 As a physical therapist, I am often asked if running is bad for your knees. Most people typically want to know what the long-term effects of running will have on their body, and want to know if they will develop knee osteoarthritis from running. Running is a simple and accessible option of exercise for most people, and has great overall health benefits. Many of my clients also report huge psychological benefits to running, so I find it important to limit fear based ideas that running is worse for your knees than not running at all. With the fear of ruining your knees through running, only 3.5% of recreational runners have knee or hip arthritis. While just over 10% of sedentary individuals have knee or hip arthritis. This means you are almost 3x less likely to develop knee arthritis if you perform regular recreational running than if you just sat on the couch and did nothing. Moderate amounts of running may actually be beneficial to the long term health of your knee joints. 1 Continuing to run with a recent diagnosis of knee arthritis is also okay! Running does not appear to increase the speed of knee arthritis. However, if you are having difficulty recovering between runs, you may want to look at training load, cross training, or potentially altering your running mechanics. Running can help you maintain a healthy weight, that in turn will reduce the overall daily stress placed on the knee joints. Finding the optimal frequency, intensity and volume for your running to provide ample recovery time is important. Overall, runners should feel great about running with proper load progression, volume, and intensity management, as well as proper sleep and nutrition, to help with post run recovery! If you are currently recovering from a running injury, you can progress back while running on a treadmill or outside, as they both create similar reaction forces through the knee joint. You may also want to assess your knee, hip, and ankle joint mobility to ensure proper mechanics. If you have any questions or need help managing your running injuries, please reach out and we can help answer any remaining questions you may have! Thanks for reading, Dr. Sam, PT, DPT, OCS 1 Alentorn- Geli E, Samuelsson K, Musahl V, etal. The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta- analysis. J Orthop Sports Phys Ther 2017;47:373–90
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 As the weather continues to warm up and we begin to look towards the outdoors for a return to running, let's give a quick rundown of what to look for when purchasing running shoes. The shoe is obviously the most important piece of running equipment. Shoes make contact with the ground, provide cushion between our body and the running surface, and affect how we absorb those loads while out for a run. Here are a couple of factors to think about when looking for a running shoe: The Brake Test   Midsole Drop or Offset (see pictures below) The drop in midsole height is the height difference between the heel height and the forefoot height of the shoe. A zero drop shoe refers to a shoe with no difference between the heel and forefoot height. A shoe with a high drop height would have a greater than 8mm height difference between the heel and the forefoot (with the heel being higher). A higher heel to forefoot height drop can lead to a pattern of landing with the heels. The mechanics of heel landing leads to greater loading and force absorption of the knees and hips while running.   Stack Height (see pictures above) The stack height refers to the amount of shoe midsole between your foot and the ground. Barefoot and minimalist style shoes have the lowest stack heights between 3-12 mm in height. The reduced amount of cushion in the midsole allows for more shoe flexibility. The lower the cushion the more likely you are to land on your forefoot or midfoot leading to an increase in loading of the achilles tendon and calf muscles, which will also reduce stress placed on the knees while running. A traditional running shoe will have a stack height around 10-29 mm in height and is what we typically think of when referring to running shoes. This allows for a wide range of flexibility and cushion. Most shoes over 30mm in height are considered maximalist shoes. These will be highly cushioned and are easily spotted on the roads or trails. A maximalist shoe provides just that: maximal cushion with a lot of foam under the foot. The increase in cushion under the heel can lead to great heel striking, which will load the knee and hips more than the foot and calf muscles. Toe Box Width  Looking at a running shoe, we want to have as much room as possible in the front of the shoe for the toes to spread out without feeling blousy or loose. Consider your distance and terrain surface for running. As your feet swell with an increased running distance, you may want a larger toe box if you are running ultramarathons. If you are trail running, a really loose shoe may limit your stability on loose gravel or uneven surfaces. You want ample room for your toes to spread and create a stable base of support for landing while running without creating slippage of the foot in the shoe. Big Toe Mobility    Big toe stiffness can affect comfort and function while running. If you have big toe extension limitations, a large midsole drop height (info above) will create pretension of your big toe into extension. If you already have a limited range of motion, a large drop height can create more problems and pain in the toe as you try to generate toe off while running. Going to a zero drop shoe, or a shoe with more of a forefoot rocker, can allow for more comfortable toe off while running. Neutral vs. Stability/Motion Control Shoe  Neutral shoes have no added bracing or foam density on the instep of the shoe to limit foot and ankle motion while running. Shoes with motion control or stability added to the midsole will have more dense foam or a plastic component added to the inside of the heel and arch area to reduce perceived pronation while landing. However, if you have a good strike pattern or stay on the outside of your foot, a motion control shoe can create more problems by not allowing the normal amount of motion to occur while running. Time to Buy When in doubt go to your local running store and try on different types of shoes. The associates at a good running store will be able to help you distinguish what type of shoe will fit your foot best. Looking at a shoe online to determine if it will work for you can lead to fit and function issues. If you find a pair of shoes that feel great and help you run pain free, stick to them. Shoe molds and uppers can change with a new version, so when in doubt go find a pair at a local store to try them on. I hope this helps, and feel free to reach out with any questions you may have. Happy running!
