running injuries – Running Ink

Do as I do: why listening to your own advice isn’t always easy

Being injured always sucks. But I can’t help feeling it’s even harder when you’re a coach, because you feel as though you should be immune. Surely, if you know so much about running, you never make training errors or run with anything other than textbook-perfect form? Ha ha. We’re only human, of course. Our bodies are no more machines than are those of our clients. But it does shake your confidence when you can’t do the very thing that you’re teaching and supporting others to do.

When I recommenced running after a week’s recovery post-Brighton marathon, my right knee started to niggle, getting progressively worse over the course of the week to the point where even walking was painful. It was frustrating – I’d been seized by that ‘just let off the leash’ feeling after the discipline of marathon training, and was looking forward to pottering through the woods and tearing up the track in equal measure. But there I was, grounded.

One thing I could do as a coach, however, was be a good role model and act how I would advise others to in my situation. OK, I’ll admit it took me a week to get my head around this, but after a flurry of ‘panic’ activities (including a course of anti-inflammatories, a knee brace, regular applications of ice) I stopped running completely, endeavoured to avoid anything that irritated it (which turned out to include both cycling or swimming) and waited for my body to do its healing thing. Oh, and I went to see a physio.

While logic suggested that my knee was ‘a bit angry’ after the rigours of the marathon and wasn’t ready to get back to the day job yet, the less-rational side of my brain was conjuring up serious issues like worn cartilage, ligament damage or tendinopathy that would put me out of action for months or even spell the end of my running career. With such a powerful psychological component to pain (and studies showing that stressing about pain actually makes it feel worse), it was really important to me to have a professional assessment. Being able to rule out these more sinister possibilities was enough to put my mind at rest and allow me to focus on building strength in my quads and glutes while it settled.

“Try not to ‘helicopter parent’ your injured part too much”

It now has, and I’m gradually building up my running again. For anyone else returning from injury, I’d recommend trying not to ‘helicopter parent’ your injured part too much. After having suffered some pain there, you are going to be super-sensitive for a while and even the tiniest twinge can be magnified in your mind. Sure, don’t ignore pain, but ask yourself how you’d score it on a scale of 1 to 5. If it’s a 1 or 2, you’re probably fine to carry on. I’ve found that smiling – and looking at the scenery – helps keep me distracted from worrying about it too much.

During my ‘off’ time, I took the opportunity to read up and refresh my knowledge on strength and conditioning and gait retraining and I’ve learned some useful new stuff, which I’ll be weaving into my Run Better workshop. You could call that a silver lining, but I’m far too cautious for that!

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Surface tension

Are you a road runner or a trail runner? It’s not a question that I could answer definitively – I run where the day’s route takes me, be it through a leaf-carpeted woodland (this morning), along a city street (last week) or across a muddy field (yesterday). Each has its own pleasures and challenges.

But some runners can be very snobby about surface. A trail aficionado recently commented on Twitter that ‘people who do road marathons hate themselves.’ You’ll find similar disparaging remarks about tarmac enthusiasts if you look at trail running forums and specialist publications. The gist of it is that road running is deathly dull/bad for you/a poor substitute and that running off-road is in all ways more fun, healthier and generally superior. I think it’s an unfounded and unwelcome division – like vegans dissing vegetarians – we’re all runners, aren’t we?

The tweet came to mind at the weekend, when I was toiling along a public footpath bordering a field that the farmer had decided to plough to the very edge of the barbed-wire fence. Each time my foot landed, the clump of earth underneath it would either crumble or roll, creating angles at my ankle and knee joints that would have a biomechanist brandishing their goniometer with alarm. Any views to be appreciated went unnoticed, since I had to keep my eyes firmly on the treacherous trail.

There was little relief to be had when I reached the stile, which was so overgrown with nettles that getting over it could have passed as a ‘I’m a celebrity…get me out of here’-style challenge. ‘Fun, this is not,’ I thought to myself. Fifteen minutes later, the nettle stings fading (the secret is to avoid touching them) I was floating along a blissfully smooth tarmac lane. The ironed-flat surface rendered me surefooted enough to appreciate my surroundings – ripe blackberries in the hedgerow, leaves just turning in the autumn sunshine. My good mood was restored.

Now, I’m not claiming that road running is more enjoyable than trail; nor ‘better’ in any way. I love the ever-changing demands of an off-road run – one minute, mud is sucking at your trainers, the next you’re bounding through knee-high grass, leaping over tangled tree roots or skipping from rock to rock. But it’s hard to find any kind of rhythm – which is why I also relish the clean, rhythmic clip of feet on tarmac and the space that that metronomic movement seems to create in my head.

One of the reasons the anti-road brigade say that trail running is ‘better’, is that it puts less stress on the body. Intuitively, it makes sense (softer surface equals a softer landing, right?) but there has been surprisingly little research to back up the claim. In fact, studies seems to suggest that there’s a complex and entirely subconscious interplay between our limbs and the surfaces we run on: the ‘stiffer’ the surface, the ‘softer’ we make the limbs, and vice versa. It’s known as ‘muscle tuning’. This continual adjustment of limb stiffness to match the surface the brain expects us to land on means that the resultant force is pretty much unchanged regardless of surface.

