Preventing and managing the most common and annoying running injuries – knee pain

The second most common running injury I see in recreational runners is knee pain, oftentimes also called patella femoral joint pain or chondromalacia patella syndrome. This knee problem very often also involves the patella tendon, whereby there is tendonopathy in the patella tendon – much like what happens in the Achilles tendon (read my blog post on Achilles tendonopathy) and / or irritation of the fat pad that lies underneath the patella tendon.

 

These problems happen due to muscle imbalance in the lower limb and poor biomechanics leading to the patella not tracking properly over the underlying patella. As the patella is ridged on the underside that corresponds with a grove in the femur, when there is poor tracking of the patella and these surfaces are not well aligned the underside of the patella rubs on the femur. This irritates the cartilage on the underside of the patella and causes pain.

 

Much like in Achilles tendonopathy, the increased loading (how much running you do) through the patella tendon causes degeneration and breakdown in the patella tendon, new blood vessel growth and pain. Correcting these problems is quite straight forward in most runners as long as they are willing to reduce their ruining volume whilst performing the necessary exercises to stretch and strengthen the right areas.

 

It is a good idea to see a manual therapists (physiotherapist, osteopath or chiropractor) who can check your biomechanics to make sure your pelvis and spine are aligned and that you have good range of motion in the patella femoral joint, feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury.

 

As running is a very hip flexor dominant sport, runners become tight in their psoas, TFL and quads. Tightness in these muscles causes the patella to move to the outer side of the knee and weaken the VMO muscle on the inner side of the knee compounding the problem. Therefore stretching and doing self myofascial release for the psoas, TFL and quads muscle whilst strengthening the VMO is warranted. Runners with knee pain have also been shown to have weak glutes, especially the gluteus medius so strengthening this area also helps prevent this condition.

 

The best ways to prevent yourself from suffering knee pain are:

 

1. Make sure you have a good pair of running shoes such as Asics or Nike. Go along to one of the specialist running shops, such as Sweatshop where they can analyse your feet and provide you with the best running shoes. They will observe you running on a treadmill in their shop and advise you of the best shoes for your running gait.

2. Get you biomechanics checked by a manual therapists (physiotherapist, osteopath or chiropractor) to make sure your pelvis and spine are aligned and that you have good range of motion and flexibility in the knees, feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury. This is how top athletes avoid injuries – they have people assessing and working on them to prevent injury.

3. ALWAYS warm up prior to exercise.

4. ALWAYS warm down after exercise by gently stretching the major muscle groups of the legs including the quads (see my video blog post).

5. Use some self myofascial release on the quads and ITB with a foam roller. See my video blog post where I show you how to do this.

6. Use an undulating periodised training plan to peak before your main run of the season, also make sure you taper your volume leading up to your main event. Don’t just go out and run as far as you can each time you train. This is a sure-fire way to breakdown at get injured.

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Preventing and managing Achilles Tendonopathy

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Preventing and managing the most common and annoying running injuries – Achilles tendonopathy


One of the most common running injuries I come across in recreational runners is Achilles tendonopathy, more commonly known as Achilles tendonitis – suggesting there is inflammation in the tendon, however this is not the case (more on this later). I’m going to talk you though how to prevent this running injury, and how you can manage it if you are already suffering from it.

Achilles tendonopathy is a debilitating condition and can be devastating for your preparation for a long distance running event and seriously hamper your performance. It can get so bad that you wake up in the morning with very stiff and painful Achilles tendons, it can be agony getting out of bed and down stairs in the morning and there is no chance you will be able to put in that early 5k before work.

This condition is wrongly thought of as an inflammatory condition – thus the outdated term tendonitis, however it is not. What happens is that the tendon gradually fails to adapt to the load that is put through it (your running volume) and the collagen fibres within the tendon begin to degenerate. The tendon cells that reside between the collagen fibres, known as tenocytes, begin to produce more ground substance, which is water and proteins that help to support the collagen fibres. This extra ground substance produces a thickening in the tendon that is perceived as swelling. The more pronounced the thickening, the worse the degeneration and pain generally is.