Thanks for reading, Sam Gillespie PT, DPT, OCS  Most people have heard we need 7-9 hours of sleep every night. However, many people struggle with getting this basic sleep requirement. Difficulty sleeping can be multifactorial, but there are some simple tips and cues we can use to help us get to and stay asleep. Caffeine consumption could be a large contributor to your inability to sleep well. Caffeine blocks a chemical in the brain called adenosine. Adenosine is a chemical that builds throughout the day, making you feel sleepy the more it accumulates. Think of your brain as an empty parking lot after you wake up. If “adenosine cars” are allowed to fill the lot, you will feel sleepy. If you fill the parking lot with “caffeine cars,” those spots will be taken and adenosine will have no places to park. This will result in you feeling more alert. The effects of caffeine peak around five hours after consumption, and last for up to 10-12 hours after consumption. A lot of people come into the clinic reporting they take melatonin to help them sleep. Melatonin is a hormone that helps you fall asleep. However, melatonin does not keep you asleep. If you find yourself waking up a few hours after taking a melatonin supplement, you may want to look at other ways of creating a better sleep schedule. Avoid viewing light from 11 p.m. to 4 a.m., as light inhibits the release of melatonin. Light from the sun early in the morning can help set your circadian rhythm. The light from the sun has a different quality than light from your phone, so try not to view your phone or other electronic devices first thing in the morning. If you are trying to go to bed at an earlier time, but have a tough time falling asleep, it takes at least two to three days to reset your circadian rhythm. Do not be discouraged if it takes at least two to three days to adjust to your new wake/sleep schedule. Blue light glasses can also be good for night time, but should be avoided in the middle of the day. We go through multiple phases during our sleep cycle. Two of the main cycles of sleep are REM and Non REM sleep. These cycles do not occur at the same time. If we miss out on two hours of sleep by going to bed late, we will miss about half of the Non-REM sleep; if we wake up two hours early, we will miss out on half of our REM sleep. So even though we are getting six out of the eight hours we need, we will miss out of half of a certain type of sleep based on whether we are going to bed late, or waking up abnormally early. Big takeaways:
If you are struggling with your sleep, give the above takeaways a shot! If you are still having trouble sleeping due to neck, shoulder, back pain - what have you - give us a call or hit the button above, to see how we can help you get a more restful and effective night's sleep.
Thanks for reading, Dr. Sam, PT, DPT, OCS  I have recently had quite a few people training for their first full marathon! One of the most common questions I get asked is: What should I eat before and during a marathon? Well, if you are racing soon, stick to eating the same meals you eat before your long training runs. Try to remain consistent with your eating habits throughout the training process once you discover what nutrition works best for your performance. Race nutrition includes fluid intake the days leading up to the race, dinner the night before, breakfast the day of, and supplements during your run. Whatever you do, avoid making any drastic changes in your behavior before or during the race. Dinner: For dinner you want to eat good complex carbs (vegetables and grains), a medium amount of protein (fish or chicken are my go-to choices), with a small amount of high quality fat. Avoid eating high fiber foods and foods with high fat content the night before the race as they are tougher to digest and can lead to GI problems during the race (i.e. beans or lentils). Again, try to remain consistent with your eating habits and don’t try anything too different before your race (common theme). Late Night Snack: If you have a difficult time waking up to eat an early pre-race breakfast, you can try eating a late snack. This also comes in handy if you have traveled or changed time zones for your race. Try to mimic what you would eat for breakfast the day before a race (simple carbs and a little protein). Breakfast: Try eating breakfast at least two hours prior to the start of the race. You do not want to eat too close to the start time or you will have to continue to digest your breakfast during the race. Your breakfast should consist of mostly simple carbs (oatmeal, bagel, toast, rice) and a little protein (protein shake, egg whites, low-fat Greek yogurt), or something like Kodiak cakes (carbs + protein in one!). Again, avoid high fiber cereals and high fat foods, as these foods are harder to digest and can lead to GI problems during the race. Pre-Race Snack: An hour before the race you can eat some simple carbs that can easily convert to energy. Fruit with honey is a good option. Oftentimes I will make a fruit smoothie ahead of time for a pre-race snack. Caffeine: Caffeine is a stimulant that can help with your performance during endurance races and training. If you are used to drinking coffee before your long runs, then go ahead and drink coffee before the race. Be aware that some energy gels and blocks contain caffeine, so test these products out during your long runs prior to race day! Caffeine can also cause GI distress, stimulate the nervous system, and lead to increased heart rate, and, if consumed in excess, can lead to increased urination. All of these issues can create problems for the endurance athlete. If you are not used to consuming caffeine, then the day of the race is not the best time to find out how you will