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Injuries Can Happen Comedy Vid 20 Secs

We all cannot stand being injured due to excessive running so the better we get at understanding the way our bodies function the more we can avoid the risks of injury. Realistically Injuries only occur through one of the following channels.

1. Accident (Trauma)
2. Longevity of activity (Overuse, Stress) Too many miles.
3. Increased Intensity (Overuse, Stress) Too fast too soon.

I will amplify on this subject in due course but for now I hope you enjoyed the accident injury video courtsey of Jim Stoxen from Chicago. Enjoy some of the articles below.

Beware Stress Fractures, Stress Reactions

Preventing and Healing Stress Fractures & Stress Reactions
by Sock Doc AKA Steve Gangemi
A stress fracture occurs when there is an overload of stress in a bone because of poor
biomechanics and sometimes accompanying nutritional imbalances. Poor biomechanics
occur due to muscle imbalances that are a result of mechanical and nutritional problems.
Improper footwear is a very common mechanical factor resulting in muscle imbalances
and subsequently a stress fracture. Those who wear footwear that is designed to absorb
shock and control motion can be setting themselves up for a stress fracture as major
muscles that help disperse and absorb shock naturally will no longer be working

Orthotics and Footwear
Orthotics typically cause similar problems, as do arch supports and shoes that lift the
heel too far off the ground and put excess stress on the mid and forefoot. This type of
footwear disrupts normal gait, causing muscle imbalances and dispersing stress to
isolated areas that is not meant to handle such a load. Eventually the area breaks down
– literally. For most, wearing minimalist shoes is very important when you walk and run
so your gait is not altered, and even going barefoot at times can be very beneficial.
When you’re walking around the house and office, going barefoot is preferable to
strengthen all the muscles, tendons, and ligaments in your foot that affect your gait and
entire body. Remember to gradually work your way into minimalist shoes and barefoot if
you’ve been wearing supportive shoes and/or orthotics for some time.
Another mechanical factor that can contribute or directly cause a stress fracture is poor
gait mechanics but not because of improper footwear. Your gait is a reflection of
muscles and joints working in harmony and when this is disrupted, an injury often
results. If the injury is impacting a bone, an athlete can all of a sudden develop a stress
fracture, though often it has been weeks or months in the making as an improper gait
has slowly been isolating stress to a specific area that is meant to only handle so much
A lot can affect your gait other than just what is on your feet. Past injuries, dietary and
nutritional considerations, and hormonal imbalances all will affect how you move. More
on gait.
Speaking of nutrition and its affect on muscle balance and gait, nutrition also plays an
important role in the health of your bones and joints. Therefore, poor nutrition can result
in a stress fracture. This is especially true when a stress fracture develops in a major
bone such as the femur – unfortunately all too common in female distance runners who
often don’t eat well or suffer from anorexia or bulimia. Many think that because a bone
density scan showed a good result means they have healthy bones. But that test
measures only quantity of bone in certain areas tested, not quality of bone or quality of
How about specific nutrients to heal?
There’s a lot more to bone than just calcium and vitamin D, though both are definitely
important here as well as overall health. Probably the most important nutrient that is
overlooked for bone health is the mineral manganese (Mn). Your body needs a lot of Mn
when bone is injured; I sometimes give a patient 50-100mg of Mn a day for a couple
weeks if they have a bone injury. Other nutrients like magnesium, copper, zinc, and
silicon are also important for bone health. Most people don’t need more calcium, but
rather they need to stop stealing it from their bones. Many think their calcium level is
good because they take a supplement or the level is normal in their blood, but they could
be robbing the mineral from bones. The body pulls calcium from bones when the blood
and tissues are too acidic, which happens when a diet is high in caffeine and/or refined
carbohydrates, as well as when there is too much of the stress hormone cortisol.
Elevated cortisol is a result of training too hard (anaerobically), not resting enough, or
too many other high stressors in life that you’re unable to deal with. So rarely do I see a
need to give a calcium supplement to a patient with a stress fracture but often I see a
need to address diet and lifestyle.
GAGs synthesis is all about how we all keep our joints and connective tissue strong and
healthy. Read more about that joint and tissue repair as it’s an important consideration
when it comes to preventing or healing stress fractures (fast!).
How about that diagnosis “stress reaction”?
Basically, I think “stress reaction” is a pathetic diagnosis and one given by a physician
who doesn’t know why the patient has the problem they’ve presented with. All it means
is that you’ve suffered some trauma/injury in an area because your body was unable to
handle the amount of stress you dealt upon that area. Stress reactions mean nothing –
they don’t tell you what exactly is wrong, how you got injured, and they sure don’t give
any insight in how to correct it. A brace (tape or orthotic) might be prescribed as well as
anti-inflammatory or pain meds, but they’re not going to address the source of the
In a stress reaction, much like when there is a stress fracture, you’re not dispersing
impact correctly throughout the proper areas of the body (typically the foot), so you’re
isolating the impact when you walk/run to a specific area or areas causing trauma. So a
stress reaction occurs for the same reasons that many other injuries occur, including
stress fractures. Gait imbalances, improper footwear, and dietary and lifestyle
considerations top the list when dealing with a “stress reaction.” We all react to stress,
it’s the type and amount of stress as well as how we react to and recover from that
stress that is going to determine whether we remain unaffected, become more fit, or
break down with an injury.

Bones Should Be Jarred

Bones Should Be Jarred

This article I wrote after reading an article which appeared in the March 9, 2014 issue of The New York Times Magazine.

I read a piece recently in the New York Times Magazine which caught my eye as it is relevant to how we use our bodies.
Bones should be jarred, they get stronger. Many experiments in the past have shown that by presenting excessive forces to bones in the form of abrupt stress, shock, this leads to them adding mass or reduces mass losses, as the subject ages. The debatable issue is the amount of stress forces required to stimulate bone and how to create these forces in a daily routine.
Recent studies at the University of Bristol collected data from male and female adolescents. At this time of the life cycle bone mass accumulates rapidly. The bone density of their hips, were measured as their daily activities were monitored by means of an activity monitor.
After a week the scientists downloaded the data gathered by these activity monitors and measured the G-Forces received by each of the teenagers. This would allow an accurate measure of impact. The teenagers who underwent the greatest impacts of >4.2G's, although not the most frequent impact, showed the strongest and highest density hip bone mass. The researchers then had to show what sort of impacts would create this type of increase in bone strength and density. Running a 10 minute mile or jumping onto a box at least 375mm high would create the relevant forces. These findings suggest that people would have to run relatively fast or undergo a lot of jumping to recreate the force required to build bone.
As we age we become more lethargic and this in turn was addressed by the researchers. In an attempt to discover how jarring could help older people and to monitor the effects of this, the researchers took 20 women older than 60 years, equipped them with activity monitors, then put them through an intense aerobics class. They also put them to test with a brisk walk and a session of stepping onto a 300mm box. None got even close to 4G's, in fact 2.1G's was the maximum force received. Suggesting that the older we are the more careful we become.
With these implications Dr Jon Tobias, professor of rheumatology at Bristol University, leading the research, suggested that "while impacts of less than 4G could help adults maintain bone mass it is unclear at this stage as to how much force below 4g would be needed. His results also led him to believe that young people and healthy adults could show great gains in bone density by running.

