The sun appeared today and the thermometer reached 40 degrees Fahrenheit (ed. note: this was written last week!). Warmer temperatures and sp
ring racing commitments result in a rapid increase in running intensity and distance. Winter legs accustomed to skiing and indoor gym workouts lack the repetitive loading rates which occur while running. Avoid a hamstring injury by avoiding the temptation to rapidly increase your running speed and-or mileage without proper training. A useful concept is Training Load Versus Tissue Capacity. Strength training and progressive tissue loading-specific exercises should be included in regular winter workouts to build hamstring tissue load capacity as we transition from winter sports back to road and trail running miles.
The hamstring is an important and complex, two-joint (crosses both the hip and the knee joints) muscle group used in running. While hamstring pulls and strains are common in runners and often healed with rest, proximal hamstring overuse injuries and traumatic hamstring muscle pulls can be painful and difficult to treat with rest alone. Repetitive micro-trauma in the hamstring attachment at the ischial tuberosity of the pelvis may result in tendinopathy (acute tendinitis or chronic tendinosis) and pain. While proper diagnostic testing is key (clinical testing by an experienced physical therapist or by a sports orthopedic physician), insufficient or improper treatment of proximal hamstring tendinosis may result in a season-ending injury. As with most running injuries, gradually increasing training volume and tissue loading is great way to reduce injury risk.
The hamstring is comprised of three muscles. All three hamstring muscles originate on the ischial tuberosity of the pelvis. The semimembranosus and semitendinosus muscles attach on the medial side of the lower leg (tibia) below the knee. The biceps femoris attaches on the lateral side of the lower leg (tibia) below the knee. The hamstring muscle group works in opposition to the quadriceps muscles. When you are flying down a hill at full speed, quads pounding and quads burning, the hamstrings act as the “brakes” to prevent knee hyperextension and to initiate the push-off phase of running.
The hamstring’s primary function is to flex or bend the knee. The hamstring’s secondary function is to aid in extending the hip. Because the hamstring crosses both the hip joint and the knee joint, it is a key muscle in the running stride.
Strengthening the hamstring in a lengthened state (eccentric) versus a shortened state (concentric) will result in hamstrings which are stronger and more prepared to manage the repetitive loading associated with running fast on flats and descending hills at speed (see exercise examples below). Core strength addressing lower abdominal, hip, gluteal, and lumbar stabilizers in a functional manner will reduce the demand on muscles such as the hamstring. Hamstring-specific strengthening with progressive loading will reduce overuse and associated tissue micro-trauma which leads to injury.
In order to quantify hamstring function, a 2D video running analysis may be indicated to determine how you as an individual run. Are you using your gluteus maximus to extend your hip, or is the hamstring acting as the primary mover? Are you over-striding and placing increased tension through the hamstring? A 2D video running analysis is a useful way to detect additional underlying running compensations in the clinic which may influence running biomechanics and resulting hamstring tissue loading.
Finally, do not forget self-care such as adequate recovery, sleep, hamstring release techniques, and eccentric hamstring exercises throughout the year to maximize your tissue load capacity. The exercises listed below are for example only. I recommend seeing a physical therapist to develop an effective hamstring-specific loading exercise program suited to your unique strengths, underlying weaknesses, and running goals. Call or email John and the PT staff at Sapphire PT with any questions or to schedule a consultation (406-549-5283 or john@sapphirept.com).
Hamstring Loading Exercises to Increase Tissue Load Capacity:
1. Glut Bridging Progression: Contract your glutes (glute max) together and hold the contraction and lift into a bridge position, holding for 5 seconds. Slowly return to starting position and repeat for one minute. Further challenge yourself by repeating glut bridging exercise with the addition of single leg marching or single leg bridging without allowing your pelvis to drop. Additional progression includes the addition of a Swiss Ball beneath your heels.
2. Step-downs: Stand on a box or step (begin with a 4-inch box and progress to taller box over time) with a pole for balance assistance as needed. Step down slowly while maintaining alignment through the pelvis, knee, and foot. Increase hamstring loading by landing further forward and by increasing the box or step height. Practice landing quietly “like a cat” to decrease impact loading.
