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calfIn this edition of Ask the Practitioner, we again connect with Mark Fadil, Clinic Director at the Sports Medicine Institute (SMI) of Palo Alto.  SMI is one of Northern California's leading orthopedic and deep tissue massage resources, assisting both world class and recreational athletes since 1996.  

RC: Tight and/or sore calves are one of the most common ailments for new and experienced runners alike.  What exactly is happening when one feels like his or her calves are tight and they have become sore to run on? 

MF: Sore/tight calves are a very common problem with runners.  Generally someone may experience sore calves when running for the first time, coming back from time off, during a period of increased speed work or during a period of increased mileage.  In each one of these circumstances the calf muscles are adapting to the stress from the increase in activity.

RC: When treating runners with sore calves, what are the most commonly reported practices that have potentially led to the problem? 

MF: There is normally some sort of change that precedes sore/tight calves.  In addition to the changes I already mentioned it can come from a change in running shoes (usually a shoe with a lower heel such as a racing flat will put more stress on the calf), a change in running surface or increased hill running.

RC: What techniques do you and your staff employ to address this problem and what can runners to do maintain the work at home? 

MF: I usually focus on three things: massage, stretching and functional strengthening.  Massage can be done by a professional therapist or at home using a foam roller or "the stick."  This can be done on a daily basis for 5 - 10 minutes.  Stretching should focus on both the upper calf (gastrocnemius) using a straight knee calf stretch and the lower calf (soleus and Achilles) using a bent knee calf stretch.  I recommend stretching after massage as well as an additional 2-3 times a day.  Each stretch should be held for at least 30 seconds.  Functional strengthening is one of the most important pieces in preventing sore/tight calves from occuring in the first place.  A great way to incorporate functional strengthening is doing heel drops off the edge of a stair.  These should initially be done on a daily basis and eventually shifted to two to three times per week for maintenance.

There can always be other issues that contribute to calf soreness/tightness.  But this should provide a good overview of the more common causes and effective treatments for most cases.
 

 



 

Rikke Johansen, D.C., is the founder of Health Logic and has 18 years of experience in practice as a doctor of chiropractic medicine.


Dr. Johansen is a Certified Chiropractic Sports Physician (CCSP), a Certified Strength and Conditioning Specialist (CSCS), and has completed the educational requirements to qualify her as a Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP) and as a Diplomate of the American Chiropractic Board of Radiologists (DACBR). She is also a USA Triathlon Level I certified triathlon coach and a USA Cycling Level II certified cycling coach.

rc:  What are the types of physical complaints Graston technique is effective in addressing?
 
RJ: The most common complaints in my practice (we see a high percentage of endurance athletes) where patients specifically come in or are sent by their medical doctors to get Graston are: Plantar Fasciitis, Iliotibial Band Tendonosis, and Achilles Tendonitis. Another common issue is post surgical scar tissue, i.e. after shoulder or knee surgery. The chronic high hamstring tear is also effectively addressed with Graston.

rc: What makes Graston different than other popular techniques, such as manual deep tissue sports massage and Active Release Technique?
 
RJ: It is important to  remember that all techniques are only as good as the overall assessment of the athlete as well as proper diagnosis of the kinetic chain and faulty bio-mechanics. A knee problem is rarely an isolated knee problem.  It is important to correct muscle weaknesses, range of motion challenges, etc. We certainly use a combination of myofascial techniques, but with the Graston instruments we are able to more specifically locate adhesions, get a sense of severity and create the localized controlled 'trauma' that will aide in normalizing the tissues.

rc: What does Graston feel like and how effective is it?
 
RJ: Everybody has different pain thresholds, and different body areas are more sensitive. Graston can be slightly painful, but more often in a 'good' way. It is often described as a rolling pin, when done on the back with a large instrument. Some people describe the smaller treatment edges as metal brushes. The technique is modified to each individuals comfort level and pain is not necessary to get results.  As to effectiveness, generally we take care of 85-90% of chronic conditions, such as those mentioned above, in 4-6 visits.