Sprinting, jumping off a 375mm box and jumping back onto it, hopping in place, were all shown to increase bone density and strength. There have been other studies done on women aged 25-50 years, which have shown significant increases in bone density after hopping 10 times twice daily over a four month period, with a 30 second interval between hops. This experiment was taken one stage further to show what happened after increasing the hopping to 20 times daily all at one time with 30 second intervals. Not surprisingly the increases in bone density were greater from the later of the two experiments.
The unfortunate catch in all of this is proposed to older individuals who may not have been doing any high impact exercise. Their circumstance may not allow them to impact their bodies to the extent required to make gains in bone density. This is bound to have a detrimental effect on their overall bone health. Research by Dr Tobias and his colleagues is ongoing and they hope to better understand the levels of impact required to benefit all ages and abilities in the future.
The important thing to remember here is your level of understanding before undertaking any form of "high impact" exercise. This is especially important if you have any joint issues where a properly qualified sports physician would be best consulted. For me, just like Dr Tobias "I plan to keep running till my joints wear out".

Colin McPhail says this to Dr Tobias "If you look after your joints by using your body as a spring, in the words of Dr Jim Stoxen, you will make them last and not wear out". So these kind of reports are all good and when we start to put things into a flowing prosepctive they start to make sound advice which will allow us to enjoy life as we grow older. Lets face it we are all destined to live longer if we avoid obesity, now one of the greatest killers on the planet. Get out there and jarr your bones but use your springs to prevent the shock from reaching the joints, avoid the foods that damage and use some of the natural foods that are available in abundance, live happy, live long, live injury free, balance your life.

How Runners Can Avoid Plantar Fasciitis:

How Runners Can Avoid Plantar

If you have plantar fasciitis and have been told by a doctor to wear a stability shoe,
orthotics, and never go barefoot, do yourself a favor and immediately switch to
another doctor, preferably one who has read about how the foot functions, and not
just knows all the names of the bones, tendons, muscles, and ligaments.
I speak from experience, since I was given this advice by a well-meaning podiatrist
when I had plantar fasciitis over a decade ago. After he finished telling me of the dire
consequences which would affect my feet if they were not externally stabilized, I
asked him how long I would have to follow his program. His answer was simple: for

I wisely didn’t follow his instructions, but I did do a little research about feet and the
maladies which affect them, and then I did some more fact-finding, and I never really
stopped my quest because what I discovered was fascinating: barefoot populations
do not have the foot problems that afflict people who wear supportive shoes. In fact,
the characteristics of traditional shoes are often the most harmful, but which sound
the most positive and comforting: supportive, stable, and cushioned. These features
are actually the ones that are the worst for the strength and health of your feet.
So much of what I was reading was different from what I had been taught that I had
to suspend my previous beliefs about shoes. So, although I knew that weak feet
were obviously more prone to dysfunction, I initially found it difficult that high-quality
shoes could be the major cause of this weakness. If I had been more systematic in
my thinking I would have realized that injuries associated with running had not
decreased, despite all the the technological advances advertised by the major shoe
One of the most common foot problems, both for runners and the general population,
is plantar fasciitis a (de)condition that seems to have reached almost epidemic
proportions, since it eventually affects one out of ten U.S. residents. Among certain
populations, including runners, those who stand for long periods of time, the
overweight, and sedentary, the rates are much higher.
Eventually I found the evidence overwhelming and was willing to enter a finding for
the prosecution: traditional shoes are the major source of maladies affecting the foot
and a significant contributing cause of other structural problems further up the chain
of movement. I was now able to ask one major question and give a simple and
accurate answer. But before we get there, let’s go into some detail about the exact
nature of plantar facsiitis.
The plantar fascia is a broad band of connective tissue stretching from the front of
the bottom of the calcaneus (heel) to the phalanges (toes). Its purpose is to transmit
stress through the foot by acting as a truss to help support the weight of the body
when standing and to stabilize the foot and improve its function as a lever as part of
the windlass mechanism while walking, running, and jumping.
Plantar fasciitis (PF) is an inflammation of the plantar fascia caused by excessive
stress. The major symptom is pain of varying intensities near the origin of the tissue,
right where it attaches to the calcaneus. The dysfunction or excessive stress is
caused by the foot being forced to operate in an unnatural way and without the full
muscular capacity that is often caused by the construction of traditional (rigid,
heeled) shoes, both running and casual. A shoe with a difference between the
height of the heel and forefoot immediately places the foot in a weaker mechanical
position by shortening the effective length of the plantar fascia and the Achilles
tendon which, in turn, forces both to become overworked. Depending upon the
frequency, duration, and intensity of the exercise, the plantar fascia can become
Q. What can you do to maintain or retain healthy feet and avoid plantar
A. Be barefoot or wear minimal shoes for as many activities as possible.
Just like minimal running shoes minimal casual shoes should fit the anatomy and
function of your feet. With no restriction of its natural range of motion, the foot is able
to maintain its strength, balance, flexibility, and responsiveness. The truth is,
theoretically we should always be barefoot, but in today’s world that is not always
possible of feasible. Fortunately, by wearing minimal shoes, almost all of the
advantages of being barefoot are preserved.
Several companies (Vibram FiveFingers, Merrell, Altra, Skora, Xero Shoes) make
excellent minimal running and athletic shoes, but there are relatively few companies
that make true zero-drop minimal casual shoes. In addition to Merrell, two footwear
brands excel: The first is Vivo Barefoot. This company, which is part of a larger U.K.-
based corporation, Terra Plana, makes approximately ten models of minimal casual
shoes, half for men and half for women. Some have laces and others are slip-on
models, but all are lightweight, flexible, and very comfortable. The other is a fairly
new U.S.-based company called Lems, and their zero-drop casual shoes have
ample-sized area for your entire foot.
Each step you take with a minimal shoe, no matter what the activity, allows you to
strengthen your feet and reinforce proper patterns of movement
This essay originally appeared here:

Biomechanical Implications for Barefoot Running

Review and Summary of the Following Published Study:

BioMechanics of Barefoot Running: Biomechanics and Implications for Running
Injuries, by Allison R. Altman and Irene S. Davis.
Sports Medicine in Current Sports Medicine Reports,
American College of Sports Medicine, Volume 11 · Number 5, September/October
2012, pp.244-250.
by Jim Hixson.

Well-known researcher and author Irene S. Davis (Harvard University) and her
graduate student at the time Allison R. Altman (University of Delaware) teamed to
write an excellent review on where we are with barefoot running. Dr. Davis has
extensively studied the correlation between multiple variables: footwear, running
form, and rates of injuries.