More recently, researchers have posited the theory that trail running may be healthier (though there is not data to prove that trail runners sustain fewer injuries as yet) because of the variety offered by the mixed terrain and undulations. Each footstep is slightly different from the last one and the next one, so the forces exerted on the body are applied in slightly different ways, reducing the risk of overuse. This makes perfect sense and is probably also why varying your running shoes, rather than wearing the same pair all the time, has been linked to a lower incidence of injury.

Variety is almost always better than doing the same thing all the time – but when it comes to running surfaces there’s no reason why a brightly-lit town pavement or a country B-road should not form part of that variety.

This article previously appeared in my Murphy’s Lore column in Runner’s World magazine

Plantar fasciitis – a fresh approach

Despite its complex name, many runners can pronounce plantar fasciitis because they’ve had the misfortune of personal experience. I’ve heard it called the ME of sports injuries because it’s so hard to pin down what triggers it and equally hard to find a way to get rid of it. It’s not uncommon for the condition to last six months or more. Part of the problem with defining the cause and solution is the fact that there’s little agreement on what PF actually is. The ‘itis’ in the name suggests it is a condition that involves inflammation but this has been challenged in recent years and some podiatrists and sports medicine experts have called for it to be known as plantar fasciosis instead. An ‘osis’ is degeneration of tissue, rather than inflammation – and as such, requires a different approach when it comes to treatment. (That might explain why the ‘usual suspect’ remedies, such as rest, ice and anti-inflammatories – or even corticosteroid injections provide little more than passing relief.)

In one study, tissue biopsies were taken from people suffering from severe PF and then assessed. There was no evidence of inflammation in the plantar fascia, but there were numerous microscopic tears and signs of degeneration (necrosis) both in the plantar fascia itself and within the intrinsic flexor muscles of the foot.

Caused by what? Well, you may not need to look further than your own footwear. A lot of running shoes (in fact, a lot of shoes in general) don’t have enough space – or the correct shape – in the toe box, causing the big toe to be drawn towards the other toes (adducted). Then there’s the common shoe feature called ‘toe spring,’ which pulls your toes into extension because the front end of the sole curves upwards (shown below). Add this to the fact that in most shoes your heel is raised higher than your toes, and you end up with the toes – most notably the big toe – being forced into both extension and adduction. As a result, blood flow (via the posterior tibial artery) to the PF and surrounding structures is compromised, allowing degeneration to take place.

To get a sense of the position in which the foot is held in most footwear, push your toes together, raise your heel off the floor and pull your toes into extension. If you now press your fingers along the medial side of the heel, you may well find you can recreate your pain symptoms. This position will greatly increase tension in the flexor muscles on the bottom of the foot as well as the PF – an effect magnified by the forces of running.

So please, if you have PF, DON’T STRETCH YOUR PLANTAR FASCIA EVEN FURTHER! Besides this exacerbating the problem, you are also stretching what is an essential part of your elastic energy return system, which helps to propel you through your running stride without using up precious energy.

So what’s to be done? First, you need to allow the toes to sit properly. That means a shoe with enough space in the toe box but more specifically, space for the big toe to sit straight, not curving in towards the other toes. I highly recommend Altra, Vivobarefoot and some Inov-8 models (those described as standard fit, not precision fit). You can check out my shoe reviews to see which brands and models fit the bill.

I also recommend Correct Toes toe spacers, which are designed to be worn inside footwear (or barefoot, of course) to help realign your toes back to their correct anatomical position. They were created by a running podiatrist in the United States, and I found them invaluable in getting over my long-standing PF (and that’s why, unashamedly, I’m now involved in selling them in the UK online).

The other important shoe-related thing to avoid if you’re suffering PF is excessive toe spring (ie. when the shoe curves upwards at the toes, court jester style) or an overly stiff midsole. Check whether your running shoe allows the foot to bend where it’s designed to bend – across the ball of the foot.

PF sufferers also need to get those feet supple and mobile again. Stretching the tight toe extensors is the best starting point.

toe extensor stretch — Toe extensor stretch

This position stretches the toes at the metatarsophalangeal (MTP) joint – the ‘knuckle’ of the foot. You can do this sitting or standing (sitting is easier to get to grips with). Extend one leg a little way back behind the body and place the upper surface of the toes on the floor. Exert a little pressure. This should bend the toes at the MTP joint.

You’ll feel the stretch across the top of the foot and perhaps across the front of the ankle. As the muscles become more flexible, bring the foot further forward, relative to the body, to increase the stretch.

Deep tissue massage is also helpful in mobilising the feet and improving blood flow when rehabbing from PF. A golf ball underneath the ball of the foot can help get that MTP joint moving, as shown below.

I also regularly use a pedi roller to stretch and ‘iron’ out the connective tissue on the soles of my feet, and get my fingers in between the big toe and second toe to massage between them, both from above and below.

There will undoubtedly be physios, podiatrists and the like who will dismiss outright the notion that modern footwear and its effect on foot structure/alignment causes plantar pain. Indeed, people suffering from PF are often given MORE cushioning and MORE support in their shoes when they actually need less. But the huge number of runners with ongoing, stubborn plantar pain that doesn’t respond to the usual bag of tricks might be more open to suggestion. That’s how I felt after I’d had a corticosteroid injection, two different pairs of orthotics, done copious stretching, icing and resting and was still on the bench nigh on a year later. Why not free your feet and see what happens? And please report back!