Pain on the side of the knee is most often derived from inflammation at or around the insertion point of the IT band*. There are many possible causes as to this inflammation, but a first objective should be to decipher if the pain is simply from inflexibility of the IT band. Ober's Test is a quick and easy way to determine this.
Ober's Test: While lying on your side on a table with the affected leg up, have a partner slowly extend (pull backwards) and abduct (raise) the leg while the knee is flexed at 90 degrees. When the thigh of leg is in-line with the torso have your partner gradually lower the leg. If the IT band is tight the leg will remain in the abducted position (raised position) and/or the knee pain surfaces.
Treatment first involves reduction of the current pain through icing, anti-inflammatories, and EMS or other physical therapy practices. Prevention techniques should also be discussed with the physical therapists, though a more thorough flexibility program involving the IT band is a safe first step.
*'IT' stands for illiotibial. This fibrous band originates at the ilium (the top crest of the hip bone) and inserts at the lateral side of the proximal tibia, just below the knee
Elliptical for Running
For those who prefer not to train outside during the winter, and are instead deciding on which type of cross-training to pursue, cardiovascular conditioning and muscle strength are key elements to consider. A common form decided upon is the elliptical. Some obvious benefits being:
· It's inside.
· There are no impact forces on the joints.
· Motion is somewhat similar to running so a somewhat similar firing pattern is used.
Then the negatives, particularly for those focused on improving running, include:
· It is different enough from running that running efficiency can be compromised
· Stabilizer muscles and over-all leg strength is reduced due to lack of impact forces
· Increased likelihood of hip injuries due to susceptibility of an excessively high turnover rate and excessive range of motion.
To help counter these negatives and prepare best for when you resume running, try the following:
1. Change the resistance and speed on the elliptical to match the stride rate and intensity of your easy running pace.
2. During 1-2 elliptical workouts per week, increase the incline for intervals of 1-3 minutes while maintaining the same stride rate done at 'easy pace'.
3. Include isometric leg strengthening exercise in your program, i.e. holding squat or lunge positions for 30-90 seconds, to facilitate balance and strength gains in muscles worked during the absorption phase (landing phase) of running.
4. If possible, include 1-2 bouts of jump-roping per week to maintain strength in some of the muscles used during the propulsion phase (push-off) of running, and to increase cardiovascular strength and endurance.
The Law of Specificity applies here in that the closest you can stay to running during the winter the better it will aid you when the weather breaks. With this in mind, running on the treadmill and aqua-jogging are the next best alternatives to outdoor running. If the above suggestions are employed, however, the elliptical can in the least keep you in the game.
Deciphering the Hydration Hype Know what to drink and when
Before 1969 runners were encouraged not to drink anything at all. It was believed that drinking anything at all would cause gastro-intestinal distress. The 1970's encouraged athletes to "drink beyond thirst." This new mantra resulted in the first case of exercise associated hyponatremia, which occured during the 90 Km Comrades ultra-marathon in 1981 South Africa . Hyponatremia, also known as water intoxication, is defined as low sodium in the blood. Sodium is vital for maintaining blood pressure and is also needed for nerves and muscles to work properly. Therefore, common symptoms include abnormal mental status, fatigue, headache, loss of appetite, muscle weakness, muscle spasms or cramps, and nausea.
There have been 10 total cases of death from water intoxication. After the 2002 Boston marathon Cynthia Lucero died as a result of over consumption of the electrolyte containing sports drink provided by the race. This condition of exercise associated hyponatremia was then studied by a group of residents from Harvard Medical School. They found that 13% of the runners they studied developed water intoxication. They also found that with some of these runners sodium actually played little role in their condition. This finding, in addition to the fact that 70% of runners who over hydrate simply do not develop hyponatremia, led to the conclusion that genetic predisposition is a more important cause to the condition than previously thought. Hyponatremia can be prevented by being in tune to your bodies' individual needs and understanding the environment you're running in. Use the guidelines and tips below to avoid hyponatremia and maximize performance.
Before your run: 2 hours before your run drink 16 oz fluid 15 minutes before drink 8 oz sports drink (if fully hydrated, skip this step to avoid an extra trip to the Port-O-John) * Research has proven that those who drink before exercise maintain lower core temperatures and heart rates than when no fluid is ingested.
During Work-out or Race less than 30 minutes: Plain water or is it's hot and humid try G2 or Ultima which provide electrolytes and less carbohydrate and calories. These are also fantastic for hot yoga. http://www.ultimareplenisher.com/
During Work-out or Race longer than 30 minutes: 4-8 oz sports drink (Gatorade) every 15-20 minutes *Practice your longer runs with the sports drink that will be provided on race day.