After a short summary of our best hypotheses regarding running and the
evolutionary development of the species, the obvious, but important fact is stated:
“Regardless of why we began to run, we clearly began running without shoes”.
Although there is an archaeological record of shoes that goes back over 10,000
years, there is no evidence that runners before the late 1970s used shoes like
today’s best-selling models. Many studies could be stopped now, if only we had the
running logs and injury records for our ancient ancestors. With that information we
could quickly determine whether or not the billions of dollars spent on technologically
sophisticated running shoes has had a positive or negative effect on running injuries,
or perhaps no effect at all.
The next section of the article deals with the effects modern running shoes have on
biomechanics. When considering “…a dual-density midsole, elevated, cushioned
heel, arch support, stiff heel counter, and an array of other features purported to
assist in foot function and reduce injury”, the authors make the important conclusion
we have learned to anticipate: “The benefits of these technological advances on
injury prevention have not been documented.”
Since most runners wearing traditional shoes contact the ground heel first and most
barefoot runners land forefoot first, a comparison of these two styles and their
respective effects on impact peak, muscular involvement, and stride length is the
subject of the next section. Obviously the two running styles result in different
running experiences, but how do they affect injury rates? Ever since Daniel
Lieberman showed a qualitative difference between strike patterns of forefoot striking
and rearfoot striking (2010), supporters of traditional running shoes have claimed
that these differences do not lead to higher injury rates for rearfoot strikers. As
Altman and Davis report, however, another study by Lieberman, published in early
2012, “…showed that mild and moderate running-related injuries occurred 2.5 times
more frequently in rearfoot strikers than in forefoot strikers.”
The next three sections are probably the most interesting for those readers who are
already well acquainted with the literature on foot strike, vertical ground reaction
force, and shock attenuation. The main questions are: Do truly minimal shoes, such
as the Vibram FiveFingers, Merrell Road Glove, and Vivo Barefoot Evo, provide the
same benefits as running barefoot? Does running in a minimal shoe lead to a style
of running that is the same as running without shoes? Will running in minimal shoes
lead to lower injury rates for injuries suffered by traditionally shoe runners? The
answers are “No”, “No”, and “No” for some people, but “Most”, “Yes”, and “Yes” for
others. So, now that everything is crystal clear, what are the major differences
between barefoot running and wearing minimal shoes while running?
Possibly the greatest benefit of running barefoot is the ability of the neuromuscular
system to receive more sensory input, whereas even “…socks likely filter out some
of the important sensory input coming from the mechanoreceptors in our feet.” In the
next paragraph the authors attempt to give some hope to runners who wear minimal
shoes, when they state that “it is still unclear as to whether they truly mimic barefoot
running.” Two paragraphs later they destroy this hope: “Without sensory feedback
between the sole of the foot and the surface of the ground…the runner may not have
the complete neural cueing to convert to a forefoot strike pattern” and “even the thin
rubber outer sole offered some protection to the heel to allow them to land on it.”
Barefoot runners, in my experience, often run barefoot all the time, that is, in all
conditions, so they can tell others that they always run barefoot. Those who run in
minimal shoes claim to be more pragmatic, claiming that they have found a middle
way, allowing them to run basically barefoot comfortably in almost all situations.
Runners who wear traditional shoes think that both these groups are constantly
flirting with danger and no matter what supposed advantages might be gained by
running barefoot of wearing shoes that allow the foot to move naturally will soon
incur career-ending injuries and be removed from the running gene pool.
From my own reading between the lines, it seems that the authors and other
researchers believe that a combination of running barefoot and running in true
minimal shoes is probably the alternative that will allow you to run most efficiently,
improve performance and reduce the chances of injury. Theoretically we should
always run barefoot, but theoretically I once tried to run barefoot on an old lava bed
and afterwards my feet were in terrible medical shape. If we all lived on golf courses
or soft dirt and the temperature was mild, then running barefoot should always be the
option chosen. Since that is not the case, let’s look at our feet the way we look at
our hands.
Certainly we can agree that our hands have evolved to move without outside support
or protection. With the exception of sufferers from circulatory or skin diseases, I
don’t know anybody who would wear gloves on a nice, bright, sunny day. But I also
don’t know many people who would intentionally walk outside on a freezing cold day
or grab a hot pan off the stove without protecting their hands. Shoes and gloves are
used to cover similar parts of the body. Neither shoes nor gloves should be seen as
“tools”, rather they are pieces of clothing that allow us to go places and accomplish
tasks that we could not do otherwise comfortably or safely.
The authors close their article with a list of about a dozen questions about barefoot
running that still need to be more thoroughly addressed.
See list here:

See List Here
And here are Dr Mark's answers to their important questions, or what I think they will
be, if and when the research eventually has been done.
–It is preferable to barefoot, because that is our natural condition, the one in which
we have evolved over millions of years to exist.

–There are certain advantages that can only be gained from being barefoot. There
are, however, situations which should encourage us to wear minimal protection, just
enough to prevent injury from the surface or the elements.
–Minimal shoes should not restrict our natural range of movement.
–Alternating between barefoot and minimal shoes should allow us to retain the
benefits we have gained from being barefoot.
–Just because one is barefoot or wearing minimal shoes does not mean that person
will necessarily have good running form, but wearing a traditional shoe precludes this
–The potential dangers associated with wearing traditional running shoes far
outweigh the temporary problems connected with switching from traditional shoes to
barefoot or minimal shoes and these problems can be lessened by providing for an
adequate transition.
–The philosophy we have towards being barefoot and wearing minimal shoes should
be applied to the rest of our lives, not just the time when we are exercising.
I think all of the questions posed by Allison Altman and Irene Davis will be answered
sooner rather than later. Judging from the number of recent publications, there are
so many more scientists interested in the different aspects of running barefoot and
minimal footwear than there were even two years ago. There are also millions of
“experiments of one” who are providing anecdotal accounts that will spur further
research. The next few years should be exciting for all runners.
Injury Part1, Understanding Why You're Injured

Injury Part1, Understanding Why You're Injured

– Sports Injury Causes:
Understanding WHY You’re Injured
Great piece of information in 4 parts to help you understand what why when and how. The
author Steve Gangemi is Globally recognized as an exceptional authority on this subject.
Please see his own site at
Welcome to the four-part Sock Doc series: “First Aid for Injuries” designed to help you
understand sports injury causes, how to prevent them, how to treat them naturally, and
how to become a better athlete.

I hope you’ll gain a lot of knowledge from these four
articles that will further emphasize the Sock Doc philosophy of natural injury treatment
and prevention. There’s a reason why you’re injured and it’s not because you forgot to
ice, stretch, or take your NSAIDs with your Wheaties. You’ll learn: why and when to ice;
if you should use heat; why you should think twice about your anti-inflammatory
medications; other therapies you can use for an acute or chronic injury; and a whole lot
more. I hope you enjoy this unconventional and highly effective information as it will help
make you a healthier, stronger, faster, efficient, and injury-free athlete.
When you’re injured, (recent – acute injury), there’s a natural inflammatory response that
occurs in your tissues as blood and other fluids enter the area that needs attention. Pain
soon follows, letting your brain know that something is not right. This pain is a protective
mechanism so you hopefully don’t cause any more unnecessary damage. The
inflammatory response initiates repair of the injured area – whether it’s a bone, ligament,
tendon, or any other body tissue. This is NORMAL and NECESSARY – so the question
is not only if you should use ice, heat, or other type of therapy, but how much should you
be intervening with the normal workings of the body, especially to the extent of taking
drugs such as anti-inflammatory medications.
Once you’re injured the questions arise like wildfire. Do you ice that injury or heat it? Or
if you use both ice and heat – which one comes first? And how long and how often do
you apply the therapy? Maybe you shouldn’t be using ice or heat at any time. Do you
wrap the injury and elevate it? Do you stay off the injured area or get in some active
recovery? How about anti-inflammatory medications (NSAIDs)? Should you take them
when you’re injured? Should you take a NSAID to speed up your recovery?
I’ll break this down and discuss how to properly use some different types of readily
available therapies to treat an injury, both chronic and acute. But first, to understand
what type of treatment you might want to employ, it’s important to understand what is
going on inside your body when you’re injured, and of course – how did you get injured?

“That Injury Came Out of Nowhere”

Injuries don’t just come out of nowhere with the obvious exceptions of trauma and
accidents. You may have been in a motor vehicle accident, crashed your bike, got
clipped during a soccer game, or slipped on a mossy rock while trail running. These
types of injures can of course happen to anyone at anytime involved in certain sports or
activities, though the extent of injury and the way in which it heals is highly dependent on
the health of the person, which I will elaborate on in a moment.
For the most part, there is a reason why you’re injured – it wasn’t just bad luck. This is
one of several key teachings of the SockDoc site. You don’t just all of a sudden wake up
with neck pain for an unknown reason or because you slept wrong. You don’t just
happen to have knee pain when you’re out running one day because of the road or trail
you ran on. And you definitely didn’t injure that muscle or joint because you were not
adequately stretching the area or applying ice properly after your workout.
What did happen however is that your body had created various muscle imbalances in
response to some, or several, stressors to your musculoskeletal and nervous systems.
These stressors affect your entire body, but localize in a certain area, (now known as
your “injury”). An athlete’s body can only handle so much stress; it will ultimately break
down. Theses stressors are due to training too hard or too often, inadequate rest or
recovery, improper diet, improper footwear, past injuries still creating compensatory
patterns in your body, or too much emotional stress in your life. Eventually the muscle
imbalances reveal themselves as pain, inflammation, and an injury.

