2014 Boston Marathon Race Report

Truth be told, I wasn’t exactly sure of my capabilities before Sunday night. I was caught up writing plans for some different athletes and studied the course based on their capabilities. Sitting down Sunday night, a mere 14 hours before the gun set us off, I decided to write a best and probable case scenario.

I’m not one to get caught up in hype. It’s weird. I’m an anxious and often impatient person. It encompasses nearly 95% of my life, but racing seems to relinquish any and all uncertainty. I sit down and look at my data from all the training I accomplished and set up realistic expectations. I simply stick to my plan and trust in my training. It’s funny. I toe a starting line every year encompassed with uncertainty of my capability. I look at previous races and think, “wow, can I really run faster than that?” Regardless, I set a plan and gave it my best go.

Our weather report couldn’t have been better. Cooler temps paired with a tail wind called for a fast day. Working my way through athletes village, which resembled that of a refugee camp, I made my way to the start. One thing was clear: it was going to warmer than anticipated. I met up with a running friend, Matt Kellman, and we decided to run together (again). Overheating was my primary concern consider winter spent more time below freezing than above. None the less, I broke down the race into five segments and went to work.

Segment 1: Start to Mile 4

2014, boston, marathon, race, report,

Plan: 6:30/mile

Actual: 6:30/mile

Mile 1: 6:38 Mile 2: 6:25 Mile 3: 6:29 Mile 4: 6:31

The first four miles are a mess of bodies and rolling downhill. With zero wiggle room, you were pretty much held to the pace of the pack. Runners were being tripped left and right, while some were pushing through for position. It was comparable to jumping lanes in traffic only to be stopped in another lane. The plan here was to bank some time without blowing the quads up early. Overall, I knew I was paced within a few seconds of the plan, but I wasn’t feeling overly confident. A crowded, narrow road left you at mercy of the pack.

With my lack of internal “hype” I’ve been known to be a rather slow starter. Inadvertently, this allows me to often run fairly even across long races. My last three marathons: Boston, New York and Pittsburgh have nearly all been even split.

Segment 2: Mile 4 to Mile 15

2014, boston, marathon, race, report

Plan: 6:35/mile

Actual: 6:35/mile

Mile 5: 6:36 Mile 6: 6:34 Mile 7: 6:39 Mile 8: 6:34 Mile 9: 6:32 Mile 10: 6:41
Mile 11: 6:40 Mile 12: 6:41 Mile 13: 6:25 Mile 14: 6:35 Mile 15: 6:40  

After coming in hot from the downhill I knew it would be tough to dial in to a slower pace. I was still feeling sluggish coming through the 10K mark, but again, I think it helped me dial it in and prevented me from over reaching. The crowds began to grow as you ran through Ashland, Framingham, and Natick. A swell in crowds was coupled with growing adrenaline. Mile four to 15 were sandwiched between defining changes in terrain, it was easy to segment this nine miles. The entire segment was laced with rolling hills. A mile slow was followed by a mile fast, eventually averaging them to goal pace. Each passing town came out in full force and provided crazy noise. Fun fact: slapping outstretched hands of toddlers provides a significant boost in energy. I used it throughout my day at Boston. Shouts of ‘Thank You Runners’ and an outpouring of support from the crowd, volunteers, and law enforcement ticked these miles away faster than ever. The first twenty miles felt easily half of that. At the tail end of this segment came Wellesley. Wellesley is home to an all-female college who are notorious for offering up smooches and noise to fuel runners through mile 15. Signs of “Stamina Turns Me On” to a rolling tally of total kisses kept you smiling and running. The noise through Wellesley was unreal. Deafening is an understatement. I imagine it’s the closest you could feel to being a professional athlete. I ticked through miles and felt fantastic. After a quick self-assessment I thought about pushing. I can honestly say I felt zero fatigue moving through mile 15. I decided to hold back, which was the right decision.

Segment 3: Mile 15 to Mile 16

2014, boston, marathon, race, report

Plan: 6:30

Actual: 6:30

This short, fast downhill segment came before the notorious hills of Newton. The plan was to bank some time in anticipation. I did just that. Felt great and ready to tackle some hills!

