It Hurts When I Run

It hurts when I run

This past week on The Injury Corner — a Facebook group I created to offer guidance and support for people dealing with chronic pain and injury — there was a great discussion with some helpful nuggets I wanted to share.

We talked about whether barefoot running can help heal low back pain and instability to the sacroiliac (SI) joint, and the difficulty of being told the activity you love may be hurting you.

I find these two subjects to be especially valuable and important both professionally and personally. As a movement specialist, I see many people struggling with the issues of pain while performing the activities they’re passionate about. As an active former athlete, I’ve struggled with the exact same issues myself.

anatomy pics of pelvis and sacroiliac joint. It hurts when I run.
It hurts when I run. Does barefoot running help heal low back pain and potential instability to the sacroiliac (SI) joint?

I have lived a barefoot/minimalist lifestyle for over five years. However, I have been unable to run consistently for the past three. I have gait dysfunction connected to 5 knee surgeries, and a long list of other injuries associated with sports, stubbornness, and my reckless youth. The gait dysfunction shows in my body’s ability to absorb the impact energy of footfall as it transfers up the kinetic chain through my ankles, knees, hips, spine, and shoulders.

leaf springs of a large truck. It hurts when I runSpring mechanism of the arch of the foot. It hurts when I run

Some quick anatomical mechanics: As you can see in the pictures above, the arches of the foot create a spring leaf suspension system similar to that of a truck. This system absorbs the energy of each step, distributes this energy equally throughout your fascial system, and re-releases the energy through the propulsion phase of your gait.

With this dysfunction in my suspension system, the arch is unable to act like a nice shock absorbing spring, and my foot lands stiff and solid. Instead of spreading the energy load throughout my fascia, the impact goes directly into the harder tissues of bone and joint structures, which don’t have the ability to absorb impact as well.

Based on my personal and professional experience, both as a barefoot runner and through helping other runners transition into a barefoot lifestyle, I don’t believe that barefoot running will help heal your SI joint. If anything, there is a really good chance that in the short term it will make things worse. SI joint instability is a mechanical-structural issue, which means the relationship between how you move (mechanical) and how your structure is able to mobilize and stabilize through movement (structural) isn’t functioning in its most efficient state. The problem has little to nothing to do with what is on your feet, whether you are running barefoot or shod. It is a problem with the mechanical-structural relationship of your running gait.

It is not an issue of whether you should run barefoot or shod, but rather should you be running at all? In my professional opinion, you should not.

Now I want to take a moment after that last statement. If you’re a runner currently running through pain, did being told you should not be running kick up an emotional response? Tune in; do you feel anger, fear, judgement, dread? If you feel any kind of emotional process, please take a deep breath and let that move through you before continuing on.

Being told a certain movement isn’t best for your body is a hard pill to swallow.
Believe me, I know how hard a pill it is to swallow. Over the past three years, I’ve repeatedly attempted to get back into running. Each time, three or four weeks in I would get painful calf spasms and I’d be out for weeks again. It has taken me years to change my mindset around exercise. I had to let go of the ego drive to do what I wanted to do (run), and instead focus on the quality movements that my body needs and desires to allow it to heal.

The path to quality, pain-free movement begins by changing your mindset around your fitness, health, exercise, nutrition, and so much more. It begins with a simple understanding:

If I am in pain, then the way I have been moving is hurting me. If I want to feel better, I must change the way that I move. To do this, I must change.

Change is a scary thing. It is a hard pill to swallow indeed. It often brings with it some big fat emotional processes such as noted above. However, If you find the deep desire to change, you have made the first step toward fundamentally changing your life.

With a desire for change, the next step is to begin checking in with your body and asking yourself some important questions about exercise and movement. When you hear yourself saying “It hurts when I run!” Here are a few questions you can ask:

Is this movement safe?
Is this movement healthy?
What is my motivation to continue to perform a movement that hurts me?
What can I let go of from my old paradigm of movement?
What movement is safe, healthy, and loving to my body?

These are questions that must be asked every day and for each exercise based movement you feel a desire to engage in, whether it is yoga, running, resistance training, swimming, cycling, etc. One day a movement may be healthy for your body, and the next day it may be unsafe or unwise to do. Even exercises which you would consider “gentle” can be too much, and yes, this can change from day to day. By getting in the habit of asking these questions each day you will learn how your body communicates with you through pain, and you will develop a new relationship and understanding with your body. This is a beautiful thing that will then shift to other areas of your life.