Additionally, most of these same stressors result in both antioxidant depletion and
corticosteroid depletion – both major predisposing factors when it comes to an injury.
(Corticosteroids are adrenal hormones – the same ones you need to balance blood
sugar and electrolytes in your body.) So the more stress you are under and the more
free radical damage present, not only are you more likely to become injured, but the
worse the injury will be, and the slower it will heal. This is discussed over and over on
the SockDoc site because it is the main reason WHY athletes get injured. It’s a huge
concept to understand and one that conventional medicine for the most part still doesn’t
quite grasp.
So, now that there’s an injury – what’s your body’s response?

Inside the Injured Body – The Inflammatory Response:
Antioxidants, Fats, Stress Hormones

Most people understand the process of inflammation at least at a basic level, that’s why
they think about ice and anti-inflammatory medications. Your body is trying to repair the
tissues that are injured so you can recover as quickly as possible. Inflammation is too
often thought of as this terrible thing though it is very important and very necessary for
health and healing. It’s when inflammation gets out of control and your body doesn’t
know when to shut it off that problems arise. Also a body that doesn’t produce adequate
inflammation may never fully heal.
The inflammatory response initiates repair but its success is very closely related to how
healthy you, the athlete, are. Though there are several factors involved in the
inflammatory process, the two most important nutritional factors to consider in regards to
inflammation are fatty acids and antioxidants. There are those antioxidants again.
A healthy fatty acid profile is a sure way to help your body recover from any injury in the
most efficient and timely manner. This will be discussed more in Parts III and IV of the
Sock Doc First Aid. Antioxidant depletion, which was one of the predisposing injury
factors just discussed, is the other major aggravating factor when it comes to the
inflammatory response. The more free radical damage you’re suffering the worse the
inflammation and injury will be. Typically, the same factors that set someone up for the
injury, (those stressors mentioned above), are the same ones that will rob your body of
antioxidants, making you both more susceptible to an injury and dictating the severity of
the injury. Sure eating antioxidant-rich fruits, vegetables, and herbs will help with free
radical damage but it’s also important, (perhaps more so), to recognize those factors
which rob your body of antioxidants – poor sleep, excess stress, environmental stress
(air, water, sun, temperature extremes), poor diet, etc.

“Damn, I’m Injured”

Well that sucks. So now what do you do? (This is the #1 SockDoc question regarding a
variety of injuries.) The first thing to do is realize WHY you got injured. No need to go
through that again, right? Nope. If you understand the why then you can not only handle
the injury correctly but keep it, and other injures, from occurring again. So if you really
think you got injured because you didn’t stretch or you ran without your orthotics or your
lucky rabbit’s foot fell out of your nutrition bag, then this is where you stop and read from
the beginning as well as some other stuff on the SockDoc site to get a better
understanding of my “madness” before you move on.
There are two common “go to” therapies that the injured athlete uses – ice and antiinflammatory
medications (NSAIDs). I rarely use ice (or heat) and I never use NSAIDs
when treating an injury of any type. There are reasons why I don’t use these therapies
often or at all, which will be explained. First – should you use ice, heat, or RICE, and if
so then when and how often? Second – should you use NSAIDs? Or perhaps more
accurately, why would you not want to use NSAIDs?
I’m going to discuss the ice/heat quandary in Part II and NSAIDs in Part III and IV. Stay
tuned but until then think about any excess stress in your life and whether you’re at risk
of antioxidant depletion, corticosteroid depletion, or fatty acid/inflammatory problems. If
you are at risk then begin by addressing those stress issues so you reduce your
chances of becoming injured as well as heal and recover faster from an existing injury

Injury Part2, Ice Heat or RICE

July 24, 2012 by Sock Doc
Okay, you’re injured. Now what? Do you apply ice, heat, or “RICE” for injury treatment?
In Part I of the Sock Doc First Aid For Injuries you learned WHY injuries occur. Injuries
don’t just come of of nowhere; they’re there for a reason and typically they are from too
much lifestyle stress.

Now here in Part II you’ll learn what to do and what not to do if
you’re unfortunate enough to sustain an injury.

Ice That Injury!?

The general idea and recommendation is to ice any acute injury, (that’s one that recently
occurred). But do you really want or need to? If your body is trying to promote some
natural and normal inflammation in the injured area won’t ice screw this process up and
delay healing? Ice very well may do just that especially if it’s used excessively.
Remember, you won’t heal without inflammation – it’s the first step of healing followed by
repair and remodeling of the tissue. If you screw up step one you will screw up healing.
Yeah, you will screw it up with ice.
Ice treatments (cryotherapy) are overused in regards to injuries. Using ice is much like
stretching – there’s no evidence that it works to promote healing and it “helps” unhealthy
people. Really it dampens the pain, providing temporary relief, (again, just like
stretching), – not actual benefits. Ice will increase lymphatic congestion as well as
dampen the connection between your nerves and muscles, thus delaying normal
You have to make a decision regarding just how much you want to calm down
inflammation. Clearly if inflammation is out of control and your body is creating more
inflammation than what is needed, then ice may help out in the short term. But when the
body becomes more inflamed than what is “normal” it’s often because that same body is
already dealing with inflammation day in, day out and that has a lot to do with antioxidant
depletion and stress, as discussed in Part I. There are of course exceptions such as
heavy trauma to a joint, but in general this is true for the typical injuries athletes sustain
that put them on the sidelines (or couch). A healthy person will not have excess or
unnecessary inflammation to the point that they will need to ice an injury at all. I’ll
discuss more about inflammation in Parts III and IV.

Ice, Ice, Baby

Ice is the typical conventional medicine go-to when it comes to an acute injury,
especially in the first 24-48 hours after an injury occurs. After several days it might be a
good idea to back off, or discontinue and let your body take over its own healing if
you’ve decided that you just have to ice because the paradigm has been burned into
your brain that it’s so important, (hey just like stretching again – okay, enough of that).
Again, the healthier you are, the less ice you’ll need and want to use because you’re
only going to make mattes worse. If your swelling and pain progress to the point that
you’re unable to keep the inflammation down without ice then it may be time to consider
other therapies or the advice of a professional.
If you’re going to use ice because your inflammation is out of control, here are some
general guidelines:
1) Never apply ice directly to the skin – a moist towel or cloth helps transfer the
cooling and protects your skin from burning. Frozen veges work well too.
2) Keep the ice on until you get a deep ache – slightly painful. This occurs just before
the area goes completely numb. You’ll get the most “benefit” from the ice if you hit the
point of the ache but not past that; typically this is 15-20 minutes. Again, this benefit may
not be the one you think (healing), but pain control and perhaps dampening excess
3) If you ice too much or too often you can increase muscle damage. Remember
you’re going to delay healing using ice!

