limiting recovery can usually be controlled. The achilles tendon has a poor blood supply so it takes quite some time for it to completely heal. I am not suggesting that you stop running, but from your question it seems clear that you should control your mileage until the pain diminishes. This is likely something you cannot run through.
Helpful Tips:
Ice after running. Stretch the calf muscles and achilles before and after running, as well as one other time during the day. Don't force the stretching; it can irritate the tendon. Check that the heel cup of the shoe does not apply pressure to the tendon. Do not run hills and do not do speed work. Try running at a moderate and consistent pace throughout your run. Do not run more than 2 consecutive days without a rest day. That is, don’t run three days in a row. Feel free to exercise on the rest day providing the exercise does not irritate the tendon or leave you feeling sore the following day. Long-term problems with the achilles can cause scaring and calcification (bone build up) in the tendon. Therefore, it is important to seek medical advise with this injury to deter from having continuous problems for years to come.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Helpful Tips:
Ice after running. Stretch the calf muscles and achilles before and after running, as well as one other time during the day. Don't force the stretching; it can irritate the tendon. Check that the heel cup of the shoe does not apply pressure to the tendon. Do not run hills and do not do speed work. Try running at a moderate and consistent pace throughout your run. Do not run more than 2 consecutive days without a rest day. That is, don’t run three days in a row. Feel free to exercise on the rest day providing the exercise does not irritate the tendon or leave you feeling sore the following day. Long-term problems with the achilles can cause scaring and calcification (bone build up) in the tendon. Therefore, it is important to seek medical advise with this injury to deter from having continuous problems for years to come.
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
Dr. Brown bio
Nutrition
Q: I am a 25-year old female long distance runner who trains regularly, running about 40 to 50 miles per week. I am concerned about good nutrition and have read that osteoporosis may be a concern for female athletes on strenuous training programs. However, I have also read that exercise is good for bone health. Therefore, is osteoporosis a concern for female athletes? Additionally, how do I know if I am getting enough calcium in my diet and what is recommended to protect against osteoporosis?
A: Background: Osteoporosis is a major health concern for both women and men who are athletes and non-athletes. One out of two women are affected by osteoporosis in their lifetime. The medical cost per year associated with osteoporotic fractures is greater than $10-15 billion with approximately 50,000 associated deaths per year. Osteoporosis is disorder of the skeleton characterized by compromised bone strength predisposing an individual to increased risk of fracture. Bone strength consists of bone density, or the amount of bone accumulated and/or lost, and bone quality, or the health and architecture of the bone. Historically, osteoporosis is associated with estrogen deficiency that occurs during menopause. New bone is formed in the first three decades of life and sub-optimal accumulation of bone early in life is associated with increased risk of osteoporosis and fractures as an adult. The female athlete, particularly the adolescent female athlete and/or females experiencing amenorrhea, or loss of menstrual cycle, are at an increased risk for bone loss or sub-optimal bone accumulation. However, regular exercise, particularly weight bearing (i.e. weight lifting, resistance training, running), can protect against bone loss and enhance bone strength. Having adequate calcium in the diet is important for achieving and maintaining optimal bone health. Studies indicate that 9 out of ten teenage girls do not meet their dietary calcium needs on a daily basis and among adult women only 20 percent meet their daily calcium needs per day. Furthermore, a high percentage of female athletes do not meet their dietary calcium needs. Importantly, in the setting amenorrhea or low estrogen levels dietary calcium alone will not reverse bone loss.
What factors are important for optimal bone health?
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: What are some recommendations for increasing calorie intake during intense training and competition to prevent weight loss?
A:
General Recommendations:
* Eat regularly consuming 5-6 meals/snacks per day.
* Eat a mixture of carbohydrate and protein.
* Avoid over restricting fat; recommend 20-25% total calories and minimally 15%.
* Eat every 1-2 hours during training/competition.
* Eat 5-6 servings of fruits and vegetable per day.
* Increase calories by adding extra meals/snack and choosing calorie dense foods.
Sample snack ideas at ~250 kcal per snack:
* Peanut butter and jelly on whole grain bread.
* Rolled flat bread with nut butter (e.g. peanut, almond, sesame) and sliced banana.
* Whole grain bun with 3 oz. grilled chicken with 1 tsp. aioli.
* 1 c yogurt with 1/2 c muselix or granola.
* Whole grain pita with 1/2 c hummus and chopped lettuce, tomato, and cucumber.
