Tag Archives: Injury prevention

Physical therapy geek: My new core-hip lineup

Physical therapy fascinates me. I spent a long time in high school and an entire semester in college thinking I’d grow up to be an orthopedic surgeon, and I’ve always been intrigued by how joints and muscles work. As you’re likely aware if you read this blog regularly, I’m also a bit of a workout nerd who privately entertains dreams of becoming a personal trainer. When it’s done right, physical therapy strikes me as a combination of the two: You get to play with people’s joints AND create workouts for them!

This fascination makes me quite possibly the most engaged and motivated physical therapy patient ever. The exercises from my 2007-2008 stint in physical therapy for an sore hip/IT band are still part of my regular core- and hip-strengthening workout.

I had my second session with a new physical therapist yesterday. I’m going to do my best to outline the full hip- and core-strengthening workout I enjoyed yesterday, with the caveat that I can barely perform some of the exercises without aid, much less describe them:

3X10 Cook hip lifts (basically single-leg bridges)

3X10 clamshells with a resistance band (shown here, along with lots of other interesting-looking running-specific exercises)

3X10 hip circles (done on all fours, by rotating one bent leg in circles)

3X10 single-leg squats

Monster walks” with a resistance band. When I proved too proficient at these, my basketball-star therapist put a resistance band around my ankles in addition to the one above my knees. Yeowch!

Farmers walk with kettlebell (you walk around the room holding a kettlebell above your head with one hand)

This crazy, intense version of a Turkish getup with a kettlebell. This one is especially tough to describe here, as New Guy would ask me to hold certain positions for longer periods of time, and would correct my form to ensure the exercise was “hitting all the right places.” Translation: “as difficult as possible.”

Single-leg deadlifts with a kettlebell. Yes, in case you’re wondering, I’m planning to purchase one of these instruments of torture for my house.

Lateral lunges, backwards lunges and leg curls with a towel placed beneath the working foot. I know — unhelpful description. I’ll work on it as I master the exercises.

Planks, with lots of crazy variations. Again, I’ll work on describing these once I’ve mastered the actual motions.

Next up: Speaking of instruments of torture, our hill-loving group-run organizer has apparently designed a doozy of a five-miler for us tonight. After the workout I had yesterday (see above!), I’m guessing tonight is NOT the night I’ll be pushing the pace on the hills.

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A new core workout

Workouts are tricky. If you’re anything like me, you spend a considerable amount of time scoping out new exercises in fitness

I found new twists on my usual BOSU moves. Yesss!

magazines and online, looking for that new twist on the simple squat or that new way to sit on a stability ball that will challenge your muscles in new and unforseen ways.

Then, as soon as you find the perfect workout, your muscles are bored again, and it’s time to change.

I’ve felt that way about my core- and hip-strengthening workout recently. I’ve been committed to a full injury-preventing lineup for several months now, which means I’m getting to the end of my rope as far as tweaking the exercises for maximum impact.

That’s why I was so excited for find this great workout with stability balls, medicine balls and a BOSU in the most recent issue of Women’s Health. I tried it at the gym on Monday, and can confirm that the stability-ball leg raise and the stability-ball hand walks will wake up even the most bored muscles. I mixed it up even more by hopping on the step mill for cardio (when’s the last time you did that?).

Next up: A group run with Pacers Silver Spring tonight, and a physical therapy session with Beefcake Brad on Wednesday. Stay tuned for his killer kettlebell workout later this week.

Have you found any really fantastic core exercises recently? If so, share them by posting a comment!


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Iontophoresis for runners: What P. Diddy and I have in common

After P. Diddy finished the New York City Marathon in 2003, he credited iontophoresis, or the use of a small electrical current to The iontophoresis patch transmits anti-inflammatory medicine to the site of my ankle sprain last year. transmit an anti-inflammatory medicine, with curbing his knee pain enough to let him complete the race.

I was unaware of P. Diddy’s experience before my doctor suggested ionto, as it’s commonly called, for my IT band two years ago, the first time I received this nifty, noninvasive treatment. I’m receiving it again now for peroneal tendonitis and/or an inflamed posterior tibialis (or, to keep it simple, a cranky ankle), and I’m optimistic it’ll get me over the why-does-it-still-hurt hump.