Ice for When There Isn’t an Injury

Though ice isn’t ideal for an injury there are still times when it can help an athlete out.
Ice and Endurance
Drinking ice water can lower your core temperature enough during training or racing on
hot days to boost endurance. And putting ice on highly vascular areas during a race can
be very beneficial too. I, as well as other endurance athletes, have seen the benefits of
dumping an ice cold cup of water down the front of the shorts while passing through an
aid station. After the initial shock it’s a good feeling!
Ice or Cold Baths for Recovery
Cryotherapy in the form of ice baths isn’t recommended for recovery and icing an area of
soreness has not been linked to reducing delayed onset muscle soreness (DOMS), but
cold baths may be beneficial. Cold baths or showers can help speed recovery – but
don’t sit in a bucket of ice – you’re not trying to numb your body. If you have an area of
your body that is tight or sore, say your calves, then you may help the healing and
recovery by standing in a cold bucket of water. Again, you’re not trying to numb your
legs/feet – but just provide a cool, relaxing sensation. Make it cold enough so the ice
slowly melts in the water.

How About Heat for That Injury – or Mixing Ice & Heat?

Heat therapy is often recommended for more chronic types of injuries. These are injuries
that are still a problem weeks, months, and even years later. Of course, if you’re still
injured after several months, or even weeks, then using heat as a remedy is at best only
providing temporary relief. You never want to apply heat to an acute injury or an area
that is inflamed – that would often make matters worse. When in doubt, don’t use heat!
Sometimes heat can provide some benefits other than pain relief by bringing more blood
and lymph flow to an area, but compression and trigger point therapy are much more
effective when it comes to a chronic (as well as acute) injury. More on this in a bit. Heat
is also very ineffective at penetrating deep into the body’s tissues. After about onequarter
inch into the body, heat can typically only raise the tissue temperature a mere 2
degrees Fahrenheit.

Warming-Up With Heat

Some recommend using heat during a warm-up to loosen up tight joints and muscles. I
can see a value here to some degree, such as for a person with very arthritic knees, for
example, who cannot walk very well without heating their knees first. However, aerobic
exercise including some tissue work, (light to moderate massage), around the involved
muscles are typically much more effective. Aerobic exercise should always be part of a
warm-up of ANY activity.

Contrast Therapy

Some physicians and therapists recommend alternating ice and heat, (ten minutes ice,
ten minutes heat), for various injuries. This is called contrast therapy. The belief here is
that there will be a more powerful effect on dampening the pain pathways present during
an injury, essentially altering the physiological response. Personally, I don’t recommend
this type of treatment because it does only just that – dampen pain. Though better than
taking pain medications, there really is no beneficial healing with contrast therapy.

RICE for Injury Treatment – Maybe Not

RICE is an acronym for Rest, Ice, Compression, and Elevation. RICE is an okay way to
deal with an acute injury but it’s not the best. Remember, you’re going to delay healing
with ice and the R-C-E is a not ideal either.
The ‘R’ for “rest” doesn’t necessarily mean you completely immobilize the joint.
Depending on the injury sustained, active rest may be more beneficial and often is.
Movement is good for an injury to a certain degree. Don’t try to push through the pain
though; you’re more than likely only going to delay the healing and perhaps create
injuries in other areas of your body. Obviously you don’t want to be mobilizing a broken
bone but lightly contracting the muscles around the area can speed up healing.
Compression is very important which means just that – compress the area but don’t cut
off circulation. You want a fair amount of pressure on the area. This can be
accomplished via wrapping the area with a bandage or even using your hands to hold
pressure over the injured area; obviously though you can’t keep your hands there
forever. Although you don’t want to treat the area that is injured in the form of a deep
massage, (which can also bring unwanted heat and more inflammation to the area),
compressing the area around the sustained injury can be very beneficial. This is similar
to the trigger point therapy techniques I discuss throughout the SockDoc site, but you
don’t want to or need to apply too much deep pressure. There may be some slight
discomfort but not pain!
Even better than just compression may be contracting/relaxing with the hands, (as in
pressing and releasing muscle points for a few seconds at a time), as this can help to
mobilize lymphatic tissue and remove the waste products thereby speeding up
healing. Also remember that, as I mention in the many videos and posts on injuries, you
want to be aware of the muscles supporting the injured area. So if you sprained your
ankle, then look for those points in your calves – and assess/treat that area. If you
injured your knee, then look for areas of tenderness throughout your thigh (quads),
hamstrings, and calves to work on. Actually in these other “non-injured” but supporting
areas you can use more aggressive trigger point therapies. Rest and elevate as
necessary too! Elevation is fine but as you can see compression/contraction and (active)
rest are the best for an injury; so RICE is about half right!

First Aid Overview: Think Twice Before You Apply the Ice

Using ice will delay normal healing. Though it will dampen pain, it is only going to
perhaps help the athlete who is dealing with excess inflammation. If you use ice, do so
wisely and make sure you’re also treating the injured area with more effective treatment
therapies such as compression and trigger points, (depending on the severity of the
injury), and resting as needed and actively as much as you can. If you’re using ice to
constantly dampen the pain or reduce swelling in an injured area, then realize you’re not
addressing the source of the injury and you’re not properly healing. Rarely should heat
be used on an injury and never on an acute problem or area of inflammation. And of
course have your injury checked out by a qualified physician or therapist if you’re not
healing properly or if there is any question and/or concern regarding the extent of
damage you sustained. Don’t be that guy (or gal) who iced and wrapped their broken
foot for weeks before having it checked out!
Hey – how about those anti-inflammatory drugs (NSAIDs)? Will those help heal your
injury faster or help you recover faster from training or racing? That’s up next in Part III.

Injury Part3, Inflammation Embrace It & Control It

Injury Part3, Inflammation Embrace It & Control It

August 4, 2012 by Sock Doc

So you’re (still) injured but now you hopefully understand why you’re injured. As
discussed in Part I of the Sock Doc First Aid For Injuries, if you didn’t have some sort of
traumatic accident then your injury was slowly developing over time due to muscle
imbalances which resulted from too much stress in your life. Now, perhaps the injury is
not healing at all or healing very slowly and you’re into the chronic stages where
compression and body work, (discussed in Part II) don’t seem to be helping anymore,
and resting (even actively), is only making you less fit. So you turn to the dark side –
drugs. I’m not talking about any of the pain-management medications (or illegal drugs)
available, but anti-inflammatories.

Should you take a non-steroidal anti-inflammatory drug (NSAID)? Before you try any
type of therapy, especially a drug therapy, you should have a basic understanding of the
mechanism behind the action – why they (may) work. You should also be aware of the
risks involved too. The one sort of nice thing about NSAIDs is that if you feel better when
you take them then you know your chemistry is off – your fatty-acid metabolism is not
functioning optimally. To understand this, you first must understand a bit of biochemistry.
As always, I’ll make it fun and applicable towards real-life situations, (I hope).

