Monday, September 26, 2016

Marathon Training Tip #12: Recover from Shin Splints

Mention the term “shin splints” and almost every runner recalls experiencing pain in the lower leg associated with running.  The term itself is non-specific and is what we call a “waste basket” term.  Pain in the lower leg usually can be identified as Medial Tibial Stress Syndrome (MTSS), stress fractures and exertional compartment syndrome.

MTSS occurs on the inside edge of the lower leg bone (tibia).  It is usually tender to touch mid-way between the knee and ankle or in the lower 1/3 of the leg.  This injury usually occurs with runners new to the sport, running on hard surfaces, training errors—doing too much too soon or increasing distances too rapidly, muscle imbalances or biomechanical faults especially excessive pronation.   The source of the pain is usually either inflammation of the tissue that lines the bone called the periosteum, or the posterior tibialis tendon that runs along the inside of the bone to the foot. 

Left untreated or pushing through this injury can lead to a stress fracture of the tibia, a small crack in the bone.  X-rays are usually not necessary and the stress fracture doesn’t usually show up for 2-3 weeks and either an MRI or bone scan is needed to find it.  Women are 2-3 times more likely to experience this problem than men and should be certain that their vitamin D and calcium intake is sufficient.  If stress fractures are recurrent, a full medical work up is necessary to rule out other potential causes.

MTSS often develops when the Achilles tendon and Soleus muscle are tight and or weak.  Performing stretching and strengthening exercises to correct that problem often eliminates the problem.  Most runners know how to stretch the Achilles tendon but often are unfamiliar with stretching the soleus.

If the lower leg pain is on the top or outside of the bone, the anterior tibialis muscle may be the culprit.  If the pain worsens during the run and the foot gets numb and the ankle gets weak, so weak that it is difficult to lift the toes up with the heel on the ground, exertional compartment syndrome may be the problem.  The muscles, nerves and blood vessels are grouped in what is known as a compartment.  If the pressure builds in the compartment the muscle can swell and the nerves and blood vessels become compressed to the point the ankle loses function.  Usually only present during running and resolves shortly after stopping, but left unchecked may require surgery to relieve the pressure.

Follow these tips at the first sign of lower leg problems:

  • Ice the area after running.
  • Stretch the Achilles and soleus.
  • Strengthen the lower leg muscles, core and hips.
  • Run on softer surfaces like a trail or track.
  • Correct excessive pronation with an arch support.
  • Replace shoes if worn excessively.
  • Cross train in pool or elliptical until pain lessens.
  • Still a problem after 2 weeks?  See a Physical Therapist or Sports MD.

Watch the video for a 3 exercises to help you recover from shin splints…

Blog post by Joe Carroll.

About Joe Carroll PT DPT SCS

Joe is a Doctor of Physical Therapy and co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master Instructor in the Burdenko Method. He continues to run and support local road races every year and knows what it takes to help athletes get to the level they desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on April 18, 2016 at the Boston Marathon raising money for Boston Children’s Hospital.

Monday, September 19, 2016

Marathon Training Tip #11: Treat Plantar Fasciitis

What is Plantar Fasciitis?

The plantar fascia is described as a thick fibrous bands of connective tissue that originates from the medial aspect of the heel through the sole of the foot and inserts at the base of each toe. It is a shock absorbing bowstring supporting the arch of the foot.  For runners the plantar fascia can be a source of major discomfort causing stabbing pain at the base of the heel and aching throughout the arch of the foot. It affects the push off mechanism of the foot and produces pain during push off phase while running.  It can also cause stabbing pain in the morning during the first few steps getting out of bed.

Plantar fasciitis was originally thought to be an inflammatory condition but recent research has found it is non-inflammatory breakdown of tissue as a result of repetitive microtrauma and the name of the condition may eventually be renamed to plantar fasciosis.  There are also studies discussing the tension on the flexor digitorum brevis and its resultant forces on the plantar fascia contributing to plantar fasciitis pain.

Diagnosis of plantar fasciitis would be tenderness to touch along the medial aspect of the calcaneus (heel bone) on the soul of the foot. Tenderness can also be present along the medial arch when palpating the edge of the fascia. The condition is also accompanied with tightness in the calf or Achilles causing a decrease in Dorsi flexion. Strength of the flexor digitorum brevis can also be a factor. In one third of all plantar fasciitis patients, the condition is bilateral.