* Yogurt/tofu Banana smoothie: 1 c vanilla yogurt, 1/2 c plain soft tofu, 1 banana, 1 tsp. brown sugar, and 1 tsp wheat germ.
* Small salad with 1/2 avocado, 1/3 c soy nuts, chopped carrots and tomatoes, and 2 tbsp of vinaigrette.
* 1 c frozen yogurt with chopped strawberries, 1/3 c blueberries, and 10 raspberries.
* 1 c granola, 1/2 c low-fat milk, and 1/2 c fresh fruit.
* Veggie or regular low-fat burger in a pita with 1/3 cucumber dill sauce (1 c yogurt, 2 tsp dill, 1 tbsp olive oil, 2 tsp red vinegar, 1/3 grated cucumber).
* Avocado & Cheddar Flat bread melt: 1/2 cubed avocado, 1/3 c shredded cheddar cheese, sprinkle of ground cumin, and flat bread. Assemble and melt in oven for 3-5 minutes.
Rebecca L. Persinger, RD, CNSD, PhD
Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking.
Dr. Persinger bio
General Recommendations:
* Eat regularly consuming 5-6 meals/snacks per day.
* Eat a mixture of carbohydrate and protein.
* Avoid over restricting fat; recommend 20-25% total calories and minimally 15%.
* Eat every 1-2 hours during training/competition.
* Eat 5-6 servings of fruits and vegetable per day.
* Increase calories by adding extra meals/snack and choosing calorie dense foods.
Sample snack ideas at ~250 kcal per snack:
* Peanut butter and jelly on whole grain bread.
* Rolled flat bread with nut butter (e.g. peanut, almond, sesame) and sliced banana.
* Whole grain bun with 3 oz. grilled chicken with 1 tsp. aioli.
* 1 c yogurt with 1/2 c muselix or granola.
* Whole grain pita with 1/2 c hummus and chopped lettuce, tomato, and cucumber.
* Yogurt/tofu Banana smoothie: 1 c vanilla yogurt, 1/2 c plain soft tofu, 1 banana, 1 tsp. brown sugar, and 1 tsp wheat germ.
* Small salad with 1/2 avocado, 1/3 c soy nuts, chopped carrots and tomatoes, and 2 tbsp of vinaigrette.
* 1 c frozen yogurt with chopped strawberries, 1/3 c blueberries, and 10 raspberries.
* 1 c granola, 1/2 c low-fat milk, and 1/2 c fresh fruit.
* Veggie or regular low-fat burger in a pita with 1/3 cucumber dill sauce (1 c yogurt, 2 tsp dill, 1 tbsp olive oil, 2 tsp red vinegar, 1/3 grated cucumber).
* Avocado & Cheddar Flat bread melt: 1/2 cubed avocado, 1/3 c shredded cheddar cheese, sprinkle of ground cumin, and flat bread. Assemble and melt in oven for 3-5 minutes.
Rebecca L. Persinger, RD, CNSD, PhD
Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking.
Dr. Persinger bio
Q: Weight loss and weight gain are normal for athletes during times of intense training, competition, and time off. How many calories does an athlete need to consume to maintain or gain weight?
| A: Maintaining body weight during periods of intense exercise and competition can be a challenge for athletes. Additionally, weight gain may occur during periods of rest or time off. Many factors influence body weight including gender, age, duration and intensity of exercise, body size, body composition, and hydration status. Body weight depends on energy balance, which is the difference energy intake and energy expenditure. Energy intake comes form calorie containing foods and fluid, where as energy expenditure consists of basal metabolic rate, the thermic effect of food, and calories burned during exercise and movement.
The calories intake recommended per day for men and women of various ages are listed below:
*Values are adapted from Recommended Dietary Allowances, national Academy of Sciences, 1989.
*Values are estimates based on body weight, adapted from www.nutribase.com. |
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Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: I am an avid runner with a desire to improve my performance. In some of the athletic stores and in magazines I have read advertisements for a performance, enhancing supplement called creatine. What is this supplement, what amounts are generally taken, and are there side effects associated with creatine supplementation?