Segment 4: Mile 16 to Mile 21

2014, boston, marathon, race, report

Plan: 6:41

Actual: 6:53

Mile 17: 6:54 Mile 18: 6:54

Mile 19: 6:39

Mile 20: 6:52 Mile 21: 7:07  

I hit the hills with a high cadence and the goal of being able to push over the top. Again, the crowd was fantastic. Fueled on spilled Gatorade, high fives, and adrenaline, I took my time on the climbs. The sun began to roast and I continued my plan that I instituted from mile five. Hit up the water station and just start dumping. I felt terrible for anyone in tow, but I know what I needed to do. I averaged 3-4 cups of water at every station: one for my mouth and the rest for my body. As I lapped each mile I knew I was off considerably and even saw a single 7:05 on Heartbreak Hill. Still feeling great I calmed my nerves coming through mile 21 and looked forward to the descent into Boston—ready for a strong finish.

Segment 5: Mile 21 to 26.2

2014, boston, marathon, race, report

Plan: Whatever I Have Left

Actual: 6:37/mile

Mile 22: 6:32 Mile 23: 6:41 Mile 24: 6:34
Mile 25: 6:44 Mile 26: 6:42 Finish: 5:49

The downhill into Boston was awesome. What a fast way to end the course, that is, unless you pounded the downhill early. I felt fantastic cresting Heartbreak Hill. The plan here was to go with whatever was left in the tank. Truthfully I felt great. I took in all Boston had to offer. I settled into a groove and kept it there. “MEB WON” was shout from the crowds and for the first time I saw an entire pack of exhausted runners began to cheer. It was amazing. The downhill into Boston began to wear on my quads and the last three miles easily compensated for how easy the first 20 felt. I hit aid station repeat button, a simple sip of Gatorade paired with 5+ cups of water over my head. I kept reflecting back to all the support I had for this race. That, paired with an awful winter, urged me to continue my push. There’s a lot of pressure when you know so many onlookers are tracking you!

Finish Time: 2:54:22 – 43 Second PR

Much like the previous 26 miles, rounding Boylston was amazing. This was by far the most amazing piece of running I’ve had to date. I dug deep and knew a PR was all but mine. It hurt and when I finished I looked down to see 2:54:22, a 43 second PR.

Throughout the course complete strangers acted as if you’re a rock star. Awestruck: the only way to describe this experience. As fatigue set in you would run up on an athlete with a prosthetic (or two). You would see a mother or father pushing their child through the run. How could you do anything but run harder? Every obstacle was greeted by the city. It didn’t matter if they knew you or not. “Let’s go, baby!” “You got this!” “Keep it up. Let’s go. Let’s Go.” launched me over these hills. Prior to running Boston I thought I would be a one and done, but honestly, I have no doubt I will be back.

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What Causes Tendon Injuries in Runners

Tendon injuries in runners are all different, yet may all have one defining similarity. It’s common knowledge amongst orthopedic professionals that eccentric activity increases the load to a tendon. For those who are unaware, our muscles can produce force as they shorten (raising a weight overhead) or as they lengthening (lowering the arm). Both activities fire the same muscle groups, but each motion causes specific muscles to either shorten or lengthen.

Common tendon injuries occur to the Achilles, patellar, and high hamstrings tendons.

Eccentric activity is always a lengthening contraction of a muscle and increases tendon tensile load. Injury can result to the tendon for a few reasons. For some, not enough rest or too much too soon can result decreased tolerance to load. For others, weakness or range of motion restrictions cause excessive eccentric activity and result in loads that are above tissue threshold. Some injuries are a result from your footwear. A simple change of shoes from high to low drop can cause excessive Achilles tendon load through midstance. If a single or repetitive load is applied above tissue threshold an injury results. At a tissue level we know what causes an overused tendon. The trick is to identify the source of excessive eccentric load and fix it.

The gait cycle revolves around two phases: deceleration and acceleration. Both are critical and each can cause various injuries. Deceleration occurs on the front half of the gait cycle. With every foot strike our body is required to control the interaction the ground. Instantaneous to foot contact our body loads downward, decelerating to the pavement. Our muscles lengthen eccentrically to not only shock absorb, but to also load for our acceleration phase–push off. For the sake of this article we are evaluating the front half of the gait cycle–the loading or deceleration phase. This phase is dominated by eccentric-rotational movement.

If we can’t control our spin to earth there are significant downstream costs.

If we can’t control our spin to earth there are significant downstream costs. Our joints, muscles, and tendons will be yanked through excessive, damaging movement as our foot progresses from initial contact to push off. A weak core, hip, knee, and ankle are all to blame, but it’s always nice to have a jumping off point. I’ll typically throw our proximal muscles under the bus and scold the core and hips. It’s not uncommon to see an Achilles Tendinitis patient develop symptoms due to their inability to control their collision with the ground. An uncontrolled landing literally wrings the Achilles like a rag. A weak chain of muscles allows for excessive eccentric movement. Remember, eccentric movement only happens in the front half of our stride. Also recall that eccentric movements increases tendon load.

