October 28, 2009
This question came from Victoria:
The message is:
At 61 years old, I recently finished the full Portland Marathon. I entered as a walker, but I was jogging quite a bit the first 10 miles. Then at the 12 miles mark, I got a horrible cramp in my right calf. I tried stretching, rubbing, etc. Nothing helped. I did the remaining 14 miles in limping pain. It was awful. At the finish line, I filled up on apples, bananas, oranges, milk, and cheese (only, as I eat gluten free). An hour later the pain was gone. Was it lack of some food or ? During the race, I only ate water with Ultima Replenisr in it, MCT oil, and a couple Purefit bars. In the 3 weeks after the race, I had some calf pain the first week and couldn’t run, but then when I added lots of deep calf stretches to my routine, no more pain even with running 4 miles at a time. I’m scared now about the next marathon, how can I not get another calf cramp?
This is not so terribly unusual. Your experience does suggest a nutritional deficit. For this reason, I am a strong advocate of nourishment for repair rather than nourishing for performance. Our bodies really need phytonutrients and other micronutrients on board in order to function normally. It is for this reason that I am a HUGE Juice Plus+ fan. This product is a blend of 26 fruit and vegetable powders in capsule form. They also make another product, Complete, a full amino acid, plant based protein powder that you can use to replenish during a marathon. I make a smoothy every day with strawberries, blue berries, raspberries, a banana, apple juice and skim milk. It is nourishing and delicious. I know many ultra-marathoners who use this product exclusively to replenish during a race and recover after. You can learn more about it at my Juice Plus website www.neiltakesjuiceplus.com. Please watch the video on the site to learn more.
Let me know if you need more information.
October 26, 2009
Did you know that something like 70% of bankruptcies recorded this past year could have been avoided if the family had an extra $100 a month in income! That really surprised me.
If you read this blog, you know I am a Juice Plus distributor and advocate. This product is validated daily for me as a foundational part of my nutrition by the outstanding published independent research the company has secured and the amazing recovery stories I hear and read about. Of course, I got involved as a distributor in the first place because Juice Plus provides foundational nutrition – micronutrients from 23 fruits and vegetables, to MY diet, and I wanted to get the product less expensively. You can learn more about the product here. I recommend you watch the video there.
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As you read on, think about this: to earn $500 a month in residual income from your savings, you would need to have about $100,000 deposited in the bank earning 5% interest, and lets face it, who pays 5% interest any longer?
I am recently returned from the Juice Plus Leadership Conference in Memphis TN. It was an amazing experience connecting with 5000 healthy people, hearing so many wonderful lectures and a benefiting from a LOT of learning that was available and offered.
The MOST IMPORTANT lecture, from my point of view, was given by a business consultant named Gordon Hester. It is probably the most important lecture you will ever listen to concerning the current situation we are in with respect to health care, wellness and economics. More than that, it might just change your life.
Listen to Gordon Here:
If you listen to this lecture and you want to know more, I encourage you to send me an email with your phone number, so I can get you on the phone and we can talk about your dreams and desires, and I can explain more about the business to you. Juice Plus is sold in over 20 countries.
I look forward to hearing from you.
October 19, 2009
This post follows on from the earlier post addressing the Unstable Lower Back. In my post, I postulated that most people could benefit by stretching their hamstrings, stretching their hip flexors, and working on their core. I also noted that thoracic mobility is important as well.
So following are a few exercises to address these issues. There are many more such exercises, but for the purposes of this post, I will just describe one exercise for each area.
You do this exercise lying on your back in a doorway, your one leg lifted high enough to put a gentle stretch on the hamstring, and then rest it against the door frame keeping you rknee straight. The other leg should be on the floor, or perhaps supported on a bolster or rolled up towel for example. You do the exercise by lifting the leg that is on the floor up to match the other leg getting a good stretch in the hamstring. Make sure to keep the knee straight in the leg you are lifting. Then lower it to the ground. Repeat this about 10 times, then switch sides.
You do this exercise with one knee on the ground. Perform a posterior pelvic tilt (think about lifting your belt buckle up toward your nose by tightening your stomach muscles). Keeping your body upright, bring your weight forward onto your front foot by bending your front knee. Make sure not to let your opposite hip lag behind. You can do this by placing both hands on the hip to keep track of it. Once you are forward and everything is a little tight – remember stretching does not need to be painful – then you can amplify the stretch by bringing your opposite hand over your head. So if you are on your right knee, you would bring your left arm over your head. Hold for a few seconds, and back off. Repeat about 10 times, then switch sides.
