BLISTERS

Posted on September 21, 2023September 21, 2023 by intraining

By Steve Manning “The Footman” – intraining Podiatrist and Coach

There is nothing worse than blisters causing you to pull out of a race. When your training, pacing and nutrition is all going well it can be ruined by a skin issue. Luckily, there are some easy ways to make sure that blisters do not undermine a great performance.

WHAT IS A BLISTER?

Blisters are formed when an external force causes stress between the outer layer of skin and the deeper layers. What starts as red inflamed skin can progress to a blister. At this point fluid forms between different layers of skin. The five outer layers of skin have no blood supply. If the blister forms in these layers it is a clear blister. If it is between these layers and the deeper dermis layer then you will get a blood blister.

WHAT CAUSES A BLISTER?

There are two ways that blisters can form – a shearing force or a pressure force. A shearing blister causes friction and a build up of heat similar to a burn. They are formed by the foot moving inside the shoe. A pressure blister can be caused by a poor fit between your foot and the shoe or an orthotic. In this situation all of the force is localised to a single location.

WHERE DO BLISTERS OCCUR?

Blisters can form anywhere there is excessive friction or pressure. Here are three common places for blistering.

Toes: Blisters usually occur on your toes when the shoe is:
– too short, hitting against the end of the shoe
– too shallow at the end of the shoe putting pressure on the toes
– too large and your toes try and grip the ground to hold the shoe on your foot
– the wrong shape for your foot.
Not enough space in the shoe can cause blisters between your toes as they rub against each other.
TIP: Try and match the shape of the end of your toes with the shape at the end of your shoes.

Arch: Blisters in the arch are more commonly formed by pressure rather than friction. The arches in some runners flatten more as they move from their foot flat on the ground to propulsion. If the arch in the shoe is too prominent for the foot then a blister will form usually at the front of the arch or the high point of the arch. Flat feet and flexible feet are more prone to these arch blisters.
TIP: An easy modification to your shoe can take the pressure off the arch. This is our most common footwear modification. Visit one of the intraining Running Injury Clinic podiatrists for help.

Heel: Heel blisters can occur if your shoe is poorly matched to the shape of the back of your heel. This can cause slipping of the heel or pressure on one part of your heel. If your shoe is too short then it can also increase the pressure on the back of your heel leading to a blister. Some runners have a lump on the back of their heel that is susceptible to blistering.
TIP: Tie your shoes and then stand up. See if you can stick a finger down around your heel. It should be a firm fit. You may be able to lace your shoes differently to reduce movement.

WHY DO BLISTERS HURT?

Blisters hurt initially because of the inflammation like a burn. After 24 hours the pain is mainly from the fluid pressure inside the blister. Draining the fluid at this stage will stop the blister hurting. You must be very careful with blood blisters that you do not let dirt get in the wound as it can cause a blood borne infection. As the skin drys it can go hard and cut into the deeper tissues.

HOW DO I TREAT OR PREVENT BLISTERS?

My 4 top tips to prevent or treat blisters are:

Tip #1: Gradually increase your training
The best prevention for blisters is a gradual increase in training. When you first start back into running or even when you start using different shoes, your skin can be ‘soft’. With time, your feet will adapt and your skin becomes stronger.

Tip #2: File your callouses
Removing excess callous regularly will also reduce the risk of blisters as they often form between the callous and the deeper layers of skin. (shearing forces)

Tip #3: Check your shoe size and shape
Toe and arch blisters are regularly from the wrong shape, depth or size shoe. Allow space for the toes, and check that arch pressure.

Tip #4 Quality of your socks
Don’t underestimate the importance of the quality of your socks. Wicking fibres will not get abrasive and will maintain their shape and integrity. Anti-chafe wax’s and lotions are very effective for longer sessions and races.

WHAT IS A BLACK TOENAIL?