For those suffering from tendon issues, begin pointing your finger at the front end of your stride and correlate with poor control during loading. It doesn’t matter if your pain is at the Achilles, knee, or in the butt (or for our train wrecks all three). Improving your ability to meet the demands of initial contact through midstance is crucial. There’s no substitute for rest, either. Tendons are notoriously slow healing and will likely require some finagling (yes, finagling) of your program. Unlike muscles, tendons are non-contractile tissue. They serve as anchors for your muscle to contract and produce force. Since muscles shorten and lengthen in a ratcheting fashion they require oxygen. Oxygen is transported via blood. My point? Blood is a good thing, that is, if it stays in your body. Your muscles are deeply routed streams and neighboring tributaries of blood vessels that transport blood. With increased vascularity comes faster healing. Tendons don’t contract though.. they’re just anchors–anchors with poor blood flow. Tendons get enough blood to survive and that’s it. Enter your frustration with slower healing.

Take a look at this video demonstrating how our body loads eccentrically at initial contact. With poor control comes increased load to joints, muscles, and tendons.

More of a visual person?? Take a look here:

If you’re suffering from a tendinitis or tendinosis you’ll need to look to the chains of muscles responsible for controlling landing forces. Start with proximal muscles that control for movement. Core and hip strengthening are always a great place to start and remember, BE PATIENT!

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First Run After Injury

The first run after injury is crucial but often butchered by most runners. Your first run sets the table for a full recovery or completely destroying a what you thought was healed injury. The internal dialogue starts to weigh the fact that you can walk and negotiate stairs without pain. Essentially every aspect of your life is pain free and seems to have resolved with a week (or two) of rest. Most of you have lived the story, some of us hear it everyday (me!). You think you’re healed–you’re fine. You lace up and head for the door. Confidence shortly begins to fill with self-doubt. Symptoms go from nonexistent to negligible climbing to ‘not that bad’. Continuing on that trajectory, your pain worsens until you’re at a perfect, yet damaging, distance from your car. You refuse to walk back and decide that running is your only option. Sound familiar?

Overdoing it seems to be hardwired into our DNA. It hinders healing, which eventually causes further damage to our confidence and psyche (oh yeah and body!). Remember, we all get hurt and injured. That’s not the point of this article. It’s more important to discuss the steps required to resume running. As stated, that first run is so crucial. Most athletes analyze runs comparatively. “Well I’m used to running 5-8 miles so 3 miles should be an easy gauge.” You’ll need to ditch the mindset if you want to fully recover. Often a first run will tolerate less than 10 minutes. Ten minutes you say? Who cares about 10 minutes? Well, for one, your injury certainly does. Were not looking to increase fitness with a short, simple run, but simply “feel it out.” You’ll want to grasp how your injury bodes before jumping off the deep end.

The All Important 10 Minute Feeler

Clinically speaking, I will always begin with what I like to a call a ‘10 Minute Feeler Run’. Ten minutes is an easy gauge that allows you to assess symptoms with minimal chance for aggravation. It’s set in stone, too. Ten minutes doesn’t mean 10:15, or 10:45. Ten is ten. I don’t care that you don’t feel anything or feel like you could run forever. Ten is ten.

Ten minutes allows us to assess your tissues immediate and latent response to load. Symptoms can be felt during the run or within minutes of stopping. For others, the effects might not be felt for 24 hours. I’ve had patients experience zero symptoms in their ‘10 minute feeler’ with symptoms drastically increasing the next day. Imagine if said individuals were to keep running. The effects of stretching a run longer could cause a setback measuring weeks to months.

Other Considerations:

Before making that crucial decision to start running you’ll need to be able to function in daily life without pain. That means walking, negotiating stairs, squatting, etc. If you can’t function at lower level activities how do you expect to fair at higher ones (running)? If you can’t do these activities then unfortunately your answer is rest. Rest can equate to 24 hours, 7 days, or even longer depending how much damaged occurred.

The key here is catching it early. You’ll know something is wrong. Burning or sharp pain is always a dead giveaway when it comes to injury identification. Symptoms may be experienced mid-run or once you stop. You know your body best. Don’t talk yourself out of an injury. The best thing is to start the rest cycle paired with ice immediately.