The extra ground substance requires more oxygen and so new blood vessels and nerves begin to grow in to the tendon from the underlying fat pad. This neovascularisation can be seen on a Doppler ultrasound and it is the new nerve growth into the tendon that can create the pain.

If the tendonopathy is severe enough surgery is required where a surgeon will literally scrape the new blood vessels and nerves off the edge of the tendon and stitch the wound back up. However, this condition can oftentimes be managed without surgery. A good physiotherapist can use soft tissue techniques or Graston technique where they literally try to breakdown and shear off the new blood vessels and nerves through the skin. These techniques are effective but quite painful, but a few sessions of painful soft tissue work can reduce the discomfort you get whilst out running. Assessing and correcting any biomechanical defects at the foot and pelvis is also very useful to correct this condition and any good physiotherapist, osteopath or chiropractor can help you. It might also be worth visiting a podiatrist or going to a shop such as Sweatshop where you can get your feet analysed and you can buy trainers that suit your feet and your running style.

The best exercise to manage, prevent and treat Achilles tendonopathy is to do calf eccentrics. This is where you do a conventional two legged calf raise lifting yourself up on to the ball of your toes. You then switch all your weight on to the affected limb and slowly lower yourself down, letting your heel drop below the level of your toes so you feel and strong stretch in your calf and Achilles tendon. You then lift yourself back up with two legs and repeat for 15 repetitions. You can perform this exercise with a straight and a bent knee to hit different portions of the calf.

The best ways to prevent yourself from suffering Achilles tendonopathy are:
1. Make sure you have a good pair of running shoes such as Asics or Nike. Go along to one of the specialist running shops, such as Sweatshop where they can analyse your feet and provide you with the best running shoes.
2. Get you biomechanics checked by a manual therapists (physiotherapist, osteopath or chiropractor) to make sure your pelvis and spine are aligned and that you have good range of motion in the feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury. This is how top athletes avoid injuries – they have people assessing and working on them to prevent injury.
3. ALWAYS warm up the calf, Achilles and ankle joints prior to exercise. See my video blog post where I show you how to do this.
4. ALWAYS warm down after exercise by gently stretching the major muscle groups of the legs including the two muscles in the calf.
5. Use some self myofascial release on the plantar fascia and calf with a prickle ball and foam roller. See my video blog post where I show you how to do this.
6. Use an undulating periodised training plan to peak before your main run of the season, also make sure you taper your volume leading up to your main event. Don’t just go out and run as far as you can each time you train. This is a sure-fire way to breakdown at get injured.

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7 steps to the body you want this New Year part 7

Step 7: Eat fat burning foods

When you reach your ideal weight and body fat, through working with your nutritiosinst for weight loss, you enter the maintenance phase you should be eating the following fat burning foods

1. Hot peppers contain nutrients that help increase metabolism
2. Tea of any colour, especially green tea has been shown to increase fat loss
3. Tahini – sesame seed lignans enhance fat burning by increasing liver enzymes that breakdown fats
4. Fish and fish oils stimulate fat burning genes and increase metabolism
5. Cranwater (1 part no added sugar cranberry juice with 8 parts water) stimulates the liver to burn fat
6. Eggs are rich in choline a nutrient essential for bile production that helps emulsify and burn fats
7. A strong cup of coffee favours free fatty acids metabolism and spares glycogen
8. Carnitine helps transport fatty acids into the cells’ mitochondria for energy burning. Carnitine is found in meat and fish.
9. Eating half a grapefruit a day has been shown to help people lose fat and improve insulin sensitivity.
10. Fibrous vegetables

If your weight loss plateaus check the following:

  • Excess calories – check your food diary
  • Carbs to high / too low – check food diary
  • Not enough fibre – check food diary
  • Not drinking enough water
  • Medications – have you started any new meds that can affect weight loss?
  • Too little exercise
  • Food intolerance – you may need to do a test
  • Alcohol consumption – is it too high?
  • Stress – how is work? How is your relationship?
  • Are you relaxing enough?
  • Excess calories from cheese and nuts
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7 steps to the body you want this New Year part 6

