On Monday, January 27, New York Road Runners hosted a live Facebook chat with HSS physiatrist Dr. James Wyss to talk about injury prevention when training for a half marathon. The following is an excerpt from the chat, with answers provided by Dr. Wyss.
Do you have any recommendations on lower back stretches for pre and post long runs?
Dr. Wyss: There are specific low back stretches that are helpful such as prayer stretch and cat-camel exercises done in quadruped position; and knee to chest and hamstring stretches done lying on your back. Most of the time, it is more important to maintain good core strength and hip/thigh flexibility. Deficits in either of those areas will cause a tight low back feeling.
Alberto Salazar said in a recent article: “WEAR THE RIGHT SHOES: The second-most-common cause of injuries, next to running too much on hard surfaces, is foot pronation and shoe instability. The more you run, the more support your foot needs.” Do you believe this statement?
Dr. Wyss: I partially agree with that statement. It can’t be generalized across the board. Some runners require extra pronation to make up for other biomechanical issues so if you take it away to support and control pronation, you may help some and harm others.
I recently tore my meniscus in my right knee. Once I am all healed up, what is the most important thing I can do to prevent knee injuries? Are there any special stretches or strength training to keep this from happening again?
Dr. Wyss: This may sound too simple, but you have to make sure that knee range of motion is full, strength is the same as the other side and he balance is equal as well. Maintaining full knee function is the key to injury prevention, but a kinetic chain analysis by a physical therapist may help to identify faulty movements or strength deficits that need further attention to prevent injury, but also to improve performance.
I have a problem with my piriformis muscle. It acts up on long runs. Yesterday after the half was painful. Sometimes it is just one side and sometimes it’s both. I do stretches too. Am I missing something?
Dr. Wyss: The piriformis muscle, a muscle in the gluteal region near the top of the hip joint, can cause pain for many reasons. Most commonly, I see patients with lumbar spine conditions that develop tight and painful piriformis muscle, hip dysfunction and hip abductor weakness is a common cause in runners for tight and painful muscle. It may be time to have an evaluation by a physiatrist (doctor of physical medicine & rehabilitation).
I ran the NYC Marathon in 2013 and developed a bad case of metatarsalgia. It’s really been slowing me down. I’ve been seeing a podiatrist for PT, but nothing is working. Any suggestions on what can be done to get me running again?
Dr. Wyss: Metatarsalgia usually recovers well with time and rest. Change in footwear or orthotics is often required. If you’re not recovered by 3 months, further evaluation and treatment is indicated. I would recommend seeing a sports medicine specialist that’s either primary care trained or a sports physiatrist.
I snapped my Achilles in 2007. Although I am fully rehabilitated and have run marathons and half marathons in the past year, my Achilles is still quite stiff in the morning and after a run. Anything I can do to improve this? The “good” Achilles often feels similar.
Dr. Wyss: There is probably not too much to do since some of these symptoms come with the territory. However, you should stretch, on a daily basis and after running, the soleus and gastrocnemius. These two muscles make up the calf muscle. It should be 20 seconds per stretch, and when that may no longer be adequate, try increasing the hold time to 30-60 seconds.
Do you have any advice on IT band pain? I’ve been training properly, but after races like a half marathon, it’s always acting up!
Dr. Wyss: ITB (iliotibial band- the ligament that extends down the outside of the thigh from the hip to the lower leg) syndromes are very common and although not debilitating, are difficult to treat. The key is to strengthen the hip girdle and core since the ITB is trying to serve a function it should not be serving. Some are helped by foam rolling the TFL (tensor fasciae latae- muscle in the thigh) and ITB, but I you do this without strengthening the hip, specifically the gluteus medius, you will not be successful. A running analysis has helped some of my patients find and correct faults in their mechanics.
What’s your recommendation of how to best treat plantar fasciitis and adjust training?
Dr. Wyss: Plantar fasciitis usually requires time and rest, but if you are running through it as many do, the keys are plantar fascia and calf stretching, especially in the morning and after running and making sure footwear modifications are not needed. An arch cushion, posterior tibialis, and toe strengthening exercises also help to support the arch and alleviate plantar fascia pain.
Dr. James Wyss, Physiatrist, specializes in the non-operative management and rehabilitation of common musculoskeletal and sports injuries. He has a special interest in spinal rehabilitation, interventional spine procedures, the use of ultrasound in musculoskeletal medicine, and injury prevention programs.