Transcript of Facebook Chat with New York Road Runners

In honor of National Running Day, New York Road Runners (NYRR) hosted a live chat with Michael Silverman, PT, MSPT, physical therapist, on training and injury prevention tips. The following is a transcript of the chat, with answers provided by Michael.

Michael Silverman, PT, MSPT
Physical Therapist, Rehabilitation Department
Hospital for Special Surgery


The information provided in this chat is for informational and educational purposes, and doesnít constitute medical or health advice for any individual problem. Please consult with your health care providers for any health problem and/or prior to starting any new exercise regimen and/or medication or changing or discontinuing any medication you have been prescribed. This chat is not intended to create a physical therapist-patient relationship, or any other duty, between you and any member of HSSís rehabilitation team.

What is the way to handle plantar fasciitis?

Plantar fasciitis is a very common condition that plagues runners, but the most important thing to do is to stretch your calves several times per day as well as ice the bottom of your foot after running or exercise.
 
I have a question about bursitis of the hip. How do I work on loosening my hip and preventing further injury while I train for my second marathon?

Bursitis of the hip can be tricky. This is something you would want to have a doctor look at, just because bursitis can be caused by a variety of conditions. Using a foam roller is a great way to loosen up the hip in general, though.

Sometimes I get ďrunnerís kneeĒ after a run. What causes it and what are ways to prevent it?

Runnerís knee is often caused by having a weakness in the hips. It is one of the most common injuries that runners get. Working with a physical therapist to develop a hip strengthening program is a great way to prevent this injury from getting worse and to prevent it altogether.

What to do about shin splints? I think itís what I have. Been nagging me for a few weeks now.

Shin splints again is one of those conditions when runners are first beginning their training; if that is the case, it sometimes goes away with time. It is something that you should see a doctor for if the pain still lingers. Overstriding can cause this injury, so shortening your stride and landing closer to your center of mass can help as well.

When training a lot with longer runs, is it safe to take ibuprofen every day?

I would consult your medical doctor about ibuprofen use with longer runs every day.

I had plantar fasciitis and would like to know how to prevent it. Also, my knees occasionally hurt after a run. Are there any exercises you can recommend to strengthen the knees?

See the above post about plantar fasciitis. In terms of your knees hurting after your runs, icing always helps as well as static stretching. I would recommend exercises that focus on the hips, not just the knees, to help with your knee pain. A physical therapist is a great resource to use to help you develop a program.

I strained my calf playing basketball on Sunday and I want to know what I can do to help speed my rehab along, specifically what kind of stretch routine I should be doing, and can I bike to get my cardio and some miles in? Marathon training was supposed to start this week and while I know I canít (and wonít) run, I want to feel like Iím still doing something to move forward.

I would recommend seeing a doctor as well as a physical therapist to help facilitate your recovery. Your PT can get you doing some non-weight bearing exercises as well as possible cardio options to keep you going.

Iím recovering from a broken foot. Iím able to walk without my cast on but I have a half marathon in October and Iím only training with weights and stationary bike. Is this a good method or am I going to have to really go nuts once I get the ok to run? And how long until I can run again?

Itís hard for me to say when youíll be running again, but it sounds like you are on the right track. The bike is a perfect adjunct to therapy, especially before you get back onto the pavement.

I have had a posterior shin splint on my right leg for the last two months. Pain fluctuates between not too bad to affecting my stride slightly. Am I doing damage by continuing to run or will it eventually go away?

My general rule of thumb is to avoid pain while running. If you are feeling this pain, you need to fix something in the chain, whether itís through strengthening, stretching, form or all of the above. Working with a therapist and possibly getting a running analysis to look at your form and structure are great ways to help with your injury.

Can running too much cause lower back pain? Iíve been having serious lower back pain recently. Iíve also been running a lot more than usual. Itís the only thing I can think of.

Yes, running can cause lower back pain and any increases in new activity can aggravate symptoms. I would consult a doctor to have your back checked out.

I am recently coming off of a foot injury. I donít think doctors even know for sure whether I had a stress fracture, other type of fracture or no fracture at all. I am still experiencing some soft tissue edema, especially after I run. Any advice you could give? I will be starting to train soon for the marathon and want to make sure I donít re-injure myself.

You sound like the perfect candidate for a running analysis. Often times these types of chronic injuries occur because of faulty form with running. I would suggest getting an analysis done as well as an evaluation by a therapist to work on a strength training program.

My husband has completely flat feet and recently tore his meniscus (had a partial meniscectomy a month ago). Should he be running or should he stick to biking? It would be sad to no longer have a built-in running buddy!