Step 6: Maintenance phase

Pay attention to your weight and body fat throughout the add back phase until your weight and body fat loss stops. At this point you have reached your maintenance diet. If your weight goes back up 2kg go back to boot camp weight loss diet phase and go back through the add back phase again until your weight loss plateaus. This will be your maintenance diet. Other examples of Paleo carbs to add back in to the nutrition plan every 14 days include baby corn, beans (haricot, mung, aduki, black eye etc…), banana, beetroot, cooked carrots, lentils, oats for breakfast, olives, Swede, turnips and other ground tubers.

Avoid neo carbs at all cost. Ask “was this around 10,000 years ago?” If not, it’s a neo carb. For instance read labels and avoid sugar in all its forms – dextrose, maltose, sucrose, high fructose corn syrup, maltodextrin, corn syrup – anything ending in ‘ose is sugar. Processed good and foods made from refined grains are also neo carbs – pasta, biscuits, pastry, pies, cakes and most bakery goods. Also look out for artificial sweeteners (aspartame) colours (tartrazine), hydrogenated fats and preservatives. If you avoid processed foods you needn’t worry about these.

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Improve your time for the Reading half marathon

 

 

You wake up on race day full of excited anticipation for the road ahead, dreaming of a personal best and glad that the months of treadmill running are behind you. However, there is a slight doubt in the back of your mind; you can’t quite put your finger on it. Have you prepared thoroughly for the race? Have you done everything in your power to make sure you finish? You know that many people “hit the wall” in a full marathon, but could this happen to you today in the shorter version of this self inflicted torture? What about cramp as you have often seen runners paralysed by a stitch or calf cramps that makes the last few miles of a run agony. Surely not me, not today!

 

But today you are going to fly through the race. You have done everything right in terms of preparation and planning, your nutrition and hydration routine couldn’t have gone better. Your forethought and attention to detail, your preparation for this race, much like how Paula Radcliffe prepares for a race, will get you that elusive personal best today. Why? Because you read the following sports nutrition advice from PeakXVfitness…

 

Carbohydrate loading

 

To improve your time for the Reading half marathon it is a good idea to carbohydrate load for the race. Carbohydrate loading is a strategy to employ that involves reducing training volume whilst simultaneously increasing the amount of carbohydrates you consume in the 3-4 days leading up to the half marathon. Your aim is to cause the muscles to store higher than normal levels of glycogen, which will give you extra energy on race day.

 

Consider the example below of a carbohydrate loading diet modified from an Australian Institute of Sport (AIS) diet plan that is suitable for a 70kg athlete providing approximately 630g of carbohydrate, 125g of protein and 60g of fat:

 

Breakfast  A large bowl of breakfast cereal with 1½  cups of skimmed milk
1 medium banana
250ml orange juice
Snack  toasted muffin with honey
500ml sports drink
Lunch  2 sandwiches (4 slices of bread) with filling as desired (meat or fish)
200g tub of low-fat fruit yoghurt
250ml orange juice
Snack  banana smoothie made with skimmed milk, banana and honey
cereal bar
Dinner 1 cup of pasta sauce with 2 cups of cooked pasta
3 slices of garlic bread
500ml sports drink
Late Snack  toasted muffin and jam
500ml sports drink

 

The trouble with carbohydrate loading is that many people get it wrong – they use it as an excuse to eat anything they want, usually food laden with fat as well as sugar, but you can see from the example above that the food consumed should be low fibre, high glycemic load sugary, starchy foods – not fatty junk food. Herein lies another problem – this food is not very good for the teeth; it’s certainly not very good for blood sugar control and could lead to excess body fat accumulation if done too regularly, and it may lead to high triglycerides, gout or liver damage that have all been associated with consuming high amounts of fructose, high fructose corn syrup and sugar in general. So only consume this type of carbohydrate loading diet in the 3-4 days leading up to your race.