Progressing from 10 Minutes

No one wants to lace up for a 10 minute feeler, especially in the colder months. You’ll spend more time getting dressed than actually running. Warming up on an elliptical or bike can help get the blood flowing and transform the experience into a workout. Remember, motion is lotion and may actually help you complete 10 minutes successfully. Once you’ve completed 10 minutes without symptoms, it’s time to progress. Every other day is your best bet. I’m guessing less than 1% will listen to what I just wrote, so please don’t go three days in a row. Fill the in between days with spin classes, strengthening, and the elliptical. These activities can serve to minimize fitness loss, keep you sane, and not re-injure yourself. You’re looking for small gains early. Literally one run to the next might yield 90 seconds of gain but take it. Ninety seconds turns into tens of minutes fairly quick. You’ll see progression every few runs but you’ll need to patient.

It’s so important to avoid the mental trap. Going out for an ‘easy 3’ is no way to test an injury. Does it make sense to throw 20-30 minutes at a recently injured tissue? It shouldn’t. Ten minutes has served me well and quickly grows to tens of minutes. It allows a safe gauge and shows improvement in a short time. Work the process, remain patient, and stay in control. You will run again… why not make it sooner rather than later?

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How to Check for ITB Tightness

Checking for tightness has often been reserved as a passive, “I need to see someone” task. And although this is often the case, there are a few life hacks that allow you to self-assess and forego a copay.

In lieu of an Iliotibial Band (ITB) epidemic that has stricken Buffalo, NY, I thought I would offer a quick self-check that could foreshadow a nasty, often nagging problem in the next few weeks. I wish I could point my finger and one specific cause: transition to outdoor running, new shoes, or another glaring issue; however, I have yet to see a correlation in mechanism from one patient to the next. Sure, there are consistencies at an impairment level (weakness, tightness, or imbalance), but again, no explanation why 14 patients walk through in 10 days, while the usual number hovers around a few per month.

Without delving into the cause and symptoms of ITBS (for that same reiterated response throw a Google Search out there), I find it more beneficial for you to understand a few often overlooked aspects of this thick, fibrous band.


how, to, check, itb, for, tightness,The ITB is an extension of your glute maximius and tensor fasciae latae (TFL) muscle and runs laterally down the leg, reaching out to grab the patella before continuing onto the tibia. More importantly, you should understand that while your knee bends and straightens the ITB shifts back and forth over a bony projection on the femur (thigh bone). An interface known as a bursa sac separates your ITB from bone. In the presences of tightness, weakness, or spasm, the ITB will drag along the bony ledge and snap over the bursa sac. Imagine drawing your finger across a guitar string. As you pull across the string bends until it slides under your finger and snaps. With every snap comes friction and irritation. Eventually, you’re left limping through your run and unable descend a flight of stairs.

In a clinical setting we determine the length of the ITB via the ‘Ober’s Test.’ It’s a quick, easy way to assess length but unfortunately, you cannot perform it solo. While Ober’s Test has been researched and remains a clinical favorite during evaluation, my little test is simply based off anatomy and clinical experience. Best yet, you can do it from home. Bust out your foam roll and get crackin’.

Learn More & How to Self-Assess

If you’re looking for more information about foam rolling your ITB, TFL, Glutes, etc, take a look at our foam rolling section. First, remember that ITB may be tight and causing your symptoms, but it’s generally caused from weakness elsewhere. Foam rolling and restoring length to this tissue is important, but will likely be short lived if you don’t address the primary causes.

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Racing with Injury: When is it ok?

Knowing when to hold or fold em’ is a life lesson. We’re all walking the line of losing battles to win the war. It’s always easier looking in too. We all lend advice of ‘rest’ and ‘recovery’ when talking to a friend, but our own battle is force fed self-assurance and justification. We justify everything about an injury. Statements like “It’s not that bad,” “maybe I’ll just run easy today,” and “I just need a day or two of rest” lay the foundation for denial. We truly are our own worst enemy. Looking beyond the injury includes encompassing self-doubt. A mental war is forging on all fronts and you’re convinced that for every run missed offsets months of training. Chillllllllll.

Running is highly addictive. Don’t believe me? Spend a day in my office. Go ahead and talk to someone who has been sidelined for a few days, weeks, or months. I see it everyday. Mood disturbance quickly can quickly evolve into varying levels of depression. Observing behavior removes any doubt that the addiction is a catalyst to breakdown and further injury. It’s simply not sustainable. Sure, it’s healthy to be active, but where does the line become drawn? At what point do we suck it up and simply say, “Well, I have to bag this one.” I see runners limping themselves through miles with that “tougher than nails mentality.” Are you really tougher than nails or are you simply afraid–afraid of what others will think? Maybe you’re afraid of posting a DNF. “I’m weak.” “I’m a failure.” “Everyone will see that I DNF’d or DNS’d.” There’s a saying that a DNF trumps DNS. Really? Does it? Is it worth the weeks or possibly months required to offset DNF (did not finish) damage?