| A: Creatine supplementation has become popular by a variety of athletes due to the notion that it can enhance muscle performance. In a limited number of research studies oral creatine supplementation has been shown to enhance performance during repeated bursts of stationary cycling and weight lifting. However, the limited research for running and swimming has not demonstrated a clear benefit of oral creatine supplementation on performance. This may be in part due to weight gain associated with creatine usage, which may negatively affect performance. The rationale for taking creatine supplements is that it will increase muscle phosphocreatine, the energy producing form of the amino acid creatine, which may enhance muscle energy, delay fatigue, and possibly improve muscle mass. Creatine is an amino acid found in the diet (meats and fish), taken as a dietary supplement (creatine monohydrate), or made endogenously by the liver, kidneys, and pancreas. "Normal" diets contain about 1-2 g/day of creatine with less being consumed by vegetarians. Creatine is stored in the skeletal muscle, heart, kidneys, and brain. In the muscles creatine exists in different forms including creatine, phosphocreatine and creatinine. During high-intensity short burst of exercise the muscle uses phosphocreatine to generate ATP, the bodies source of energy, for muscle contraction and power. Consuming creatine supplements has been shown to increase the amount of phosphocreatine in muscle, improved regeneration of phosphocreatine during recovery, and may increase muscle mass. Therefore, increasing muscle phosphocreatine can aid in providing energy during short burst of activity and may prevent muscle fatigue. Unfortunately, there are no clear guidelines for creatine supplementation. However, in a survey of dosing of male college athletes an initial loading phase for 2 to 5 days of a 20 g/d (0.3 g/kg body weight) dose, which is followed by a maintenance dose of 2 g/d (0.03 g/kg body weight) has been reported. Exceeding the dosing regimens has not been shown to further enhance maximum muscle creatine concentrations. Furthermore, muscle phosphocreatine levels return to baseline after ~28 days after cessation of creatine supplements. The reported adverse effects include weight gain (e.g. 2-5 pounds during loading phase), muscle cramping, gastrointestinal disturbances (e.g. diarrhea and gastrointestinal cramping), increased risk of dehydration, and impairment of kidney function. Moreover, there are limited studies documenting the long-term effects of oral creatine supplementation on other organs such as reproductive organs, heart, or liver. In summary, oral creatine supplementation may enhance performance during short bursts of high-intensity exercise such as stationary cycling or weight lifting. Limited studies reveal a positive benefit of creatine supplementation on enhancing running performance, likely due to weight gain associated with supplementation. As with many dietary supplements that claim to have ergogenic or other health benefits more research is needed in order to better understand both the positive benefits and potential side effects of short and long-term supplementation. Therefore, when considering taking oral protein supplements it is recommended to consult with your physician or sports medicine professional to discuss usage. References and Web Resources: Juhn, MS: Oral Creatine Supplementation, Separating Fact from Hype. 27(5): 232-234,1999. http://www.physsportsmed,com/issues/1999/05_99/juhn.htm Juhn,, MS, O’kane JW, Vinci DM: Oral creatine supplementation in male collegiate athletes: a survey of dosing habits and side effects. J Am Diet Assoc 99(5): 593-595, 1999. Juhn MS, Tarnopolsky M: Oral Creatine supplementation and athletic performance: a critical review. Clin J Sports Med 8(4):286-297, 1998. United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Washington, DC: Dietary Supplement Health and Education Act of 1994 (DSHEA 1994): Public Law 103-417). http://web.health.gov/dietsupp/toc.htm |
| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
Q: I have consumed coffee and tea for many years. As an active long distance and trail runner who likes to compete, I have read different information about the effects of caffeine. Is it okay for me to have caffeinated beverages and will they affect my exercise performance?
A: Caffeine is the most commonly consumed over-the-counter drug. In the United States the average amount of caffeine consumed per day is about 200 mg, or 2 cups of coffee. Additionally, more than 10% of the population consume greater than 1000 mg per day. Caffeine (Table 1) is naturally present in many foods (i.e. coffee, teas, sodas, and chocolate), but is also found in non-prescription medications and in certain prepared foods (i.e. energy bars and gels). Caffeine is a drug with no nutritional value and is absorbed quickly peaking in the blood by about 1-2 hour. As an ergogenic agent, caffeine has been shown to enhance performance in both short-term and endurance exercise performance.
Effect on Performance: Laboratory research suggests that consuming 3-9 mg/kg (e.g. 2-6 cups of coffee or 200-1000 mg) of caffeine before increases both short-term and endurance exercise performance. Despite a limited number of controlled studies, sprint performance does not appear to be affected by caffeine. The mechanism by which caffeine exerts its positive benefits is not fully understood, some suggest that it may be related to sparing of muscle glycogen or the effects on lactate utilization. Because caffeine is an ergogenic aide the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) have determined that acceptable limits of urinary caffeine are <12 mg/ml and <15 mg/ml, respectively. For example, a 70 kg male that consumes 5-6 cups of coffee (~9 mg/kg caffeine) would be expected to have less than 12 mg of caffeine per ml of urine at about one hour after consumption. |
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: As an avid runner and swimmer, I am very concerned with nutrition. My diet consists of a variety of foods, including plenty of fresh fruits, vegetables, whole grains, and high quality protein sources. However, I am really fond of chocolate and like to have a piece during the day as a snack. I have heard that chocolate may have beneficial effects on health, so what is the current thinking?