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Few life changes will have a greater impact than the arrival of a newborn.  Both the physical challenges for mom, as well as the stark changes in family schedule and breadth of responsibility for both parents can justifiably upend priorities.  This can wreak havoc with the comfortable patterns of habitual runners.

Chances are, unless you have had a very quickly moving adoption, you have been well aware that changes in your running routine await the arrival of the new bundle of joy.  Very likely, transitions have already occurred for mom with the ups and downs of pregnancy.  Whether a quick return to work or flexibility for extended parental leave is on the horizon, here are a few tips and ideas for runners in the throes of new parenthood:

Consider how baby gear purchases, such as a stroller, can assist you in the eventual pursuit of a return to running. Yes, that sounds crass – you are about to enjoy one of life’s greatest blessings, and running should come to mind?  Well, if there is anything that you intend to continue doing on a regular basis after your baby comes, it probably saves time and money to anticipate how you can manage that practice within the context of your baby’s first few years at home.

For example, many running families use a jogging stroller (or a stroller with that capability) for their primary stroller.  Initially, it can be used for regular stroller duty, particularly now that many jogging strollers can attach baby carriers and inserts allow for extra padding with newborn babies.  When eventually jogging becomes appropriate with the little one, everyone is used to the new gear, how it fits in the car, the baby finds it to be a smooth transition, and more enjoyable / contented baby running might result.

Moms: set a completion goal, but no sooner than 6-12 months after giving birth.  Dads: choose flexible goals in the first year.

While the experience of every mother is different, having a goal to shoot for can often inspire (to lose weight, to re-grasp a feeling of independent personhood, etc) when life seems completely turned on its head.  Set a goal too soon, and it may become a needless stressor, both logistically, and physically, when the body is out of shape and sleep is minimal.  Set a time goal too soon after giving birth, and the unpredictable physical aftermath of motherhood can create frustration.  By a year, many moms are beginning to recognize their bodies again, and having a date to look forward to (as a return to the experience of being an athlete) can be a very motivational tool.  Just enjoy your first goal race after baby to celebrate how far you have come.  Use subsequent goal races to return to previous fitness and pace levels.

New dads are also saddled/ delighted with the many transitions of fatherhood, but many times must navigate a tricky landscape of an initially supporting role in the physical sense.  Without the obvious setbacks of pregnancy and giving birth, it may be enticing to set a big goal, almost in celebration of the new family member.    However, in this particular instance, it is worth considering flexible goals.  Neither of you quite know how you will feel physically or rest-wise as these dates get closer, and the last thing needed is more stress.   One option to keep dad on track could be to pick a distance goal with three or four options in 60 day range.

Have patience with your body after baby (yes, dads too!)

For many first time parents, the adrenaline of new parenthood eventually wears off, but many nights of limited sleep remain.  Schedules change and keep changing.  Things like foam rolling, stretching, strength routines, and other ancillary activities may be cut out to preserve what little time remains to run.  Unsurprisingly, aches and pains might crop up, and the legs might not recover as fast.  Control what you can control.  Consider occasionally modifying your running routes and other patterns to avoid a fruitless comparison contest with your well-rested self.

For moms in particular, resist the urge to return to serious training until you are cleared to run by your doctor.  Be sure to progress incrementally.  Just like a marathon recovery that is too short, a postpartum running injury may not crop up immediately.  Rather it often surfaces after the premature progression has been established over several weeks or months.

Shop and prepare for running with body after baby.

One of the most common roadblocks to a successful return to pre-baby running fitness can be the first few efforts out the door.  For many moms, postpartum bodies feel like complicated new appliances with misplaced instruction manuals, what with the likely weight gain and the new demands and dimensions of various body parts.  All of us know better than to establish self-esteem from outside appearances, but without a couple running items that fit, it can be that much harder to get out and get started.  Having a high impact / supportive sports bra and shorts that fit your current size can make a difference, and are worth shopping for even in advance when you have more flexibility in your schedule.

When it comes time for stroller jogging, find the bike paths.