Here are a few certainties of being injured:

1. Anyone and everyone will be out running on your drive home
2. You will be bored
3. You will grow impatient
4. You will be difficult to live with

Although #1 will be beyond annoying, while #4 is annoying for your family, #2 and #3 is where the damage comes. Boredom breeds impatience and annoyance, which inevitably leads to rushing an injury. Find a way to fill the void. Find a way to sweat with some well needed cross training. Spend time with your family and friends, but please, stop freaking out and rushing the process.

I know the difficulty associated with skipping a planned event. I, like you, are not immune to injury. After a full week of minimal running I had to make the difficult decision of logging my first DNS (did not start). The entire week was a mixed bag of emotions. Early in the week I knew the right call. I convinced myself that I was out. Simple as that. Easy, right? Packet pick up with my wife and friends was a tough pill to swallow. That big race jive gets you itching, not to mention questioning your decision. A few trots down a hallway and some running in place opened inner dialogue. “I have no pain, maybe I can run.” The trots became progressively longer (yes I was that guy trotting down the sidewalk in jeans to “test it out”). I still knew I shouldn’t run, but the ‘what if’s’ circled the wagon. See! We’re all a little crazy. When push came to shove I stuck with my gut, which ended with the right decision. I toured DC on foot and began to feel my Achilles at mile 5, which most certainly would have been sooner and to a greater intensity if I was racing. At the time of this post, I’m nearly 95% recovered and most certain that I would have missed Boston if I raced at DC.

running, race, with, injury, when, is, it, ok
Bagging the race allowed me to run 7 uninterrupted miles through DC and soak in the National Mall. Picture Left: Capitol Building. Picture Right: Kickin’ it with Abe

Now, this all needs to be put into context. The DC race was a ‘B’ race with an overall goal of prepping for Boston. If it were Boston I would have run and dealt with the consequences. You’ll need to weigh the situation, too. Never let a B, C, or fun race jeopardize your A race. This is a frequent topic of conversation with my patients. Refrain from arguing the cost aspect, too. I don’t want to hear it. Eating a race fee is nickels compared to what you could possible spend in copays and deductibles when seeking treatment.

As runners we’re consistently pushing our upper limits, often stroking bad habits of training and racing. Worst yet, we get away with it when were younger and more resilient–it sets the expectation. As we age and healing slows, we fall back to said expectations. Athletes reminisce of better times: pairing hard workouts or two-a-days was all in a day’s work. Runners consistently log miles when they know it’s against their best judgment. Maybe it’s a fear of appearing weak or simply being afraid of losing fitness? We all have our own reasons and most of us live in denial. Eventually it will catch up with you.

Since when did seeking help become taboo? “I’m afraid to get treatment because they’re going to tell me to not run.” I hear this quite often, but when a knee, ankle, hip, whatever, has been beaten for weeks, what else can you expect? Be proactive and be attuned to your body’s signals. Most injuries begin minor and can be fixed quickly with minimal down time and treatment sessions. The longer you wait, the longer the process.

Remember, DNF does not trump DNS.

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Core Strength, Injuries, and Speed

Core strength and stability at the lumbar spine and pelvis are foundational principles of both injury rehabilitation and athletic performance. For all of you looking for ripped, strong abs—think again. Stewart McGill et al stress the importance of core endurance over core when trying to prevent back pain in sport or life.1 This makes sense, doesn’t it? We need the core endurance to sustain the impact from thousands of steps. We’re not generating torque through a single swing of a club or bat. Golfers and baseball players still need core endurance for moving throughout their environment, but they also need a powerful core that can generate large amounts of torque.

core, strength, running, speed, injury
Above is a cross section of the abdominal cavity. The grey represents bone (ribs and vertebrae), while the red represent muscle. Some deep abdominal muscles are missing from the picture but you can begin to see the attachment and structure of our lumbar stabilizers. Even your diaphragm, the inner most muscle on display, can influence spinal stability. Abdominal and spinal muscles pull equal and opposite to stabilize our spine and are extremely important to prevent buckling under load.

Your Core. Your Injuries.

It’s common practice to look above and below any injury. Knee pain usually stems from weakness or tightness above and below. The same is usually, but not always, said for the majority of injuries. A study conducted by Leetun et al found that hip external rotation and abduction (think glutes) weakness are significant predictors for injuries in basketball players and track athletes.2 The most common reported injury of the 139 subjects wasn’t at the hip or low back. Foot and ankle injuries were reported by 65% of athletes, the knee followed with 23% of injuries, and finally the low back, hip, and pelvis with a mere 12% of injuries. Think about that for a minute. Those with the weakest core were most likely to be injured. Said injuries were no where near the weakness, either. A weak core leaves your appendages out to dry. Your feet and ankles, which brought home 65% of injuries, are forced to fend for themselves and in all reality–lose.