A: All foods can be considered part of a balanced and healthy diet. Generally, it depends on how much of given food that you consume as part of your daily diet that makes it balanced or not – balanced is good. Chocolate is one food that tastes good, but may also be part of a healthy diet when consumed in moderation. Additionally, research suggests that certain components of chocolate, or flavonoids, may be protective against heart disease and stroke. Flavonoids are present in a variety of foods including cocoa, chocolate, tea, and red wine. The flavonoid content of foods is diverse with different foods containing various concentrations of different types of flavonoids. Additionally, depending on the processing of the food, much of the flavonoid content can be lost or destroyed. Table 1, shows the flavonoid content for various foods and beverages.
*Adapted from Scalbert and Williamson, J Nutrition 130: 2073S-2085S, 2000 and Hannum, SM, et al. Nutrition Today 37(3):103-109, 2002. |
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: After a long run or event, I enjoy having a glass of beer or wine. Will this type of alcohol consumption affect my performance?
A: In adults moderate alcohol consumption can be part of a normal diet. In general moderation is defined as 1 alcohol equivalent per day for women and 2 for men. Table 1 lists the alcohol equivalents and calorie content of various types of alcoholic beverages. According to the National Institute on Alcohol Abuse and Alcoholism, people who consume alcohol in moderation are at low risk for developing problems related to alcohol consumption. Some studies find that drinking alcohol (i.e. wine, beer, or distilled beverages) in moderation may reduce the risk of heart disease. However, due to the addictive properties of alcohol some people should not drink alcohol. For the athlete who consumes alcohol it is unlikely that low to moderate alcohol consumption will affect performance. However, it should be noted that consuming excess alcohol prior to an event could influence hydration status and/or performance. Additionally, consumption of alcohol prior to exercise can impair ones ability to perform. Therefore, drinking responsibly and knowing the affect of alcohol on ones body is important.
For more information: http://www.niaaa.nih.gov/ |
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: My wife and I are avid runners and are in our 60's. Are there special diet recommendations for older individuals?
| A: Adults over the age of 50 do have nutrition requirements that are different from adults and children. As humans age the incidence of disease increases and diet recommendations often need to be tailored for specific disease states. The benefits of exercise in the population over 50 are tremendous. Routine exercise can reduce the risk of disease (e.g. heart disease, high blood pressure, diabetes, and osteoporosis) and improve balance and strength. Therefore, it is recommended for people over the age of 50 to participate in regular exercise. Generally, regular exercise means 30 minutes or more a day of physical activity, which can include walking, running, strength training, swimming, yoga, or gardening. Strength training is particularly important for preventing osteoporosis and improving balance and strength. As part of a healthy lifestyle for older adults you should also consume a balanced and nutritious diet. Diet: Research shows that a healthy diet may help prevent a variety of health problems including diabetes, obesity, heart disease, and cancer. A good place to start is by looking at the Food Guide Pyramid, which provides the basics on consuming a balanced diet. The table below lists recommended calories, protein, and selected nutrients for adults over 50 years of age. However, depending on your level of exercise you may require more of calories and protein. For most individuals this may amount to increasing daily calorie intake by 500 to 1000 calories depending on your level of physical activity. Additionally, consuming adequate nutrients is important for overall health and for exercise performance. In order to get all of the recommended vitamins and minerals some individuals take a daily supplement which can be recommended by your dietitian, physician, or pharmacist.
*Adapted from the 1989 Recommended Dietary Allowances (RDA) and the 1997 Dietary Reference Intakes (DRI), National Academy of Sciences. |
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
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Q: Soy products are reported to be healthy because they protect against heart disease and cancer. As part of my training I try to consume high quality protein sources such as meats and seafood. Are soy products considered good protein sources for athletes?