Eicosanoids and Inflammation:

To understand how a NSAID works, you must understand a bit about something called
an eicosanoid, (pronounced: eye-kah-sah-noid). An eicosanoid is a hormone-like
substance made from two long chain essential fatty acids, alpha-linolenic acid (ALA, an
omega-3 fatty acid) and linoleic acid (LA, an omega-6 fatty acid). The primary role of the
eicosanoids is to regulate immunity and inflammation within the body.
There are three groups of eicosanoids that are important when it comes to
understanding inflammation causes and treatments. Two of these groups are more antiinflammatory
and for simplicity I’ll call them Group 1 and Group 3. The other group,
Group 2, is more pro-inflammatory. All three groups are important – some inflammation
is normal and necessary in the body especially during an injury, (discussed in Part I and
II of the Sock Doc First Aid).
Group 1 eicosanoids are derived from the omega-6 fat Gamma-linolenic acid (GLA)
which is formed from linoleic acid (LA). These fats are commonly found in vegetable oils
and nuts/seeds (the oils of such), whether raw or refined. They are typically a more antiinflammatory
Group 3 eicosanoids are derived from the omega-3 fats of Eicosapentaenoic acid (EPA),
which alpha-linolenic acid (ALA) can create. ALA is abundant in flax seed oil and
walnuts while EPA is commonly found in the oil of fish and other sea creatures (algae).
They are also a more anti-inflammatory eicosanoid.
Group 2 eicosanoids are derived from what is known as arachidonic acid (AA), a proinflammatory
eicosanoid. AA is obtained in the diet from red meat, dairy, shellfish, and
eggs. The amount of AA is greatly dependent on the diet of the animal which produced
that food, or is that food. AA can also be synthesized from the omega-6 LA, (vege oils),
converting it a pro-inflammatory eicosanoid, (whereas LA is an anti-inflammatory fatty
acid if it converts to GLA), and this as you’ll soon see is a major problem especially
when dealing with injuries.

Balanced Eicosanoids Means Controlled Inflammation

So why is the biochem lesson important? It’s actually very important because if your
eicosanoids are balanced then you’ll be very successful at creating enough inflammation
to heal and calm down inflammation when your body has had enough. A healthy
immune and nervous system need balanced eicosanoid levels too.
You can see that if you have too many of Group 2 eicosanoids (AA) and not enough of
Group 1 (GLA) and Group 3 (EPA) then your body will be in an inflamed state. This
alone can create an injury, (a biochemical-type of injury), and if/when you sustain an
actual physical-type of injury, that pain and inflammation will be much greater than if
your three eicosanoid groups were in a normal and healthy balance with one another.
So how do you balance your eicosanoids? You primarily do so through diet. Though
many say that this is easily done by eating more of Group 1 and 3 foods and less of
Group 2 foods it is not that simple, (though not that complex either). You can’t simply just
eat a lot of veges, nuts, and seeds and pop some fish oil capsules to have stellar antiinflammatory
Groups 1 & 3 and consume little to no Group 2 fats which are more proinflammatory.
Sorry, but there’s a bit more to it than that.

There are two reasons why this thought process doesn’t work. One reason is that the
more pro-inflammatory Group 2 (AA) can be made from the anti-inflammatory Group 1
(GLA), as previously mentioned so you’ll create inflammation if you eat too many Group
1 fats. (WHAT?! – You’ll see why in a bit). Another reason is that Group 2 (AA) is not as
bad as it’s made out to be; you need a certain amount of AA fats to be healthy and heal
from injury. After all, as you hopefully know from reading other Sock Doc articles, I’m a
big proponent of Group 2 fats – pasture raised red meat, free range eggs, and organic
dairy (heavy cream and butter – yum!). Confused? I hope not – read on!

Arachidonic Acid Has Its Nice Side

Arachidonic acid (AA), that “more” pro-inflammatory fatty acid, is vital for good health
especially when it comes to the nervous system. AA is perhaps the most important fatty
acid in respect to a developing human being. Along with DHA from fish oil and other
marine lipids, (as well as breast milk), AA is the most abundant fat in the brain. AA
protects the brain from oxidative stress – that’s free radical damage. Hey do you
remember in Part I of First Aid For Injuries that oxidative stress was a predisposing
factor when it came to inflammation? Now hopefully you see the link and the importance
of some AA fats in your diet. AA is also necessary for the repair and growth of skeletal
muscle tissue. That’s right – it helps with repair and growth of tissue – that’s an anabolic
process and a necessary one when it comes to an injury.
The key to healthy AA though is to make sure you don’t have too much and that you’re
getting it from the right sources. Actually consuming foods high in AA is very unlikely to
increase inflammation. Put another way, eating red meat, dairy, shellfish, eggs, and
other foods touted as “unhealthy” because of their AA levels will not make you more
inflamed. But more AA that is derived from Group 1 omega-6 fats will make you
inflamed, and this is the most important part of this entire story/lesson.

Carbohydrates and Stress Increase Inflammation

As you just learned, it’s how AA is derived (and also metabolized) in the body that
dictates whether it is pro-inflammatory or an anabolic eicosanoid that will benefit your
health, fitness, and potential injury. The way to increase inflammation in your body is by
increasing the amount of AA your body makes from linoleic acid (LA), the omega-6 fat.
Unfortunately, this process occurs very easily.
High insulin, as a result of a high carbohydrate diet, and high cortisol, from excess
stress, are the two main ways a person will convert their LA to AA. When LA is
converted to AA due to such reasons, (and there are others too, such as smoking and
alcohol), the process if very fast and inflammatory. As you may have now realized, high
carbohydrate foods are those same foods that often contain high levels of the omega-6
oils, (corn, safflower, soy, sunflower, peanut, and other cooking oils). So a person
consuming breads, cookies, pastries, and other baked goods will increase their insulin
level and their LA level, which will then convert to the inflammatory AA fats. That ain’t
good, it’s an inflammatory storm.
Stress, as you know, increases cortisol levels. Although a normal amount of stress is
good as are normal levels of cortisol throughout the day, increased and unleashed
stress can spike cortisol levels and leave them high for hours, days, and even months or
years. The increased cortisol will also take the anti-inflammatory LA fats (Group 1) and
convert them to pro-inflammatory AA (Group 2) fats. Reducing stress will reduce cortisol
levels and reduce inflammation and that also has a positive impact on antioxidant levels
which are so important when it comes to injury prevention and treatment; (remember
that in Part I?) That means resting and recovering well, (not overtraining), building a
solid aerobic base, modifying your lifestyle (emotional stress), and of course eating a
proper diet, will help you naturally fight inflammation and repair tissue. You’ll heal up
faster than anyone could have ever expected!
So do you take that NSAID? That’s next in Part IV along with several ways you can
naturally tame inflammation in your body. But until then, whether you’re injured or
concerned about getting injured, consider removing all refined polyunsaturated
vegetable oils from your diet as well as most if not all refined carbohydrates to lower
inflammatory levels. Next, evaluate the stress in your life to help normalize stress
hormone levels and naturally decrease free radical damage, both of which can
predispose you to injuries.

Injury Part4, NSAIDs Friend or Foe, Good or Evil

Injury Part4, NSAIDs Friend or Foe, Good or Evil

August 14, 2012 by Sock Doc

If you’re injured do you take an anti-inflammatory medication commonly known as
NSAIDs? After all, as you learned in Part III of the First Aid for Injuries, some
inflammation is necessary and normal when you’re injured. Inflammation is all about
balance – if it’s out of control then you have several aggravating factors I discussed in
Part I. Is it better to take a NSAID just in case?

Should you take one as a sort of
“prevention” even if you’re not injured? This is the big question, (I hope you didn’t
forget), especially since athletes love to take NSAIDs. Before you decide, it is important
to understand the effects of NSAIDs and how they work.

Now How About That NSAID?

In the 2008 Brazil Ironman 60% of the athletes said they used some form of NSAID in
the previous three months before the race. In the 2000 Olympics 25% of the athletes
used them up to three days before their event. Clearly the majority of athletes are
suffering some type of injury often or they feel as though the NSAID will give them a
competitive edge; I once thought this too. Well, there’s one final thing to understand and
that’s why these NSAID drugs work and that has to do with an enzyme called
cyclooxygenase, or COX for short. Once you understand this you’ll see why taking a
NSAID can be “beneficial for some” when it comes to an injury but also how they can
hinder healing and actually provoke more inflammation.