You do this exercise standing with your back to a counter or perhaps the arm of a couch that you can place your foot on. You do the exercise by putting your foot up on the object behind you. Then you have to make sure to do a posterior pelvic tilt as described above, bring the knee behind you in the midline, and tighten you stomach muscles. Then you gently bend the front knee feeling the stretch in the Quads – the front of the thigh. to get more stretch, step further away from the object rather than by bending your knee more. Maintain the stretch for about 20 seconds and then back off. Reset and repeat about 10 times before you switch sides.
Do this exercise with your back to a wall. Stand about 8 inches from the wall. If you are very stiff, you will need to orient your self at a 45 degree angle, lets say to the right side. The pick both hands up in front of you so that your elbows are bent and your palms face away from you. Without moving your feet, rotate to the right side and place both hands on the wall in front of you. Keep your upper body away from the wall as you gently lean your hips into the wall. You should feel the stretch through the thoracic spine. Remember, you should not force this move. Make sure that the stretch is not painful. Back off and repeat 5 times from the starting position before you go the other way if you are at a 45 degree angle. If you can do the exercise without moving your feet from the mid line, then just go from one side to the other. After you have done 5 each way, then start over.
My all time favorite exercise for glut strength is the Potty Squat. Stand in front of a toilet (make sure the seat cover is down!!) Lift your arms to the side at shoulder height. The way you do this exercise is to use GOOD FORM to squat. This means you stick your butt out keeping your back hollow. As you do so, you bring your hands and arms straight forward. You do not sit down, but instead, you touch and go. As you return to standing, bring your arms out to the side once again keeping them at shoulder height. Repeat 20 times. You should eventually be able to execute 20 repetitions in 20 seconds.
The Front Plank is a good starting point. Start in a prone on elbows posture. If you are unable to start the exercise on your toes the way I describe here, then start on your knees. You initiate the exercise by lifting your butt into the air so that your body is suspended between your toes and elbows. Make sure you keep your stomach tight, your back flat and your neck and head level. Also make sure to breathe deeply. Hold the position for up to one minute. If you cannot hold for a minute, put your knee down for a second and go right back up to finish the minute.
October 13, 2009
I recently received this email in my in box:
“I’ve been suffering from mild pain/ discomfort around the 3rd and 4th metatarsal heads on my right foot. This seems to have flared up after my last marathon in May, and it has never really died down. I get some relief, but not total relief, by placing a met pad behind the metatarsal heads.
Before I go further, perhaps some background info would help. I’m female, age 42, marathon runner. I have a neutral foot, and I tend to be able to handle high mileage (80-90 mpw). I have bilateral bunions that don’t hurt. I’ve had orthotics in the past, but no longer wear them. I wear a minimalist shoe for shorter runs (Nike Free 5.0)and a more cushioned shoe for long runs (Adidas Supernova Glide). I don’t appear to pronate at all on the right foot, but slightly on the left foot. The wear pattern on the bottom of the left shoe shows a circular pattern under the big toe. Finally, I had a tibial stress fracture on the right side last year.
OK,here’s my situation: Recently, I was experimenting with placement of the met pad on the right foot. I don’t know what made me think to do this, other than it just felt like a good idea, but I placed the met pad directly under the first metatarsal head (directly under the big toe on the ball of the foot).
I immediately noticed 2 things: First, my posture while running was greatly improved. I felt as if my right and left sides were balanced for the first time, and I had a sense that my arms were able to swing freely and evenly for the first time. It felt really good. Second, I felt as if my right foot was finally able to act as a lever upon push off, and I instantly felt I could run at the same pace using less energy (which translates to running faster). Oh! I also completely got rid of the met pain by doing this!
I feel as if I’ve stumbled on to something very useful, but I am a little afraid to mess my biomechanics as I’m just educated enough to know that when you do this you affect the whole chain from the ground up. I’d hate to end up with an injury further on up the chain!
Anyways, I was just wondering if you could provide any input as to why it would proprioceptively feel so good for me to raise up the 1st metatarsal head? Should I continue to do this, and if so, with what material? It seems like the harder the material the better.
In closing, it seems like I have a lot of “biomechanical clues”, but I need help interpreting them. I hope you can shed some light!