A: Soy products are a high quality and excellent source of protein and may also have health benefits. Research has documented that soy protein may reduce the risk of developing heart disease. The Food and Drug Administration supports the health claim that 25 g of soy protein per day in conjunction with a diet low in saturated fat and cholesterol may decrease the risk of heart disease by lowering cholesterol. Moreover, soy products contain isoflavones, which may exert health benefits because of either their antioxidant effects or their weak estrogen-like effects. Although more research is needed, isoflavones may be protective against osteoporosis, certain types of cancer, the side effects of menopause, and heart disease. Soybeans are the main source of soy protein and the basis for all soy products. Many types of soy products exist and contain varying amounts of soy protein and isoflavones. Table one compares common consumed soy products and the amount of protein and isoflavones present. Soy oil is extracted from soybeans and it contains high concentrations of essential fatty acids and vitamin E which may be beneficial or protective in heart disease and inflammation. Soy protein is part of a healthy diet and is a high quality protein source when consumed as part of a balanced diet.
Adapted from the USDA food consumption database, http://www.nal.usda.gov. |
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
Q: I have read that runners and other athletes often restrict dietary fat. Is this true? What are trans fatty acids and are they bad for you? What are the recommendations for athletes regarding fat intake and the types of fat?
| A: You are correct, research studies suggest that some athletes consume diets very low in fat (e.g. 10-15% total calories from fat) and often low in calories. Insufficient consumption of either carbohydrates or fats can result in muscle fatigue and impair performance. Although limited research exists, dietary fat, like carbohydrates may be important during long duration physical activity for optimal muscle metabolism. However, it should be noted that extremely high fat diets (e.g. 60-70% fat), which are typically very low in dietary carbohydrates, are associated with reduced performance during endurance exercise. It is recommended that a healthy diet consist of 20% of total calories as protein, 50% as carbohydrate, and 30% as dietary fat. Types of Dietary Fats:
Trans fatty acids have received more press recently due to their demonstrated effect in increasing the risk of heart disease. It is recommended that we limit our intake of these types of fat and consume polyunsaturated, monounsaturated, and omega-3 fats instead of trans and saturated fats. In the 1995 Dietary Guidelines for Americans it is acknowledged that trans fatty acids raise blood LDL-cholesterol, albeit not the same extent as saturated fat. The Food and Drug Administration has proposed that food labels contain information about trans fatty acid content of products. As a final note, adequate research does not exist to suggest which types of fats may be more or less beneficial for exercise performance. |
| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
General Questions
Q: I have been experiencing increased difficulty breathing, chest tightness, and wheezing when running, especially when the weather is colder. Am I just out of shape or could this be a sign of asthma?
| A: Exercise induced asthma (EIA) is a real condition and more common than many may think. An estimated 12% to 15% of the general population is affected. Sufferers range from children to world-class athletes. Up to 90% of people who have been classified as asthmatic, experience EIA during the course of their condition. Individuals who have not been diagnosed as asthmatic or those not having respiratory allergies still may experience EIA. EIA is defined as a decrease in lung function and increased airway resistance upon vigorous exercise. Symptoms may include wheezing, coughing, fatigue, difficulty breathing or chest tightness during and/ or after physical activity. Triggering factors: cold air, dry air, air pollutants, poor physical conditioning, airborne allergens (ie. pollen). Activities such as running that require a high oxygen intake are more likely to cause EIA. Increased intensity level of an activity increases the severity of the reaction. Treatment:
Evaluation must be specific because active individuals often have lung function well above normal predicted values when compared with sedentary individuals. |
| Dr. Jeffrey P. Metcalf Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care. Dr. Metcalf bio |
Q: In keeping up with my training schedule I frequently seem to be fighting off nagging injuries. What can I do to get out of this cycle?
| A: As the old saying goes, "an ounce of prevention is worth a pound of cure." We often ignore the early little signs when our health is fading, and only address problems as they limit our ability to perform our daily activities. Being "in tune" with how your body is feeling and taking steps early on to solve problems will help avoid most all running related injuries and health problems in general. Health care should be just that, focused on what can keep us healthy and at our best rather than focused on the end stage symptoms. Listen to your body to keep it working right. Most injuries are due to a progressive process from the repetitive stress brought about with running. Research has shown us that the symptomatic presentation with a health problem is generally the last thing to show up as a problem progresses and the first thing to go away as our body heals itself up. Symptoms are similar to the oil light coming on in your car, at this point you better get it taken care of quick before a serious problem arises. Ideally we want to maintain an optimal level of true health, and to do this we must have all parts of the body functioning at 100%, 100% of the time. Keeping ourselves at this level of health before the oil light needs to send us that warning sign. How do we maintain this level of "health"? There are no quick fix answers, but with good habits relating to diet, exercise, and practical health maintenance care this level of wellness can be obtained. |
| Dr. Jeffrey P. Metcalf Helping fellow runners stay healthy allows Dr. Metcalf to combine two of his passions in life, running and Chiropractic health care. Dr. Metcalf bio |
Q: How do I know if my shoes are worn out?