While plantar fasciitis is thought to be caused by being flat footed, and flat footed runners have higher occurrence rates, it is not clinically proven that fallen arches are predisposing factor. Runners of all arch height can be affected by this condition.


Treatment of plantar fasciitis can come in many forms. There is strong evidence supporting manual therapy including self-mobilization of the ankle joint and toes as well as self-soft tissue mobilization of the plantar fascia itself.

Stretching of the gastroc as well as Soleus components of the lower extremity also have strong supporting evidence of improving plantar fashion conditions. Stretching of the sole of the foot by pulling the great toe back is another treatment technique that is supported by strong evidence.

For those runners with significant morning pain, night splints have also proven to be successful in reducing plantar fasciitis pain. Foot orthoses with a supportive arch are also clinically proven and have strong evidence of improving this condition.

Other external treatment alternatives which have good supporting evidence are anti-pronation taping of the plantar aspect of the foot as well as kinesiotaping of the arch of the foot.  RockTape shows an example below:

Strengthening of the flexor digitorum brevis will also help in the treatment of plantar fasciitis conditions. Different ways to perform strengthening exercises for the flexor digitorum brevis include a simple exercise such as picking up rocks or marbles with your toes or trying to scrunch a towel or pick up a hand towel with your toes.


While treatment of plantar fasciitis is a good thing to know, knowing how to prevent it in runners is probably more important. Changes to increase mileage to quickly as well as increase in hill training are common flaws that can lead to plantar fasciitis conditions. Making sure you have good ankle joint flexibility to perform Dorsi flexion as well as well stretched lower extremities and a strong flexor digitorum brevis will also help prevent this annoying condition.

Watch the video for some self-help treatment techniques...

Blog post by T.C. Cleary.

About T.C. Cleary PT DPT SCS

T.C. is a member of the Cape Cod Rehab Running Team not because she enjoys running herself, but because she is one of the select few PTs in Massachusetts to be Bard Certified in Sports Physical Therapy. An ice hockey player and coach, T.C. particularly enjoys working with high school and college athletes. She believes in treating everyone the way you would want your child or mother treated and employs many different interventions to obtain maximum recovery. T.C. also has special interest in Anterior Cruciate Ligament (ACL) Injury Prevention & Treatment along with Concussion Management.

Friday, September 16, 2016

Autumn: A Transitional Time of Year

When the sun is setting earlier and the temps are cooling down it can be a challenge to continue with your gym routine. Don’t let the leaves changing throw you off your game, instead take advantage of this beautiful time of year and let it be a positive transition into the winter!

What Can You Do?

Sign up for community events
This is the perfect time of year to sign up for that turkey trot or reindeer romp! There are plenty of local walk/run road races that support great causes, so get your name on the list and begin the training today. You can do it!

Hit the Trails
Enjoy the changing leaves and crisp air outside by taking a trail run or walk on a nature path.

Turn Fall Chores into a Workout
According to Health Status, a 150-lb. person can burn 135 calories by raking leaves for 30 minutes. Turn outdoor chores into a game by setting small, achievable goals to help pass time and burn away fat

Exercise Early
With the time changing and the sun setting earlier it can feel like a real drag to get to the gym later in the day.  It feels later than it is and people feel more tired than usual. Get that workout in early and relax in the afternoon.

Vary Activities
With the cooler weather setting in, it might be time to try something new at the gym. Get into a spin class, try yoga or get a new set of exercises from a personal trainer. Set yourself up right for the winter!

Seasonal Advice

Dress for the weather
Invest in some comfortable cool weather workout gear. Dress in layers that can easily be shed so you can keep exercising in the outdoors a little longer.

Drink water, Drink Tea!
Don’t ignore the bodies’ need for water just because it’s cooler outside. Staying on top of your fluid intake can help with both exercise recovery and appetite control. Green tea and black tea contain antioxidants that help ward off diseases during flu season so you can remain healthy and active as the season shifts.

