by Ross Henshaw, MD, The Sports Medicine Center at Danbury Orthopedics

Dr. Ross Henshaw

Dr. Ross Henshaw, a fellowship-trained knee, hip and shoulder orthopedic surgeon, specializes in Sports Medicine at Danbury Orthopedics. He is also Medical Director of Danbury Hospital’s Sports Medicine program. Dr. Henshaw treats athletes of all ages and levels – from the recreational to the professional.

As any runner will tell you, this simple sport is one of the most rewarding and convenient exercise activities. It’s a wonderfully efficient way to improve your health, except when it produces chronic, nagging injuries. So what’s the best way to safely enjoy a running program? Start smart, with a progressive training schedule that gradually builds the intensity and duration of your workouts.

What the Pros Say

Typically, a running coach or trainer will recommend increasing distances no more than 10% a week.  If you have never been a runner, seek advice from friends, trainers or your local athletic store. There are also great resources on line and in print. But if you have an underlying health condition or are new to exercise, make your first step a consultation with your physician to be sure it’s OK to start running. Orthopedically, running is a safe exercise for most people but there are exceptions, even among athletes. So if you have a history of orthopedic injury or joint pains, particularly those involving the legs or spine, seek the advice of an orthopedic surgeon.

While any form of exercise can cause or aggravate a preexisting injury, endurance sports generate typical injury patterns. Endurance sports by definition involve prolonged repetitive motion. While a soccer player may run 3-7 miles in a game, depending on position, he or she is rarely only running straight ahead at the same speed. But runners go straight ahead at a maintained speed, which means your hip, knee, ankle and arm motions are roughly the same for the duration of the exercise. Hills change the degree of motion and add more jarring forces.

The longer the duration and more hilly the terrain, the more our joints are cycling and the more our tendons and ligaments are pulling and rubbing around our joints. When we start an endurance sport like running and build up too quickly, the abrupt increase in joint motion can lead to ‘overuse’ injuries.

The Top 5 Complaints

In my practice, the most common running injuries are hip bursitis, kneecap pain, shin splints, Achilles tendonitis and plantar fasciitis. Here’s a quick anatomy lesson:

Hip Bursitis

‘Trochanteric Bursitis’ is an overuse injury caused by friction between the illiotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural ‘cushions’ called ‘bursa’ that are designed to reduced this friction, but if they have not had time to adapt they can swell and hurt. (A related injury is ITB syndrome.)

Kneecap pain and Patella Tendonitis

Often grouped as ‘anterior knee pain’, this refers to pain in the front of the knee and is common among runners. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or ‘patella’ for leverage across the knee. This generates pressure and can cause the kneecap to become sore. It’s especially evident when people walk down stairs or inclines and is precipitated by excessive downhill running. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills.

Shin Splints

Shin splints, or ‘posteromedial tibial stress syndrome’, can occur on one or both shins, but most commonly on the dominant leg depending on your stride. Pain originates at the lower third of the inner part of the shin just behind the bone. The pain is usually discrete and easily reproduced by pressing on the trigger point. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with ‘pushing off’ it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running, early or later in a run.  Some people try to run through the pain, which worsens it so that even walking becomes painful. Treatment for this overuse is rest and cross training.  Some people may be predisposed to shin splints because of running style or leg, ankle or foot alignment.

Achilles Tendonitis

The strong Achilles tendon is prone to inflammation when starting a running program, particularly on hilly terrain. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers. Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment for this pain is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

 Plantar Fasciitis

Dreaded heal pain! Its most common early symptom comes not with running, but with the morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot. When we run the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. Best treatment is to recognize it early and rest, cross train and take an anti-inflammatory. More severe cases may require calf stretching, night splints that keep the plantar fascia stretched, and heel pads.

Pain is a warning!

While it sounds like a lot can go wrong, most of us can enjoy running without ever suffering from these common maladies. As a sports medicine specialist, my best advice is to recognize symptoms early and not ignore the pain. Early recognition and treatment generally lead to a quicker recovery. I also recommend cross training. Even if you prefer running as your primary aerobic exercise, you’ll benefit by incorporating other forms of conditioning such as biking, elliptical, stair master or swimming. If you pay attention to symptoms and mix it up, you can help avoid painful injuries due to repetitive overuse of the joints … and stay active.