respond. During the race: It is good to know what nutrition will be supplied during the race. Some races are sponsored and will have the nutrition supplements of the race sponsor out on the course. For example if they are supplying GU gels, but you are used to Honey Stinger products, then you should plan on bringing your own nutrition for during the race. A good option is to set an alarm on your watch throughout the race to prompt you to drink and eat small amounts on a regular basis. That way, you are more likely to keep on track for your nutrition goals. One of the biggest issues I see with novice endurance runners is the lack of fluid and energy intake early in the race. It takes time for your body to digest and use the energy you consume. If you wait until you feel thirsty, or start to feel shaky from glycogen storage loss, it’s too late. So, I tell runners to drink and eat early in the race and drink before you feel thirsty. Maintaining hydration throughout the entire race with smaller but consistent amounts is easier on the stomach than trying to play catch-up with large amounts of fluids once you feel thirsty. After the race: You want to make sure you continue to stay hydrated. If it was an especially hot race, you may need to continue replacing your electrolytes throughout the day with a sports drink. Make a plan, stick to the plan, and good luck racing! Thanks for reading,
Sam Gillespie PT, DPT  About ⅔ of the population will suffer from neck pain and headaches at some point in their lifetime. Stress, posture, and muscle tension can all lead to headaches. Some common causes that can predispose you to headaches are: staring at a computer screen all day, lifting heavy weights overhead at the gym, or limited mobility of the neck, upper back or shoulders. Tension headaches refer to headaches related to muscle or fascial tension, and the postural changes that accompany the muscle tension. This increase in tension might be from stress, a physically demanding job, or poor posture and muscle fatigue at the end of the day. Tension and stress can lead to trigger points and tightness in your postural muscles. This muscle tightness can directly refer pain into the head and face creating headaches on one or both sides of the head. Muscle tension in the neck can result in compression and squeezing of the nerves going into the base of your head. Compression of these nerves can lead to pain behind the head, along the temples, as well as behind the eyes. Usually this compression is felt directly below the base of the head in the upper neck region, and is associated with a more forward head posture.
You can also get headaches from dysfunctional jaw mechanics (TMJ) associated with upper neck stiffness. The upper neck region can tilt the head and jaw creating abnormal muscle tension in the neck, jaw and face. If you have headaches associated with eating, notice your jaw clicking this may be an indication of neck and jaw dysfunction, also termed TMD. Incomplete mechanics of the joints of the neck and upper back, as well as shoulder stiffness can create additional stress on the muscles of the head and neck. What steps can you take to relieve or reduce your chances of getting headaches caused by incomplete mechanics?
If you have tried these methods of headache relief, but continue to have symptoms contact us below to see if physical therapy is a good option for you. Thanks for reading. Dr. Sam Gillespie  Many people run because it can be done anywhere, is a year round activity, requires minimal equipment, and has excellent cardiovascular benefits. Over half of all runners will sustain a running-related injury while training and around 90% of marathon runners will experience a running-related injury. Reasons to increase your step rate, and reduce your step length, while running:
Small changes in your step rate, or running cadence, can have a major impact on your running resilience. Your step rate refers to how many steps you take in a minute while running. Increasing the step rate while running at a constant speed will decrease your step length. Think about walking across the room vs. jumping across the room. Taking more steps while walking requires less impact forces than hopping the same distance. “Overuse” injuries due to running are often a result of these higher loads of force while landing. Some people can even hear themselves landing with louder steps as they run. Your speed and stride length will influence the impact forces your joints, tendons, and ligaments are required to absorb while running. Increasing step rate has a positive impact on the ankle, knee, and hip joints. The knee joints were most positively affected by increasing step rate, with a 20% reduction in impact forces with only a 5% increase in step rate. This increase in step rate will create a reduction in stride length while maintaining the same running speed. There are many positive benefits of running with a shorter stride and higher step rate. A smaller stride length allows for you to land with your body’s center of mass over the landing foot. This will lead to less impact forces in the knees, hips, and ankles while running. Increased step rate leads to more efficient running mechanics. Improve your running economy with reduction in “up and down” wasted motions while running. You can also reduce the risk of shin splints due to the reduction in shock absorption during landing while running with smaller strides. Things to think about after committing to increasing your step rate and reducing your stride length:
Thanks for reading, Sam Gillespie PT, DPT, OCS Today we are going over one of our favorite treatment styles at Athletes' Potential- Blood Flow Restriction Training, or BFR. We use the Owens Recovery Delfi units in our office.
