In preparation for the ING New York City Marathon, New York Road Runners hosted a live Facebook chat with HSS physical therapist Marla Ranieri on Monday, August 19, 2013. The following is an excerpt from the chat, with answers provided by Marla.
I know basic ankle rehab and balancing exercises but is there anything you recommend for people with recurrent ankle injuries to keep the ankle strong?
I would also recommend first seeking out a physical therapist or a trainer especially if this is a chronic/recurrent issue – however resistance band exercises are very useful. You wrap the band around your foot and slowly point and flex using the band as resistance, and then you can pull the band to the side and turn your foot inward and outward to work the different stabilizing muscles of the ankle. These seem easy, but if you do them slowly with higher repetitions it will help with endurance of the muscles.
I have severe heel pain within a half hour of completing a run. In the mornings, I’m barely able to stand on it. Do you think I can carefully continue to train and make the marathon? I don’t want to cancel my first one!
It sounds like you have plantar fasciitis. I would recommend stretching your calves, wearing a night splint, rolling your foot on a frozen water bottle and having support footwear (no bare feet even in the house) to decrease your symptoms. If you start to feel better then you can continue with your training, but make sure your pain decreases first.
What are the best stretches for calf pain?
I like the runner’s stretch (leaning against a wall in a lunge position with your back heel on the ground) You should perform this stretch with your toes facing forward, slightly outward and inward to get different parts of your calf, and with your knee slightly bent to stretch the deeper calf muscle (the soleus). I also really like stretching your calves on an incline.
I took bad fall running this past Friday and banged both my knees. Other than some bruising, it wasn’t painful when I started back running this morning. Are there any other precautions I should take before I continue my training program, especially since longer distances are becoming the norm?
I would make sure you have full range of motion in your knee and look for signs of swelling. If you feel that your strength and range of motion is adequate and pain is not an issue then you can continue with your training program. Just make sure you do some short runs to test out your knee before doing a long one.
What’s the best way to treat an ongoing sore hamstring after sprint workouts so I can keep running?
You may be taking long strides during your sprints and or over stressing your hamstrings. You can have a Running Analysis done at HSS (Sports Performance and Rehabilitation Department) to make sure your mechanics are correct. You should also try to strengthen your core and hamstrings before continuing on with your sprint workouts.
Like many runners, I experience ITB issues that usually start rally bothering me around mile 16 or 17. I know foam rolling and stretching are key. What other exercises do you recommend and do you feel regular weekly sports massages are helpful?
I recommend strengthening your gluts and your core. You can seek out a personal trainer at the gym to help build your exercise program. In addition, I feel massages are helpful if you have the financial means when training for a marathon.
What are your thoughts on compression calf sleeves?
I think they are a good idea to decrease swelling and minimize spider veins, especially if you have any issues with decreased circulation.
Is there any foam rolling regiment, plan that you would suggest to avoid strains, injury during marathon training? How frequent, which areas to focus on, etc?
I would suggest foam rolling before and after your runs focusing on your ITB, quads and gluts. I recommend performing 15-20 rolls on those body parts. In addition to foam rolling always remember to strengthen your muscles. You need to train to run not run to train.
It’s too late for me to avoid injury! What are your thoughts on acupuncture to treat plantar fasciitis? Is that something that HSS or regular western sports physical therapy centers would offer?
HSS does offer acupuncture, but I wouldn’t necessarily recommend it for plantar fasciitis. We have a program called MELT run by Polly de Mille for plantar fasciitis that would be appropriate for you. I also would recommend stretching your calves throughout the day and purchasing a dorsiflexion splint to wear at night.
How can I avoid issues with my IT band while training?
It is very important to stretch before and after your runs especially if you have ITB syndrome. You can use a foam roller to help roll out your ITB. I would also highly recommend strengthening your gluts and your quads to make sure that you have the appropriate mechanics while you are running.
Marla Ranieri is a doctor of physical therapy and the current sports clinical resident at the James M. Benson Sports Rehabilitation Center at Hospital for Special Surgery. Marla is a former National/International League gymnast and collegiate scholarship athlete at Stanford University. In addition to assisting the USA Medical Team staff for the USA Gymnastics Classics and Championships, she has presented on corrective conditioning programs, strength training, injury prevention, and pain management for serious athletes. She is an avid runner and has participated in a marathon, half marathon, and mud runs, as well as volunteered with the medical team for the New York City marathon twice.