Your Core. Your PR.

In previous articles we talked about punishing the ground at push off. We used the analogy, “you can’t fire a cannon from a canoe.” At push off you’ll fire your hypothetical cannon (your leg) into the ground. The structural support for that cannon makes a huge difference. You can be a loose noodle of stability, allowing your trunk, pelvis, and spine to tip, bend, and rotate, effectively diminishing any force at push off force, or you can push from a strong, solid base. Sato and Moka conducted a study on run performance and core strength recently. Their subjects ran 20-23 miles a week averaging 9:30-10:45/mile. Comparing pre-test and post-test 5,000m results were startling. The test group that was subjected to six weeks of core strength saw improvements of 47 seconds compared to the 17 seconds of the controls.3

At first glance it’s obvious that we can’t all expect a 47 second PR by supplementing with core strength (read endurance), but we may be able to expect the same 2.7% gains.

Predicted 2.7% Gains with Adding Core Strength
5K:  30 minutes
48 Second PR
5K:  22 minutes
35 Second PR
5K:  18 minutes
29 Second PR

Now, obviously your results will vary. We are simply applying the gains from the test group to other 5K times. Clinical experience and running know-how tell me that these times will diminish based on pre-existing fitness level. Runners performing at a higher, faster level will likely see less improvement, but I believe they will get faster. To my knowledge and search there are no studies published experimenting with a faster study group.

Clinical Observations

Whether you’re an athlete at the novice, amateur, or professional level, there’s no doubt that improving your proximal stability can benefit you in life or sport. Too often runners focus on the “sexy muscles.” Tearing through crunches and sculpting chiseled quads might seem like a good idea, but we’ve all seen that muscle guy at a race… he’s usually behind you. Focus on strength that matters. Focus on strength that allows you to not only get through life without pain, but through sport. The research supports that core strength can not only keep you healthy, but also clipping off miles faster than ever.

1. McGill, S. M., S. Grenier, N. Kavcic, and J. Cholewicki. Coordination
of muscle activity to assure stability of the lumbar spine. J. Electromyogr. Kinesiol. 13:353–359, 2003.
2.Leetun D, Ireland ML, Willson J, Ballantyne B, Davis IM. Core Stability Measures as Risk Factors for Lower Extremity Injury in Athletes. Med Sci Sports Exerc. 36(6):926-934, 2004.
3. Sato K, Mokha M. Does Core Strength Training Influence Running Kinetics, Lower-Extremity Stability, and 5,000-M performance in Runners. J. Strength Cond. Res. 23(1):133-140, 2009.
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Two Signs of Impending Running Injury

Understanding injury is extremely important. Knowing when to run and when to rest can make the difference between needing a few days or a few months (or longer) to recover. Remember, you’re in this for the long haul. Unless you’re running to pay the bills, you’ll need to make smart decisions that preserve your body. Too often runners and triathletes sacrifice months of training on the backend for a single year of glory. Long, hard days racing and training add up. This is particularly true in our “more experienced” athletes (*cough* over 40). Unfortunately, The whole system is feed forward. Hard training yields quick results, which, in turn yields more hard training. The effects are latent, though, which often results in an ambush of injuries. It may take weeks or even months for injured tissue to rear its ugly head and when it does your season may be over. Look at your race and training schedule and ask yourself, “Does this make sense on paper?” Ask yourself, ‘WWSS’ (What Would Steve Say) if I showed this to him. Continue reading

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Knee Pain: Looking to the Foot for Answers

Knee pain is and will forever be the jumping off point for your family, friends, and even strangers to segue into their uneducated medical opinion regarding the irreversible damage at your knees. Despite countless research studies finding no connection between running, mileage, and symptomatic knee osteoarthritis, you’ll never hear the end of it. Even worse, one condition of the knee is so common in runner’s its actual garnered the name, “Runner’s Knee.” At the top of every runner’s ‘things I hate to talk about’ list are injuries… especially with family… and even more so with members who have that “I told you so” attitude.