Black toenails are blood blisters under your nail. They are often formed by pressure downwards on the end of the nail rather than just a short shoe. The result is a blister under the nail and the nail is then destined to fall off. You must be careful draining black toenails and it may be better to have it treated by a podiatrist if it covers more than half your nail. You should maintain short toe nails and cut them short a few days before any long race.

You don’t want blisters

Blisters can be small, but mighty painful causing interruptions to your training or a limp in your important runs. They usually can be an easy fix, but if you have tried everything to stop them, come see our intraining podiatry team. We know how to check if the way you run and your foot shape matches your shoes, and how to make the changes to stop blisters from happening.

If you are having trouble with blisters, black toenails or calluses, book an appointment with our podiatry and team at intraining. Call iHealth on 3870 2525.

Steve Manning "The Footman"

Steve has been a running shoe aficionado for the last 4 decades and as the owner of intraining Running Centre has helped thousands of runners find the perfect shoe. He is a member of the Footman Biomechanics Group of the International Society of Biomechanics and a previous President of the Qld branch of Sports Medicine Australia. As a Podiatrist specialising in running sports injury prevention he utilises footwear prescription and modification to keep you running. Contact Steve at the intraining Running Centre, [email protected] for all your footwear questions.

How to manage hamstring muscle injuries

Posted on September 14, 2023September 21, 2023 by intraining

Dodgy hammy? How to manage hamstring muscle injuries

By Doug James – Physiotherapist and Podiatrist at intraining running injury clinic.

Are you dealing with a niggling hamstring injury that just won’t go away? Have you tried stretching it only to find it feels worse the next time you exercise?

Hamstring muscle injuries are well studied in elite footballers. This is partly due to the high prevalence of these injuries in football (soccer) players[4,10], but also because of the large financial cost associated with keeping players healthy (soccer superstar Lionel Messi will get paid over $92,000 per day for the next few years[1]). While this research helps to progress management and treatment of injuries in non-elite athletes, it’s worth noting that there is a key difference in the type of injuries that footballers and distance runners typically develop.

Location matters

Hamstrings consist of 4 muscles found on the back of each of your thighs. The main functions are to assist the gluteus maxiumus to extend the hip (move the thigh backwards) and (along with the calf) flex the knee. Research shows that hamstring muscle injuries typically occur in one of two locations [3,4,5,7]. In runners, hamstring muscle tears tend to occur in the distal (towards the knee) and mid portion of the lateral (outside) muscle, whereas footballers tend to develop the injury on the inner part of the upper hamstring. The difference in injury location is largely due to the different types of movement involved with each sport. Football injuries tend to occur during kicking where the muscle is forcibly overstretched [10]. By comparison, running injuries tend to occur during higher intensity running efforts where the muscle attempts to maintain length during the swing phase of gait [6]. Injuries can occur closer to the buttocks, though often this is a tendon injury – this article will focus on muscle injuries alone.

Some good news

The good news for runners is that the median recovery time for lateral hamstring injuries (dependant on relative severity) is about half that of medial/proximal hamstring muscle injuries [4].

…and some bad news

While runners (with a lateral hamstring injury) can look forward to a speedier return to sport, this injury type tends to have a greater risk of reinjury [7] with up to one-third of athletes reinjuring the hamstring within a month of returning to sport[9]. This high reoccurrence rate needs to be factored in when planning the first 4-6 weeks of training after returning from injury.

Risk factors

Given that fast paced running is a high-risk activity for hamstring muscle injuries, the logical solution would be to avoid it – though this would be a shame as high intensity running carries a number of benefits for running performance.

Muscle strength imbalance (where the quadriceps (thigh) muscles are far stronger than the hamstrings) also poses a risk. Aside from these, one of the biggest non-modifiable risk factors to getting a hamstring muscle injury is having had a previous hamstring injury [2,4,5,6].

