By: Holly Warner, PT, DPT

Training errors, along with certain running biomechanics, place us at risk for developing a running related injury. Excessive pelvic drop and hip adduction can contribute to an increased risk of developing gluteal tendinopathy or a gluteus medius/minimus muscle strain, especially when we also have exceeded our tissue’s load capacity through an abrupt increase in running mileage or intensity.

Gluteal tendinopathy is often the cause of lateral hip pain (pain on the outside of the hip) in runners. This type of injury often happens due to increased compressive loads placed on the gluteal tendons at the greater trochanter located on the outside of the hip. The compressive loads are often caused by excessive pelvic drop or hip adduction when running. 

Pain is often felt running, especially uphill, and also when lying on the affected side, climbing stairs, and with single leg activities. 

It is important to avoid stretching with this type of injury, such as IT band stretching. Stretching the lateral hip structures actually further increases compressive loading of the tendons and mimics the type of movement that is often the cause/mechanism of injury. Instead, the best way to treat this type of injury is to strengthen the hip abductor muscles (gluteus medius and minimus), starting initially with isometric exercises. Isometric exercises are exercises that cause a muscle to work/contract without moving the joint. Types of these exercises for the gluteus medius and minimus muscles might look something like this:

 

To learn more about lateral hip pain and for specifics on exercises to try, check out Sapphire Physical Therapy’s blog post on Addressing Lateral Hip Pain In Runners. Whatever your injury may be, Sapphire PT is ready to help!

Photo: Votography Images

By: John Fiore, PT, owner of Sapphire Physical Therapy

The function of the foot

There are many simple yet highly effective exercises to aid in foot function

The human foot is an evolutionary marvel. The human foot contains twenty-six bones, thirty-three joints, and one-hundred ligaments, muscles, and tendons. Humans have the unique ability to walk on two legs (bipedal walking), due in part to the ingenious balance of mobility, shock absorption, and propulsion found in our feet. Our ancestors climbed trees and traveled on all four extremities. As humans diverged from our primate ancestors, our toes shortened for push-off, our heel (calcaneus) mass increased for foot strike, and our mid-foot arch developed for shock absorption and recoil.

Why focus on foot function?

Most of us keep our feet covered in socks and shoes and rarely considering the important role our feet play in our daily lives and recreational activities. I have seen many feet in twenty-eight years of physical therapy practice, and I am confident that there is no such thing as the perfect foot. The take home message of this article is the importance of regularly addressing foot joint mobility, strength, and balance to allow your unique feet to function properly for a lifetime.

John Fiore helping a runner after the Snowbowl 15k. Photo: Votography Images

Foot stress increases when the ankle joints are stiff. When the lower leg and foot musculature (intrinsic muscles on the bottom of the foot) are weak, foot and ankle strain increases. In addition, foot and ankle joint impact increases when our foot is not capable of effectively absorbing and transferring impact force associated with landing, especially during running and jumping activities.

Next steps

While it is true that more impressive exercises exist (squats, lunges, deadlifts, planks), there are few exercises as important for living, working, playing, running, or jumping without pain than foot-specific exercises. I recommend being proactive in regard to your foot health, especially if you have recreational or competitive goals in 2021. Make an appointment with one of our physical therapists for a consultation, individualized exercise program, and training recommendations. Sapphire PT specializes in foot and ankle treatment. Our services range from preventative, to post-operative, to custom foot orthotics fabricated on-site for your unique foot issues.

Photo: Seth Orme

Evie Tate, PT, DPT
Sapphire Physical Therapy

Bone stress injuries (BSI) or “stress fractures” are one of the more common running-related injuries seen in female runners (1,2). These injuries occur when our bones are broken down faster than they can be rebuilt.  There are a few reasons why runners are more susceptible to BSIs, some of which being the repetitive, uniform loads applied through bones with each step and the perception that “lighter is faster” in regards to body weight.  This is where Relative Energy Deficit Syndrome (or RED-S) comes into play. RED-S looks at all the systems in the body that can be negatively impacted when we do not take in the same amount of energy (i.e. food) that we are expending (3).

One of the things that can happen when someone is experiencing RED-S is that they can develop low bone mineral density, which in turn can increase the risk of developing a BSI (3). As you can see in the graphic below, when someone is dealing with this energy imbalance, it can have major implications not just on bone, muscle and tendon health, but also on mental and emotional health (3). Common signs and symptoms of RED-S include disordered eating, amenorrhea in females, low testosterone in males, fatigue, and depression/anxiety (3). It is important to understand that RED-S can negatively impact you both athletically and in your day-to-day life.