3. Quadruped Plank: Add a single leg lift (hip extension) while maintaining a level back-pelvis. May be modified by resting on your forearms.
4. Eccentric Hamstring Treadmill Stepping: Set treadmill to the slowest speed. Face backward on the treadmill and hold the hand rails. The support side (the left leg shown) is 
placed off of the treadmill belt. The exercising leg (the right leg shown) is placed on the belt. Slowly resist the forward motion of the belt with one leg as the belt moves. The exercising leg then is moved back to the starting point by flexing the knee and extending the hip.
5. Forward Glider Disc Lunge: Stand with exercising foot on a glider disk (use poles or counter support as needed). Slowly slide foot of exercising leg forward and slowly allow your knee so straighten slightly (do not fully extend your knee or you may do the splits) while avoiding excess hamstring tension. Return to original position and repeat.
6. Nordic Hamstring Curls: Kneel in an upright posture and have a second person hold your lower legs and ankles against the ground (or you may hook your heels beneath a stationary bar). Place hands in front of body and slowly lower towards the floor as shown without excessive hamstring tension. Slowly return to starting tall kneeling position.
Photo: http://prohealthphysio.com.au/exercises/nordic-hamstring-curl/
References:
1. Cushman, D.; Rho, M., Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report. Journal of Orthopaedic & Sports Physical Therapy 2015, 45 (7), 557-562.
2. Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Physician and Sportsmedicine 2005, 33 (5), 32-43.
3. Finding the balance photo: https://blogs.bmj.com/bjsm/2016/04/11/balancing-training-load-and-tissue-capacity/
Product Review: Squirrel’s Nut Butter
Sean Kiffe is a Runner’s Edge Ambassador for the 2018/19 season. He is very visible around town as he runs just about every Runner’s Edge race
and Run Wild Missoula event each year. We asked Sean to review a new anti-chafe product called Squirrel’s Nut Butter. Read his review below and you can also follow Sean’s adventures on instagram@seankiffe.
Squirrel’s Nut Butter is a newer line of anti-chafe and skin care products with an all natural ingredient list. At first glance I had to wrap my head
around the fact that this product was not food. With nutrition products on the market like Clif Bar’s Nut Butter Bars it can be confusing. That said, the Squirrel’s Nut Butters list of ingredients does not read like a chemistry textbook and would more than likely be just fine to eat. The product’s invention was intended as a treatment for eczema for one of the founder’s children. It would appear that the uses of this salve are far reaching beyond athletic purposes.
I tested the Anti-Chafe Salve in the stick format (it also comes in a small tub container). The primary ingredients are coconut oil and beeswax. Any endurance athlete knows the discomfort that chafing can cause and the invaluable proactive benefits of a product like this. I used Squirrel’s Nut Butter primarily on my two problem areas, the nipples and inner thighs. The butter applied easily and was scentless. For anyone running medium to long distances, this is a must-have product.
Other products like Body Glide, Gold Bond and Chamois Butt´r have been around for a while but neither have the simple, hypoallergenic ingredient list like Squirrel’s Nut Butter does. It should be noted that there is a vegan option as well.
I’ve used Body Glide for years now and by comparison the Squirrel’s Nut Butter product was just as effective, if not more so. The anti-chafing quality was excellent and it did not lose its effectiveness after prolonged effort and sweating. I’d strongly recommend this product to any athlete. It’s inexpensive, made from a simple list of natural ingredients and it works as promised. The Squirrel’s Nut Butter Company also offers products for cycling and skin restoration, all boasting the same all natural ingredients.
Runner of the Month: Tammie Dry
Winter Running and Training Tip: Reducing off season hamstring injury
By: John Fiore, PT
Sapphire Physical Therapy
The sun appeared today and the thermometer reached 40 degrees Fahrenheit (ed. note: this was written last week!). Warmer temperatures and sp
ring racing commitments result in a rapid increase in running intensity and distance. Winter legs accustomed to skiing and indoor gym workouts lack the repetitive loading rates which occur while running. Avoid a hamstring injury by avoiding the temptation to rapidly increase your running speed and-or mileage without proper training. A useful concept is Training Load Versus Tissue Capacity. Strength training and progressive tissue loading-specific exercises should be included in regular winter workouts to build hamstring tissue load capacity as we transition from winter sports back to road and trail running miles.