About Danbury Orthopedics:

Since 1954, Danbury Orthopedics has been providing the greater Danbury, CT area with state of the art orthopedic care. The practice’s physicians are fellowship trained surgeons and specialists who offer comprehensive and patient centered care across the full spectrum of orthopedic issues. Its Centers of Excellence offer specific expertise for Foot & Ankle, Hand & Wrist, Spine, Sports Medicine and Total Joint patients, and its Rheumatology, Pain Management and Therapy Services departments offer specialized treatment for non-surgical care.  The practice sees more than 70,000 patients annually and performs more than 5,000 surgical procedures each year. For more information or to make an appointment with Dr. Henshaw, please visit http://www.dortho.com/or call 203.797.1500.

By Dane Burks

One piece of equipment that can be useful and convenient for a runner is a home treadmill. But with so many choices, how do you pick the right one?

Here are some questions that I ask my customers when they are ready to purchase a treadmill:

• What treadmills have you tried and liked already at the gym?
• What features are you looking for? (programs, degree of incline or decline, PVS (personal viewing screen), iPod connectivity)
• What type of running surface do you like? Firm, semi firm, or cushioned.
• How often/long are you going to be running on it and will more than one person be using it?
• What’s your budget?

Answering some of these questions will help narrow down the choices.

If you are perplexed by what to spend then let’s clear that up. Consumer Reports advises that you spend at least a $1,000, but most of the top rated treadmills are $1,500 and up. Precor is usually at the top of the list and in my experience they make a good product with good customer support. It is important to know that manufacturers of fitness equipment make them in tier levels.

1. Residential: Usually the cheapest and can be found in any big box store such as Sears or Dick’s Sporting Goods.
2. Light commercial: These models are commonly used in hotels and apartments complexes. They are a little more expensive than residential, but also more durable.
3. Commercial: You’ll find commercial model treadmills in a YMCA or Gold’s gym. These are significantly more expensive and intended for very high usage.

Understanding the different models:

The increase in price gets you an increase in durability, stability, function and the amount it can be used continuously. The easiest way to explain it is to think of the models of Ford Trucks. You have basically three options, Ranger, F150, and Super Duty F250/350. With each choice you get an increase degree of function and capability.

The truck model analogy brings up a fourth choice: used or refurbished commercial fitness equipment. Like cars or trucks, used can be a good choice because you get a low milage unit with all the features for sometimes half of what you would pay for it new.

Residential Models:

If you buy a $500 treadmill from one of the big box stores then you are basically buying a throwaway unit. Typically, the store selling the unit isn’t covering the warranty on the product. The manufacturer subs out the warranty work to a third-party contractor. Residential service can be challenging to schedule so sometimes you can wait a month or more before you get service. Once the warranty expires, labor and travel rates apply adding from $100 to $150 and that is just for the diagnostic fee. If the service tech can’t repair the unit in the first visit, which often happens, then you will be billed a return-visit fee plus the cost of parts. You end up paying more for the repair than you did for the treadmill.

Light Commercial Models:

The next option is a vertical market or light commercial unit which will usually cost anywhere from $1,500 all the way up to $4,000 for a high-end one. These units have better quality and stability and are designed to be used several hours a day by multiple users. They come with decent warranties and are usually worth repairing at least one time out of warranty for the higher cost units.

Full Commercial Models:

Commercial units are designed to be used continuously 8 plus hours a day by every kind of user imaginable from hard core runners to light walkers. They range in price from $4,000 all the way up to $15,000 for the most expensive. You’ll probably find that after using a full commercial model, lower end treadmills don’t feel quite as durable. These treadmills feel the best but the price point of the light commercial is what most people are willing to spend.

Refurbished Full Commercial Models:

This is where the used/refurbished comes into play. You can have the quality and durability of a commercial treadmill for about the cost of a light commercial treadmill. If refurbished by a reputable, service-oriented company, a refurbished treadmill will last longer and cost you less overall than a new full commercial model. Extended warranties are usually available for purchase. Treadmills that retail new for around $7,000, can be purchased for around $2,500 to $3,000 refurbished. In our experience, we have done far fewer service calls on treadmills that we fully refurbish than those we sell new. Our philosophy has always been that it’s better to make sure that they run good going out the door than to spend all of our time doing service calls on poorly refurbished units.

 What do you get for your money?

If you invest your money in a commercial treadmill, what does that get you in features compared to the other tier models?

Treadmills all have some standard features which can be seen across the board. Treadmill diagnostic memory records show that most users use the quick start/manual option 90% of the time while only 10% actually use a program. I mention this so people will not get wrapped up in the program capabilities. All commercial treadmills come with user programs, a 12 to 14 mph max speed, elevation to 15%, contact and telemetry heart rate, and a varying degree of screen data. iPod connectivity comes standard now on some but not all. PVS is not standard and is an awesome feature but it is also very expensive to repair outside of warranty. The cost of wall mounted TVs has come down so much that this is the option I recommend for entertainment. In my opinion, a simple commercial treadmill with the basics is the best option. Features are great but can lead to a lot of service frustration.

