not-so-fast-physio-blog

[not-so-fast-physio-blog]

Your Race is Over. Now What? Time to Recover

You did it! You crossed the finish line! You just accomplished a feat that far too few will even dare to imagine.  You just did something totally awesome!!!  

Now that the race is over, particularly for you half and full marathoners, it’s time to focus on recovery.  After all, it’s highly unlikely you just ran your last race. You’re not going to just hand over your library card and stop being a runner.  So, whether you just knocked out a personal best or barely staggered across the finish line, it’s important to have a plan in place to take care of yourself, so you can soon get back to getting after it!  

Phase One: 0 to 24 hours

Refuel, Rehydrate, Repair

Immediately after crossing the finish line, go for high carbohydrate drinks and sources of protein and complex sugars.  Replenish fluids and energy stores and make available to your tissues the amino acids necessary to kick start tissue repair.  Think Gatorade, Chocolate Milk, Bananas, Oranges, PB&J

Get off your feet and reflect on your awesomeness, all the while giving an assist to your circulation.  Inflammation in your tissues after doing hard work, and running a long ways IS hard work, is normal, healthy, and necessary for initiating tissue repair.  Let it do it’s thing and don’t interfere by doing things like “cool-down jogging” and “ice baths”.  Manage swelling, which is different from inflammation, and can be a source of discomfort and a detriment to tissue healing, by elevating your feet and using compression wear.  A little light foam rolling may also be helpful, but don’t get too carried away.

Limit the alcohol.  Believe me, it kills me to say this.  What better way to celebrate your awesomeness than with a cold beer!  But alcohol dehydrates and distracts your metabolism from what it should be focusing on, repair.  Eat and drink healthy nutrients that will continue to fuel recovery.

Sleep.  You need it.

Phase Two: Days 2 and 3

Recover

Continue to focus on rehydrating and eating well, and get good quality, and quantity, sleep.  

Your body’s process of repairing muscle and other tissues continues to be in high gear.  To support this process, work to get the blood flowing a little bit and continue to manage swelling by using elevation and compression, while easing some movement into your day with light walks or an easy bike ride.  If you have access to a pool for water walking or some structured “floating,” fantastic.  A light massage may also be in order!  

Stay away from running.  

I repeat, stay away from running.

If you did manage to sustain an injury during the race, here you might start to gain a better understanding of what exactly happened, which leads to figuring out what you may need to do to get things getting better.  This is when it’s nice to know a good PT!  In fact, here’s one! 

Phase Three: Days 4-7

Starting to Feel Better

Continue to focus on recovery.  As you start to feel better, you may feel inclined to go for a run.  It’s just so damn addictive!  Hold off a little bit longer.  

Continue to push fluids.  

Find easy physical activity throughout your day and listen to your body!  Let the repair continue.  Stick with the walks, cycling, or swimming.  

Phase Four: Weeks 2-4

Ease into It

Slowly reintroduce intensity into your workouts by listening to your body and how you feel.  If soreness and fatigue accompany an activity, back off a bit the next day.  Cross-training here can be quite useful as you look to ease back into running.  As you start to feel better, and begin thinking about that next race down the road, take time to reflect on your training and performance in the last race. ��Identify areas that might need greater focus in when training for that next race, so you can keep on running on.  Because running is AWESOME!

[not-so-fast-physio-blog]

Should You Be Ashamed of Yourself?

A few weeks ago a buddy of mine, who happens to be a really good runner, especially by my standards, came up to me and said, “Hey Nate, the back of my legs have always been pretty tight.  Is that something I should be worried about?”  I told him, “Not necessarily, why?”  He replied, “Well, the other day at boot camp we were warming up, doing some stretches, and the group was giving me a hard time as I’m not really able to touch my toes.”

He’d been Hamstring Shamed.

