Pain-Free Running, Part II

Last post, I described how I started to get back into running, and how it wasn't working for me. This time I'll describe where I went from there.

First, I'll share my definition of "pain-free" running: No joint pain, no foot pain, no back pain or any other structural body pain. No shin splints. No plantar fasciitis. No tendon pain.

Muscle pain, though not desirable, should not be unexpected. If cramps occur, they should be taken as a clear sign of over-doing it, and are an excellent reason to end the run and start walking. Tendon pain must be prevented and avoided to the greatest extent possible, but when it does occur it must be treated as an injury.

While doing the 1/2 mile runs described in the prior post, I noticed some pain in the front and side of my knees that tended to ache and fade slowly. I scheduled an appointment with my GP, who promptly referred me to Dr. John Fellow, a sports medicine specialist.

X-Rays revealed some roughness on the inside of one of my knee caps (mild chondromalacia), and Dr. Fellow also detected a small amount of patellar tendonitis on both knees (not unexpected at my age). After performing some mobility and stability tests, Dr. Fellow's final diagnosis was ITB Syndrome (ITB = IT-Band = IllioTibial Band, the tissue along the outside of each thigh). This too is very typical of people getting into running, and Dr. Fellow was not too concerned. He prescribed some stretches, which I added to my normal (and very thorough) stretch routine.

A note about stretching. Over the years I've put together a great 20-minute active stretch routine that borrows from yoga, modern dance, martial arts, strength training, massage therapy, and, of course, doctors. It has kept me extremely flexible and very limber, and has provided many benefits beyond flexibility: I'm much more resistant to accidental injury, since I can bend before I break, and I'm more able to catch myself when I stumble, instead of falling. I can't recommend highly enough the value of a proper and safe stretch routine!

Over the years, I've accumulated some basic rules about stretching. These are my rules, based primarily on my own experiences. Since I'm in no way a stretching expert, you should take them only as basic advice, not as laws.

1. Never stretch a cold muscle. This is #1 for a reason, since it is the easiest way I know to rip muscle and tendon. Don't do it. Never, ever. Always warm up a muscle before stretching it.
2. Never stretch immediately before hard exercise. Recent studies have shown that stretching decreases both muscle strength and endurance when done before hard exercise. Stretching is best used as a recovery activity, or as part of a series of low-intensity exercise or training activities (such as in a fitness class). Think of stretching more like vitamins: Something you want to take daily, but not right before a big race.
3. Always activate the muscle being stretched. Never "relax" into a stretch. Work against the muscle being stretched, but don't over-do it. Mild to medium activation is all that's needed.
4. Never "fall" into a stretch using gravity. Gravity may be used provide a slight assist, but should not be used to force a muscle to lengthen. Re-orient your body (such as lying on a mat) so gravity can't help over-do the stretch.
5. Never "bounce" in a stretch. This is another great way to rip a tendon or muscle. The worst general error in this area concerns stretching the groin and Achilles tendons. Be very careful!
6. Never "force" a stretch. Go gently and slowly to the limit of motion, then hold using dynamic tension (pull using opposing muscles, and stay in the same place). Excess force can cause a range of injuries, including joint dislocation.

I won't go into the "why" behind each of my rules, but I will say they are generally based on my own mistakes, or watching the mistakes of others. I won't describe my specific stretch routine here, though that may be a topic for a future post.

The bottom line is to make no assumptions about stretching: If you don't know what you are doing, then stick to doing an easy warm-up followed by very gentle stretches, with muscles activated (stretch against a tense muscle using the opposite muscle), without any gravity assist.

Back to the main topic: I did only easy 1/4 mile runs while waiting for the new stretches to help correct my ITB Syndrome. When all was well, I resumed my 1/2 mile runs, this time without knee pain.

When I extended my run to 1 mile, I started huffing and puffing at the limit of my fitness, and the old ankle and hip pain returned (without knee pain this time), I also had shin splints, and my feet hurt. I was running with the same style I was using 15 years ago: A long stride with a hard heel strike. Immediately after that run, I took off my shoes and probed my feet and all my joints. My plantar fascia were tender, and my joint stabilizing muscles all were tight, much tighter than I had ever noticed before.

Some Googling led me to several running and sports medicine web sites, which helped me put together a picture of what was probably going on: When running faster and farther, as I started to fatigue my hard heel strike caused my foot to slap onto the ground. That slap sent a shock wave up my leg that caused my shin splints. The foot slap was also stretching my plantar fascia, which was making my foot hurt when I pushed off of the ball of my foot. The stretched plantar fascia was making my foot less stable, which in turn was causing me to tighten my ankle for additional support. The ankle support muscles soon tired, and the knee tried to provide the needed stabilization. But my knee was now more limber, so rather than taking more damage and hurting, it became weaker, and the weakness traveled up to my hips.

I had gone from running using my feet, legs and muscles, to running on flippers under stacks of wobbly bones. No wonder I hurt!

At this point, it was clear I needed to do things differently. My next thought was simple: If I could get rid of that foot slap, perhaps I could completely prevent the rest of the joint pain. More about that in the next post.