A good resource for asking questions about which treadmills perform best is a treadmill service technician. They keep millions of machines going every year so member-customers do not miss their workouts on their favorite treadmill. They know more about the equipment than the manufacturer and will give you an unbiased opinion about which ones are the best. They are a good reference if you want to know details about a particular brand or model. They also deal with the manufacturers on a daily basis so they know which ones have the best customer service.

I am high on service technicians because I started my company as one long before we started selling equipment. As a company that started doing service 10 years ago, we’ve done work for just about every major commercial fitness equipment manufacturer. We currently provide repair service for 15 manufacturers. Our experience has been that these manufacturers have a good product and good customer service: Cybex, Matrix, Precor, Schwinn, Stairmaster, and Freemotion. They all have strengths and weaknesses but for the most part these are good companies.

 Where do I find the right treadmill?

In my opinion, there are not a lot of experts on fitness equipment in the mainstream sporting good stores. It’s best to talk to someone who deals strictly in fitness products such as a speciality shop like ours or a commercial treadmill manufacturer. A local shop is a good choice because you support a business in your community and possibly get a one-stop shop for new, used, and refurbished commercial fitness equipment along with service and delivery. As a customer myself, the fewer people I have to deal with the better so I want a one-stop shop.

My dad use to tell me to pick a dealer not a car so you get the total package. The same applies with fitness equipment — especially commercial. Reputable stores will have full time service technicians and a stock of parts for the products they carry or easy access to them. In most cases they will have options for lower repair costs with rebuilt or used parts.

How do I get the treadmill repaired when needed?

First, always get your owner’s manual when you purchase a new treadmill. It will have a preventive maintenance schedule on how to care for you treadmill weekly, monthly, bi-annually, and annually. If you weren’t given one, you can typically find them online. The manual should have a list of error codes that your treadmill may display when something is malfunctioning. These error codes can lead you to a simple solution for repair or signal you to get more professional help. If you are close then you also have the option of bringing your treadmill to them to have it repaired so you can not get hit on a travel charge. Some shops offer moving and logistics services in case you ever want your treadmill moved. So choose a reputable shop and you will be pleased with the outcome.

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About Dane Burks & Co. Fitness

Dane Burks & Co. Fitness is a Hendersonville fitness equipment supplier that sells and services new and refurbished commercial equipment for home and fitness centers. The company has built its business on providing cost-effective strategies for providing equipment for facilities and individuals, including refurbishing used equipment, repair of equipment components instead of replacement, and providing routine maintenance on equipment to maximize usable life.

For more information about Dane Burks & Co. Fitness, visit daneburksandco.com or call 615-826-2411.

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 About Dane

Dane is the founder and president of Dane Burks & Co Fitness. Dane learned fitness center operations by advancing through the ranks of the YMCA of Middle Tennessee, one of the largest nonprofit fitness networks in the country, becoming Wellness Director for two centers. In this role he managed the staff, property and equipment, and he trained and certified employees in personal training. He also developed and maintained equipment budgets and inventory. He left the Y and started Dane Burks and Co Fitness in 2003 to provide fitness centers with full-service equipment management, including installation, training, maintenance, service, storage, and reselling.

He blazed a new path in equipment management by redesigning the supply chain process with manufacturers, improving logistics for parts delivery, and making sure his service technicians respond quickly. He serves as manufacturer’s rep for four major fitness equipment manufacturers, and he strategizes with his fitness center clients to maximize their equipment purchases, saving them thousands of dollars. His fitness center clients range from the biggest to the smallest, and they all benefit from Dane’s relentless drive for innovative solutions.

For example, he manages the YMCA of Middle Tennessee’s fitness equipment service, maintenance, operation training, and inventory program for 30 centers in Tennessee and Southern Kentucky. The inventory replacement and resale program that he developed for the Y handles their annual turnover of $2.5 million in equipment. The program involves tracking, moving, storing, and reselling up to 3000 pieces of equipment each year. The program also replaced an expense for the Y with an additional revenue stream.

Dane obtained his Bachelor of Science in Exercise Science and Wellness from Middle Tennessee State University. While he was employed with the YMCA of Middle Tennessee, he received the YMCA Program Excellence Award. He was also YMCA National Personal Trainer Trainer and Fitness Specialist Certified. Dane also served for twelve years in the U.S. Military as an Infantry Combat Medic.