In my experience, a majority of my patients have been able to return to running following a meniscectomy. I would let him run his course of therapy and when he is cleared to run, follow their instructions given by his therapist, including proper shoes that provide good arch support.

After I hit six miles in a run, my left knee feels like itís locking up when I start walking afterwards. If feels this way when my leg is at its straightest while the foot is taking a step on the ground. What is this and is it dangerous? Is there anything I can do to prevent this?

I would recommend seeing a doctor. Itís tough to say without physically looking at your knee. From there, they can recommend a proper course of action.

Any advice in regards to shin splints and tightness in my calves after a run? I stretch lightly before and after again after it seems to be getting better but still nagging.

See above about shin splints but get those calves loose before you run. I strongly recommend a dynamic warm-up before you run, followed by static stretching after your run.

I recently started running again in training for the marathon. I had an IT (iliotibial) band problem in the past so gave it up and I have just started training and my left knee is hurting again. I think I may have also done too much too soon, but could you tell me what causes it? I only have the pain on one side. How can I prevent it and also is it ok to keep running?

IT band syndrome is often caused by a weakness in the hips/core. Strengthening the muscles in this region, as well as incorporating plyometric exercises into your routine, is a great way to train. If you see a therapist, they can prescribe these types of exercises. If you are feeling pain, I would not recommend running until youíre feeling better.

Iíve been having tendonitis in my ankle area (just above ankle bone) for weeks now. I ice it and take ibuprofen and have tried to stay off running but I have a 10K this weekend. Is it ok to run with tendonitis and what can I do to prevent making it worse?

If you have not been running, I would not recommend running. Having this injury for some time now, which is still lingering, and not running, you will not feel too good during the 10K and will be at a high risk of making it worse. There are plenty of 10Ks. Get yourself feeling better and do one of those.

Iíve always had tight IT bands that cause some knee discomfort but have easily been managed with my foam roller and strength/stretching. Iíve been running a lot more frequently and my hip just started to get achy after almost every run and seems to be a symptom of the pesky IT bands. Any specific hip stretches or tips I can try out to focus on that area?

Glad to see that you have taken advantage of the foam roller for your IT band. I would try to shorten your stride slightly. This can help prevent some of those injuries from getting worse, decreasing the shock through the leg when you land.

My question is about piriformis syndrome. I have been experiencing soreness in my right buttock for several weeks. It feels great running but the soreness comes when I am sitting. Also feel some pain down my legs at times, but nothing too severe. I am using a foam roller which helps but is there more I could be doing to heal this as I move into marathon training/longer runs?

Piriformis syndrome is tricky because it can be caused from a variety of things. You want to avoid things that aggravate the symptoms. Now is the time to see a physical therapist and doctor to help get those symptoms from getting worse, especially with the beginning of marathon season approaching.

Iím recovering from a case of Achilles tendinitis in both legs. I took a few months off and am starting to up my distance for a half in mid July. It feels a lot better but anytime my calves feel a little tight, Iím nervous itís my Achilles tendinitis coming back. How can I isolate real symptoms from ďfearĒ symptoms?

Itís tough to say specifically how to differentiate your pain, but I would say keep a pain diary and note what you were doing when it hurt. Look for a pattern and thatís how you can differentiate between the tendinitis and the ďfearĒ symptoms.

I typically use a foam roller on my IT band but Iíve also started using a tennis ball for smaller, hard-to-reach areas. How long should I be keeping the foam roller or tennis ball on my tender areas for trigger point release? Is it normal to feel soreness after trigger point release?

The tennis ball is fine to get a more specific trigger point. I have several patients, who are now no longer patients, keep up with the tennis ball/foam roller to release trigger points. Muscles get tight so staying proactive with your symptoms is a great way to prevent injuries from occurring. The soreness is normal following the trigger point release.

I had a medial meniscus repair in December 2011. It was revealed that I am almost bone on bone with that knee articular cartilage. I just started running again (beginnerís class) with knee sleeves. I still have some pain. Should I use Osteo Bi-Flex to help this issue or not run altogether? I love running but not at the risk of permanent injury.

I would consult the doctor that repaired the meniscus.

I keep re-aggravating an Achilles/calf strain even though I have been trying to build back mileage slowly (10% per week). Do you have any suggestions on how I can keep my marathon training going without getting reinjured?

Whenever I have someone that continues to injure themselves with the same injury, I refer them to a running analysis. Something is going on with your form that keeps you getting hurt.