Here’s how the treatment works: A physical therapist fastens a patch with anti-inflammatory ointment to the spot on my ankle that hurts. Then, she attaches a tiny device that administers a low electrical charge for just a few minutes – since I use the self-contained patch, there’s no need to keep it hooked up to the device for long (another version of ionto uses a large machine to transmit the charge, and takes about 15 minutes). I feel a slight twinge — not pain, exactly, but a little sensation that lets me know something’s going on. I leave the patch on for two hours to let the medicine do its thing. Repeat, essentially, every other day for two weeks.

I like that this is noninvasive and basically risk-free. I like that I’m receiving the treatment on my ankle — since the muscles and tendons are closer to the surface there, my chances of it working are greater. I like that I may have the boniest ankles in the history of ankles for the same reason.

Finally, I like that it’s only one way I’m looking to attack the problem. I’m also doing several prehab exercises given to me by the therapist I worked with yesterday, an enthusiastic woman named Toni. Toni told me she embarked on a prehab program to strengthen her own ankles after multiple ankle sprains clued her in to possible weakness.

She gave me a TheraBand, and showed me how to use by pointing and flexing my foot in all four directions: plantar flexion, like pressing on the gas pedal in your car; dorsiflexion, pulling back in the opposite direction; and inversion and eversion, or pulling the resistance band from side-to-side.With the ionto and the exercises, it can only be a matter of time before my ankles are in good working order again!

Thanks to everyone who commented on my post about managing a runner’s stomach. My next experiment, thanks to your thoughtful and interesting suggestions (other ideas still welcome!), will be oatmeal and a banana. Which sounds pretty delicious, even without the run.

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Product review: Trigger Point’s Quadballer

A Running Times story comparing some popular self-massage tools for runners says

The Quadballer: My newest abusive relationship.

The Stick is known as the toothbrush for muscles. The Quadballer, on the other hand, is like a dental tool.

I got turned on to the Quadballer only recently, when searching for a step up from my beloved/much-hated (it’s one of those relationships) foam roller to soothe my often-sore IT band. As soon as I started reading about its hurts-so-good powers, I had to have it. Thanks to a friend with a Trigger Point discount, I bought a Quadballer for a price that fits my race-registration-depleted budget, and it arrived at my front door last week.

The patented material the Quadballer is made from aims to simulate the feeling of an actual massage, and man, does it ever! The diagrams show its usage to be very similar to a foam roller, but this baby ain’t no comfy, cushy foam roller. There’s a reason why the instructional materials note that runners should only spend three to five minutes on each exercise — any more, and you’ll risk bruising.

For that reason, my first night with the Quadballer was kind of difficult.  I didn’t seriously overdo it; I just didn’t realize the extent to which a little goes a long way. I used to spend a good 30 minutes lolling around on the foam roller to work out post-run kinks. With the Quadballer, it’s more like five minutes, which is yet another reason to invest in one. It’s too soon to tell whether it’s the definitive cure to my IT band problems. But I can already tell it’s helping, and can a runner ask for anything better than that?

Have you tried this magical little instrument of torture? Any tips, praise or warnings to pass along?

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Build stronger ankles and feet

My right ankle, which first got cranky on me while running in Rock Creek Park December 2008, was the only part of me that felt a little sore and swollen after the Marine Corps Marathon Oct. 25. So as part of my six weeks of laying low and being smart following the marathon, I’m prehabbing like crazy, attacking foot and ankle exercises with the gusto I approached core- and hip-strengthening workouts with a few months ago.

Here’s a roundup of what I’m doing:

Towel scrunches: Lay a towel on the floor. Move it closer to you by scrunching your toes repeatedly.

Toe taps: Tap your foot for a minute straight. Repeat.

Calf raises on a step: Self-explanatory.

Various resistance-band exercises in which I pull a resistance band toward me or push it away from me with my feet. (Check out a photo of the latter here).

Picking up small items with my toes. This one barely feels like work, so I’m having a hard time committing myself to it.

Tracing the alphabet with my toes. Again, I don’t feel an obvious challenge or benefit here, so I have a hard time making myself do it.

Tons of balance stuff, which was already part of my core- and hip-strengthening workout. And fear not: I haven’t forgotten about the good ol’ core. I even added some new exercises lately: a side plank in which you place a stability ball between your feet, a front plank in which you balance your feet on a stability ball, then bring one knee at a time toward your chest.