 

Also eat foods such as tropical fruit, dried fruit and whole grains and use sports drinks instead of eating too much jam, honey and muffins. These foods also provide vitamins and minerals that help to turn your food in to energy. Once you have finished the race go back to your normal diet.

 

Hydration

 

This is perhaps THE most important thing you can do on the day of the race. Dehydration can have a serious negative effect on performance. As little as 2% dehydration causes:

 

  • 8% loss of speed
  • 10% loss of strength
  • 20% loss of cognitive function

 

Dehydration occurs through the loss of water from the body, mainly in the form of sweat that is evaporated from the skin as the body tries to prevent overheating. Sweat volume and electrolyte loss varies from individual to individual and depending on the ambient temperature. If it’s a hot day, you’ll sweat more and dehydrate quicker.

 

Monitoring hydration status

 

Basing your urine colour against a chart of different colours has been used for some time to determine hydration status (see chart). A dark yellow / brownish colour indicates dehydration, whereas a clear light yellow colour indicates hydration. Just remember that if you take a multivitamin your urine will be bright yellow regardless of whether you are hydrated or not.

 

Hydration strategies for the race

 

Drinking water is usually the first line strategy to replace fluids lost through sweat, however consuming large amounts of plain water is not recommended to replace fluid or electrolyte losses and can lead to hyponatremia and even death. Consuming beverages that contain electrolytes is the most sensible way to replace salt and water lost in sweat. These include sports drinks such as Lucozade hydro, Poweraid or Gatoraid. Drinking between 2 and 4 bottles of these sports drinks interspersed with water is appropriate during the race. It is also wise to salt your food in the days leading up to the race, however if you consume any processed foods you will need to take in to account the amount of salt in these products.

 

Another good option is to use the product Elete which is an electrolyte add in (google elete). This can be added to water, juice, tea and other beverages that you consume throughout the day leading up to the race to improve rehydration. More simply you could just add a pinch of good quality salt to your beverages – this is less scientific but a good option for those who do not want to spend money of pre-designed products. Other naturally “salty” drinks such as Vita Coco are also very good.

 

Rehydration after the race

 

To replace fluid loss after the race the easiest thing you can do is to record your pre and post run weight (write these down on a bit of paper), adjust this for fluid consumed and urine passed (roughly) and drink 1.5 litres of fluid for every kg of body weight lost. Once again these beverages should contain electrolytes and should be consumed gradually after the race.

References

Australian Institute of Sport
http://www.ausport.gov.au/ais/nutrition/factsheets/competition_and_training2/carbohydrate_loading

Achten, J. Halson, S. L. Moseley, L. Rayson, M. P. Casey, A. and Jeukendrup. A. E. (2004). Higher dietary carbohydrate content during intensified running training results in better maintenance of performance and mood state. Journal of Applied Physiology 96: 1331-1340.

Bocarsly, M. E, Powell, E. S, Avena, N. M, and Hoebel, B. G. (2010). High fructose corn syrup causes characteristics of obesity in rats: Increased body weight, body fat and triglyceride levels. Pharmacol Biochem Behav. [Epub ahead of print]

Burke, L and Deakin V, (2006). Clinical Sports Nutrition (3rd Ed). McGraw-Hill Medical

Colgan, M (1993) Optimum Sports Nutrition. Your Competitive edge. Advanced Research Press. New York.

Elliott, S. S, Keim, N. L, Stern, J. S, Teff, K, and Havel, P. J. (2002). Fructose, weight gain and the insulin resistance syndrome. American Journal of Clinical Nutrition, 76(5):911-922

Kershaw, E. E. and Flier, J. S. (2004). Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology and Metabolism, 89 (6): 2548 – 2556.

Johnson, R. K, Appel, L. J, Brands, M, Howard, B. V, Lefevre, M, Lustig, R. H, Sacks, F, Steffen, L. M, and Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health. A scientific statement from the American Heart Association. Circulation 15;120 (11):1011-20

Khanna, G. L, Manna, I. (2005). Supplementary effect of carbohydrate-electrolyte drink on sports performance, lactate removal & cardiovascular response of athletes. The Indian Journal of Medical Research. 121 (5): 665 – 669.