During Work-out or Race longer than 2-3 hours: Try a sports drink with electrolytes, carbohydrate and protein such as Accelerade or Sustained Energy and Perpetuem After: Use a recovery drink after a race or workout, especially if you have no appetite after running. Recovery drinks can also serve as a pre-run meal if you can't tolerate solids when fueling up. Ultrarunners might want to experiment with these drinks during exercise to help meet their high need for calories.
*Examples: Recovery drink, Latte or chocolate milk if on the road, toast or bagel w/egg or peanut butter with glass juice (has 4x the potassium of sports drinks). Side: Researcher Jason Karp, M.S. of Indiana University tested chocolate milk vs. Endurox R4 recovery drink vs. a regular sports drink. The chocolate milk has the magic 4:1 carbohydrate to protein ratio, is cheap and tastes good. He used nine endurance cyclists who did an interval training workout, rested 4 hours drinking the chosen test drink, then worked out to exhaustion. Each rider was given each drink on three different days. The results - chocolate milk was as good as or better than the sports recovery drink and the regular sports drink for performance, heart rate, perceived exertion, and lactate levels.
Tips: · Carry a hand held bottle or fuel belt (re-stock at a coffee shop/convenience store) · Carry cash to purchase sports drink · Eat salty foods days prior to long run/race (tomato juice, pretzels, baked potato chips, pickles, crackers) · Don't waste water on your head - Putting water over your head does nothing to lower body temperature · Pinch cup in half to drink more easily while moving · Compare pre and post exercise weights (a 1% weight loss can hamper performance. If you exhibit symptoms of hyponatremia and gain weight during exercise you may need an individualized fluid plan) · Alcohol consumption is contraindicated due to it's diuretic properties · Caffeine by comparison is a much milder diuretic and in those who regularly consume, it may have little effect if any at all.
Carol Rodriguez Boston Running Center Sports Nutritionist
Below is a short excerpt of a recent email interview of Rowena and Erika by a local sports journalist.
What's the general difference between yoga for runners and general yoga? Are there certain poses or types of yoga that runners should focus on?
Rowena - The Boston Running Center has carefully crafted a yoga class specific to the needs of runners by integrating the expertise of the Head Running Coach, the yoga instructor and the running community. Yoga for runners focuses on hip openers, stretching leg muscles, strengthening abs and upper back, and nourishing breathing exercises. Overall, the body will benefit from yoga, however finding the balance between running and yoga is important. For instance, poses after long runs should not tax the body any further. Runners should practice fewer standing poses and practice supported (seated and reclined) poses to relax and restore the body. Poses recommend after long runs: Downward facing dog, Pigeon, legs up the wall, supine twists.
Erika - Yoga for runners implements a series of postures designed to lengthen and stretch muscles used when running (hamstrings, Iliotibial band, iliopsoas muscles (hip flexors), tibial muscles, achilles tendon, and the plantar fascia). It also focuses on the spine to alleviate the extent of compression we exert when we run. Many of the postures incorporate the use of the abdominal muscles (to include transverse, oblique's and rectus abdominus) to build strength in this critical area of the runner.
Most runners are extremely inflexible, so what's the best way to approach yoga in the beginning? How do you make sure you don't over strain early on? What are the common mistakes runners make?
Rowena - The best approach is to ask questions and BREATHE. The yoga teacher's role is very important. When working with new students it is important to get information on injuries or tweaks in the body so that modifications can be given. The yoga sequence has to make visceral sense in order to gingerly stretch muscles and create space in the joints.
Erika - A novice runner does not run a marathon on their first day, it is something that is built over time; they may begin with one mile and then they work their way up. The same holds true in yoga. You begin your practice where you are in the present, and gradually over time, increase your body's flexibility. It is best to listen to what the body is telling you, use props, go with ease and be patient. Runners have an inherent sense of their own pace, such a mindset should be brought to the yoga mat too.
Do you know of any runners that saw a dramatic benefit to their running (times, injury prevention, form improvements) from doing yoga?
Rowena - Definitely! Personally, I have experienced a dramatic benefit to my running especially in terms of time (I continue to shave time off my 10Ks and half marathons (up to 40 minutes)), injury prevention and endurance. Forrest Yoga has a healing quality and I healed my hip injury incurred from running. Students have said that the flexibility and strength they cultivate in class translates into great runs.
Erika - I have known quite a few runners that improved and brought themselves out of injury through a yoga practice. I had a student who noticed she breaths much better during her runs and her stride could open more easily. It is not uncommon for people to have serious back issues from running and lots of students (runners and non-runners alike) have experienced great relief in their back from the practice.