Any favorite foot- or ankle-strengtheners I should add to the list? Share them by posting a comment!

In other news: I’ve found a fantastic new pool! The Takoma Aquatic Center, located about 10 minutes from my apartment, or maybe 20 minutes by Metro, is an Olympic-sized pool set up horizontally, so there are something like 12 lanes open for lap swimming at any given time. It’s a fast pool, and I immediately felt awesome once I got in despite a three-week hiatus from swimming. I glided through 2X1,000 yards, and didn’t feel tired and creaky until the end of my 5X200 IM set. I’ll definitely be heading back for more soon.

Finally, my Women’s Running story about sports psychology and motivation, Think Like the Pros, is live online at active.com. Check it out — I got so many helpful tips from it, and hopefully, you will, too!

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Lessons learned

After the Marine Corps Marathon Oct. 25, I exchanged a few e-mails with my friend Kaveh, who had to defer his entry until next year thanks to an ankle injury. We traded notes about how we ended up injured in the first place, and what we learned from those injuries. Here’s the parade of horribles that followed my Nashville Country Music Marathon in April 2007, after which I proceeded to:

Run two days after the marathon, a hard 30 minutes with Steve
Run my usual 6-mile route several times per week, with a semi-long run on weekends, because I wanted to “keep up my mileage,” doing absolutely zero cross-training
Go to a wedding in June wearing these *adorable* espadrilles, enjoy a few glasses of wine at said wedding, twist ankle on espadrilles, spend week on crutches courtesy of a doc in a box while awaiting a visit to the sports ortho (advice to you: When you have a drink in one hand, your high-heeled shoes should be in the other)
Resume running schedule immediately after getting doctor’s OK, with no physical therapy, apparently worsening some crazy muscle imbalances caused by a week of not using my left leg
Backpack 26 miles with a 30-lb pack the weekend after doctor’s OK
Be really surprised when my hip hurts so bad I can’t walk after the Marine Corps Half Marathon in Jax in October.

Shocking I ever managed to hurt myself. I was being so smart.

I’ve wised up since then, cross-training like crazy with only three quality running days per week, doing all sorts of core- and hip-strengthening exercises and sitting out as soon as something starts to hurt.

But I’m realizing I still have a lot to learn. The one thing that does kinda hurt post-marathon is the ankle I sprained running in Rock Creek Park in December 2008, which seems to be a sign that I should lay low for six weeks or so, skipping long runs to let my body completely heal itself. More importantly, I need to add some ankle- and foot-strengthening exercises to my repertoire, even though these are so boring, they make core work seem like a costume party. Take towel-scrunches: You place a towel on the floor in front of you, then proceed to pull it toward you by flexing and scrunching your toes. Thrilling. But I’m hoping exercises like these help end my foot/ankle problems for good. If you know of any great foot- or ankle-strengthening exercises, pass ’em along.

I also think I need to start speedwork earlier; nagging injuries kept me from adding speedwork to my training until halfway through my training schedule for MCM. My plan in training for the spring is to lay low for maybe six weeks to let my body fully recover from the last marathon, then start speedwork immediately in December.

I need to ask for a little help from my friends. I try to avoid boring my non-running friends with details about my training, but I realized I’ve done so to a fault, failing to even mention to many close friends that I’d be running a marathon until the weekend of. When my friend Jessica asked what we were up to Sunday, Oct. 25, and I told her it was Marathon Day, she immediately offered to come watch. I said that would be cool, if she wanted to; no big deal if not. I saw Jessica at mile 19, right after a major low point on the National Mall, and it just about saved my race. That’s one of the reasons it’s looking like the National Marathon in March is the revenge race for me; though it’s hilly and can be sparse in the final miles, it’s also located in a place where I can ask my friends to come support me in exchange for a nice pasta dinner the night after.

Finally, about those hills: I need to make my training all hills, all the time, so I’m not intimidated by the somewhat hilly course. My plan is to identify the biggest and most intimidating hills on the course, and to Metro downtown and do hill repeats on them. I don’t want to be wondering how I’ll do on the inclines; I want to know.

Which lessons have you learned from marathons past? Share them by posting a comment below!

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My revamped IT band plan

The BOSU and I will become close friends over the next two weeks.
Strengthen your core with the BOSU.

