Congratulations and special shout out to everyone who participated in the Baltimore Running Festival! It is marathon season and you have just completed 26.2 miles! It is a lifetime achievement to be proud of and something that not many people can dream of accomplishing. The amount of preparation, hard work, and determination it takes to complete a marathon has paid off.
But now what? More than likely you never trained for the whole 26.2 miles, but rather only about 20 miles for your longest run and then relied on adrenaline and determination to get you to the finish line. By that 20 mile marker you could start to feel it deep in your muscles and joints. Asymmetries are bound to form as one calf tightens, you start to cramp in a hamstring, or your IT band becomes irritated as you push your body to its limits to reach the finish line. The soreness is from over-stressed muscles, which have caused micro tears within the muscle. Don't worry, this is a normal occurrence and your body will work to rebuild and become stronger. It does not change the fact that you may be sore.
Initially a hot/cold alternating shower to improve circulation, then refueling your body with proper fluids and protein should be taken into consideration. Starting the second day, a combination of rest with non-stressful movements to promote blood flow to sore muscles will be important to decrease tension. Try an easy walk, swim, stretching routine, or easy yin style yoga. You hope these areas of tension go away on their own with rest, but they often hang around feeling restrictions even with daily activities. After the initial rest period when you begin back training these muscle imbalances can hinder your body from performing at its peak ability and can lead to more serious injury.
It is advised that you follow up with a knowledgable physical therapist who can work these imbalances out through deep tissue work or even myofascial decompression. They will also teach you strengthening exercises to improve your running form by targeting the specific areas of weakness that lack the necessary endurance for such a long distance. If treated early you will often only need 2-3 sessions to get back to your baseline, plus you will have greater knowledge to maintain your body in the future. This is all at a relatively low cost considering registration fees, running shoes, hotel room, and your desire to continue your lifestyle in a worry free manner.
Pioneer PT has the ability to come directly to you via a mobile clinic and provide one-on-one care with a doctor of physical therapy for a full hour. Service is direct care meaning you will not need to waste crucial time going to your doctor or a specialist for a prescription. Pioneer PT is your musculoskeletal expert and direct point of access for heath related needs.
The meniscus acts as a cushion in the joint between the thigh and shin bone as well as providing extra stability at the knee. It naturally moves forward and backward in the joint depending on the knee position.
Arthroscopic surgery usually involves meniscectomy, which means to cut out or remove a portion of the meniscus. Why would you want to cut out the cushion in your joint? Could this possibly contribute to more "bone on bone"or joint irritation and degeneration? The failure rate of meniscus surgery is fairly high (1), and often leads to total knee replacement.
To top it off, research at the highest level is showing that there is no difference between groups for surgery verses no repair in 35-65 year olds (2).
Here are my suggestions:
1.)Majeed H, Karuppiah S, Sigamoney KV, Geutjens G, Straw RG. All-inside meniscal repair surgery: factors affecting the outcome. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology. 2015;16(3):245-249. doi:10.1007/s10195-015-0342-2.
2.) Sihvonen R, Paavola M, Malmivaara A The FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators, et al
Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial
Annals of the Rheumatic Diseases 2018;77:188-195.
Fall Mountain Biking Tips:
Fall is my favorite time of the year in the Mid Atlantic. The colors, the smells, the weather, the food, and family are all amazing. It is the perfect time to get outside to take it all in and enjoy a nice trail ride.
The leaves are now falling and they sure look nice, but this is the time of year to be careful on the trail. Freshly fallen leaves are slick and act just like ice. They also hold moisture longer, which adds to a slippery ride. These tips will not only benefit you now, but can help you to become a better rider when conditions are ideal. Here are some tips to enjoy the fall mountain biking season.
First thing is first, know the trail if you are planning to get after it. Knowing the trail does not make it boring, it makes it more fun. Riding new trails are exciting, but it is not as enjoyable not knowing where you are going or the typical conditions. Your "home trail" is more fun, because you learn where you need to carry momentum to make it up a hill more easily, or hit off a log or rock to catch some air. You also learn where to slow down so you do not take a spill in sections of the trail that are technical or wet. Lessons are often learned the hard way and you remember them.
Second, always keep your eyes down the trail picking a line of attack. This will help you to avoid obstacles that slow you down and decrease the chance of pedal strikes. Sometimes with the added leaves and sticks that have fallen it will actually smooth out the trail in certain sections. Maintaining speed and keeping your eyes up allows you to hop obstacles that may be obstructive and help you to maintain a more direct line of attack on the trail. Always stay on the attack with the most direct route.
Third, stay light on your bike. This includes your hands and feet. There is no need to give your handle bars the death grip, it will just increase fatigue. Staying light on your bike allows you to roll over obstacles easier. For example helping to pull your bike or hop over an obstacle by first pulling up on your handle bars and then lifting your bike with your feet will decrease hard hits that slow you down. Use your legs to absorb the hits rather than holding your body stiff, and you will last longer on the trail.