Avoid Holiday Candy & Treats
According to the National Institutes of Health, on average, non-obese adults gain about a pound a year around the holidays. Be sure to pack lots of healthy snacks to munch on throughout the day to help deter you from grazing on sweets that pop up in the office, at home or at holiday parties.

Everyone dreads those holiday pounds so think of Fall as a time to prep yourself for a healthy winter. Setting goals and getting involved now will start your progression towards a happier, healthier you.

Blog post by Farran Jalbert.  

Monday, September 12, 2016

Marathon Training Tip #10: Reduce Knee Injuries

Pain is a language.  Ignore it and you will more often than not pay the price.  Most running injuries are not traumatic, but present over time beginning with pain during the activity of running and progressing to pain during and after a run.  Acting at the first warning sign will shorten the recovery time and reduce any down time that might be necessary.  If you ignore pain more likely than not symptoms will worsen and more time will be lost from your training.  If pain worsens to the point that it is painful with normal daily activities or keeping you awake at night, you should seek a professional evaluation.

The knee is a complex joint and primary shock absorber for running.  Approximately 12 times body weight is absorbed with each stride.  Patella-femoral injuries, sometimes referred to as Runner's Knee occur if we land with our knees extended or do not have strong quadriceps and hamstrings along with a flexible Achilles tendon to absorb shock.  Landing toward the midfoot with a slightly flexed knee and performing strength training exercises can help minimize this injury.  Follow this link to learn a series of strength training exercises for runners using a simple piece of equipment:

Training Errors

Increasing the number of times you run per week and or number of miles per week is the biggest culprit.  When injury does occur it is best to modify your schedule and remember the ultimate goal is to be healthy come race day.  Missing a week of scheduled runs is preferable to pushing through and worsening the injury.  If you can keep the pain level below a 4 on a 1-10 scale during a run, 10 being terrible pain, it is usually safe to continue on a reduced frequency and duration schedule.  Increase non-impact activities to either help recover following runs or to substitute if pain is greater than 4 or present at rest.  Highly recommended is water running.  If a pool is not available then try the elliptical trainer or spin bike for low impact cardiovascular conditioning.

Biomechanical Faults

“Stay in your hinges.” The late Dr. Rob Roy McGregor, sports medicine pioneer coined that phrase and simply means to run with good alignment.  When alignment is off, the stress on the knee will be magnified with each stride.  If you have arches that collapse (excessive pronation) the inside of your lower leg and inside of your knee is susceptible.  If you tend toward valgus (knock knee) or varus (bow legged) you are susceptible for Iliotibial band (IT band) issues.  

Strengthening the outside of the hip is often overlooked, but is key in preventing and recovering from many knee injuries.  Here is a link with an exercise called Scooters used to strengthen the hip abductors:

Proper shoes as well as arch supports are important as well as correcting any muscle imbalances.

Use a common sense progression of 10% per week in your training, correct and condition the muscles that cross your knee joint, listen to your bodies signals and your knees will carry you many miles without a problem.

Watch the video for a few simple self-help techniques...

Blog post by Joe Carroll.

About Joe Carroll PT DPT SCS 

Joe is a Doctor of Physical Therapy and co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master Instructor in the Burdenko Method. He continues to run and support local road races every year and knows what it takes to help athletes get to the level they desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on April 18, 2016 at the Boston Marathon raising money for Boston Children’s Hospital.

Tuesday, September 6, 2016

Marathon Training Tip #9: Other Recovery Techniques

Last year I completed my first 2 half marathons.  I was cruising through my first half back in June and I remember saying to myself at mile 10, “Wow, I can’t believe how great I feel!”  Then I got to mile 11 and my left calf started to cramp, shortly followed by my right calf.  No matter how much stretching I did on the course, I could not stop the cramping.  It wasn’t pretty but I finished the race, limping across the finish line.  I remember the pain being severe over the next few days at work but this didn’t stop me from registering for another half marathon in the fall. 

Moving forward with my training, I decided to try wearing compression sleeves over my calves.  There isn’t much evidence out there supporting that they’ll improve performance, but there is some evidence stating that they prevent muscle soreness post longer runs.  I wore these sleeves during my second half marathon last year and I got through the entire race without cramping and without excessive soreness afterwards either.  