Back in July, when I was struggling to get past a flareup of an old hip injury, I decided to embark on an amped-up core- and hip-strengthening routine to get my body in the best possible running shape before starting to train for the Marine Corps Marathon on Oct. 25. I’ve culled a few new exercises from the pages of Runner’s World and the collective wisdom of other runners since then, and wanted to pass along the plan I’m convinced has kept injury at bay as I’ve tackled 15-, 18- and 20-mile runs.

3 X 25 walking lunges
3 X 25 single-leg presses
3X 25 single-leg squats
Hamstring curls
Leg lifts with weights (I do these on each side, on my stomach and on my back. Here’s a how-to for the side-lying lifts.)
Clamshells (shown here, along with lots of other interesting-looking running-specific exercises)

On the BOSU, flat side up, blue side on the floor:

-Squats with 10-lb med ball: 3 sets of 8
-1-leg raises in following positions: 3 sets of 15 seconds/each
(all of these require you to balance on one leg in the middle of the ball while doing something else with other leg)
-leg bent 90 degrees at knee (shin parallel to ground)
-leg bent 90 degree at hip (quad parallel to ground)
-leg extended 45 degrees out from side of body
-leg extended back 45 degrees/body forward (think swan)
Feel easy? Close your eyes, which makes it harder to balance.

What’s your favorite core- or hip- strengthening exercise? Share it by posting a comment!

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When should you run again after an injury?

For a month now, I’ve been gloomily telling people I’m laying low, with no

I ran my first "long" run to prep for the Marine Corps Marathon this morning. But I'm keeping my goals flexible.

I ran my first “long” run to prep for the Marine Corps Marathon this morning. But I’m keeping my goals flexible.

long runs or speedwork, until August. This is per my doctor’s suggestions to let my sore IT band heal after a flareup in May.

“August?” asked one of my running buddies the other night. “Like, next week?”

Apparently, time flies when you’re running three times a week, no more than 6 miles per run, and stretching and doing core work like your life depends on it!

So last night, for the first time since my awesome running doc and I formulated a plan that would let me at least try to still run the Marine Corps Marathon on Oct. 25 this year, I pulled out my FIRST training plan to confirm that this is do-able. Long story short: It is. And though it’s not technically August for another two days, it’s time to test the theory.

So this morning, when I headed out for a rare early trail run, I was already thinking: Is this the day I’ll try my first “long” run, an 8-miler that aims to test my not-so-sore-anymore hip?

This was basically a microcosm of the bigger questions I’m dealing with: How will I know if I can run the marathon without sidelining myself for months again? And, writ even larger, when is it OK to run again after an injury?

My friend Kaveh, who’s also signed up for the Marine Corps Marathon, is dealing with the same dilemmas. He skipped his long run on Saturday because, as he describes it, “my shin was killing me with every walking step.”

He asked my opinion about how you know when you’re ready to train again: “Specifically, when you’re training for a marathon and every run seems crucial.”

This is so hard, and so personal, and depends on each individual’s body and goals.

As I learned by watching people literally limp over the finish line with the help of kind, possibly crazy volunteers at the Nashville Country Music Marathon in 2007, it’s certainly possible to run a marathon with a pretty terrible injury. If you’re cool with the risk of a stress fracture or worse leaving you unable to run at ALL for months following the marathon, then push on.

I’m not going to be that person. Kaveh and I both have the luxury of having finished a marathon before, so we don’t have that to prove to ourselves. As much as I feel a desperate urge to test myself again, proving to myself I can run a marathon quickly, being able to run on regular basis means more to me than any finisher’s medal.

I personally find it vital to have a doctor — one who understands and appreciates my running goals — give me the OK to proceed. But my doctor doesn’t exactly hang around the house, waiting for me to ask his opinion on a daily basis, leaving much of the decision-making up to me.

A couple rules of thumb, from various doctors, physical therapists and, you know, afternoons spent procrastinating on runnersworld.com:

  • Don’t run if you’re limping. Once your form goes, you can injure more than just the site of the pain.
  • Don’t run if it’s a sharp pain (as opposed to a dull ache) that gets worse as you run. This could mean a stress fracture, and if you run on this, it could get exponentially worse.
  • It’s better to be 10 percent undertrained than 1 percent overtrained, i.e., injured. Err on the side of caution, big time.

