Monthly Archives: March 2016

First Time for Everything: PT

Hokas have been my shoe for 2 years. Lookout Mountain 50, #1 Master’s Female, December 2016. Ball of foot pain. Sport’s Doctor. Metatarsalgia in my left foot. I decided on Altras, wide toe box, zero drop, toes won’t cram together, less toe spring. Posterior Tibial Tendon irritation.  Back to Doctor. Back to Hokas. I decided KT taping for toe and tendon. I maintained my 45-60 mile weeks and dealt with the irritation. It was not crippling, just annoying and not going away. Gotta get relief. I decided to take 8 days off of running to ease my symptoms.  I decided to see a PT.

True confessions, my entire 14 years of running life (10 years on the road, 4 years on the trails):

  1. I have had a massage, only twice in the past 2 years.
  2. I have never “rolled” anything.
  3. I have never visited a Physical Therapist (PT).
  4. I am 44. (my readers know by now that I LOVE being this age, but that is a long time to go without the above)

My friend recommended Leah Sawyer  to me. Check out her creds:

  • Stanford University- BA in Human Biology 2003-2007
  • Duke University- Doctorate of Physical Therapy 2009-2012
  • Certified Lymphedema Therapist (CLT)- certified since 2015
  • CSCS (Certified Strength and Conditioning Specialist)- certified since 2009
  • Trigger Point Dry Needling (basic and advanced levels)- certified since 2010
  • Functional Movement Systems (FMS)- certified since 2012
  • Astym Provider- certified since 2014

I had my first appointment last Wednesday. I arrived and Leah and I talked for a bit about the history of my injuries. She asked me to do several movements, i.e.. heel raises, squats, single leg squats, lunges, etc. She looked at my foot/tendon and asked some more questions. She took some measurements. Then, she went to work on my calf muscle, close the my Posterior Tibial Tendon. She performed Astym on the muscle of my calf. She also did Astym on the bottom of my left foot.

Astym treatment is a physical therapy treatment that regenerates healthy soft tissues (muscles, tendons, etc.), and eliminates or reduces unwanted scar tissue that may be causing pain or movement restrictions.

“What is Astym?”

“We use the analogy of spaghetti to explain the problem,” says Macias. “There are fibers in the muscle tissue that should be parallel to each other like spaghetti in a box so they all fit together and work together. When the muscles are overworked and injured, the body lays down scar tissue so the fibers lay down more haphazardly like cooked spaghetti and interrupt how the tissue can glide.”

-Nancy Maes, “Astym Treatment Heals Pain For The Active and Overweight”

A Few Questions for Leah:

1. How do you decide what treatment to give your patient (s)? Do you start with one therapy and progress to another, based on response? Or do specific injuries generally have a treatment they respond to best?

Treatment is completely individual, so I take into account a number of factors including the patient’s athletic goals, lifestyle goals, their whole body posture, flexibility, strength, etc. The severity and duration of the injury matter too. It’s a complicated algorithm and definitely a bit of a science and an art!

2. What is the easiest injury to treat? Quickest to heal?

No injury is necessarily “easy”. Everyone’s injury is important and significant to them, so I don’t necessary compare on injury to another. That being said, it is really fun to treat young athletes because they heal sooooo quickly and respond to exercise so rapidly. They are like little starfish! 

3. What is the hardest injury to treat? Longest to heal?

High hamstring injuries can be really nagging, take a lot of patience (for both the therapist AND the patient), and require very specific but incremental treatment. I’ve dealt with this myself, so I enjoy helping patients overcome hamstring issues but also know how frustrating it can be. 

4. Hardest ‘type’ of athlete to treat? Easiest athlete to treat?

I am a runner, I’ve been a runner my whole life, but we can be so stubborn and act as our own worse enemy! That being said, I truly enjoy treating runners. As a stereotype though, we can be difficult 🙂 Cross fitters can also be difficult as they tend to not want to rest. 
Easiest athlete…hard to say. Any athlete that prioritizes their long term performance and health over short term goals will do well. I can’t say this is specific to a sport, but to a personality type. I’ve had to learn to think this way myself over the years. 

5. As an athlete ages, does it take longer to heal? Do you change the form of treatment based on age?

It does, absolutely. I hate to admit it but our connective tissue changes with age and the time we take to heal, recover, strengthen, etc changes as well. They have done studies showing this with stretching specifically. Knowledge is power though- as long as one knowns what to expect, he or she can plan and modify accordingly. 
I always say that age is NOT a diagnosis! People don’t get injured because they are “old”. They don’t stay injured because they are “old”. The get or stay injured because they haven’t altered their training or recovery as needed. They can still reach very high goals, but need to go about it in a different way. 

6. Do men’s bodies and women’s bodies heal differently? Faster? Slower? (Does Testosterone influence how fast a person heals?)

It certainly can, but I’m not sure that I’ve seen this as an obvious contributor to recovery times. That being said, I tend to see certain injuries in men vs women. I think this is more a function of how we learn to move and/or what muscles we tend to strengthen. This predisposes us to certain injuries, but I don’t think that hormonal differences are the main component for these differences. 

7. Do you see a lot of athletes who over train? Can you tell?

Oh yeah. And I can tell. As a physical therapist, there are certain things that I KNOW should work and reduce a person’s symptoms. Even though I cannot predict that specific rate of improvement, I should be able to predict a round about recovery time. If a patient is performing their home exercises, coming to their appointments, and their symptoms are still not changing or they are getting worse, something else is going on. More often than not, it’s overtraining. 
Usually I can tell if a patient is an “overtrainer” or not right away. As physical therapists we treat the whole person, not just the body part, so I definitely alter my treatment and exercise prescription based on this. 