COX Enzymes and Inflammation

COX enzymes are important for the conversion of Group 1, 2, and 3 fats to their
respective eicosanoids, (review here in Part III). There are two COX enzymes but it is
the COX-2 that affects the eicosanoid production. NSAIDs simply block (inhibit) the COX
enzymes from forming all three eicosanoids – both Group 1 and 3 (anti-inflammatory) as
well as Group 2 (pro-inflammatory, usually).
If you feel better, (your symptoms are improved), when you take a NSAID (aspirin,
ibuprofen, naproxen), then your fats are out of balance; you’re feeling the effect of the
NSAID lowering the high level of Group 2 (AA) because you have too much
inflammatory AA in your body which as you learned in Part III is from too much stress
and refined carbohydrates and vegetable oils – not healthy fats from red meat, eggs,
and dairy. You can also see that the NSAID will lower the anti-inflammatory eicosanoids
production too, but typically when a person is dealing with inflammation they have low
levels of Groups 1 & 3 anyway so they reap the “benefit” of the pro-inflammatory Group
2 inhibition.
Now this also means that if you take a NSAID to try to fight an inflammatory condition
you could actually make matters worse by increasing inflammation! This occurs when
your levels of Group 2 AA fats are normal as are your Group 1 & 3 eicosanoids. Taking a
NSAID will now have an effect on Group 1 & 3 essentially lowering anti-inflammatory
levels while blocking normal and necessary anabolic action from the Group 2 AA fats.

Acute Trauma and Effects of NSAIDs

How about a NSAID during the acute phase of an injury, especially trauma? Sure,
NSAIDs can be of “benefit” here regardless of whether your fats are balanced or not.
This is because the NSAID will block the COX enzyme which forms a prostaglandin,
which is one type of eicosanoid. Prostaglandins levels are increased naturally in
response to trauma so limiting or lowering their formation via a NSAID may help only if
there is excess inflammation or your body doesn’t know when to shut-down the
inflammatory process, (because you’re unhealthy). Prostaglandins are there to help
repair that damaged tissue and form collagen – the building blocks of muscle tissue.
Remember, you don’t want to mess around with this natural process, at least not too
much, so more isn’t better and some isn’t necessarily advised. I never use NSAIDs,
(myself or in practice), because if the fats/eicosanoids are balanced then your body can
quickly adapt and adjust. Now of course if you sustained a very traumatic injury with
widespread inflammation or life-threatening aspects I’d surely consider using a NSAID to
get out of the danger zone, but very little and only on a case-by-case basis. But you
don’t just stay on these drugs as they can be, and are, dangerous.

NSAID Dangers

Yes, NSAIDs have their dangers. Many may remember back when Vioxx and other
COX-2 inhibitors were pulled off the shelf only to be put back on the market later. Next,
from trusty Wikipedia: “An estimated 10-20% of NSAID patients experience dyspepsia,
(that’s indigestion), and NSAID-associated upper gastrointestinal adverse events are
estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United
States, and represent 43% of drug-related emergency visits.” Wow. And think about how
many more people have other adverse reactions from a NSAID – documented as well as

Other types of GI symptoms can result from NSAID use as well as renal (kidney),
cardiovascular, and nervous system problems. NSAIDs also deplete the necessary
sulfur in your body that you need to repair your joints.
I’ll add in my personal story of the days when I used to take NSAIDs. I used to take
NSAIDs during my early years racing Ironman, particularly the mid-late 1990s. In 1999,
while I was racing Ironman USA, (the inaugural Lake Placid, NY race), I crashed my bike
at the start of the second loop, right at mile 56. The bike wasn’t in bad shape, but I had
some good cuts and road rash on my thigh, arm, hand, and ankle. Back then I carried
Aleve while I raced, (yeah I didn’t know any better). So I took the Aleve, (naproxen), and
I took more, and more. I continued to take the Aleve throughout the rest of the race, and
I raced well enough to qualify for Hawaii. So it was a good day, despite all the pain,
which was dampened by the Aleve and high level of cortisol while racing. The next day
my urine was bright red, and there was blood in my urine for the next several days, (that
I could see anyway). I clearly caused some (temporary) kidney damage, made worse by
“normal” Ironman race dehydration. I’ve never taken a NSAID, (or any other medication),
Even a low dose NSAID can cause problems mentioned including slowing down the
normal repair of muscle, bone, and other tissue. Additionally, NSAIDs may not only NOT
reduce inflammation, but increase inflammation in your body by triggering a reaction of
another type of eicosanoid that is made from AA – leukotrienes. Leukotrienes can be
several hundred times more inflammatory than a prostaglandin and are known to be
common triggers of asthma. So don’t think that a NSAID will only help and never hinder;
that is often not the case as they can have the very opposite effect/reaction. This is
especially true if you’re healthy and your fats are balanced and hopefully they are!

Balance Your Eicosanoids – You Don’t Have a NSAID Deficiency

To make “natural NSAIDs” in your body you need to balance your eicosanoids. As you
have learned, much of this is achieved through diet and lifestyle stress management.
This article, long as it may be, could be a book in itself but I’ll end this with ten key
points/steps you can take to achieve healthy levels of anti-inflammatory Group 1 and 3
eicosanoids and healthy levels of pro-inflammatory anabolic Group 2 arachidonic acid so
you’re naturally anti-inflamed and ready to heal.
1) Limit or eliminate those refined omega-6 vegetable oils (corn, safflower, soy,
sunflower, peanut, and even canola to a degree). Get your healthy omega-6 fats from
vegetables and unrefined, raw nuts and seeds; (Don’t go crazy on nuts and seeds and
“eat them all day” either.) Taking a supplement high in GLA may sometimes be of benefit
– the best sources being borage and black currant oils.
2) Eliminate all partially hydrogenated “trans” fats from your diet – these actually
block Group 1 and 3 eicosanoids but not Group 2, and you know what that means (I
3) Lower carbohydrates especially the refined carbs. Lower carbs means lower
insulin and that means less inflammatory AA
4) Lower cortisol (stress) levels. Lower stress means lower cortisol and that means
less inflammatory AA. Read the Sock Doc Training Principles to understand aerobic vs.
anaerobic (and so much more!)
5) Consume pasture-fed beef, free range eggs, cream, and butter to achieve healthy
and desirable levels of AA. Extra virgin olive oil is also a great fat to consume too,
though monounsaturated and not an essential fatty acid (EFA), it’s still important for
good health as are fats found in coconut oil, coconut milk, and 80% or higher cocoa
chocolate. Eat them up!
6) Consider a fish oil supplement to increase Group 3 eicosanoid levels. Flax may
work too, but it has to be converted by the body to EPA, and there are many ways this
can be blocked, some of which are genetic. And too much EPA can create oxidative
stress and even inhibit healthy levels of AA, neither of which is good. So don’t go crazy
on fish oil supplements – I typically recommend the healthy athlete take one tsp or a
couple capsules a few times a week.
7) Sesame seed oil contains a compound called sesamin, which is great at blocking
LA from being converted into AA, especially in the presence of high insulin levels. I use
unrefined sesame seed oil a lot with patients with this problem, but I also make sure that
they correct the problem by not continuing to eat a lot of carbs (sugar) and vegetable
oils. 1-2tsp a day can help.
8) Certain nutrients, such as vitamin B6, magnesium, zinc, vitamin C, and
niacinamide, are needed for proper eicosanoid production. A deficiency can mean you
don’t make them!
9) Herbs such as turmeric, boswellia, and quercetin can help fight inflammation too –
10) Aspirin, or any other NSAID, is NOT a vitamin. You will never have an Aspirin
This concludes the four part Sock Doc First Aid For Injuries Series. I hope you
learned a lot and have made further progress in your overall health and fitness

Knee Pain, No Need For It

No Need For Knee Pain – Running, Cycling, or Anytime

June 13, 2011 by Sock Doc (

Knee pain is a common complaint for many runners, cyclists, and triathletes leading
them to succumb to pain medication, anti-inflammatories, knee braces and other
contraptions just so they can continue pushing through the miles. From elite athletes to
fitness walkers, an individual may be told they have bursitis, tendonitis, arthritis,
chondromalacia patellae, iliotibial band frictional syndrome, a meniscus problem or some
other ailment as their diagnosis gives a name to the problem but does absolutely nothing
to treat the condition or tell them how it even occurred in the first place.