Changes to the neuromuscular system (muscles and the nerves that supply them) are common after injury and negatively affect how the muscle functions [6,7]. Age is the next highest risk factor [2,4,5,6,8] with the risk increasing for every year past 23 [8] – this may be a confounding finding, as the older you are, the more likely you are to have had a hamstring injury at some point, though there are possible biological reasons as well. As we age, we tend to have a reduction in the flexibility and quality of cartilage in our tendons which may predispose us to a greater risk of injury.

Poor quality sleep and insufficient sleep, along with stress can lead to increased risk of injury. It’s suggested that less than 7 hours sleep can lead to a 30% increase in injury.

What about super shoes?

Super shoes (carbon fibre plated, thick soled racing shoes) may contribute to the development of injuries in this region. As this style of shoes is relatively new, little long-term research exists investigating its effect on injury. The stiff sole of super shoes means the big toe and ankle joint movements are altered which possibly puts stress on parts of the body in particular the pelvis, glutes and hamstrings. This finding is difficult to conclude given that people wearing this type of shoe are often running at a higher intensity which is a known risk for hamstring injuries.

Watch for warning signs

Athletes that develop hamstring muscle injuries often report a feeling of ‘tightness’ or ‘tenderness’ in the hamstring shortly before the injury strikes [5]. While hamstring tightness is a relatively common complaint (nearly everyone I treat complains they have tight hamstrings), noticing tightness on one side only is a particular concern. Having stiffness in your lower back or hips, or feeling stress and tried should also be treated with caution. In these cases, it would be wise not to undertake high intensity running such as speed work, hill running or races until these symptoms have been addressed.

Prevention helps (somewhat)

A large number of football-focussed studies show that hamstring strength training in the offseason can help reduce the burden and occurrence of hamstring muscle injuries during the competition period, though not completely. While this concept can translate to runners, a different series of exercises are required. Running technique can also play a role in the development of hamstring muscle injuries. Overstriding (landing on your foot too far in front of your body) is a fairly easily modified risk factor, though more difficult to control at higher speeds.

What to do if injury strikes?

A hamstring muscle injury can feel like anything from a sensation of tightness (Grade 1/mild injury) to a strong sharp debilitating pain (Grade 2-3/more severe injuries). In the less severe cases it’s often tempting to stretch your hamstring and return to running, however in cases where a muscle tear exists, these actions can greatly increase the amount of damage and likely recovery time – from what may have been a few days rest, to possibly several months off (and maybe even surgery).

As per most injuries, rest and ice packs can greatly aid your recovery in the early days. Avoiding stretching is imperative to preventing further damage and early treatment usually results in faster recovery. Seeing a physiotherapist or sports podiatrist will help you to diagnose the type of hamstring injury (location and possible severity) based on the history and clinical examination. Scans, particularly MRI, can be helpful but are usually not necessary and are unable to accurately determine amount of recovery time needed [12].

The road to recovery

Hamstring muscle injuries require a considered approach for proper rehabilitation. World renowned Sports Physician Peter Brukner proposes a seven-part management plan [8] addressing the following areas:

- Biomechanical assessment and correction
- Managing neurodynamics (nerve tension particularly in the sciatic nerve)
- Core stability
- Increasing hamstring muscle strength

- Incrementally increasing running speedwork
- Injection therapy
- Stretching/yoga/relaxation

As mentioned previously, there is a high risk of reoccurrence with hamstring injuries, and so particular caution should be taken in the first 4-6 weeks of returning to sport and running. While the injury may feel 100% better there are adaptions to the nervous system that take time to overcome [11]. It’s been found that it can take up to 2 months for an athlete to return to return to their pre-injury maximum running speed (assuming minimal fitness was lost during the recovery period)[7] and so patience is needed while overcoming this injury.

If you’ve developed a hamstring muscle injury, or are keen to learn how to avoid it, contact the intraining running injury clinic for an appointment. Now based at I-Health Indooroopilly.