The Bike: My Rehab and My Recovery

Cycling can benefit runners for both recovery and training. It aids in recovery by flushing the legs out. A super-easy spin has no impact, and you’re moving blood through the muscles. On the opposite end of the spectrum, cycling can be great for building high-end aerobic training doing intervals. You also can maintain a ton of fitness with riding if you are injured.

-Jenny Hadfield “How To Improve Running Performance With Cycling”

First, let’s talk about why runners should even think about cycling in the first place. Whether you hop on a road bike or a fitness bike at your gym, both are non-impact cross training exercises that help build your engine – your lungs, capillary network, and heart strength. You can keep off unwanted pounds and maintain a pretty good fitness baseline even if you’re just cycling.

-Jason Fitzgerald “Cycling or Spinning? The Best Cross Training for Runners”

I use the stationary bike to rehab injuries and to recover between races. When I was training for Zion 100K last year, I had two separate calf strains over the course of 24 weeks. I rested from running for 8 days each time. This time off did not rock the momentum of my training or cause any fitness setbacks. I sat on the bike each day, while I waited, while I healed.

I also love to use the bike, after a race. I rest completely from all activity for 3-5 days, after each race, depending on how I feel. After that brief period of rest, I usually sit on the bike each day for a week before I get back to running.

At my gym,  I ride a True CS200 upright bike. I break my workout into two parts.

Part I: This part is a hill climbing workout. The hill pattern depends on the day. I like a consistent pattern with climbs and breaks.

  1. I set the bike to manual, so that I can adjust the level and change the height of the climb on the screen.
  2. I set the workout time for 28 minutes. This means that each line segment that appears on the screen is one minute long. It helps me to anticipate the climbs and breaks. 🙂
  3. I like to create a different patten each workout.
  4. Latest example of a workout pattern.
  • 1 minute @ level 9
  • 1 minute @ level 11
  • 1 minute @level 14
  • *repeat for 25 more minutes

Part II: 10-14 minutes. I work on cadence. I choose a few songs on my shuffle, set the bike to manual and ride @ level 10 for the given time. The songs determine my turnover.

There is also a correlation between pedal stroke cadence and running strike cadence. The concept behind this idea is that developing a higher pedal stroke cadence will supposedly lead to a higher foot strike cadence. A higher foot strike cadence means the feet are turning over faster and therefore spending less time in contact with the ground, hence there is supposedly less impact and less chance of injury.

-Jannine Myers “Could Spinning Be the Best Cross Training for Runners?”


Hills on the ‘Mill


Hill sessions force the muscles in your hips, legs, ankles and feet to contract in a coordinated fashion while supporting your full body weight, just as they have to during normal running. In addition, on uphill sections your muscles contract more powerfully than usual because they are forced to overcome gravity to move you up the hill. The result is more power, which in turn leads to longer, faster running strides.

“Everything You Need To Know About Hill Training”

. . . hill sprints in particular can produce specific adaptations in the neuromuscular system (i.e., rate of motor unit recruitment, synchronization, etc.) that will allow the body to generate force faster. The faster you can summon force, the more total force power you can generate during a rep attempt.

Another cool aspect of hill running is that it increases your ankle flexion, which allows you to “pop” off the ground more quickly. This means that you’ll be spending more time in the air and less time on the ground, which is good for your running economy and pace.

To give you some idea of how hill training can impact a runner’s economy, consider a famous study performed at the Karolinska Institute in Sweden. The 12-week study examined the impact of twice-weekly hill sessions on the running economy of trained marathoners. The researchers found that “after 12 weeks of twice weekly hill sessions, the athlete’s running economy had improved by 3%. This improvement would have helped them take as much as 2 minutes off a 10 mile time or 6 minutes off a marathon.”

“Benefits of Hill Training”

With a good hill, you can train almost perfectly. Hills build leg strength, increase your running economy (efficiency), prevent injuries, reduce impact forces on your legs, increase stride power, and improve the neuromuscular communication pathway.

-Jason Fitzgerald, “Hill Running 101: How to Take Your Running to New Heights”

I positively LOVE hill running. I have always liked hill running. I think it is the challenge of it. I also think I like it so much because not everyone will choose to do it. I know that I have posted before on hill workouts. The quotes above should take away any doubt of the benefits of hill running, hill repeating. As a road marathoner, I would have one day a week, dedicated to hill repeats. As a trail, ultra runner, I repeat hills at least twice a week.

The treadmill is a GREAT tool for your hill work! Here is an example of how I am using it now to get ready for my 50 mile race in April and my 100 mile in September.

BEGINNER: 30 minutes on the treadmill, AFTER a shorter mid week run or after a long run.

Treadmill at 15% for 30 minutes. Speed 2.8-4

ADVANCED: 2+ miles on the treadmill, AFTER my long run.                                                       (MY setting and speed example)

Treadmill at 15%, power hike for 10 minutes, speed 3.8-4

Treadmill at 15%, run for 5 minutes, speed 4.3-4.5

Treadmill at 15%, power hike for 1 minute, speed 3.8-4

Treadmill at 12%, run for 5 minutes, speed 4.3-4.8

Treadmill at 15%, power hike for 1 minute, speed 3.8-4

Treadmill at 9%, run for 5 minutes, speed 4.3-4.8

Treadmill at 15%, power hike for 3 minutes, speed 3.8-4

cool down by walking on the treadmill for 5-10 minutes

Things to consider:

  1. In the beginning, the speed is not as important as the incline.
  2. It will feel hard.
  3. Start with 15 minutes
  4. Use this as a supplement to your trail running
  5. In the beginning, use the beginner workout as your “short run day”, follow up with stretching or core work
  6. Give yourself 3 weeks before you increase your distance or your speed

“Be the coach who loves the hills”

-Randy Accetta