Just as parents at their wits’ end will drive a baby around the block, hoping to induce sleep, the stroller experience for your baby / toddler can vary wildly from soothing to disruptive, which in turn may have a direct impact on your ability to reintegrate running positively into your daily life.  Bumpy roads, streets with many stop lights, turns or undulations may be your only options, and by yourself, you might barely notice these parts of the route.  However, the stroller years might also serve as a chance to get to know the flat, off street routes in your region better than you might have before, and allow the jogging stroller experience to emerge as a positive parenting interactive time rather than a struggle of wills.



{mp3}ATM for Serious Runners{/mp3}


{mp3}ATM Top 10{/mp3}


lee_yogaStephanie Lee (pictured) has been practicing yoga for over 12 years in a variety of diverse settings that include Hawaii, Greece, Italy, and Thailand.

RC: Yoga is a commonly mentioned term these days, but what exactly is yoga and what is it intended to do?
 
SL: There are many types of yoga practices, each offering something different, but all with a common strand. Yoga can be your own sanctuary outside of the madness of the day's routines.  It's a safe, non-chaotic environment where you can find peace in your body and mind.  When you leave the studio, you can take those learnings with you and apply to everyday life situations.  Once a yogi, always a yogi.  Yoga can help you build a healthy lifestyle that complements Western Medicine. It's a loving and comfortable environment to discover the connection of your physical, emotional and spiritual body.

RC: What generally about yoga might make it beneficial for runners?
 
SL: There are a wide range of benefits from practicing yoga.  Not only is it physically challenging to your body, it's an opportunity to relax and focus the mind with wonderful benefits to all of the internal organs in need of repair and detoxing. Yoga improves your posture and blood flow, it lowers cortisol [hormone released in response to stress], releases tension, provides an immune boost, helps regularity and most of all aids in peace of mind.  It's an inner balance. Yoga, paired with running, can create more flexibilty, strengthening of the joints and muscles, and gains in your ability to stay focused.  It can enhance your breathing and provide you with a better night's rest.  In all yoga practices, you need to spend that time within your own body on your mat.  In some practices like Bikram, you are facing obstacles such as remaining in the studio throughout the entire 90 minutes with absolutely no talking in extreme heat.  It is a very challenging environment as at times there can be up to 60 people in some classes.  This is where you need to pull your wandering mind back in and focus on being present within yourself and your own abilities to complete the class.

RC: What are a couple beginner poses or exercises a runner might try to explore these benefits?

SL: Some basic, yet very beneficial poses a runner may be interested in incorporating to their workout are the following:
Half Moon, Eagle, Separate Leg Stetching (which are all in the standing series), plus Wind Relieving Pose and Half Tortoise, which are a part of the floor series [ed note:  Runcoach does not have an association with or specifically endorse any of the sites used to illustrate each pose].  It would also be advised to incorporate controlled breathing and meditation as these can go hand and hand with a runner's world.



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Although we earn a small reprieve from the early morning darkness with next month's time change, many runners are just settling in for a long winter of running in the dark.  Whether you rise early to beat the rush before the workday begins and the kids wake up, or fit in a run at the end of the day, nighttime running is a fact of life for many athletes.  Here are a few tips for staying safe and maximizing these workouts until the sun reappears.

Avoid risk-taking

While running the same route again and again might seem unappealing, or stopping your awesome tempo run briefly to make sure a passing car sees you, it is always worth it.  Stick to routes where lighting can help provide safety and mark your path, even if that means doing multiple loops around a few block radius.  Head to a local track and run while kids are playing soccer or lacrosse under the lights in the evening.  Put off exploration of that new trail until the weekend when you can run in the daylight.  Set aside the headphones so that you can be alert to your surroundings (yes, you can do it).

Choose routes for the presence of sidewalks away from the roadway.  Consider places of business where early morning activity takes place in a typically safe manner, such as a gas station, bagel shop, or Starbucks and include them on your run.  Check for daily sunrise and sunset times so you can safely estimate when you will need to be in spots that are safe for those times of day.  In short, give yourself at least one more measure of safety precautions than you would ordinarily take.  That may mean boredom and repetition, but is always better than not being able to run at all or risking adverse events

See and be seen

Many running apparel companies and specialty brands have introduced reflective clothing and devices to help runners stay safe in the dark.  Sometimes we focus on being visible to cars and others by wearing reflective gear, and other times we focus on keeping our path lit with headlamps and other illuminating devices.  In reality, both are important at all times.  A hard fall because of an unseen root or sidewalk crack is dangerous, and of course it is crucial to be visible to vehicular traffic.   It isn’t always possible to be completely visible in the dark, but taking care to be seen and to seeing where your feet will travel can be a crucial safety precaution.