Mountjoy, 2018

 

When working to improve bone mineral density and address signs of RED-S, it is important that you use a multi-disciplinary approach.  This means, you may work with a physical therapist, dietician, primary care physician, and/or a psychologist. It is also important that each member of your care team communicates and is working together. 

From a physical therapy perspective when combatting low bone mineral density, it is important to incorporate strength training and plyometrics, or jump training. In order for strength training exercises to be most beneficial for improving bone mineral density, you must be lifting heavy weights, not just performing body weight exercises (4). Heavy strength training has been shown to be more beneficial for improving bone mineral density than bodyweight exercises alone (4). Once your physical therapist feels you are ready, you should incorporate plyometrics into your routine.  Jumping, when added in conservatively and progressively, can aid in improving bone mineral density as well (5).  

A key takeaway is that while running is a wonderful sport, it can quickly move across the spectrum from helping your physical and mental health to hurting it.  Ensure you are taking the steps to protect yourself and incorporate strength training and plyometrics in your routine!

For more information regarding RED-S in endurance athletes, join us on Saturday, April 10th for our Women’s Running Clinic virtual seminar. We have speakers across the community discussing various topics related to all things running, including disordered eating and REDS in runners. Register here: https://runsignup.com/Race/MT/Missoula/WomensRunningClinic

 

References:

1 Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine. 2014;48(7):491-497. doi:10.1136/bjsports-2014-093502 

2 Wentz L, Liu P-Y, Haymes E, Ilich JZ. Females Have a Greater Incidence of Stress Fractures Than Males in Both Military and Athletic Populations: A Systemic Review. Military Medicine. 2011;176(4):420-430. doi:10.7205/milmed-d-10-00322 

3 Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., … Budgett, R. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687–697. doi:10.1136/bjsports-2018-099193 

4 Mosti, Mats P, Trude Carlsen, Elisabeth Aas, Jan Hoff, Astrid K Stunes, and Unni Syversen. 2014. “Maximal strength training improves bone mineral density and neuromuscular performance in young adult women.”  The Journal of Strength & Conditioning Research 28 (10):2935-2945.

5 Vlachopoulos D, Barker AR, Ubago-Guisado E, Williams CA, Gracia-Marco L. The effect of a high-impact jumping intervention on bone mass, bone stiffness and fitness parameters in adolescent athletes. Archives of Osteoporosis. 2018;13(1). doi:10.1007/s11657-018-0543-4 

 

 

 

Photo: Seth Orme

By: Evie Tate, PT, DPT at Sapphire Physical Therapy

Have you ever had an overuse injury like a tendinopathy (also known as tendinitis)? A common misconception about this injury is that rest is the most important piece to recovery. Though rest is important, it is not the most important part of your recovery. While adjusting your training volume during a time of injury, you should also be progressively loading your tendon.  Tendon fibers become stronger when they are put to use in an intentional way.  

We know that tendon injuries for runners are typically due to overuse. Running can put up to eight times one’s body weight through the Achilles tendon with each step (1). We also know that a single, unweighted calf raise only puts around 3.5-3.9 times one’s body weight through the Achilles tendon (2). In order to withstand the demands of running, we must perform exercises that are heavier than just our body weight alone. 

When introducing exercise with heavier weights, it is important to start out with lighter weight and higher reps.  Every week or two, as your body adjusts and becomes stronger, you can increase the weight you are lifting and decrease the reps. This is what we mean by “progressive loading.” This is the best strategy to use when introducing heavier exercises into your workout routine.  Some excellent exercises for runners to start implementing into their routine include calf raises, squats, Romanian deadlifts (RDLs) and lunges (3).  Depending on the amount of running you are doing, you most likely only need to complete these lifts two to three times a week, with at least one rest day in between to ensure you are allowing your body optimal time to recover. 

References:

1 Willy RW, Halsey L, Hayek A, Johnson H, Willson JD. Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running. J Orthop Sports Phys Ther. 2016 Aug;46(8):664-72. doi: 10.2519/jospt.2016.6494. Epub 2016 May 12. PMID: 27170525

2 Effects of minimalist and maximalist footwear on Achilles tendon load in recreational runners. ResearchGate. https://www.researchgate.net/publication/281406583_Effects_of_minimalist_and_maximalist_footwear_on_Achilles_tendon_load_in_recreational_runners. Accessed January 7, 2021.

3 Blagrove RC, Brown N, Howatson G, Hayes PR. Strength and Conditioning Habits of Competitive Distance Runners. J Strength Cond Res. 2020 May;34(5):1392-1399. doi: 10.1519/JSC.0000000000002261. PMID: 29023328.