The balance of the muscles surrounding the entire knee joint is essential for the knee to
function normally, as well as to provide maximum power and strength. Starting in the
front of the leg, the quadriceps make up the majority of the musculature as well as the
patellar tendon. Often athletes are told they have tendonitis if there is pain below the
kneecap or bursitis if there is pain above the kneecap. The integrity of the quadriceps
and their balance with the hamstrings and gluteus maximus muscles is of utmost
importance. With respect to gait, fatigued (“weak”) quads will cause an athlete to run
with an exaggerated kick back with each push-off. Another symptom of fatigued quads is
a feeling of weak knees or thigh muscles when climbing stairs, or being unable to stay in
a squatted/kneeling position for a while without pain and/or discomfort in the thigh or
knee itself. Often this is because the quads are working too hard because the powerful
gluteus maximus muscles are not functioning correctly, perhaps from injury, overtraining,
or some disturbance in the gait.
Deep inside the very lower front part of the thigh muscles, just on top of the femur (thigh
bone) lies a very small, but sometimes very troublesome muscle called the articularis
genu. It is many times overlooked in knee problems, especially those chronic in nature,
and can be a major culprit with what may appear to be bursitis-like problems. Deep
trigger-point work on this muscle can sometimes be of great benefit, allowing the muscle
to heal. But sometimes that fluid-filled sac between the tendon and the bone can be
inflamed, which is called bursitis. If it’s on back of the knee, it’s known as a Baker’s Cyst.
Bursitis must be treated differently than tendonitis, though often a person is given a pain
drug and/or anti-inflammatory drug for any problem, hoping for the best. To heal the
bursa, one needs optimal calcium metabolism; this is the key point for bursitis. This does
not just mean that calcium needs to be available in the body, but the proper balance of
fats is also needed to drive the calcium into the soft tissue to heal the bursa. It is the
fatty acid balance that most people don’t have in their favor.
Optimum fatty acid balance means two basic things – no harmful fats and plenty of the
healthy ones. Harmful fats are the partially hydrogenated fats, commonly referred to as
“trans” fats as well as excess vegetable oils. Trans fats are listed as shortening,
margarine, and as partially hydrogenated corn, vegetable, soy, cottonseed or some
other oil on a package. These fats cause a lot of inflammation and block essential
enzyme reactions from occurring while also preventing the good, anti-inflammatory fats
from doing their jobs. Even eating them a little bit is a problem because the half-life is a
whopping 51 days. That means after 102 days there is still 25% of the stuff causing
problems and over a year before some people can metabolize all of it entirely. This
pretty much ends the debate whether to eat margarine or butter. Those still eating
margarine because they were told it is better for cholesterol and body weight can see
why it’s beneficial to change to butter and get the laboratory-made trans fat out of the
diet 100%.
Healthy fats are the essential omega-3 and omega-6 fats. Most people are deficient in
the omega-3s because they are primarily from fish and flax seeds, and to some extent
walnuts – foods often not consumed in high amounts. Most eat too many omega-6s fats
found in processed, packaged, and fast food. Healthy omega-6 fats are plentiful in most
vegetables, nuts and seeds, and legumes but the ones found in soy, corn, safflower, and
peanut oils can quickly inflame the body, especially when consumed with too many
carbohydrates. So a good amount of both omega-3, (perhaps supplementing with flax or
fish oil), and omega-6 fats from raw nuts, seeds and vegetables, and a diet absent of
trans fats will allow the body to fight inflammation and recover faster, as well as lower
cholesterol and heart disease risk. And, for the purpose of this topic, it will allow calcium
to be pushed into the tissues to heal inflamed bursa. As a side note, two other
symptoms of inadequate calcium metabolism due to poor fatty acid metabolism are calf
cramps, especially ones at night that resemble “Charley horses”, and cold sores/fever
blisters, including herpes simplex infections. (Yes, these are viral infections, but their
eruption is often provoked by a calcium problem.) Also, although olive oil is a great fat to
eat and should be included in every diet, it is not considered an essential fat because it
is an omega-9.
Tendonitis of knee is perhaps the most common diagnosis given to many runners when
there is pain around the knee that isn’t in the meniscus or the actual muscles. One such
tendon pain is along the iliotibial band, or ITB, and a major complaint that forces many
runners to stop their activity all together, sometimes for many months. The pain, known
as ITB Frictional Syndrome, (ITBS), is a stabbing pain over the outside of the knee, and
sometimes on the outside of the mid-thigh region. Athletes are told to ice it and take
some anti-inflammatory medication (NSAIDs). However, this rarely helps with healing as
many know after the fact if they’ve dealt with this miserable injury. The use of these
NSAID drugs causes a major amount of sulfur depletion in the body, and this is the
same stuff needed to repair the cartilage (such as knee cartilage!) and detoxify
hormones in the liver. Instead of using NSAIDs, this problem can usually be treated
quickly and without the use of medication by evaluating the balance of the muscles
contributing to the pain as well as addressing fatty acid imbalances. Check out the
SockDoc video on ITBS here.
Pain on the inside of the knee is just as common, especially at the area called the pes
anserinus which is just to the inside of the lower part of the knee. This is where three
muscles come together to make up a significant amount of support for the inside of
knee. When these muscles are not working as well as they should, they leave the medial
meniscus open for problems due to the improper biomechanics of the joint. The
imbalance of these muscles, and often pain and/or weakness around the inside of the
knee is usually associated with adrenal gland problems. An athlete will often have this
discomfort along with other adrenal gland related symptoms – dizzy when standing up, a
craving for salt and/or sugar, irritability and blood sugar handling problems, and perhaps
a history of shin splints or plantar fasciitis. Sleep problems as I discuss here, and poor
performance while training and racing are signs that the adrenals are taxed too.
Evaluation of overall stress – training, diet, and lifestyle is of utmost importance.
The muscles of the back of the knee cannot be forgotten as they often are. The
hamstrings as well as the calf muscles are two of the major players here – with such a
great distance these muscles span on the back of the leg, they are very important not
only for the knee, but the foot and low back as well. These muscles functioning
abnormally will cause the athlete to have a foot problem, or a knee problem, or a lower
back or hip problem, or maybe one after the other – or simultaneously. These also tend
to occur from taxed adrenal glands due to too many of life stresses at once, or excess
anaerobic activity, or a poor diet.
And let’s not forget how important footwear is and the mechanics of the feet when
dealing with knee pain too…
Proper pronation of the foot, a major source of shock absorption, and the muscles of the
foot are extremely important for the health of the knee. If the foot is not functioning
optimally then the knee takes a lot more stress than it is able to handle leading to
various aches and pains as described above. A strong foot is necessary for a strong
knee, and that means considering minimalist-type footwear and staying barefoot as
much as possible so the muscles, ligaments, and tendons of the feet become strong and
supportive to provide proper proprioception, balance ,and power to not just the knee, but
the entire body.