By Dr. Eugene Zeitler, D.C., M.S., ART

When the weather gets cold and the running season winds down it is a great time to alter your training program. I often recommend, especially for hard core runners who are training intensely, to take a week or two off and give your body a chance to recover from several months of training. I look at training and racing as a mathematical equation:

Training + Recovery + Nutrition = Performance

Quite simply, if you overtrain and under recover you underperform. If you over recover or skip too many workouts and constantly make excuses not to train, you will never get in shape and you will underperform. If you tend to be in the first category and usually don’t give yourself a rest, then take some time off. You might be surprised at how good you feel and how much stronger you are when you return to training.  Also, remember that you are what you eat. If you do not eat well and at the proper time, then your body cannot refuel, repair and recover properly, causing you to underperform.

My biggest concern with runners is that they often do not diversify their training program. This can be very detrimental and often leads to injury. When I take an athlete’s history, I look to see what other forms of exercise they do throughout the year.  Frequently, runners run and do little or nothing else. No core training, no multi-directional training, no strength training, and no other forms of cardiovascular training.  Let’s take a look and see why this can be harmful.

Core muscles are those muscles that help move and stabilize the spine. Why are they so important? Think about what is happening during the running stride. When a person runs, there is an alternating pattern of opposing arm and leg swing. When you stride forward with your left leg your right arm swings forward to counter the action of the leg. The core musculature helps to control these two counteracting forces. So a strong core helps to protect the spine from injury by dissipating these forces. Certain muscles that are directly used during the running stride originate from the lumbar spine. For example, the psoas muscle attaches to your last thoracic vertebra and all of the lumbar vertebra and discs. It spans across the pelvis and attaches to what is called the lesser trochanter of the femur, or the inside of the upper thigh. This muscle helps you to bring your leg forward and flex your hip during running. If your core muscles are not strong and cannot effectively stabilize the spine, then the psoas muscle can place a substantial amount of stress on the spine and cause injury. Great examples of core exercises include planks, side planks and chops.

Why is multi-directional training so important? Think about when you were younger or if you have children. Watch how they play and exercise. Then think about running. What direction do you go in when you run? Forward obviously. Then think of your child playing soccer, football, field hockey, hockey, lacrosse, etc…In what direction are they moving? Multiple directions. I find that most people after high school tend to switch from multi-directional sports to unidirectional sports, i.e. walking, running, swimming, biking and machine based weight lifting.  Now you end up without training laterally, diagonally and backwards. People are 3  dimensional, not 2 dimensional. So when designing an effective training program you have to think 3 dimensionally. Muscles surround a joint from 360 degrees and if you do not train all of the muscles around the joint then you are potentially creating strength ratio discrepancies around the joint called muscular imbalances. A muscular imbalance is when certain muscles get significantly stronger than other muscles around the joint because one constantly focuses their training on those muscle groups. This can lead to tendonitis and eventually tendonosis (degenerative changes and microtearing of the tendon) and over the longer term, degenerative arthritis. So when you are in the gym, instead of only doing forward lunges, why not do your lunges in multiple directions, i.e. forward, diagonal, lateral and then in those same directions, but backwards performing what is called a clock or star pattern.

You can also hire a personal trainer and have them educate you on a functional training program.What is functional training? It is a training program that duplicates normal human motion. It involves multiple muscles and joints at the same time. Quite simply, think of a squat versus the leg extension machine. We squat everyday and all day long, getting in and out of chairs. What muscles and joints are involved? Too many to list! When you use a leg extension machine you are isolating the quadriceps muscle at the knee joint. This is not very functional or efficient and it doesn’t even duplicate normal human biomechanics. How about joining a zumba class, yoga, or pilates. Play some indoor tennis or racquetball. Take those dancing classes you have always wanted to take. Do you see the common factor in all of these activities? Yes, they are full body,  multi-directional activities. Kettle Bell training and TRX training can also be great, but a word of caution. Only do these activities, just as the other activities, with highly qualified trainers. I always tell my patients that the money they spend on a good trainer is more than made up in copays to me because of injuries resulting from improper training. Remember, not all trainers are created equal so do your research!

I also like to see runners do other forms of cardiovascular exercise. Why? Because running beats-up your body, especially those who train high mileage or intensity. Running increases compressive loads going through the lower extremity anywhere from 2 ½ times to 7 times your body weight compared to 1 1/2 times to 3 times your body weight when walking. The goal of a runner is to take 90 foot strikes per leg per minute. If you do an hour long run think about the stress going through your lower extremity. Doing other aerobic activities such as biking, swimming, cross country skiing, elliptical, and snow shoeing can be great alternatives. Not only that, but it is great to be comfortable in another cardiovascular activity, not only to decrease the  wear and tear on your body, but also to allow you to train if you get injured before a big race for which you have been training for months. On more than one occasion, I have had runners crying in my office because they have to stop training for a period of time due to injury. If you don’t have an alternative method of training, how do you expect to be able to keep up your cardiovascular fitness if you get hurt?