Hamstring muscle injuries – references:

[1] Source: Website: http://money.com/money/5313998/lionel-messi-net-worth/ [cited 26.8.19]

[2] Arnason A, Sigurdsson SB, Gudmundsson A, et al. Risk factors for injuries in football. Am J Sports Med 2004;32(1 Suppl):5S–16S.

[3] Askling C. Types of hamstring injuries in sports. Br J Sports Med 2011 02;45(2).

[4] Askling CM, Tengvar M, Thorstensson A Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols British Journal of Sports Medicine 2013;47:953-959.

[5] Askling CM, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med 2014 04;48(7):532.

[6] Bourne M, Opar D, Shield A. Hamstring muscle activation during high-speed overground running: Impact of previous strain injury. Br J Sports Med 2014 04;48(7):571.

[7] Brukner P. Hamstring injuries: prevention and treatment—an update British Journal of Sports Medicine 2015;49:1241-1244.

[8] Brukner P, Nealon A, Morgan C, et al Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme British Journal of Sports Medicine 2014;48:929-938.

[9] Petersen J, Hölmich P Evidence based prevention of hamstring injuries in sport British Journal of Sports Medicine 2005;39:319-323.

[10] Schuermans J, Van Tiggelen D, Danneels L, et al Biceps femoris and semitendinosus—teammates or competitors? New insights into hamstring injury mechanisms in male football players: a muscle functional MRI study British Journal of Sports Medicine 2014;48:1599-1606.

[11] Tam N, Santos-Concejero J, Coetzee D, Noakes T, Tucker R. Muscle co-activation and its influence on running performance and risk of injury in elite Kenyan runners. Journal of Sports Sciences 2016; (March), 1–7.

[12] Wangensteen A, Almusa E, Boukarroum S, Farooq A, Hamilton B, Whiteley R, et al. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med 2015 12;49(24):1579.

Doug James – Physiotherapist and Podiatrist

Doug James is a qualified physiotherapist and podiatrist with a special interest in running and sports injuries. He combines the two treatment approaches to achieve successful outcomes for clients of all abilities from non-athletes to elite athletes. Bachelor of Podiatry (honours), Master of Physiotherapy Studies. Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment. Doug is also a keen runner having completed the New York Marathon.

Understanding muscle tears

Posted on June 28, 2023June 28, 2023 by intraining

Muscle tear assessment and management for runners.

By Doug James Physiotherapist and Podiatrist

Pain is not an uncommon occurrence with running.

For newer runners (or those returning to running after time off) pain might be felt on most runs due to fatigued muscles or being short of breath.

For more experienced runners, pain usually becomes a less common occurrence and may only be felt during faster paced interval sessions, hill repeats, or long runs. Your muscles will work harder and produce an amount of discomfort during the session and possibly for a few days following – a sensation know as Delayed Onset Muscle Soreness – or DOMS. While pain can be expected in these situations (and in some ways helpful), differentiating between ‘good pain’ and ‘bad pain’ can help to keep you running.

Running fitness and conditioning is developed by running for at least twenty minutes a few times per week. Gradually this stimulus encourages improvements to your lung function making breathing feel less laboured when exercising. You will improve your muscle strength and endurance -which usually means less muscle fatigue and discomfort while running – and faster recovery afterwards. Consistent training over the course of a few months should have you feeling fitter, and running with less pain.

Unfortunately, some pain is almost inevitable.

In a 12-month period, runners have around a 70% chance of developing an injury that will prevent them running for a week or longer. Of these injuries, muscle tears are one of the more common. They can develop while running, particularly at higher intensity (faster speeds and/or steep terrain) or as we fatigue. The severity of a muscle tear is graded based on history, symptoms and/or imaging findings (such as Ultrasound or MRI) and this can help to predict the recommended treatment and amount of recovery time. There are a number of different grading systems, but the most commonly used involves a 3-point grading system.