There may come a time in my training when erring on the side of caution means giving up on the MCM dream for this year (with a new immediate goal of deferring until 2010). But for now, I’m taking it one week at a time, increasing my mileage slowly, listening to my body and being prepared to be flexible.

So this morning, I did one trail loop of about five miles — about a mile each way to get to and from Rock Creek Park, with three miles of actual trails. Then, I really tuned in to how my body felt. My hip felt loose. My form felt strong. I reversed the loop and did it again for a total of about eight miles. First long run, done!

That’s not to say I’m getting cocky. On my way back, I bought a huge bag of ice from the Giant. That’s right — I took an ice bath after an 8-miler, an uncomfortable tactic usually reserved for only the longest runs. I’ll take one after my longest run every week, continue with my plan to build the strongest core this side of Rock Creek … and just continue to see how it goes.


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The two-week IT band plan

My running doc has instructed me to lay off the long runs and speedwork

The BOSU and I will become close friends over the next two weeks.

The BOSU and I will become close friends over the next two weeks.

until August to give my hip time to cool down.

So what’s a girl to do with that time, other than run an uninspiring, disappointing 5K?

I’ve been pretty good about my physical therapy exercises, from my much-hated leg lifts to the super-fun BOSU work, and I’m always good for a few minutes of plank position. But for the next two weeks, I’m vowing to make core strength and PT my main focus, with running and swimming mere afterthoughts. This means doing a roundup of core/PT exercises — as much as an hourlong workout — every other day. The idea is to get myself as strong as possible, so when I do start my long runs, I’ve done everything I can to avoid injury.

After the two-week period, I spend a week in Monterey, Calif., where I’ll continue to lay low, with a few awesome trail runs and a bike ride through San Francisco mixed in. Then, as discussed with my running doc, I’ll start with an 8-miler, and work my way up from there. If my hip doesn’t cooperate? Hey, at least my abs and butt will look great!

Here’s a roundup of the exercises I do to keep my IT band strong and supple:

Start sitting upright on a stability ball, then walk your legs forward so the ball travels up your spine until it reaches your shoulder blades. With your arms extended out to the sides, lift your hips up until your torso is parallel to the floor. Then lift one knee about 45 degrees, lower it, then lower hips toward the floor, and repeat on the other side for one set. Do three sets of five to seven reps, with two minutes rest between sets.

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Resources for injured runners

Rest. Ice. Stretch and foam roll (yeah, I made it a verb. What?). Pop glucosamine tablets. Pop anti-inflammatories. Get a massage.

I’ve tried all of these remedies to soothe my sore hip. I’ve also spent way too much time searching for helpful tidbits online, and I thought I’d share some of the best links here.

This Runner’s World story provides some great tips for getting your head in the right place, and offers real-world experience from Kara Goucher, who says being injured made her realize that she is more than a runner — she is a person who loves to run. If she can wrap her brain around that, certainly, I can, too.

Other take-aways: Almost all runners — some research suggests 70 percent per calendar year — end up with an injury at some point. Almost all runners recover from those injuries. Stay positive. Focus on recovery, using it as an opportunity to strengthen weak muscle groups. And if it helps, hang out with your running buddies off the road.

Other resources I’ve found helpful:

Runner’s World Injury Prevention Guide: This link takes you to the mother of all injury-prevention pages, with links to everything from exercises to strengthen weak muscle groups to a “What Hurts” database that helps diagnose aches and pains.

Running Times guide to injury prevention and recovery. This offers insights from MDs, professional marathoners and others, and explains why things like ice, massage and stretching help.

This Running Times spread about cross-training explains how cross-training can actually make you a faster runner, starting with an anecdote about how Alberto Salazar qualified for the Olympic team after a two-month hiatus from running, relying on swimming as his primary activity following an IT band injury.

This Amby Burfoot blog post about coping with injuries offers some great tips and insights. Says Burfoot: “We all get injured eventually. Like, 100 percent of us … it’s no big deal, since 100 percent of us also recover from our running injuries.”

Playing the Pain Game from active.com

Have a great injury-prevention link? Share it by posting a comment!

Looking for inspiration to cross-train — or just to train? Read about Runner, triathlete and DC Mayor Adrian Fenty who Men’s Fitness has named in its list of the 25 fittest men.  This is no small feat, considering “fittest” includes Rafael Nadal and Tim Tebow.

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