Pain-free running and beyond
I hope to be able run regularly again. But only when running is a healthy movement choice supported by my body. Only then will I even consider the question of whether to go barefoot or shod. To help me achieve this long-term goal to run again, I am receiving regular assessment and treatment from one of the top movement specialists around.

As long as you are saying “It hurts when I run”, running is not a healthy movement choice. At least not until the inefficiency of movement in your running gait has been fully assessed and corrected. To do this I highly recommend finding a highly skilled movement professional who specializes in gait assessment. This would not be a shoe salesperson!

If you need help finding a movement professional in your area, please let me know. I will do my best to connect you to the best health care team available. If you are in Austin, Texas, contact The Art of Fitness for walking and running gait assessment so we can get you running pain free again.

Do you have a frustrating or inspiring injury related question or story? Please share in the comments below.

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Knee Pain and Running

Running and Knee Pain

There is a conversation taking place on facebook in a runner’s forum about knee pain and running.  What you are about to read is the exchange I had with the author of the original post.  Check it out below.  And will you do something?  If you know someone with knee pain that you think this would speak to, will you pass the link along?

The Question:

Ok fellow runners…ever since I took a week off post 1/2 marathon I can’t run more than 2.5 miles without excruciating knee pain. Never once happened before. This is bullshit! Help!!!

My Response:

Knee pain is a postural issue. It has less to do with a problem at the knee and more to do with mobility and stability dysfunction at the hips, feet, upper back, core, and shoulders. For any adjustment to be effective, the entire biomechanical chain must be addressed.  Not just the knees.

No Pain sign. Knee Pain Running.I work on postural dysfunction in four (4) stages:

Knee Pain Running

1. Pain: Your range of motion must be, first and foremost, PAIN FREE! This means, if it hurts to do… DON’T DO IT!!! If your knee hurts to run, squat, or lunge, etc… hold off on these exercises until you can do them without pain.  What to do about the pain?  I address the pain through movement assessment, hands on massage therapy, and a personalized exercise program. I recommend finding a highly movement therapist who uses walking and running gait assessment and has experience successfully treating these types of injuries. I typically see a significant reduction in pain within 2-4 treatments.

Practicing some full body self massage using a foam roller may also provide some temporary relief from the pain.

2. Mobility: Once the pain is reduced, you will need to work on improving your functional range of motion, such as the ability to perform a functional deep squat or lunge. IN MY OPINION, IF YOU CANNOT PERFORM A FUNCTIONAL DEEP SQUAT OR LUNGE, YOU SHOULD NOT BE RUNNING! PERIOD!!! These are progressive movement patterns that lead up to running. Babies learn to squat-ass-to-the-grass BEFORE they learn to walk and run.  You must do the same.  So do it.  And on top of training for functional lower body mobility, you will need to work on upper body mobility as well. When your thoracic spine, scapula, and neck are restricted, your hips will not function properly.

3. Stability: Now that you have improved Range-of-Motion (ROM), you will need to train your body for stabilization with this renewed ROM. This is the basic definition of posture. The ability of your body to stabilize throughout your entire ROM. For more on posture, read:

What is Posture

Here are some super basic corrective exercises to get you started.

The Foundation of your Posture – Injury Prevention Begins at your Foot

Corrective Exercises for the Hips

Corrective Exercises for the Scapula

4. Conditioning: Running is a very basic movement pattern. It is also a very small percentage of our overall functional movement pattern. If the only form of exercise you are doing is running… you are running directly into a potential injury. Your body needs to be conditioned throughout it’s entire movement ability. Full body functional movement is vital to overall health and vitality, as well as running ability. Another way to think about this is: How do you want to feel when you’re 70, 80, 90, or 100? Do you want to run comfortably in advanced age? Conditioning your body through full functional movement patterns, which includes running, is the key to both of these questions.

I encourage you to hire an expert team to help you through this process. The investment now will save you thousands in your long term pain and health. I suggest hiring a therapist to help with the pain; a movement coach to help improve your posture; and a running coach to teach you how to run (years and years of sitting on our butts means that we don’t know how to do this very basic movement pattern – even if we run frequently). Here is a link with tips on finding a quality therapist and coach:

Five Steps to Choosing a Professional Therapist

Good luck.