When faced with an injury you always want to remember the acronym P.R.I.C.E.

P stands for protection from further injury

R stands for rest

I stands for ice

C stands for compression

E stands for elevation

Paula Radcliffe sporting compression
as she sets the World Record at the
2003 London Marathon!
During exercise muscles produce lactic acid.  Too much lactic acid causes muscle soreness and also makes muscles fatigue quicker leaving them susceptible to injury.   Wearing compression socks helps fight the effect of gravity and can help return blood to the heart quicker.  This allows the body to eliminate lactic acid more efficiently allowing our muscles to perform better over the course of a long run. In theory this sounds great!  My calves definitely felt the difference in a good way.  But do they actually work?  

There is a great article written by Andrea Bachand, MSc PT, BSc Kin who does an excellent job summarizing the current evidence on this topic.  Basically most studies do not correlate wearing compression socks to improved running performance or improvements in physiological performance such as HR, blood lactate levels, or VO2 max profiles.  However, one study from the International Journal of Sports Medicine by Bringard et al back in 2006 showed that wearing compression tights decreased running energy costs but only at very low speeds.[i]  So the compression socks/sleeves may provide a benefit for those like me who run at 9-10 minutes/mile or slower paces.  You can check out Andrea’s article here:

Ice is always beneficial after an injury.  It is a natural anti-inflammatory.  Sometimes the body over compensates for an injury and swelling can become excessive.  Ice helps reduce swelling immediately after an injury.  However, when swelling is already present, that’s where combining ice with compression can help even more.

Game Ready is a company that provides Active Cold Compression Therapy.  A sleeve is wrapped around the injured body part which circulates ice water and inflates to aid in the healing process.  Cold therapy is effective because it slows the metabolic demand of cells, which limits the cells need for oxygen, preventing secondary tissue damage.  The unit then inflates adding compression to the desired body part.  This produces a pumping action, mimicking what our muscles do. This muscle pumping-like action helps eliminate swelling from the area, aiding in lymphatic drainage and improving blood flow. [ii]

Another company that provides dynamic compression is NormaTec and has become very popular among professional athletes.  NormaTec makes dynamic compression devices that use a Pulse Massage Pattern to help improve lymphatic drainage, thus improving blood flow.  There have been several studies published demonstrating the benefits of dynamic compression.  There are 3 components to NormaTec’s patented Pulse Massage Pattern. Pulsing is the first component.  This is more effective than static compression because it mimics the muscle pumping action of our arms and legs, “greatly enhancing the movement of fluid and metabolites out of the limbs after an intense workout.”[iii]  NormaTec also utilizes gradients to mimic the one way valves in our veins and lymph vessels.  These valves prevent fluid backflow.  NormaTec uses hold pressures in separate zones to keep fluids from being forced in the wrong direction, allowing the device to deliver maximum pressure in each zone.[iv]  NormaTec than utilizes a distal release pattern, releasing the hold pressures in lower (or distal) zones once they are no longer needed to prevent backflow.[v]  There are 7 levels of pressure.  I feel most comfortable at level 5.

Check out the video below to listen to Celtics Head Athletic Trainer, Ed Lacerte, explain the benefits of NormaTec![vi]  (I love Waltah!)


I’ve been using the NormaTec sleeves as part of my recovery from a recent hamstring/calf injury.  It feels great after a 15-minute treatment and really helps accelerate the recovery process.

These are a just a few things that can help speed your recovery after a long run or help accelerate the healing process after an injury.  Let’s face it, us runners hate to take time off from running!

Blog post by Jon Carroll.

About Jon Carroll PT DPT OCS

Jon joins the Cape Cod Rehab Running Team with a few personal running accomplishments including finishing his first 2 half marathons in 2015.  A three sport athlete in high school, Jon took up running after completing his first Falmouth Road Race back in 2010 and hasn’t looked back.  A Physical Therapist and Orthopedic Clinical Specialist (OCS), Jon enjoys working with runners because he knows how good running feels and understands the frustration when runners have to take a break when injured.  Jon’s goal is to run a full marathon in the near future.  His motto: “Ultimate fitness is a marathon, not a sprint.”