A three point grading system for muscle tears

Grade 1

A grade 1 muscle tear (or strain) is the least severe grading. A muscle injury with this categorisation involves damage to less than 10% of the muscle, and may not be easily detected with imaging. Grade 1 injuries are often imperceptible when they occur, but may become noticeable fairly shortly after the running session has ended. They tend to be felt as a mild to medium pain when stretching the muscle or putting it under strain (e.g. calf muscle tears are often sorer when walking up stairs). There tends not to be much strength loss, and some stiffness may or may not be apparent after rest.

Grade 2

Grade 2 muscle tears are more serious, and involve between 10-50% of the muscle cross section. They are quite obvious when they occur and are acutely painful with a noticeable loss of power. Further pain and damage occurs if the athlete tries to continue running with this injury. It is possible that Grade 2 injuries start as a grade one injury that aren’t identified at the time of the injury or are poorly rehabilitated. Muscles with grade 2 injuries will have a marked reduction in flexibility and will likely feel quite stiff after rest. This is from a protective mechanism whereby the brain orders the muscle to tense or spasm to prevent movement. Trying to stretch the muscle while the protective mechanism is engaged will often result in a stronger sensation of tightness and likely more damage to the muscle.

Grade 3

Grade 3 muscle tears are far less common in long distance running, rather seen more often in sprinting and contact sports. These injuries involve damage to at least half of the cross-sectional area of the muscle and may also involve the tendon. Unless the muscle is already significantly damaged, it is unusual that a distance runner muscle will generate enough force to create this degree of damage. A muscle with a grade three tear will have significant strength deficits to the point it may not be able to generate any movement.

Muscle tear injuries require time off running.

It may be 1-2 weeks off for a grade one injury, with a progressive return to running as tolerated. Grade 2 injuries have a more variable range of recovery times, but this can be anywhere from 2 weeks to 2 months. Grade 3 injuries can take longer still, and in some cases may require surgery to enable the muscle to repair at all. Rest is an important element for the first few days of the more sever injuries, however strengthening should also be prescribed early in the rehabilitation process, with an assessment of the runner’s form and training schedule included prior to the return to running.

Understanding your pain

It should be noted that not all pain is due to muscle tears, nor is pain always the enemy. Some pain is inevitable and can help to encourage adaptions to running training. High intensity running training (such as intervals or hills) can be painful, but this pain will decrease shortly after reducing intensity. These sessions are necessary for improving your speed. As a newer runner, or an experienced runner having performed a challenging training session (or when racing) soreness in the hours or days following the session can be expected. This pain and stiffness felt after the activity is called Delayed Onset Muscle Soreness (or DOMS). DOMS has been shown to be useful as experiencing this pain once can help reduce it reoccurring after similar training, enabling better recovery.

Being able to differentiate between a muscle tear, or training related DOMS can help to optimise your training/recovery balance. Knowing when to stop during a run, or how long to rest between runs can help to maximise your training, and minimise unnecessary down time. Aside from rest, a progressive strengthening plan is essential for proper rehabilitation and future prevention of this injury.

If you suspect that you have a muscle tear and would like advice the severity of the injury and how best to rehabilitate it, contact the intraining running injury clinic for an appointment today.

Doug James – Physiotherapist and Podiatrist

How to run your best race

Posted on June 21, 2023June 21, 2023 by intraining

10 tips to help run your best race.

with Steve Manning – intraining Podiatrist and Lvl 4 Running Coach

It’s race season !!!

Gold Coast Marathon and Sunshine Coast marathon are major goals for many of you. Steve’s put together his 10 top tips to help you run your best possible and hopefully enjoyable race.

You don’t need to use them all to help you run well, but each can give you a greater level of confidence in your ability to race well. Plus, as you practice each of these over your running journey, you will discover different racing experiences.

The most important aspect is to enjoy your racing and love your running.

Finally, and often forgotten, is your race plan. (Tip 6). If you are not sure how to do this, make sure you book in to see one of our team at the shop to help create a plan suited to where you are at with your racing now.