Keep others in the loop

Whether you live with others in your household or reside independently, leave a note, a text, or other word where you plan to go every time.  If you encounter any trouble on an evening run, it may be until daylight before anyone is aware of your extended absence or be able to see you in distress alongside a road.    Particularly if doing something strenuous or extended, such as a long run for a marathon training cycle, estimating a time of return can help ease the mind of others who aren’t used to the length of these runs, as well as determine when you are indeed overdue.    Whenever possible, try to meet others for nighttime runs.  Both as a safety measure and as added encouragement when the winter is at its darkest and coldest point, a partner or group willing to meet you at a nighttime hour can make all the difference.

Be creative

Roads and outdoor tracks may not be the only venues for getting in runs.  Enclosed walkways, indoor public spaces, the perimeter of a well-lit parking lot, and even a circuit of long hallways in winter-affected cities might provide occasional safe locations for runs when things are truly awful and dark.    Consider a short-term gym membership, even if just to break up the workout by running there, doing some miles on the treadmill, and running home.  If winter is really getting the best of you, consider sampling some indoor cross training disciplines you have been waiting to try, or investigate the possibility of all-comers indoor track meets in your community as a way to get in a good hard effort inside.

While nighttime running may not be pleasant for many, runners across the country and around the world have thrived with a schedule comprised primarily of workout times before dawn or after dusk.  The good news is that sunlight is likely around the corner as spring returns, and the challenge of darkness is an opportunity to exercise the type of commitment and persistence that will serve you well when faced with a rough patch in your next goal race.  Embrace the challenge, stay safe, and keep up the good work.



There are almost unlimited ways to get an enjoyable workout in when you are in a recovery cycle, need to give a running related sore body part a rest, or when you are hoping to add activity without additional running mileage.  In the chart below, we focused primarily on activities which function as running replacements in terms of cardiovascular stimulation vs activities like yoga, which may have other helpful primary benefits such as flexibility, etc.

Have a question, comment, or recommendation on your favorite cross training exercise? Weigh in on the forum!

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Ask the Practitioner: Back Pain

Written by Dena Evans September 17, 2012

Angelique-headshot-web
Dr. Waite holds a B.S. in Exercise Science from Creighton University and a Doctorate in Chiropractic Medicine from Palmer College.  She has treated the knees of professional cyclists, the hands of musicians, the backs of police officers, the shoulders of golfers, and the feet of marathon runners.  Dr. Waite is a certified Active Release Techniques (ART) and Graston Technique provider, and specializes in the treatment of all manner of soft tissue and repetitive strain injuries.  




rc: Many recreational athletes struggle with periodic back pain.  What
are a few of the most common problems you see as people seek treatment
in your office?


AW: Low Back Pain due to Psoas (long muscle along the lumbar region) tightness, Paraspinal Lumbar tightness (knots in the low back in muscles adjacent to the spine), and Sacroiliac joint pain due to ankle instability
rc: What are some common situational factors the average person can
avoid to in order to reduce the chance of developing periodic back
pain?

AW:  Common causes of low back pain include sitting for long periods of time and continuing to use your running shoes beyond 300 to 400 miles.  Since running is a repetitive motion exercise which can lead to repetitive strain injuries, don't put off making an appointment for myofascial release such as Active Release Technique.  Make sure you stay hydrated and don't over train!

rc: What can you do at home to encourage maintenance of a healthy back?

AW:  Simple things we can do include maintaining a daily stretch routine, getting up and moving around every 20 minutes if you have a desk job, going to a Pilates or Yoga class once a week, using your foam roller on the hamstrings, adductors, quads, and IT bands, and making sure you cross train as an increase in overall strength and core strength will give you a more efficient stride.


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