Thanks in advance-
PW is exactly right – there are many biomechanical clues in her report to me. All of the clues point at orthotics as a solution for her problem. The orthotics I recommended to PW based on the “evidence offered” is a device with a forefoot post. I deduced from this email that this person has a forefoot dysfunction that is resolved with a forefoot post (the met pad under the first ray).
The other clue is the wear pattern (the circular pattern under the big toe) also suggests that the foot is spinning before pushing off. this sometimes occurs when there is dysfunction in the foot that also points to a fore foot post as a solution.
The third clue is the tibial stress fracture. This usually occurs because the tibia is attenuating forces in an unusual fashion such that a fracture occurred.
With respect to biomechanics, my mantra is “Structure Governs Function”. If the Tibia is being overloaded AND the foot is spinning, AND a first ray post improves efficiency, THEN there is a biomechanical deficit that would be resolved with an orthotic device with a forefoot post.
The etiology of this dysfunction begins with embryonic growth and development. In the 8 week old fetus you can see the legs sprouting out of the trunk with the soles of the feet rotated so that they point “up”. As time passes, the hips rotate so that the soles of the feet are “down”. Depending on how much they correct to the right orientation (too little or too much), the feet end up with more or less pronation to begin with.
Remember that the foot has two jobs in life: First to be a mobile adapter, and second to be a rigid lever. In order for the foot to operate in this fashion, there is a mechanical effect called the Windlass effect which causes the foot to transform from the mobile adapter as it hits the ground, into a rigid lever for propulsion. The way this happens is that the ligaments and joint capsules bring the bones together as the heel comes off the ground and the plantar fascia along with the deeper structures allow the foot to become rigid enough to push you off into your next step. So the foot travels through space and the joints are all loose allowing the foot to adapt to the surface, and as your body comes over the foot, the windlass effect causes the foot to become more rigid and propulsion occurs.
In the event one has a forefoot that is in a supinated position relative to the rest of the leg and foot, in order for that forefoot to get on the ground, it has to travel further in space, and this takes time too. Since the talus follows the calcaneus, and since the tibia follows the talus, this latent time period and longer journey of the forefoot causes the motion to be increased at the knee (frontal plane) , and even at the hip (transverse plane). In order to run, this process is often short circuited, and the foot, instead of transitioning on to the first ray so you can push off with the big toes, instead, the foot spins on the 2nd, 3rd, and 4th metatarsal heads and the foot rolls over the inside of the big toe (leading to bunion deformities of the big toes).
The long and short of it is that the foot with a forefoot deformity is an excellent candidate for orthotics with a forefoot post.
In my post The Case for Barefoot RunningI make the case for forefoot striking. Where someone has a forefoot dysfunction however, orthotics in shoes are preferable to barefoot running.
You can also read more about forefoot varus in this post from December 2008.
Filed under: foot pain
,medial tibial stress syndrome
,shin splints posterior tibial tendinitis
| by Neil Chasan, PT, MMT @ 5:30 pm | |
October 8, 2009
Coincidentally, I have had two almost identical issues pop up this week. One as an online question, and one in the clinic. In both cases, the pain is identified as cramping and pain in the quadriceps that came on for no apparent reason. In the first case, a world class runner, the other in a regular runner.
In the first case, the pain started in the quads after a deep sports massage. The injury was described as being caused by the elbow of the masseuse was painfully digging into the tissue between the quad and the adductors.
The pain manifested as a dead leg during a critical race. After the race, the athlete could not recover and found himself limping. This is disastrous to his training schedule because with a big race coming up, the NYC Marathon, every day lost to training reflects in the final time. In a competitive elite athlete this is of major concern.
To tackle the problem, we are treating him daily, using ultrasound, deep frictions, manual stretching, general stretching, sticking, ice and electrical stimulation, and the athlete is also running on a gravity unloader that is allowing him to run faster than normal, but with much less weight on his leg and no pain.
The second case,the one offered by an email question, had nos known onset. This reflects the possibility of a compensatory mechanism for potentially unbalanced musculature that requires at the minimum, a full movement assessment in order to figure out which tissues are restricted and which are too long.
In the first case, in spite of being a world class athlete, there are numerous muscle imbalances that if resolved will increase his performance dramatically. I suspect the same sort of issues in the second as well, but because I could not examine the athlete, I could only surmise.
In any event, I refer you back to the post I wrote in December of 2008 on the subject of Hip Flexor Tightness, because many of the issues with the quads will be resolved by addressing the hip flexors as well.