Kohli R, Kirby M, Xanthakos SA, Softic S, Feldstein AE, Saxena V, Tang PH, Miles L, Miles MV, Balistreri WF, Woods SC, Seeley RJ. (2010). High-fructose medium-chain-trans-fat diet induces liver fibrosis & elevates plasma coenzyme Q9 in a novel murine model of obesity and NASH. Hepatology; 52(3):934-44.

Lê, K A Faeh, D Stettler, R Ith, M Kreis, R Vermathen, P Boesch, C Ravussin E and Tappy L. (2006). A 4-week high fructose diet alters lipid metabolism without affecting insulin sensitivity or ectopic lipids in healthy humans. American Journal of Clinical Nutrition; 84(6):1374-9
Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. (2010). A High-Protein Diet With Resistance Exercise Training Improves Weight Loss and Body Composition in Overweight and Obese Patients With Type 2 Diabetes. Diabetes Care; 33(5):969-976.

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7 steps to the body you want this New Year part 5

Step 5: Add back phase

From day 16 onwards you eat on a 6:1 day ratio, i.e. you eat as per boot camp for 6 days and can have a cheat meal every 7th day at 6pm. Put all the cheat food you want to eat on the table, eat it and as soon as your ass leaves the table the cheat is over – it’ not a cheat evening. From day 16 onwards for two 7-day cycles add in all berries, 2 servings a day. You can now have meat and berries for breakfast for example.


From day 30 onwards for two 7-day cycles add in 1 serving of the following fruits per day – cherries, grapefruit, apricots, pears, apples, plums, peaches, oranges and grapes.



From day 44 onwards for two 7-day cycles add in full fat plain yoghurt and live cultures. You don’t have to eat this every day, it’s just allowed. If you are dairy intolerant – avoid it.


From day 58 onwards for two 7-day cycles add in 1 serving of quinoa, brown whole grain rice or amaranth with lunch or dinner.


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7 steps to the body you want this New Year Part 4

Step 4: Cheat day

This little trick was taught to me by Charles Poliquin. On day 15 of the boot camp eat what you like all day. Organised cheating is part of the plan, it aids the weight loss process and allows you the freedom to enjoy food without feeling guilty and stops you from falling off the low carb wagon.

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Vegetarian diets are not healthier for you….

Dr Briffa points to some research that shows that it is a myth that a vegetarian diet is healthier for you than a diet containing meat=>

http://www.drbriffa.com/2011/01/07/question-marks-raised-over-the-vegetarian-diet/

 

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7 steps to the body you want this New Year part 3

Step 3: Determine your optimal animal protein intake

Protein is essential for weight loss. Eating protein releases a chemical in your stomach called peptide YY (PYY) that reduces hunger. Protein is also more thermogenic than fat and carbs, meaning it causes you to burn more calories. Here is a guide to how much protein to eat:

Males
Males 1.5-2g of protein per kg BW per day

Females
Females 1-2.g of protein per kg BW per day

So how do you work this out? Meat and fish contains approximately 22-25g of protein per 100g of flesh. So for example a 70kg male would need to eat 1.5-2g of protein per kg BW per day. That equals 105-140g of protein, which is roughly 600-650g of flesh throughout the day.


You should aim to spread this protein intake out throughout the day by eating 5-6 meals. So divide your protein requirement by the number of meals you need to eat to meet your protein goal.


For example 140g of protein divided by 6 is roughly 24g of protein at each meal, which is roughly 100g of meat or fish per meal.

Alternatively you could do the following
Breakfast: 100g
Snack: 50g
Lunch: 150g
Snack: 50g
Dinner: 200g
Snack: 100g

You protein can come from anything that runs, swims or flies – so any meat, fish, poultry or seafood is great to eat. Just make sure you eat quality organic meat and fish to avoid oestrogens, growth hormones, antibiotics and pesticides stored in animal fat.

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