These perceived feelings of tightness are pretty common among people, whether it be hamstrings, or hips, or calf muscles, and I generally don’t get too worried about it unless it’s associated with discomfort or difficulty performing a task.  I asked him, “Are you having any problems with your daily activities?” “No.”  “Are you having any pain?” “No.”  “Have you noticed any change in your running or gait?” “Nope.”   “Well then, you’re probably as flexible as your body needs to be for what you want to do.  Stretch if you want.  Or don’t.”

This exchange got me thinking though.  Flexibility is a wide ranging topic and one where everyone seems to have their own opinions.  To add to that, many of those opinions are miss-guided, or flat wrong.  So let’s take a look into flexibility and stretching, and see if we can tease out the important stuff, so you can decide for yourself if stretching is something you need to do and whether or not you’re flexible “enough.”  As always, the aim of The Not-So-Fast Physio is to empower we “average” runners.  The information referenced will be biased towards running.

Often when runners reflect on their own perceived lack of flexibility, wondering if they need to stretch more, they often ask themselves the following questions:

Do I need to be more flexible?

Should I stretch before running so I don’t hurt myself?

Should I stretch after I run?

My (insert body part) hurts. Should I stretch it?

If I don’t stretch will I get old and stiff?

We’ll try to address them here.

“Do I need to be more flexible?”

There is no “Gold Standard” for just how flexible anyone should be, namely, how much motion you should have available at both ends of a joint’s movement spectrum.  You just have to have the necessary range to accommodate the movements needed to complete your desired activities.  If you want to be in the ballet, you damn well better have muscles like Laffy Taffy.  That isn’t necessarily the case for runners, whose muscles often more closely resemble Kit Kats.  In fact, those Kit Kats can be somewhat rewarding.   A few studies have shown that runners with shorter hamstring lengths are actually more efficient runners, which helps them run faster and longer.  Runners need enough hip extension, ankle dorsiflexion, and big toe extension to load the stance leg all the way back for a solid push off.  This typically isn’t an issue.  By buddy should tell his hammies “Thank you!” and then look at his fellow boot campers and say “Back off, my hamstrings are AWESOME thanks!”

Other types of exercise or athletic activity require greater levels of flexibility, and doing mobility work (which can include static stretching) may be needed to get you where you want to be.  In the end, if you want to be more flexible, go ahead and stretch it out.  Stretching feels good.  It’s relaxing.  It helps you feel more pliable. It calms the nervous system.  It can be quite beautiful.  Just know that when it comes to running problems, lack of “flexibility” is usually not the culprit.

Final Answer: Probably not.  In fact, being “tight” in some areas may be beneficial for runners.

“Should I stretch before running so I don’t hurt myself?”

It’s a common belief that stretching decreases your risk for injury.  It’s also a common belief that you should stretch to warm up.  So you’ll often see people at the gym or near the starting line doing toe-touches, calf stretches on the curb, or knee to chest stretches on their back, just to name a few.  Studies show, however, that static stretching has no impact on whether or not you will sustain an injury.  Injuries still occur.  The research also shows that static stretching as a warm up impairs performance, as it decreases the ability of your muscles to produce strength and power.  

The vast majority of injuries sustained by runners can be traced back to overload, meaning the runner has run too far, too long, or too fast (maybe too slow?).  All tissues have a breaking point.  To truly decrease your risk for injury, you need to build capacity into your tissues.  You have to build an ability to accept load, then propel that load forward, over and over.  Stretching and flexibility really have little to do with this.  You need to focus on building capacity through running and strength training.

•Side note: If you’ve experienced a significant injury or undergone surgery on an area that has resulted in significant limitations in mobility at a joint in the leg, you may be at a higher risk for injury as other joints above and below will need to compensate.  This can result in overload injuries in the compensating tissues.

Should you warm up before exercising? Absolutely.  Our muscles are like ketchup.  If it’s been sitting in a bottle on a shelf in the fridge, it won’t move well initially as you try to pour it out.  But, if you shake it and get it moving, it flows quite nicely.  You need to get your muscles moving, but it should be through an active warm up, such as a slow jog, walking knees to chest, jumping jacks, whatever.  Incidentally, this also prepares your cardiovascular and pulmonary systems for what lies ahead.  You need to prime the pumps.  Static stretching doesn’t do that.  On top of that, it decreases strength and power output.  We don’t want that.

