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 correctly. 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 youre 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 youve 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 stress. 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 dont 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 health. How about specific nutrients to heal? Theres 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 dont 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 youre 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 its 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 doesnt know why the patient has the problem theyve presented with. All it means is that youve 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 dont tell you what exactly is wrong, how you got injured, and they sure dont 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 theyre not going to address the source of the problem. In a stress reaction, much like when there is a stress fracture, youre not dispersing impact correctly throughout the proper areas of the body (typically the foot), so youre 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, its 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
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:
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 ever! I wisely didnt 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 companies. 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, lets 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 inflamed. Q. What can you do to maintain or retain healthy feet and avoid plantar fasciitis? 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 todays 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: http://motioncenterstl.com/minimal-casualshoes- plantar-fasciitis/
Biomechanical Implications for Barefoot Running Injuries
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 todays 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, lets 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 dont know anybody who would wear gloves on a nice, bright, sunny day. But I also dont 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:
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 possibility. 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
Sports Injury Causes: Understanding WHY Youre 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 http://sock-doc.com 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 youll gain a lot of knowledge from these four articles that will further emphasize the Sock Doc philosophy of natural injury treatment and prevention. Theres a reason why youre injured and its not because you forgot to ice, stretch, or take your NSAIDs with your Wheaties. Youll 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 youre injured, (recent acute injury), theres 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 dont cause any more unnecessary damage. The inflammatory response initiates repair of the injured area whether its 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 youre 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 shouldnt 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 youre injured? Should you take a NSAID to speed up your recovery? Ill 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, its important to understand what is going on inside your body when youre injured, and of course how did you get injured?
That Injury Came Out of Nowhere
Injuries dont 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 youre injured it wasnt just bad luck. This is one of several key teachings of the SockDoc site. You dont just all of a sudden wake up with neck pain for an unknown reason or because you slept wrong. You dont just happen to have knee pain when youre out running one day because of the road or trail you ran on. And you definitely didnt 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 athletes 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. Its a huge concept to understand and one that conventional medicine for the most part still doesnt quite grasp. So, now that theres an injury whats your bodys 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, thats 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. Its when inflammation gets out of control and your body doesnt know when to shut it off that problems arise. Also a body that doesnt 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 youre 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 its 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, Im 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 didnt stretch or you ran without your orthotics or your lucky rabbits 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 dont 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? Im 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 youre 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 http://sock-doc.com Okay, youre 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 dont just come of of nowhere; theyre there for a reason and typically they are from too much lifestyle stress. Now here in Part II youll learn what to do and what not to do if youre unfortunate enough to sustain an injury.
Ice That Injury!?
The general idea and recommendation is to ice any acute injury, (thats 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 wont ice screw this process up and delay healing? Ice very well may do just that especially if its used excessively. Remember, you wont heal without inflammation its 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 theres 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 healing. 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 its 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. Ill 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 youve decided that you just have to ice because the paradigm has been burned into your brain that its so important, (hey just like stretching again okay, enough of that). Again, the healthier you are, the less ice youll need and want to use because youre only going to make mattes worse. If your swelling and pain progress to the point that youre unable to keep the inflammation down without ice then it may be time to consider other therapies or the advice of a professional. If youre 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. Youll 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 inflammation. 3) If you ice too much or too often you can increase muscle damage. Remember youre going to delay healing using ice!
Ice for When There Isnt an Injury
Though ice isnt 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 its a good feeling! Ice or Cold Baths for Recovery Cryotherapy in the form of ice baths isnt 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 dont sit in a bucket of ice youre 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, youre 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 youre 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, dont 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 bodys 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.
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 dont 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 its not the best. Remember, youre going to delay healing with ice and the R-C-E is a not ideal either. The R for rest doesnt 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. Dont try to push through the pain though; youre more than likely only going to delay the healing and perhaps create injuries in other areas of your body. Obviously you dont 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 dont 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 cant keep your hands there forever. Although you dont 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 dont 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 youre 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 youre using ice to constantly dampen the pain or reduce swelling in an injured area, then realize youre not addressing the source of the injury and youre 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 youre not healing properly or if there is any question and/or concern regarding the extent of damage you sustained. Dont 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? Thats up next in Part III.
Injury Part3, Inflammation Embrace It & Control It
August 4, 2012 by Sock Doc http://sock-doc.com
So youre (still) injured but now you hopefully understand why youre injured. As discussed in Part I of the Sock Doc First Aid For Injuries, if you didnt 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 youre into the chronic stages where compression and body work, (discussed in Part II) dont seem to be helping anymore, and resting (even actively), is only making you less fit. So you turn to the dark side drugs. Im 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, Ill 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 Ill 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 eicosanoid. 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 youll soon see is a major problem especially when dealing with injuries.
Balanced Eicosanoids Means Controlled Inflammation
So why is the biochem lesson important? Its actually very important because if your eicosanoids are balanced then youll 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 cant 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 theres a bit more to it than that. There are two reasons why this thought process doesnt 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 youll create inflammation if you eat too many Group 1 fats. (WHAT?! Youll see why in a bit). Another reason is that Group 2 (AA) is not as bad as its 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, Im 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 thats 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. Thats right it helps with repair and growth of tissue thats an anabolic process and a necessary one when it comes to an injury. The key to healthy AA though is to make sure you dont have too much and that youre 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, its 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 aint good, its 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. Youll heal up faster than anyone could have ever expected! So do you take that NSAID? Thats next in Part IV along with several ways you can naturally tame inflammation in your body. But until then, whether youre 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
August 14, 2012 by Sock Doc
If youre 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 youre injured. Inflammation is all about balance if its 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 youre not injured? This is the big question, (I hope you didnt 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, theres one final thing to understand and thats why these NSAID drugs work and that has to do with an enzyme called cyclooxygenase, or COX for short. Once you understand this youll 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; youre 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 doesnt know when to shut-down the inflammatory process, (because youre unhealthy). Prostaglandins are there to help repair that damaged tissue and form collagen the building blocks of muscle tissue. Remember, you dont want to mess around with this natural process, at least not too much, so more isnt better and some isnt 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 Id 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 dont just stay on these drugs as they can be, and are, dangerous.
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, (thats 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 undocumented. 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. Ill 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 wasnt 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 didnt 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. Ive never taken a NSAID, (or any other medication), since. 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 dont 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 youre healthy and your fats are balanced and hopefully they are!
Balance Your Eicosanoids You Dont 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 Ill 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 youre 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; (Dont 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 hope) 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), its 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 dont 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 dont make them! 9) Herbs such as turmeric, boswellia, and quercetin can help fight inflammation too naturally! 10) Aspirin, or any other NSAID, is NOT a vitamin. You will never have an Aspirin deficiency! 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 potential!
Knee Pain, No Need For It
No Need For Knee Pain Running, Cycling, or Anytime
June 13, 2011 by Sock Doc (sock-doc.com)
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 its on back of the knee, its known as a Bakers 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 dont 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 its 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 isnt 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 theyve 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 lets 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.
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