The hamstring is comprised of three muscles. All three hamstring muscles originate on the ischial tuberosity of the pelvis. The semimembranosus and semitendinosus muscles attach on the medial side of the lower leg (tibia) below the knee. The biceps femoris attaches on the lateral side of the lower leg (tibia) below the knee. The hamstring muscle group works in opposition to the quadriceps muscles. When you are flying down a hill at full speed, quads pounding and quads burning, the hamstrings act as the “brakes” to prevent knee hyperextension and to initiate the push-off phase of running.
The hamstring’s primary function is to flex or bend the knee. The hamstring’s secondary function is to aid in extending the hip. Because the hamstring crosses both the hip joint and the knee joint, it is a key muscle in the running stride.
Strengthening the hamstring in a lengthened state (eccentric) versus a shortened state (concentric) will result in hamstrings which are stronger and more prepared to manage the repetitive loading associated with running fast on flats and descending hills at speed (see exercise examples below). Core strength addressing lower abdominal, hip, gluteal, and lumbar stabilizers in a functional manner will reduce the demand on muscles such as the hamstring. Hamstring-specific strengthening with progressive loading will reduce overuse and associated tissue micro-trauma which leads to injury.
In order to quantify hamstring function, a 2D video running analysis may be indicated to determine how you as an individual run. Are you using your gluteus maximus to extend your hip, or is the hamstring acting as the primary mover? Are you over-striding and placing increased tension through the hamstring? A 2D video running analysis is a useful way to detect additional underlying running compensations in the clinic which may influence running biomechanics and resulting hamstring tissue loading.
Finally, do not forget self-care such as adequate recovery, sleep, hamstring release techniques, and eccentric hamstring exercises throughout the year to maximize your tissue load capacity. The exercises listed below are for example only. I recommend seeing a physical therapist to develop an effective hamstring-specific loading exercise program suited to your unique strengths, underlying weaknesses, and running goals. Call or email John and the PT staff at Sapphire PT with any questions or to schedule a consultation (406-549-5283 or john@sapphirept.com).
Hamstring Loading Exercises to Increase Tissue Load Capacity:
2. Step-downs: Stand on a box or step (begin with a 4-inch box and progress to taller box over time) with a pole for balance assistance as needed. Step down slowly while maintaining alignment through the pelvis, knee, and foot. Increase hamstring loading by landing further forward and by increasing the box or step height. Practice landing quietly “like a cat” to decrease impact loading.
4. Eccentric Hamstring Treadmill Stepping: Set treadmill to the slowest speed. Face backward on the treadmill and hold the hand rails. The support side (the left leg shown) is
placed off of the treadmill belt. The exercising leg (the right leg shown) is placed on the belt. Slowly resist the forward motion of the belt with one leg as the belt moves. The exercising leg then is moved back to the starting point by flexing the knee and extending the hip.
5. Forward Glider Disc Lunge: Stand with exercising foot on a glider disk (use poles or counter support as needed). Slowly slide foot of exercising leg forward and slowly allow your knee so straighten slightly (do not fully extend your knee or you may do the splits) while avoiding excess hamstring tension. Return to original position and repeat.
6. Nordic Hamstring Curls: Kneel in an upright posture and have a second person hold your lower legs and ankles against the ground (or you may hook your heels beneath a stationary bar). Place hands in front of body and slowly lower towards the floor as shown without excessive hamstring tension. Slowly return to starting tall kneeling position.
Photo: http://prohealthphysio.com.au/exercises/nordic-hamstring-curl/
References:
1. Cushman, D.; Rho, M., Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report. Journal of Orthopaedic & Sports Physical Therapy 2015, 45 (7), 557-562.
2. Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Physician and Sportsmedicine 2005, 33 (5), 32-43.