Have a great season of racing

Steve

1. Tapering

After months of progressively harder and longer training, you should have had a peak of mileage last week. The longer the race the longer the taper time required. Tapering is a reduction in total training load in the 3 weeks before a major goal race. This can mean no more long runs, fewer runs, shorter runs, less quantity in speed sessions.

2. Sharpening

When quantity is reducing in the taper intensity should be increasing. You run faster in speed sessions with more recovery between reps. Short time trials and races can also help stimulate your body so that it knows a big effort will soon be required.

3. Predictor Race

2 weeks before your major goal race you need to complete a shorter race that you can use to predict a realistic goal for your major goal race. It should be under similar conditions to your goal race regarding the surface, time and hilliness. If you run 10km in 45:00 minutes then you multiply that by 4.7 to get a realistic marathon time (3:31:30). You can get a half marathon time by dividing your marathon calculation by 2.1 (1:40:45). If it is your first half or full you should add an extra 5 to 10 minutes.

4. Power Session

10 to 12 days before your major goal race you do a power session. In this session, you only do 3 reps but run them much closer to maximum effort. This session should be the only time in training you run at maximum effort. They will usually be 15 to 30 seconds faster than your normally 1km rep pace. This is only possible because you have been tapering, you are only doing 3 reps and you also have maximum recovery of 4 to 5 minutes.

5. Pace Session

The Tuesday of race week we do a session where you are trying to run exactly at race pace. This should be the pace you want to run for most of the race. We normally do 3 x 1km with a 1km recovery. You cant look at your watch at all during the rep. Before you check your time after completing each rep you need to guess what time you ran. 3 seconds too fast is just as bad as 3 seconds too slow. Over the 3 repetitions you should not be out by any more than 10 seconds total. This is great practice for race day to make sure you do not go out too fast. It is also a good wake up call about how hard it is to run at your target pace.

6. Race Plan

Most people go out too fast in races. They are feeling good and get carried away with the crowd. This is a big mistake and can sometimes make it impossible to run your best potential time. 10 seconds a kilometre too fast at the start converts to a minute slower per kilometre at the end of the race. You should be running slower than goal pace the first 3 to 5km and then run slightly faster than goal pace for as long as possible. For example if your goal is to run 5 minutes per km you should start at 5:15/km. After the first few kms you should have warmed up and settled in and should be running at 4:55/km. By a bit after halfway you should be back on your average goal time but running faster then you need to achieve it. If you maintain that pace you will run even faster and if you slow the last few kms you will have a safe buffer all created in the second half of the race.

7. Carbo-loading

Long races will come close to depleting your freely available energy reserves. It is stored as glycogen in your blood, muscles and liver. Fat can be used as an energy source but has a greater metabolic load as it needs to be converted to glycogen. Many people try to delay this depletion with gels, chews and sports drinks. However it is also important to start the race with maximum reserves. This can be achieved through Carbo-loading where you increase the amount of carbohydrate you eat in the 2-3 days before the race. You should have more refined starches like white rice, bread and pasta. In the day before the race you should reduce high fibre foods and have higher carbohydrate foods that you like to eat. I also wake up 3 hours before the race and have some carbohydrate. You will also need to increase water intake but be careful of over-hydrating or overeating.

8. Race day nutrition

On race day I have a caffeine sports drink about 20 to 30 minutes before the start of major races. This tops up my energy and the caffeine helps me be prepared for a big effort. During the race you can use sports drinks to help reduce the risk of dehydration or Hypernatremia (diluted blood and low sodium levels). Sports gels and chews can also be used to maintain blood glycogen. You should try to have some supplementation at least every hour. It is important that you like the taste of any supplement you use so that it is maximally effective and you do not get sick. Try them in training before race day to be sure they will work on the day.