Despite the fact that most knee injuries for runners are non-arthritic, it seems that all of them are lumped together. Runner’s Knee, a condition that results in compression load intolerance under your knee cap, has nothing to do with degenerative changes of the joint. It’s no secret that we need to look elsewhere when evaluating knee pain. Clinicians and enthusiasts alike have all jumped on the “strengthen your hips” bandwagon. For good reason, too. We consistent tell patients that if your big, strong neighbors up top (your hips) aren’t producing force and absorbing shock, the force needs to come from and go somewhere. This will be enough for some runners. For others it’s just another attempt to try and understand why their knees hurt.

Don’t get me wrong, exploring hip strength is a great place to start, but what if you’ve traveled that road and found no relief? Luckily, you still have options. Just as we look to the hips for the answer, we need to look below. The foot and ankle is often overshadowed with hip strength in both literature and the clinic. Tight calf muscles or a tight ankle joint will effectively transfer their shock absorbing properties up the chain. Hello knee.

The inability for the shin to glide over a fixed foot will ultimately be problematic. As our foot glides into dorsiflexion our elastic muscles of our calf, predominately soleus muscle, will absorb that force. Stiffness or tightness will cause early heel rise, diminished shock absorption, and the transfer of force to the knee.

How do I check my ankle flexibility?

For those of you have already pulled up on your toes to self asses flexibility, stop it. You need to know that you have two muscles in your calf and only one of them is worth assessing in this instance. Secondly, pulling up on your toes is open chain, meaning your foot is off the ground. You’ll want to assess your flexibility with your foot fixed to the ground (closed chain).

Start by standing perfectly straight with your feet shoulder width apart and facing straight ahead. Squat straight to the floor as you allow your knees to drop out over your toes. Your heels MUST stay flat and you MUST keep your shoulders, hips and ankles aligned. You’re also cheating if you allow your knees to fall inwards.

Normal: Your knees should drive out to your big toe or even an inch beyond. You’ll likely feel a stretch in your lower calf muscle, the soleus.

Abnormal: Yep, I said you’re abnormal (don’t worry I am too). If you’re heels rise too early, you lose. If you feel pinching in the front of the ankle, you lose. If you cannot keep your shoulders, hips, and ankles in a perfect vertical line, you lose. If you can’t keep your heels flat and drive your knees well beyond your toes, you lose.
runsmart, foot, ankle, knee, pain

Each abnormal finding means a different issue. Here are the likely scenarios:

Early Heel Rise

Your muscles don’t allow for enough motion. Early heel rise is likely happening while you run, transferring force into the knee.

Pinching in the Front of the Ankle

Pinching is likely a joint mobility problem. You’re likely feeling impingement between your shin and foot.

Excessive Range of Motion

Congrats! You’re like me. For some, you’re too flexible. Your ankle doesn’t have a buttress to stop movement. In these instances more strength is indicated.

Just remember, when your knee, foot, or hips hurt, the source of the pain is likely elsewhere. To sit and hammer on a painful bodypart without looking to get the neighbors (joint above and below) involved is ill-advised.

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Running Injury vs. Everyday Ache

It’s the age old question, “When should I just tell my body to be quiet and when should I listen?” If only the answer was clear cut, distinct, and easy. I’m a firm believer that most runners lack the discipline and patience to avoid long term injury. We feel things pull, tweak, (and) or ache. While most are unable to conclude if the feeling is ‘a usual ache and pain’ or something more serious, there are some rules that can help you determine if you should keep running or not.

The verge and inspiration for this article is founded not only by multiple user requests, but my own experiences wheeling and dealing with injuries. Remember, every runner experiences some wear and tear, some just more than others. The slope to the bottom is slippery. Runners underestimate the seriousness of a gradual ache or pull. That ache or pull could be nothing, sure, but it could also be a warning shot. Your body may be telling you there’s worse on the horizon. Navigating the storm is confusing and rarely the same. I plan to link my patients and my past experiences with injuries. For some pain is only present while running while others suffer during daily activities (stairs, squatting, etc.). Your pain may oddly improve as you run while others can pinpoint to the mileage of symptom onset. This article is intended to be a blueprint to identifying the difference between a warning shot and a typical everyday ache.

Most runners are delusional, literally running on a prayer (Whoaaaa, oh! We’re half way there. –couldn’t resist.) A mixed bag of emotions circles the run. You’ll convince yourself it’s all in your head or ‘not that bad,’ but knowing when to circle back for home or call for a ride is extremely important. The structural damage that can accumulate within a few minutes is horrifying. Most of my patients have heard me say, “When you have that ‘should I still be running?’ thought, STOP. Rounding out a mile or finishing the last few driveways can offset a weeks’ worth of rehab.”

