Why do I keep getting the same injuries when I run? – Part 3

Part 2 of this article series we discussed the ways the foot can have a big impact on all the joints above and cause various forms of running injuries. In part 3 below, we will discuss the critical role of the hips and pelvis, and their importance to running without pain and injury.

The hip, or coxofemoral joint, is a classic ball-and-socket joint that attaches to your pelvis. It is inherently a very stable joint due to the depth that it possesses, but hip muscle weakness is incredibly common problem among runners. One of the distinct signs we look for as bio-mechanical experts is a hip drop or, “Trendelenburg sign,” during stance phase (when the foot is on the ground).

What that means is that when you are on one leg while running we are looking if that opposite hip drops (see image below). If it drops significantly compared to the other side we know that hip weakness is present. Hip weakness can be attributed to back, hip, knee, and foot pain.
That’s how important it is!

At Manual Medicine Spine & Sports Physical Therapy, we perform “Running Analysis” to evaluate our runners’ strides to get to the root cause of their pain and provide corrective exercises to not only eliminate your pain but also prevent it from coming back. We video tape and perform a gait analysis to look at every aspect of your running.

Another key area we look at here at Manual Medicine Spine & Sports Physical Therapy is the connection of the hip which is at the pelvis. Making sure your pelvis is level and balanced is critical to keeping you pain free and running well. We do this in a variety of ways such as soft tissue mobilization & massage, joint mobilization, corrective exercises, muscle energy techniques, clinical kinesiology, and even trigger point needling.

We are experts at balancing the pelvis to make sure that your hip muscles are firing well. As we are balancing your pelvis, we will prescribe exercises to help address those specific issues that we found. These corrective exercises will help you hold the work we have done and allow you to build strength on a more solid foundation.

If you’re having any pain on your runs, contact us to see if your hips/pelvis could be the root cause of the problem so you can get back on the trail and start running without pain again. 202-670-8874

Why do I keep getting the same injuries when I run? – Part 2

In last week’s blog post ( week of February 25, 2018), we discussed how your knee is usually not to blame when it hurts during runs. And we specifically addressed how often over-pronation issues can really impact the knee.

There is an old saying that is ‘as the foot goes so does the knee.’ This is very true.

Pronation is not inherently a bad thing. In fact we need to pronate through our feet. It is how we properly transfer forces through our body.

Pronation is the foot movement in which your foot rolls in causing your arch is getting to get lower. But when we over-pronate we put our other joints as risk for injury…including our feet.

But how do you know if you pronate too much? Do you know if your shoes are enough to provide the support you need?

Try this: Get the bottom of your feet damp and then step on a piece of paper. If your footprint has no gaps/indentation in it, you most likely have flat feet and need more support than you could get from most shoes.

[Aside: if you read Born to Run and think everyone should be running around barefoot, we have about 100 past patients that were injured
by running in minimalist shoes who would tell you differently. Barefoot running can be appropriate for some runners, but certainly not all of them.]

Over-pronation can often be caused by having flat feet. The arch is NOT meant to be a weight-bearing surface of your foot. When your arch becomes a weight-bearing surface, problems begin to happen. The knee collapses and the hip begins to rotate inward. If you repeat this enough, injury is not far off.

So what can you do if you over-pronate and are at risk of injury (or already hurting)? A good pair of supportive shoes is a great place
to start. Since every foot, body type, and running style is different, we can’t suggest specific shoes here in this article without evaluating your feet. So our best advice is to make sure you choose your running shoes with the assistance and guidance of a professional who has a lot of experience working with runners and shoe selection.

Though strength is very important, when your full body weight is coming down on one foot during your running stride, there’s only so much that the muscles in your feet can do. For those who severely over-pronate and collapse through the arch, even strong feet and supportive shoes may not be enough to avoid running injuries at the foot, ankle, knee, hip, or low back.

In this situation, Custom Orthotics are your best bet. They are an assistive device that are placed in your shoe to provide the exact level of support you need and to help distribute forces more evenly through the foot and up the leg. We have seen people with debilitating foot, knee, hip and back pain get amazing relief and the ability to return to running once they started using custom orthotics.

The market is filled with many options of what to put under your feet. Most over-thecounter shoe inserts and arch supports do not provide the support needed by someone who has significantly flat feet.

At Manual Medicine Spine & Sports Physical Therapy, we are experts in evaluating the foot and in the creation of custom orthotics. If you have any foot, knee, hip, or back pain when you run, it may have something (or everything) to do with your feet. If you’d like to have a free assessment of your feet and whether or not you would have less running pain with custom orthotics, call me at 202-670-8874.

Getting sick is inevitable. In fact, most adults usually get two to three respiratory infections each year. However, we all have obligations that cannot wait, especially if it’s a newly made New Year’s resolution. It can certainly feel like a huge setback, and more
so when it involves a new focus on getting healthier. The past 3 weeks, we’ve been hearing a lot about the rampant flu. Just 2 days back, NBC had a story covered on this year’s flu epidemic.

Last week, I came down with a bad cold, and it totally affected my ability to engage with people in my life let alone exercise. Thankfully, I bounced back quickly. A number of my patients have been asking me this week, whether it is okay to exercise when they’re
feeling sick. So I figured, I’d write a blog post with some helpful tips about it.

Common sense should tell you that if you have a little cold, then scale back the intensity and duration of your workout. However, there are instances where you should back off completely and take time off. Here are some considerations so you know the difference.

Let us start with an easy rule to remember–if your symptoms occur from your neck up, then it’s alright to perform a light exercise routine. If, however, your symptoms travel below your neck–stay home! In other words, if you have a common cold, which is often
limited to upper respiratory symptoms like a runny or stuffy nose, then it is usually okay to exercise. However, if you are experiencing general achiness, Gastric symptoms, chest congestion, or profound weakness, then stay home and drink plenty of fluids.

Now let me clarify one exception to the “above the neck” rule, and that being whether you have a fever. Since a fever is going to raise your body’s core temperature, which will also most likely get you dehydrated, you do not want to add insult to injury by taxing
your body with any type of exercise workout. In addition, once your fever has broken or you have recovered from a bad illness, it is best to avoid exercising for at least the next 24 to 48 hours. Moreover, when you do finally resume your exercise routine, do not pick up where you left off–ramp up slowly.

Now, under normal circumstances (aside from being sick and exercising), regular, moderate activity can help your immune system which, in turn, helps to prevent future illness. Note–the key word being moderate. Whenever you perform extreme exercise
at very high levels, then you compromise your immune system (think running a marathon).