Fourth, you must understand center of gravity and not be afraid to move around on your bike! Riding in a straight line it is definitely more efficient to keep your body still, but how often is your trail straight?
Keep your weight over your rear wheel the majority of the time. This will assist descending and even more so ascending. Keeping your weight over your rear wheel and maintaining a seated position will ensure that all the power you put out goes directly into forward momentum. If your weight shifts too far forward to your front wheel, then those difficult ascents will turn into hike a bike because your back wheel will lose traction and spin out especially on the leaves. On descents keeping your center of gravity low by either hanging off the back of your seat or hitting the dropper post will allow you to have greater control. The front wheel will float over obstacles and have less chance of hanging up causing you to go over the bars.
Watch the camber of the trail. For example, if the trail is on an angle from left to right with the left being the high side, DO NOT lay your bike on edge to left in attempt to turn left. These extremes cause decrease tire to ground contact area and with the slick conditions make you prone to slipping out. Instead shift your weight on the bike by moving your body to the LEFT with gentle handle bar turn to the left. Try to keep the bike more upright, which increases tire to ground contact area and helps to maintain traction.
Fifth, we just touched on: maintain maximum tire to ground contact area. This can also be achieved by running lower air pressure in your tires, which increases surface area of tire to ground contact. This can be achieved best tubeless, or with plus sized tires. 29 inch wheels have more contact area than 27.5, but fat bikes rule when conditions are not at the best.
Enjoy, stay safe out there, and see you on the trails!
Ice or heat? R.I.C.E or M.E.A.T?
One of the most common questions asked by clients is what to use for their injury, ice or heat? Both have their place, both are beneficial for pain relief, but one may be better than the other. Ice constricts your vessels helping to limit swelling, and heat increases circulation helping the healing process by bringing beneficial nutrients and flushing out the waste. Both heat and ice also assist in reducing pain because they give our bodies another sensation to contend with. When ice or heat are applied, our larger sensory pathways kick in and help to overshadow the smaller pain pathways; therefore dulling the effects of pain.
Traditionally ice is used 20 minutes on, 20 minutes off for the first 2-3 days after an injury. This is where RICE comes into play. RICE stands for Rest, Ice, Compression, and Elevation. RICE along with NSAIDs or non-steroidal anti-inflammatory drugs such as Advil are often utilized. However, please consult with your doctor before taking over-the-counter medication, because NSAIDs have been shown to limit long-term bone and tendon healing. Swelling is at its peak at this point and it should be reduced, or should it? Reducing swelling will reduce pain short-term, but our bodies produce this for a reason. Swelling acts as a natural "splint" causing us to protect the painful area and promote healing when it is most crucial.
Now, the next step depends on the extent of injury and you should consult with your doctor or physical therapist before beginning. Here, MEAT, another method of dealing with injury comes into play. Timing can range from the day of with a minor muscle injury to 1-2 months for severe ligament or bone damage. MEAT stands for Movement, Exercise, Analgesics, and Treatment. I am a huge fan of early mobilization as long as there is no fracture or surgery requiring a lengthened rest period. Nothing crazy, but movement targeting gentle range of motion should be initiated early on after injury. Heat applied for 10 minutes prior to motion can promote circulation and allow greater ease of motion. Exercise should begin next, starting to strengthen the muscles surrounding the injury site. The easiest type of exercise is an isometric where you tighten a muscle without moving, like when power lifters pose by tightening their muscles or some of you may know Charles Atlas. Concentric exercises, followed by eccentric, and finally progressing to full body functional movements with the goal to return to activity. A is for Analgesic, which means dulling the pain like Tylenol or Acetaminophen. Tylenol helps to dull the pain without limiting circulation like NSAIDS. Pain relief promotes improved movement, but Tylenol too can have side effects. Those with liver problems may want to stick to ice and heat if pain is tolerable. Again with medication please consult with your physician or pharmacist if you are unsure. Finally, Treatment that involves mobilization and releases by a skilled practitioner such as a physical therapist, who is an expert in movement will help you return to full function and the activities you desire.
Unfortunately there is no straightforward answer, but I will try to clarify. I prefer a combination, as pieces of both RICE and MEAT have their benefits. Swelling acts like a natural "splint" for a reason during the initial healing process. At a micro level our bodies need this crucial rest period to heal. However, do not wait too long because humans are the best at compensating and will often find other ways to function, which is not always the best. Ice can and should be used early on for the first 2-3 days after injury then a combination of heat and ice can be used to promote circulation during the rehab process.
James Dulkerian, DPT
Active outdoorsman with an honest soul and a passion for health.