The Response:

Jesse, in a perfect world I would LOVE to be able to hire all of those folks to help me out. I have contacted an ART (Active Release Therapy) doctor in hopes they’ll be able to help me a little bit. As for the rest I’m going to have to go it alone or go through my HMO (which everyone knows could take years) to get to a physical therapist. My knees don’t actually hurt unless I’m running. I can do squats and everything w/o knee pain…it’s when my glutes get tight about mile 2 that everything goes to pot. So I’m sure some of it’s my form and some of it is that I’m just too tight. I will continue to work on it and stop running for the time being. Perhaps yoga is in my future…

My response:

I completely understand the issue of cost. At the bare minimum, I encourage you to invest in a foam roller, softball, lacrosse ball, and golf ball. This will allow you to do a great amount of the massage work on your own. The foam roller alone should make a huge difference with your pain during running. It may take a few weeks. Here is another article on foam roller therapy that has a bit more detail to it.

How to Treat and Prevent Injury and Become a Better Runner

Finding a good teacher, Part II

When looking into a PT, I recommend really vetting them out. You want the most educated, experienced, passionate, top of their game professional available. You are looking for a highly skilled therapist, preferably one who includes manual therapy; as well as multiple other modalities; and looks at the entire movement system, not just your knees. If they treat the knees in isolation, find another therapist! Hopefully, it won’t take too long, but you are better off taking your time searching for a high quality therapist who is the best fit than to settle on someone who isn’t.

Can you really do a functional squat?

The majority of clients that I see, at the time they come in, say that they can do a squat. The fact is they cannot do a “functional” squat. This is what I consider a functional squat:

This Is A Functional Squat

Baby squatting with perform form. Knee Pain Running.
If you can’t do this from standing to sitting to standing keeping your shoulders down and back, without your heels coming up, your feet rolling out, or without pain then you can’t do a functional squat.

Here is a great little video from Barefoot AngieBee describing squatting

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The Importance of Good Form running and Interval Training

A couple of weeks ago I touched upon the subject of the need to train good form running, not conditioning in Injury: Recovery & The Grand Return. In today’s post, I want to dive a little deeper into the subject of Form.

What is Good Form Running?
Picture of toddler performing a perfect squat. Good form running.When it comes to movement patterns, including – but certainly not limited to – squatting, lunging, running, jumping, throwing, etc, form is paramount. Break down in form is what breaks the body.

Poor form is one of, if not the primary cause of, chronic pain and injury.  This goes whether you are an elite level athlete, weekend warrior, or even a sedentary couch potato. The way you move has a direct and definite impact on how you feel.  It has everything to do with your form, good or bad.

Form is the applied combination of technique and skill. Form is a learned behavior.  It is built through repetition (aka practice), and is embedded in the nervous system. When you learn a new movement pattern, your nervous system creates a specific neural pathway for this new skill (the connection of one part of your nervous system with another).

At first this pathway is weak; the connection is poor. But the more often you repeat the movement pattern, the stronger the neural pathway becomes.  Sustained consistency goes farther than sheer force of effort.   It’s kind of like building a road.  Over time, as more and more traffic uses the road, it is expanded.  Over time, with enough use (i.e. traffic in this example), the road is slowly transformed into a highway.

Proper form takes the right movements and deeply hard wires them into a specialized skill through perfect repetition of movement patterns.

Poor form takes the wrong movements and deeply hard wires them into bad habits through the repetition of imperfect movement patterns.

Poor form

Is inefficient, leaks energy, and makes tasks harder and more exhausting to perform.
Wears down the soft tissue of joints, leading to inflammation and damage.
Creates dysfunctional pain patterns throughout the body.
Increases your short and long term medical costs, by way of…
-visits to doctors and physical therapy
-pain medications
-surgeries
-hospital stays
Poor form, in short, shortens your life!

Good form running

Increases efficiency – You move smoother and faster, jump higher, squat more weight, etc., all with less effort and strain.
Minimizes wear and tear on joints, ligaments, tendons, cartilage.
Allows you to do more with your body and your life.
Speeds recovery time.
Is preventative medicine.
Reduces short and long term health care costs.
Prevents living a life of pain and injury.
Increases productivity.
Proper form, in short, lengthens your life!

Good form running must come first

This is important. Proper form and poor form are both developed through repetition.  The difference lies in the quality of the movement being repeated.