Iíve been dealing with posterior tibial tenosynovitis for over two years. Iíve had cortisone injections and physical therapy. Although it is much improved, it does continue to give me pain, especially upon first waking in the morning. Any suggestions on exercises, etc. that may resolve this ongoing issue?

I would try stretching before you go to bed and as soon as you wake up. Also, sometimes with that pain that occurs in the morning, changing the way you sleep helps. Iíve recommended to patients to sleep with their feet hanging off the end of the bed to help them relax as they sleep and this has helped.

I just recovered from a 1.5 month stint of shin splints, but am feeling great now. What do you recommend in terms of exercises, stretches, etc. for preventing their reoccurrence during marathon training season?

An overall strengthening program for your core and lower legs is what I would recommend. A performance specialist, such as one of the coaches we have here at the Hospital, can help you develop a plan and prevent reinjury from occurring.

I too have IT band problems. Do you recommend resting until all pain goes away or can I just manage it with a foam roller and stretching and accept itís going to hurt during some runs? Iím worried itíll get worse and worse or cause permanent damage unless I take complete rest (which I donít really want to do, plus I am due to start marathon training soon).

I rarely instruct patients to run while they have pain. Everyone has the occasional pain, but if itís something that is happening consistently, I would consult a rehabilitation professional to get you back to running pain-free.

Sometimes after a long run my hips will hurt me the next day. Could this be due to the way Iím running or not stretching properly? Anything you can recommend?

It could be due to a few things. Try this: incorporate a dynamic warm-up into your routine, to be done before you run, followed by static stretching after you run. See if this helps. If hip symptoms persist you should be evaluated by an orthopedic specialist.

My concern is that I get really bad shin splints. It feels as if an upside down metal crown is digging in ankles all the way up my shins. I have switched tennis shoes three times and with more cushion, the better they get, but still have them. I went to see a podiatrist and told me to do some weight training for my shins, put a little weight on the feet and flex my feet up and down and ice. Please help if you have any recommendations.

Sounds like you are doing calf raises. This is a common exercise given to people who have shin splints. Keep up with the ice as well.

Why do my legs keep feeling so heavy and it slows me down?

Tough to say. Start your runs at a slow, comfortable pace and gradually build up. This should help.

At what point in cycle of injuries do you recommend a runner step back and re-evaluate footwear choice, particularly on a change to a lower minimalist shoe, e.g., 4mm, heel-to-toe drop? In other words, when is an injury or series of injuries a symptom of a form issue?

That is something where you should get your form analyzed to see if it is a form, strength, flexibility or foot issue. From there, you can make the proper plan of action.

Looking forward to my 21st NYC Marathon, but I am finding that my age (64 ¾) is an issue when trying to get treatment for knee injury. I am definitely not ready or willing to give up running but need some treatment for my left knee. I am looking for a doctor who will treat me as a runner in really good physical condition, not by my birth date. Any suggestions?

Contact HSS Physician Referral Services. They will help you find a doctor to match your condition.

On long runs I occasionally get muscle spasms of very short duration in my lower back. I had a back x-ray and apparently I have a slightly curved back/mild scoliosis. Will this affect my running in the long term and is there anything I can do to ameliorate the situation?

There are plenty of people that have scoliosis who continue to run pain-free. With that being said, you may have to focus a little more on maintaining a strong base of core and hip strength to prevent injury and these muscle spasms from occurring.

Iím a marathon/half marathon runner. Over the last few weeks, I have had groin and hamstring pain. The pain originates in my adductors and just this past week started radiating to my hamstring. The pain is only in my right leg and initially causes discomfort when running, but as I warm up it goes away. I experience much discomfort when stretching. I have been icing it, taking Advil, AND using foam rollers but itís not really getting any better. Any advice?

I would recommend seeing a doctor. See the above post about Physician Referral Services. That way you get a firm grasp of what is causing your pain.

Iíve been nursing a knee injury since the Brooklyn Half a few weeks ago. It seems to be in the ďgoose footĒ area as a result of a tight hamstring. Itís affecting my hip as well. Any advice on things I can do to get back up to speed and prevent this from happening again?

I would definitely ice but since that injury occurred almost three weeks ago, I would consult a doctor just to make sure itís nothing serious.

Do you have any suggestions for relief of lateral femoral nerve entrapment syndrome? The more active I am, the less it bothers me. I go through periods, where at night, I get a stabbing pain in my lateral thigh followed by numbness. Sometimes itís just numbness. I have been to the doctor who referred me to physical therapy, which I was already doing and I am in excellent shape, very strong.

I would follow the instructions that you physical therapist gave you. They know your condition better than I do. It does make sense: the more active you are, the less pain you have. Good luck with your rehab.


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