Hopefully this article has given you some ideas to ponder over the winter months. Diversifying your workout can be fun and exciting and most importantly, it can help prevent running injuries.

Remember, train hard, but be smart during this upcoming racing season!

Eugene R. Zeitler, D.C., M.S., ART

Chiropractic, Active Release Techniques, FAKTR-PM, Kinesio Taping,

Manual Therapy, Sound Assisted Soft Tissue Mobilization,

McKenzie, Rehabilitation, Sports Medicine & Nutrition

www.eugenezeitler.net 

This athletic lesson is too good not to revisit!  Original blog post in 2010.  Sometimes a reminder is good.

After years of racing, I think I have read every “how-to” book on running, triathlon, nutrition, fitness and sports training possible. I know intervals, sets, laps, watts, heart rate, injury prevention and every other aspect of what type of effort works and what doesn’t. My training partners know that I know it but also know that I don’t always practice what is written. Sometimes because I don’t feel up to it and sometimes because it is too much or usually because I am a workout cheater by nature and unless someone holds me accountable, I will get away with the least.

I am always in search of learning something new and innovative that doesn’t cost a lot but that makes sense as far as improving my sport or making it more interesting. Lately most of what I have learned is from sitting in on Sarah’s cello lesson that she has once a week with Lois. Sarah started lessons with Lois late this summer. Lois is a beautiful woman, accomplished cellist and now my triathlon coach. No, she isn’t giving me workouts, she is giving me plenty to think about and her weekly words to Sarah are helping me tremendously.

Lois’s cello studio is behind her house. Inside is a wonderful wood paneled cello conservatory. Pictures of great cellists, young student’s art work and other’s concert accomplishments fill the walls. Lois is a petite, fair woman with a quiet yet commanding voice. She speaks softly but with conviction. I find myself trying to dig into a book while Sarah has her lesson but mostly end of taking mental notes of Lois’s words. I could never play the cello but I can take Lois’s words and improve my passion.

Becoming a fine cellist requires commitment to practice. Repeating 4 bars at a time of a piece over and over, then the next 4, then the next, then putting it all together will make a piece into a masterpiece. Lois told Sarah that it is possible to “know” a piece and play it , but repetition makes you “own” the piece. Committed to the piece will produce a better outcome than understanding how it is to be played and glossing over it. I think of this with racing. Many athletes have the mechanics, the gift of talent and strength and go into races with all the right tools. Many then fall apart as they have not rehearsed situations that might occur or not know the course completely…they get through the race but let short pitfalls own the race.

Early in the summer, Sarah indicated to Lois that she wanted to audition for Orchestra with the intention to move into the next group. Lois thought about it for several minutes and then told Sarah it was a big reach and would require commitment to master the two audition pieces. Sarah left dejected and unsure whether she was ready to commit. A few days later, Sarah began stepping up to the challenge. One of the pieces, Tarantella, by Squire is about the dance that was performed after a Tarantula bites. Frantic, fast paced then lovely, the music (especially to those that don’t know music) can sound either really great or really wrong.

During Sarah’s last lesson she played the audition piece. I sat there and listened, Sarah played the piece beautifully (to her mother’s ears), and I wondered what Lois would say. She began to tell Sarah about a famous violinist that had mentioned this phrase to play by, “Cool head, warm heart”. Play with emotion but not so much that it gets the best of the piece, keep your head in the music, but not so much that there is no passion. BINGO! Sarah did well in her audition, she achieved her goal and I have a new mantra.

Cool head, warm heart. I began to research this a bit and now know that it is a Beach Boys song (not a great one), a blog and a common quote of which there is no known owner. Whoever crafted those words needs to know how well it applies to racing. Whether it is a 5K or an Ironman, if I am truly out there to do my best, there has to be a balance between the head and the heart, too much of one can or not enough cannot produce the result. I always marvel at the incredibly fit, structured athlete that comes to the starting line with the body, training and equipment to win. Toeing the line with this athlete is intimidating, watching them fall apart in the race because they have over thought the wattage, the heart rate, the complex schedule is hard to see. Even when their results are great, they are not satisfied. Too much thought not enough emotion.

I think the counter is true as well. Too much heart and not thinking about procedures and technical aspects also leads to disaster.
Thank you Lois for not just teaching the technical aspect of music to Sarah but also teaching her the emotional and how to balance. Thank you also for the triathlon coaching…not sure if you will race anytime soon but I have a mantra for you!