A:There is no specific sign to tell that your shoes are no longer providing the proper amount of cushioning and support. The cushioning materials are usually ethylene vinyl acetate (EVA) or polyurethane (PU). These materials are both plastics that have a finite amount of "life" as shock absorbers.
The life span is shortened by exposure to ultraviolet light, ozone, heat, and repeated impacts. Impacts from running are further affected by your weight and the surfaces on which you run. The more weight or the harder the surface, the shorter the life of the shoe. Due to these factors, the life span is usually 300-500 miles. Remember to keep the above factors in mind when thinking about replacing shoes.
Changing your shoes before they are completely without cushioning and support will not cause any problems. Changing them after complete loss of cushioning and support can cause severe problems.
The life span is shortened by exposure to ultraviolet light, ozone, heat, and repeated impacts. Impacts from running are further affected by your weight and the surfaces on which you run. The more weight or the harder the surface, the shorter the life of the shoe. Due to these factors, the life span is usually 300-500 miles. Remember to keep the above factors in mind when thinking about replacing shoes.
Changing your shoes before they are completely without cushioning and support will not cause any problems. Changing them after complete loss of cushioning and support can cause severe problems.
Q: Can you help me understand the difference between bursitis and tendonitis?
| A: Bursitis is inflammation of a bursa, which is a fluid filled sac that helps decrease friction over the bone in order to protect ligament and soft tissue structures. There are many causes of bursitis such as a direct blow (acute trauma) or chronic trauma as seen with overuse injuries. There are certain inflammatory conditions such as gout and rheumatoid arthritis that can lead to bursitis also. There are eight major bursae around the knee and three major sites of bursitis around the hip. The hamstring, quadriceps and ligament complexes have connections to the bursae and help with cushioning and support. The classic signs of bursitis include a gradual onset of pain in the anatomic region that becomes proportional to activity level. Pain is present upon waking in the morning. Walking often aggravates pain. A limp is often noticed when pain is severe. Tendonitis is inflammation around a tendon involving the tendon sheath-or covering around the tendon. A tendon, by definition, is a structure connecting muscle to bone. Tendonitis may occur anywhere in the body but is often seen in runners. For example, Achilles tendonitis may result from overpronation, recent change in shoe wear, sudden increase in training-especially with hill running. The Achilles' tendon is particularly vulnerable to injury because it belongs to a muscle tendon group that crosses two joints. Runners may develop bursitis or tendonitis as a result biomechanical abnormalities (muscle imbalances, excessively flat feet, high arches etc.) or training errors (too much, too soon, too often). |
| Dr. Greg Coppola Greg has run more than 10,000 miles and cared for thousands of athletes at the high school, collegiate and professional levels. Dr. Coppola bio |
Q: What is the difference between an arch support and an orthotic?
| A: This depends largely on how you define ‘arch support’ and orthotic’, so I will provide some definitions and answer your question based on these. An orthotic, referred to here as a functional orthotic, is designed to modify the function of your foot. These are custom-made from semi-rigid materials and prescribed for your feet and individual biomechanics. An assessment of your foot biomechanics and specific running needs is made, and then a mold of your foot is taken on which the device will be built. When all these factors are taken in account, semi-rigid functional orthotics are comfortable to wear and usually only cause irritation or pain if they are improperly prescribed or made, or the runner doesn’t follow wearing instructions correctly. Functional orthotics are usually posted or angled in such a way that the biomechanics of your foot is intentionally modified and/or improved. Under the definition provided here, arch supports are not designed to alter foot biomechanics; they solely provide support for the arch of the foot. This support tends to stabilize the arch and the joints in the middle of the foot. Arch supports can be very comfortable and assist with many injuries such as heel pain. Because it is possible to buy arch supports ‘off-the-shelf’ and not ones prescribed by a doctor/therapist, it can be difficult to find the arch support that fits your foot correctly. Whether a runner needs an arch support, a functional orthotic or neither should be determined on an individual basis. |
| Dr. Nick Brown Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas. Dr. Brown bio |
Q: I have heard some mixed reviews on strength training, is it right for runners?