Final Answer: No.  Use an active warm up to feel loose and get the blood flowing.  Stretching gets you stretchier, which is awesome if you need more mobility to better fit a task.  But that’s not all too common in running.  If you want to decrease your risk for injury, you need to get stronger.

My “____” hurts. Should I stretch it?

Sore or painful areas often feel tight, so it seems logical that stretching the area will fix it, or make it feel better.  Let’s take the plantar fascia for example, as it is a common place for runners to experience pain and/or tightness.  Pain is a perceived sensation resulting from the brain deciding that either an acute injury has occurred or there exists a suitable threat of harm to occur.  It’s not often that a runner steps on a nail when running, so most plantar fascial pain is a result of the brain notifying the runner that the tissue is struggling to keep up.  There exists a threat of harm.  Pain is therefore a protective mechanism that hopefully stops you from incurring serious harm to your tissues.  Along with pain, your body also “stiffens up” the area under threat (your calf might feel tight).  Again, this is a protective mechanism to hopefully keep you from doing something stupid and really hurting yourself.  You should listen to your body here.  Will stretching help in lessoning your heel pain and loosening your calf muscle?  It will, but remember what we discussed earlier.  Static stretching “turns down the volume” of your nervous system.  This helps to decrease the threat messages going to the brain and subsequently relaxes the musculature.  Therefore, stretching may help to decrease your perception of pain and discomfort and will loosen the muscle.  Be mindful that the effect is short lived, which is why you often have to keep “re-stretching” the painful tissue.

To truly address your pain or discomfort, you have to get to the root of the problem, and that is that your nervous system is telling you that the tissues are not handling well the loads you are placing on them.  You need strength and capacity, which is a common theme here!  For runners with plantar fasciitis, you’ll commonly see calf stretches prescribed for treatment.  They do work to decrease discomfort, but in the end the stretch isn’t what gets people better.  The latest research calls for strength exercises to build capacity and force the body to adapt to handling greater loads.  There’s also evidence that changing your running mechanics can be of assistance.

Final answer: Stretching will help to decrease discomfort.  But the likely reason you have pain is that your tissues aren’t able to handle the load you are asking them to take on.  Back off a bit on the running, possibly look at your running mechanics, and strengthen your tissues.

If I don’t stretch will I get old and stiff?

This question’s straight out of the Not-So-Fast Physio Mom’s mouth!  I’ll keep this simple and to the point.  If you don’t use it, you’ll lose it.  If you lose it, you can’t handle it.  If you can’t handle it, you’re in for trouble.  Stay active, move, stretch, and strengthen.  Build capacity into your body, and your body will reward you by allowing you to do the things you love to do for years and years.  Mom, with love I say, “Pick up a weight and lift it a few times.”

Final Thoughts on Static Stretching and Flexibility:

1.You need to have the necessary range of movement required to complete your desired activity.  If you lack the range, static stretching will lengthen the desired muscles over the course of 3-8 weeks (depending on the studies reviewed).  Remember though, if you don’t use it…

2.Stretching is not the ideal warm up for physical activity.  Use a dynamic warm up to loosen the muscles and get the blood flowing.

3.If you’re trying to get over an injury, or even prevent an injury, stretching is not your best option.  Strengthen your tissues to prevent most issues!

4.It’s true that as we age we do lose elasticity in our muscles and various connective tissues.  But it is not so much that which drives us to lose flexibility.  Rather, it is the hours upon hours that we spend sitting and eating crap.  So get moving and do something awesome!

Thank you so much for reading.  Please share with all of your friends. If you have any questions please comment in the comment section and I will do my best to adequately provide an answer.  If you have any concerns regarding a current injury, or would like specific coaching with regards to running or strength training, you can contact me by email (natedickesphysicaltherapy@gmail.com)  or my website.   

Keep running!