Why does this matter?

Because you cannot train form and conditioning at the same time.

You cannot learn a new movement pattern (form), and – at the same time – use that movement pattern to train for endurance, strength, power, or speed (conditioning).

For example, say you are recovering from a running injury.  If you are training to improve your running gait (form), you cannot use running to improve your conditioning. The two – on a fundamental level – don’t work together!

Training to improve your form and training to improve conditioning are fundamentally incompatible.

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To improve form, you need practice… perfect practice. You need to practice your good form running perfectly in order for it to stick.  When you train for form you are allowing your neurological system to develop new bio-mechanical habits. Because it is so important to have flawless form, you must repeat the movement pattern flawlessly with every repetition.

At the beginning of form training, perfect form breaks down at the first sign of fatigue. Once fatigued, you will no longer be able to maintain good form running.

Training with imperfect form reinforces the poor movement patterns that will ultimately lead to injury.

At the same time, you cannot improve your conditioning without fatigue.  Fatigue is a core component to training endurance, strength, power, and speed. You will not achieve significant improvements in your conditioning without training into some levels of fatigue.

Perfect Practice Makes Perfect! Good form running.
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Case Study. An example from real life:
Susan had not had the time to run in over three months.  On Saturday she decided to try one mile for her first run.  One mile is a pretty short distance, and a perfect place to start to get back into good running condition, right? She ran at a 10 minute mile pace.

Here’s the problem: because of her level of conditioning, she is only able to run with proper form for about 1-2 minutes before fatigue sets in.  Once fatigued, it is impossible to maintain proper running form without rest. Each and every step she takes after her form breaks down is a step down the path of a poor neural pathway.  

If she decides to push through and complete the mile without rest, she will actually spend 80% of her running time practicing poor form. That is 80% of her training time building upon a highway system of dysfunction and future pain and injury!

Is that what she wants?  Is that what you want?

The same example can be used for all forms of movement.  Fatigue affects your form in all activities, like swimming, cycling, tennis, resistance training, etc.

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If you want to improve your form, if you want to reduce the recurrence of pain and injury, then you must train with patience.  You must limit how much you perform the desired movement until you have fully developed your new and improved form.

You need perfect practice until you have perfect form.

Then, and only then, can you use that movement to train conditioning.  It may take a few months or longer, depending on your age, conditioning level, injury history, and a few other factors.

It is very likely that you will be able to work on your conditioning in some way.  However, it must come from activities in which you already have a high level of skill and technique.

In any specific movement pattern, you cannot train form and conditioning at the same time.  Perfect form first.  Train conditioning later.

Interval Training
One of the best training methods for improving form is interval training.  Interval training maximizes the benefits of repetition and minimizes the instance of fatigue.   It involves a series of low to high intensity exercises followed by periods of rest or recovery. Interval training includes in the vital rest and recovery your body needs to maintain proper form.

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Case Study. An example from real life, Part 2:
Let’s take another look at Susan’s run.  Instead of running a mile nonstop, she can do a series of one minute runs followed by one minute recovery up to ten times, or really as long as she can maintain proper form, whichever comes first. Not only will she be able to get in the distance that she wanted to run, but she will do it using proper form during a much greater percentage of her workout.

Over the course of several weeks, she can slowly add more time to each running interval and decrease the time of each recovery interval. This helps improve form, increase mileage, and prevent injury. Within a couple months, she will be able to run nonstop for the desired distance while maintaining great form.

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Barefoot Running
Person running barefoot. Good form running. If you have been thinking about making the switch to a barefoot lifestyle, this interval training is an ideal time to incorporate barefoot running into your training. By adding barefoot running into your training you get immediate feedback in your running form.  Basically, bad form will hurt immediately, allowing you to make immediate adjustments in your form.

It is also a great way to force yourself to limit the total amount of training time each day. Your feet will be far too sensitive to train beyond fatigue and poor form. A proper barefoot running transition needs to be done slowly.

It is important with barefoot running that you do not attempt to Push Through The Pain. (Here is more reading on how to make a smooth, safe, injury free transition into a barefoot lifestyle.)

12 Week Interval Running Program

This is the same interval training that I included in the article about Injury and the Grand Return.  It is an excellent interval training program and is a solid way to get back into proper running form.  Jump back over to the bottom of the “Injury” article to have a look or click here to download it as a PDF.

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