| A: For some time there existed a belief that runners may not benefit from strength training. Although the health benefits of aerobic exercise have been shown conclusively, many fail to appreciate the cardiovascular benefits of strength training. The literature supports strength training as a means of reducing cardiac stress and improving cardiovascular risk factors. It can help prevent and treat obesity, a risk factor for diabetes and coronary heart disease. Body composition improves in individuals who strength train since muscle mass increases relative to fat. Runners may already feel healthy and question why they should invest time from running to another form of training. The answer may be that it could provide an extra "kick" when needed. The lactate threshold and the onset of blood lactate buildup are extended by high volume weight training. These parameters, when maximized for each runner, may help allow high intensity exercise to be sustained longer. Some authors have suggested that strength training may prevent medial tibial stress syndrome (shin splints), plantar fasciitis, and patellofemoral dysfunction. In fact, strength training may be more benefical to runners than power athletes with regards to injury prevention, given the higher volume and frequency of endurance workouts. |
| Dr. Greg Coppola Greg has run more than 10,000 miles and cared for thousands of athletes at the high school, collegiate and professional levels. Dr. Coppola bio |
Q: I have noticed that some people land on their heels when they run, while others seem to land on their toes. What is the best way for my foot to strike the ground when I run?
| A: There is no “best way” for your foot to strike the ground. In fact, the way your foot strikes is dependent on a number of factors including running speed, stride length, whether you are running up or down hill, biomechanics, and the list goes on. Let us first start with a basic description of the way a foot “normally” strikes the ground. In biomechanics, the period when the foot is in contact with the ground is called the stance phase of running (or walking). The stance phase is comprised of sub-phases called contact, midstance, and propulsion. It may surprise some people to know that during the contact phase, a large part of the body’s natural shock absorber is pronation. Initial ground contact usually occurs at the heel, with the toes slightly up and the foot positioned such that the outside of the heel strikes first. Heel strike will usually be pronounced when your stride length is longer or for example, when you are running down hill. As you quicken your running speed, the point of foot contact moves forward toward the toes. The extreme example of this is during sprinting, when the toes or the ball of the foot contacts the ground first. One biomechanical factor that affects foot strike is related to knee position. If your knee is completely extended or straight for foot strike, heel contact is usually exaggerated. Slight flexion of the knee, a better knee position in preparation for ground contact, will aid in shock absorption of ground impact. Tight muscles can also influence your foot position during ground contact – for example, some people run on their toes because of tight calf muscles. |
| Dr. Nick Brown Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas. Dr. Brown bio |
Q: Running in the summer months can be more taxing on the body depending on the temperature. In hot climates what are the recommendations for fluid replacement for runners? Also how much fluid do you lose and what is the best way to replace lost fluids.
| A: Fluid balance or maintenance of normal hydration is critical for optimal exercise performance and overall health. A disturbance in fluid and electrolyte balance can affect cellular activities and the function of heart and muscles. For example, as little as a one percent reduction (e.g. 2 pounds in a 150 pounds person) in body weight due to dehydration can negatively affect the ability of the body to transfer heat and maintain normal temperature. Inability to regulate body temperature increases demands on the heart and impairs exercise-performance. Both high-intensity duration and moderate-low intensity endurance exercise-performance can be affected by fluid balance. For example, during one hour of exercise you can lose more than one quart of sweat, which is equivalent to 2.2 pounds if the fluid is not replaced. Additionally, the exercise intensity, duration of exercise, and the climate temperature can have dramatic influences on fluid balance. Recommendations from The American College of Sports Medicine*:
*Adapted from American College of Sports Medicine, Position Stand on Exercise and Fluid Replacement, Med. Sci. Sports Exerc., Vol. 28, No. 1, pp I-vii, 1996. |
| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
Q: As a runner I have experienced joint pain in my knees and hips. A friend suggested that glucosamine and chondroitin sulfate might be helpful for improving my joints. What information is available about the use of these supplements and are there concerns with taking these supplements?
| A: Both glucosamine and chondroitin are found in the body and serve as the major precursors for the structural materials in joints, bones, skin, and blood vessels. Although, the body can make both glucosamine and chondroitin, they may also be purchased as nutritional supplements. When administered orally glucosamine and chondroitin sulfate have been shown to slow degenerative joint disease and improve the symptoms of osteoarthritis. The mechanism by which these compounds slow or reverse degenerative joint disease is due to their ability to act as substrates for the formation of healthy cartilage, the major structural component of joints. Additionally, the use of these supplements has been shown to reduce the use of non-steroidal anti-inflammatory meditations. Glucosamine is a structural amino-sugar found in tissues, whereas chondroitin is a large protein derived from cartilage. Although they are present normally in our bodies, for the purpose of producing dietary supplements glucosamine and chondroitin are extracted from animal tissues. In general, glucosamine comes from the shells of lobster, crab, and shrimp and chondroitin from animal cartilage. Although the combined use of these supplements has become popular, there is little evidence to suggest that taking them together is better than taking either alone. Commonly Tolerated Oral Dosage: glucosamine sulfate - 500 mg/3 times/day for a minimum of 6 weeks chondroitin sulfate - either 400 mg/2 times/day or 800 mg/day Considerations:
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| Rebecca L. Persinger, RD, CNSD, PhD Rebecca is active in the Seattle running and cycling communities and enjoys other outdoor activities including: snowshoeing, skiing, mountain biking, and hiking. Dr. Persinger bio |
Q: I have been a cyclist for many years and have recently started running. How much running should I begin with since my fitness is already good?