3. Finding the balance photo: https://blogs.bmj.com/bjsm/2016/04/11/balancing-training-load-and-tissue-capacity/
Product Review: Saucony Peregrine 8 Ice+
Caution, ice is slippery!
Now that we have that out of the way I will start with a few things that these shoes cannot do. They do not prevent ice from being slippery. They also
will not prevent the string of curses that will enter your mind later this winter (and may come out your mouth) after too many weeks of running on the rutted, icy, frozen roads in Missoula.
What will these shoes do for you?
that is possibly the biggest asset of these shoes. If you know you will be spending your entire run in snow and ice then I would recommend picking up something from Kahtoola, DueNorth, or your favorite sharp winter accessory. If you don’t have any then I am sure the crew at Runners Edge can fix that problem. If your run is like many of mine have been lately (mix of pavement, dirt, rocks, ice, and snow) then these shoes will help a lot. Since they are built on a proven trail shoe they can handle every type of trail I throw at them. The traction is terrific! When I come around the shady corner into the snow there is no need to change my stride. If the next corner is solid ice, well then I still do need to run with a little caution. They do not act like metal spikes! However, like a good set of snow tires, they do improve traction over regular trainers and with a few carefully placed steps I am past the ice and still running. I will throw out the disclaimer that I have already owned Peregrines in the past and loved them so I probably went in with high hopes and they did not disappoint.
Well have you ever driven a car in the winter weather with snow tires? I would consider these shoes the snow tires of the running world. I don’t take my snow tires off if the roads are dry and I would not hesitate to wear these shoes when the roads or trails are free from ice and snow. In fact I think
How about the shoes?
There have been some changes with the Peregrine 8 from previous models. They have removed any kind of rock plate and increased the amount of foam underfoot. In a recent trip around Lake Como (when I was not running across the actual frozen lake) I was intentionally taking some of the lines that were littered with rocks to see if I could tell a difference. My feet did not feel any discomfort. The biggest increase in comfort I noticed was due to the Runshield upper. They are not waterproof, but they are extremely water resistant. I have had them in the cold snow, wet snow, and rain and my feet have been dry every time. The dry snow is usually fine, but I often return with wet feet after being out in the rain or sloppy snow. I plan to add a pair of short gaiters and continue testing these all winter! The outsole has changed a little and the Ice+ have the addition of the Vibram Arctic Grip to help with the slippery sections, but they still maintain the great grip I remember. They are still a neutral trail shoe sporting the 4mm drop and a great new upper.
Conclusion
Traction devices for your shoes are like tire chains, the absolute best when the going gets really rough. On all those other days when you want to be able to cruise at higher speeds and across varied terrain then these trail shoes will not let you down. I think the Peregrine Ice will see a lot of use this winter!
Practical Winter Running Tip: Protecting Your Feet from Potential Traction Mishap
By John Fiore, PT
Sapphire Physical Therapy
Icy and snow-packed roads and trails synonymous with winter in Montana are here. While Missoula runners often trade running shoes for ski boots, January marks the beginning of training for the 2019 running season. Runners have numerous ways to transform running shoes into traction beasts to tame the worst winter running conditions. Traction can be added via sheet metal screws, Due North traction devices, or Kahtoola Microspikes. While all of these options will dramatically improve traction, they also place increased stress on the foot. Protecting your feet from the focal pressure points secondary to running shoe traction devices will increase winter running enjoyment and reduce foot injury.
Ice is as firm as concrete. Add wire and metal traction devices between and icy surface and the foot and the stage is set for metatarsalgia. The term metatarsalgia is used to describe “pain in the metatarsal bone(s) of the foot. The metatarsals are located in the forefoot between the bones of the midfoot and toes. Metatarsals are long, slender bones which function to absorb impact and allow the foot to accommodate to uneven surfaces. When a metatarsal becomes irritated due to high, repetitive impact, a bone inflammatory response occurs. Reducing impact, pressure, and weight bearing will reduce metatarsalgia symptoms. A simple rock plate can be made at home to reduce the risk of developing metatarsalgia secondary to running with winter traction devices. Below are several photos and a description of how to make any pair of running shoes into a pair of metatarsalgia-proof winter running beasts.