Deciphering Between Pushing Through or Pulling Up

Even in the most stubborn of individuals, I believe all runners know when it’s time to bag a workout. Deciphering between every day ache and impending doom can be tough, yes, but it’s not impossible. It really comes down to proceed with caution or a stop ASAP. Here are few things to think about when you start to translate the old tongue of injury prevention:

Proceed with Caution

You know your body best, but don’t let that be a loop hole in protecting yourself. General aches and soreness, especially new ones, should draw your attention, but feel free to keep running. Most minor aches, pulls, and pains resolve mid run and you certainly don’t want to overreact every time you feel a tweak. Heck, if that were the case most of us would never run again. Discomfort that you feel during any run should 100% resolve when you stop or shortly thereafter. The pain shouldn’t be sharp, stabbing, or burning. Dull ache is generally a caution sign. The symptoms shouldn’t persist across multiple runs, either. You’ll feel it one run and then it’s gone the next.

Seek Shelter!

On the flipside, any sharp, stabbing, or burning pain is generally a sign of inflammation or damaging of tissue. Every step will create further damage and more intense symptoms. Finishing or bagging your run quickly is important. Every step can and will create further damage. For some their lucky enough to be at the tail end of their run, for other’s you may be miles from home. If catching a ride isn’t an option you’ll want to make sure you keep running. Stopping for water, to walk, or for a bathroom break will cause your symptoms to magnify. You even might end up walking home. As soon as you can, douse your injury with ice. AVOID HEAT! Ice will help manage tissue breakdown and inflammation.

If you failed to bail on the run for whatever reason (stubborness, denial, or you’re too far from home), you’ll still need to apply ice and quickly. An injury is usually marked with symptoms that intensify post run. You’ll notice trouble squatting, walking, or negotiating stairs. The pain may present as being sharp, burning, or overly tight. If you experience tightness, burning, or sharp pain with daily activities you likely sustained an injury. (Note: I did not mention a dull ache.) Feeling symptoms at rest or with daily activities will be a red flag for you.

If you’re disciplined enough to stay off your feet for a few days post injury and perform the right corrective exercises your injury should heal quickly. This article will lead you through the opening stages and a quick recovery. For most, a particular sensitivity accompanies most runs after a recent injury. Generally dull aches will come and go, while a true injury only intensifies. Don’t be fooled by a pain that improves as you run, either. Read here why your pain may improve while you run.

Remember, most runners know they’re hurt, but conjure up ideas that it’s “not that bad” or “all in their head.” Don’t freak out about missing training time (easier said than done). Pushing through or being stubborn with an injury will only fail you in the long run (pun intended). Fix the problem, whether it’s your training, run form, or anatomy.

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RunSmart Yoga for Runner’s

RunSmart Yoga is about marrying flexibility, balance, and strength in a 6 week, 12 workout program. It’s as effective as it is efficient. Our yoga program is designed to specifically target problem areas for runners. Each workout lasts roughly 30-35 minutes (minus the first day), leaving your more time for life and, of course, running.

Why RunSmart Yoga?

I, like you, love to run. Sure, I cross train and work on strength, but it’s always an afterthought to a run. I use RunSmart Yoga to supplement my running and never to replace it. Performing our online workouts is easy. No more lugging off to the gym and spending precious time commuting. We challenged Yoga expert and athlete Laura Igoe to build a six week yoga program around our core movement principles and knowledge of running. She delivered. RunSmart Yoga can be performed from anywhere, which means you can’t faster from work, home, or even on the road. Load them up on your laptop, tablet, phone, or internet TV and get ready to sweat!

Do I need to know what I’m doing?

No. You’re hearing it from the horse’s mouth. I started this program with little to no knowledge of Yoga movements and postures. RunSmart Yoga is a ‘learn as you go’ program. We’ll post videos along the way to help you out, but working through the program is the best way to learn it. You’ll likely need to spend a few days on a single workout to master the movements. Don’t get frustrated if you’re having a little trouble following along. As you learn to sync the movements and breath you’ll flow through this like a champ and be stronger for it.

These videos are posted along the way to help you…

How to Incorporate the Program:

RunSmart Yoga is designed to supplement your running and not be inserted as a substitute. Perform the workouts twice a week for six weeks. Easy running days or complete off days are perfect for this program. For most runners, the program lasts longer than six weeks. Sloppy balance, strength, and flexibility can turn this six week journey into nine weeks or longer. Don’t rush it. Take your time.

Incorporate with other RunSmart Online Workouts

RunSmart Online offers other strength workouts; including our Run-Specific physical therapist designed ‘BaseSix Program’. Incorporating other strength workouts can be accomplished by performing RunSmart Yoga once per week, while the second strength day being BaseSix.

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