What are we doing with BFR? We are essentially restricting the blood flow that goes to a particular limb, in this case, Dr. Sam's arm by about 50%. What that does is restrict the blood flow coming out. Now when we do that, there are very interesting things that happen hormonally with exercise. You can get up to 200% increase in your human growth hormone. This won't make you look like The Rock but you will start to recover faster and build your connective tissue in a quicker way that wouldn't normally happen in a regular gym setting. If you haven't tried this or you'd like more information on this, please reach out to us! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Here are my 10 favorite baseline prerequisite screens for runners. These screens test for mobility, strength, and your ability to control your trunk, pelvis and hips. Making sure you are able to pass these screens is a good way to reduce your risk of injury and to enhance your running performance and economy. These tests can also provide an opportunity to assess areas you may need to focus on during your strength and mobility training. 1. Big Toe Extension (see above below): The ability to extend through the big toe is important for progressing your body over your planted foot while running. If you cannot extend your big toe, you will often see compensatory strategies from the leg or lower back above. We would like to attain ~70 degrees of big toe extension. Using a wall or doorway, try stretching your big toe, allowing the ball of your foot to reach the floor.  2. Ankle Dorsiflexion Wall Test: The same concept applies for progressing through your ankle. If you have calf tightness or limited ankle joint mobility, you may struggle to progress your shin forward. You will often see compensations from the leg and back above or from the midfoot below. For running, we would like to attain ~30 degrees of forward mobility (ankle dorsiflexion). 3. Hip Extension: Hip extension is the third aspect of progressing the body forward over the stance leg during running. Since running is mostly a mid range sport for the hip, ~five degrees of hip extension would be adequate, as long as there is no compensation from the lower back muscles. Keeping the front of the pelvis on the floor during this test should help assess hip mobility without compensating from the lower back. 4. Single Leg Heel Raise: Assessing calf strength and endurance is vital for distance running. During this test, perform the heel raise at a tempo of one second up/one second down per heel raise. Set up using a small plate, or step, to achieve a small amount of ankle dorsiflexion. Come up to a complete calf raise for each repetition and stop if you are unable to elevate to the top of your calf raise height. We would like to see ~30 repetitions. 5. Single Leg Hop Test: This test assesses the ability to absorb loads and create tension in the calf complex. We would like to see one-second hops for at least one minute. 6. Lateral Heel Tap: This test assesses your balance, pelvic and hip muscle control, and also assesses the mobility needs at the ankle required for running. Using an eight-inch step, tap the ground with your heel directly to the side. 7. Rear Foot Elevated Split Squat (RFESS): This is another good test for balance and hip control, as well as the ability to generate force through the leg complex. We would like to achieve 10 repetitions without compensation and to maintain good balance throughout each rep. 8. Single Leg Hamstring Bridge: The repeated hamstring bridge is a great way to assess the strength and endurance of the muscles behind the leg. During the test, perform a single leg bridge at a tempo of one second up/one second down per rep. Perform from regular 18” bench/chair height. Try to create a straight line from the knee/hip/shoulder, showing good hip extension each rep. We would like to see 30 repetitions. 9. Single Leg Bridge Hold: During the single leg bridge hold, we are assessing your ability to maintain good hip, pelvis, and lumbar control while engaging the gluteal and hamstring muscles. Hold for 30 seconds without compensating at the hip, pelvis, or lower back. 10. Side Plank This is a good test for assessing muscle endurance of the lateral hip and oblique abdominal muscles. Without proper hip and core muscle endurance, there will likely be compensatory pelvic drop or lower back muscle use to maintain pelvic and hip control. Perform a side plank from the floor with the opposite leg raised. This can be performed on a GHR machine if you have shoulder issues. We would like to see comfortable holds for longer than one minute without dropping the pelvis. You should be looking for any difficulty maintaining these test positions, any loss of balance issues, or any mobility restrictions required during these tests. If you notice any of these deficits, this is a good opportunity to address your needs during your strength and mobility training sessions. If you are unsure of your results, or would like an expert eye for your assessment, feel free to contact us! Thank you and happy running!
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