9. Supershoes

Supershoes have carbon plates, co-polymer midsoles and high stack heights with a big taper to the toe. They have been shown to have up to 8% improvement in race times depending on the person. They have also been shown to be effective for runners of all levels of ability. One of the big effects runners have reported when using supershoes is that their legs are in much better shape at the end of long races. Instead of hitting the wall and cramping and entering a survival shuffle for the last few kilometres runners are running strong at the end of races. This also results in better recovery after a marathon. intraining has a big range of supershoes so you can try them on and have a run to compare. Different supershoes will be more effective for different runners so you need to let your feet tell you which one suits you the best.

10. Foot check

You should have a quick check of your feet before a long race. Make sure your toenails are short so you do not bet a blood blister under the nail. If you have an excess buildup of callus then it can move independent of the rest of the skin and lead to blistering. If you are worried about your nails or callus then you can book into the clinic for a foot tune up before race day.

A rule of thumb is to not try anything new on race day. Practice using your gels, shoes and clothing beforehand. Stay in control and stick to your race plan. Follow these 10 points before race day and you can be confident that you will run your best potential time when it is most important.

Steve Manning "The Footman"

Tibialis Anterior Injuries

Posted on June 7, 2023June 7, 2023 by intraining

Tibialis Anterior Injuries – How to treat your shin and ankle pain.

By Doug James – Physiotherapist and Podiatrist – intraining running injury clinic

If you’ve ever had shin muscle soreness, or pain on the top of your foot, there is a chance it might have been due to an injury to the Tibialis Anterior (TA).

The TA muscle has an important role in running and walking. It assists the Posterior Tibialis muscle to control from rolling inwards too quickly or too far. It also helps by lifting the foot upwards, and to control how quickly the foot is lowered from this position. Without this muscle working well, you would be far more likely to trip over.

The TA is a large muscle located on the outer side of the bony ridge running down the front of your shin starting just below the knee. At the lower third of the length of the shin the TA muscle becomes a tendon that passes over the front of the ankle, the top of the foot and then attaches to two bones on the inner side of the foot at the high part of the arch.

When considering the anatomy of the ankle, there are up to 8 muscles* that assist with plantarflexing the foot (the movement that allows us to push off when walking or push up on to tip toe)(*fun fact: the plantaris muscle is absent in 7-20% of limbs, likely becoming less common due to its decreased role in humans since evolving from our tree dwelling days). Conversely, there are only 4 muscles that help with lifting the foot upwards, however their job is relatively easier as they only need to contend with gravity rather than bodyweight. The TA is by far the largest of these muscles, and can be prone to a number of different injuries.

Compartment Syndrome

Compartment Syndrome is when excessive pressure builds up within a muscle. This is usually due to an excessive amount of blood and metabolic waste being trapped within a tight muscle fascia (wrapping) that can’t expand sufficiently, and the body unable to clear the fluid build-up adequately. This can happen in underconditioned athletes (and often new military recruits) that have dramatically increased their training. This injury is quite painful, and in some cases requires surgery to fix, particularly when circulation or nerve function is affected. Compromise to nerve function or circulation can result in temporary or permanent foot drop, which as the name suggests, results in an inability to lift the foot. There are a number of other reasons why this may happen so it is important to have this examined urgently.

Thankfully many compartment syndrome cases respond well to reduced training and a more gradual build up. Changing footwear, and use of orthotics can also help improve symptoms in some cases.

Tibialis Anterior Tendinosis

The TA is a relatively long muscle with a similarly long tendon. This muscle is active (and sometimes overactive) during a large portion of the walking and running cycle and therefore has a higher-than-average risk of overuse and injury. Athletes that are newer to running are often under-conditioned for the stress that running will place on this muscle and tendon. Poor foot strength or joint instability (hypermobile / overly flexible joints) may lead to an overreliance on the TA muscle to stabilise your arch and foot position. Also worth considering is whether your shoes are too flexible, or too stiff as these can also play a role in injury development. The amount of training undertaken, rest between sessions, and training terrain are also worth examining. Running up and down hills can lead to a dramatic increase in how much the muscle has to work, particularly on the downhill component where the TA needs to control the rate at which the foot is being lowered down.