| A: One of the main and obvious differences between running and cycling is the ground impact that your body experiences during running and not cycling. Not only will your muscles take some time to get used to this, but bones, ligaments and tendons also need time to adapt to this new form of ‘impact’ loading. Muscles also tend to ‘push’ during cycling, while muscles in running absorb shock from ground impact. These are different types of muscle actions or contractions, and a cyclist who begins to run for the first time can experience soreness in their legs even though they are fit. This soreness can in some cases be a precursor to injury. Even the very fit cyclist should begin slowly with their new running program. The reverse is of course true for runners beginning cycling and the high loads associated with pushing the pedal. Cyclists also tend to have very strong thigh and calf muscles. In some cases, this extra strength is associated with muscle tightness, or inflexibility. Calf muscle tightness can place extra stress on the foot and heel, and in many cases people who experience heel pain such as plantar fascitis have tight calf muscles. That is not to say that cyclist with tight muscles will get heel pain, however, it is important to note that inflexibility is a prominent contributing factor of injuries in running. So, start out cautiously and don’t push the intensity or distance of you runs too much at first. Stay well within your fitness level and perhaps run only 3 times a week and not on consecutive days until your body starts to adapt to the impact associated with running. |
| Dr. Nick Brown Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas. Dr. Brown bio |
Q: I keep hearing about R.I.C.E., what is it?
| A: R.I.C.E. stands for Rest, Ice, Compression and Elevation and is a common acronym used to describe treatment of acute injuries such as traumatic ankle sprains and bruising. The acronym R.I.C.E.D. is also used; the “D” indicating Drugs for pain reduction or inflammation. Ice, or cryotherapy has a role not only in acute injuries, but also in overuse injuries related to running, particularly in the initial inflammatory phase that occurs in the first 24 hours after injury. For runners, this is the 24 hours after each run that irritates the injury, or sets up an acute inflammatory phase. Inflammation has several characteristics; heat, pain and swelling are the most noticeable. In simplified terms, ice helps with the heat, and compression and elevation control swelling. The overall effect is to reduce inflammation and usually pain. Runners with overuse injuries will usually benefit from RICE, and at the very least, ice pack application to the injury site after each run. Be careful never to apply the icepack directly to the skin, always place a layer, for example, a shirt or kitchen towel between the ice pack and your skin. Keep the icepack on the injury for 20 minutes. If you notice skin irritation or reduced sensation at the injury site for extended periods after ice application, stop and seek medical advice. As with all injuries, it is advisable to seek medical advice. |
| Dr. Nick Brown Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas. Dr. Brown bio |
Q: I have played soccer for many years and have always worn soccer shoes that were quite tight. How should I fit my running shoes?
| A: The quick answer is “not as small as your soccer shoes”. You really do need a little extra room around your toes, especially if you are planning on running longer distances. One important aspect is to ensure the running shoe fits around your arch and heel very well while allowing extra space for your toes. The actual fit of a shoe depends not only on the length of the shoe, but on the last or shape of the shoe. Different footwear companies build shoes with different lasts. Brooks has different lasts within its own brand; accommodating the curved “C” shaped foot, semi-straight (universal), or straight (linear) foot. In general, a majority of people fit into a semi-straight shoe known as the Brooks’ universal last. Shoe sizes can also vary between shoe types. For example, you may wear a size 9 street shoe but you may need a size 9.5 or 10 running shoe. A good solution to your problem is to go to a reputable running store where experienced sales people can help you with the correct fit. This assessment should be based on a number of factors including your running plans for the future, past and/or present injuries, and your foot and body type. It can also be helpful to take in shoes that you have worn in the past and make notes as to what your likes and dislikes were with different models. |
| Dr. Nick Brown Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas. Dr. Brown bio |