Materials:
Step Three:
Product Review: Brooks Cascadia 13 GTX
Sean Kiffe is a Runner’s Edge Ambassador for the 2018/19 season. He is very visible around town as he runs just about every Runner’s Edge race
and Run Wild Missoula event each year. As an avid trail runner, we asked Sean to review one of our waterproof shoes, the Brooks Cascadia GTX. You can also follow Sean’s adventures on instagram@seankiffe.
Brooks Cascadia 13 GTX
Wt.: 12.3oz
Drop: 10mm
Category: Trail
As the daylight fades and temperatures start to drop, many of us are forced inside to the treadmill. While the treadmill is not an all-bad, the allure of a shoe that is aimed at keeping you running outside no matter what the conditions is very enticing. The Brooks Cascadia has always received high praise as a trail running shoe and the Gore-Tex version is a nice adaptation to an already solid shoe. I was excited to test a pair of these this month, in what promises to be apt conditions for testing a waterproof shoe.
Fit:
After lacing up the Cascadia 13 GTX my feet felt completely at home. The cascadia hugs the heel very snug and tightly. The lace cage compresses evenly, distributing the pressure of the tongue super comfortably on the top of the foot. The super tight weave of the mesh upper is pliable yet durable and allows the foot to move where and when it needs to. The toe box is on the narrow side but it did not feel cramped at all. The sizing is true to fit. The shoe felt a little rigid at first but after three runs in the sloppy Missoula conditions they have begun to loosen up nicely.
Performance:
While a lot of Gore-Tex running shoes carry weight like a tank, the Brooks Cascadia is pretty light (12.3 oz) compared to other Gore-Tex trail runners I have experienced. Other leading brands weigh in between 14 and 20 ounces. Advances in Gore-Tex fabric technology make it lighter and less rigid than older versions. These shoes are light and nimble and sit right in the weight range of other non-GTX trail runners. While some waterproof trail runners look more like hiking shoes, the Cascadia presents like a true running shoe with the added waterproof bonus. The Gore-Tex fabric is remarkably breathable. Not once did I feel as if my feet were dampened by their own sweat.
My first run out in these shoes saw some of Missoula’s classic “not sure if it is fall or winter” weather. The messy mix of slush, water and snow was a perfect test for a Gore-Tex shoe. The Cascadia 13 was impressive in these conditions. The waterproofing and breathability of the shoe performed flawlessly. My feet were dry and happy the entire time. The Cascadia shed water nicely and did not hold on the water like some shoes might.
Brooks uses its proprietary BioMoGo DNA technology in the midsole and it’s both responsive on the trail and cushioned enough to make the longer efforts less impactful. On the first few runs that I did in these shoes I felt very connected to the road and trail surface but cushioned enough to push as hard and as long as I wanted to.
The rugged 3D rubberized mud guard that extends from the toe box to the heel is nothing short of armor. It is tough and pliable at the same time.
While protecting your foot from the lashing of ice and other trail debris, the mud guard does not sacrifice the flexibility of the shoe one bit.
Brooks uses what they call a rock shield guard to improve stability and disperse the impact of those more pointed encounters your sole might have on the run. This combined with the cushion of the DNA midsole make for smooth and confident ride. The triangular Pivot technology allows for targeted flex in just the right spots on the sole of the shoe.
The Cascadia 13 GTX has the added bonus of a gaiter attachment on the heel of the shoe which will be nice for really sloppy spring conditions or deep snow. There is also a well thought out small pouch on the tongue of the shoe that you can tuck your laces up into.
Overall:
The Brooks Cascadia 13 GTX is a great choice for the runner who is not willing to move things indoors when it gets cold and sloppy. Gore-Tex, the industry standard in waterproof technology performs just as promised with the Cascadia, waterproof and breathable. The comfort and quality of the Brooks brand really comes through in this shoe. It’s light, responsive, waterproof and solidly constructed. At an MSRP of $160.00 the Cascadia is worth every penny. The Cascadia 13 GTX is certain to keep you running outside regardless of what the seasons throw your way.