Tendon Compression Injuries

Because the TA tendon passes over the front of the ankle and top of the foot, compression injuries such as tendinitis (inflamed tendon), tendinosis (chronically inflamed tendon), and/or tenosynovitis (inflammation of the tendon sheath) can develop from shoe laces overly tight shoe laces. Reducing the lace tightness can help, though sometimes altering the lacing pattern is necessary to better eliminate the pressure to allow the tendon to heal.

Things to watch (and listen) for

While heel striking is completely common (and normal) when running, landing on your heel a long way in front of your centre of gravity usually results in an excessive amount of both lifting and lowering required from the Tibialis Anterior muscle. As such it may be prone to overuse injuries. If you are a particularly noisy runner that makes a “slapping” sound when the front of your foot hits the ground you could be wearing shoes that don’t suit your foot and/or have a weak TA muscle. Thankfully, these things can be fairly easily remedied, and are discussed below. A stiff ankle joint may also be to blame, though this often takes some work to address.

Ways to manage your Tibialis Anterior injury

Assuming your TA injury isn’t a medical emergency (cold, limp foot, or unrelating shin pain hours after exercise – if this is you, please go to the Emergency Department at your nearest hospital) a reduction in training load is an important first step. Taping your foot and/or massaging your shin can help to give some short term symptom relief. From there it pays to improve the strength in the muscle and tendon through conditioning exercises. It’s also worth seeing a sports podiatrist to check that your running technique and footwear aren’t contributing to the issues. Simple changes here can make a big improvement in how comfortable your shins can be while exercising. If you’ve been dealing with a sore shin muscle book in to see the injury experts at the intraining running injury clinic.

Doug James – Physiotherapist and Podiatrist

Why the ASICS Kayano 29 is a good high mileage training shoe

Posted on June 1, 2023June 1, 2023 by intraining

Why the ASICS Kayano 29 is a good high mileage training shoe

By Steve Manning “The Footman” – intraining Podiatrist & Lvl 4 Coach

In a previous shop newsletter, I suggested 3 reasons to use Stability Shoes:

1. Manage injuries related to pronation
2. Better support for slower running
3. Increased shoe durability

In this newsletter, I would like to highlight a particular stability shoe the Asics Kayano 29.

For many years the Asics Kayano was the most popular running shoe sold in Australia. The reason for this popularity was the versatility and comfort of this shoe. It was a reliable shoe in the high-mileage training category. Perfect for long runs and durable enough to push past the 800km mark for many runners. Asics kept a winning formula with the Kayano rather than trying to change it for change’s sake.

However the current Kayano has benefitted by the improvements in materials technology. In particular the inclusion of FF Blast+ has improved the softness and energy return. However they have not compromised the stability thanks to the LiteTruss system which is multiple midsole densities that are greater on the medial, inside of the shoe. An external thermoplastic heel counter collar prevents deviation of the heel counter over time.

The Kayano 29 is a very plush shoe that maintains the stability that many runners need. Medial ankle pain, shin pain and knee pain can be a direct result of inadequate medial control in a shoe. The Kayano is one of the premier stability shoes available.

Because of it’s popularity there are multiple colour options. There is also a knitted upper option with a sock fit – no tongue. The Kayano Lite 3 is another option that has a softer feel and uses GuidanceLine rather than LiteTruss for its stability. A kids version of the Kayano uses FF blast and does not have the heel counter collar but incorporates all of the premier technology of the adult Kayano.

For the month of June, we are offering all Kayano 29 at a special discount of $200. This is the perfect time to try out the Kayano if you need some extra support for your feet.

Steve Manning "The Footman"

How to deal with a pain in the butt (a glute injury)

Posted on May 9, 2023May 9, 2023 by intraining

Gluteal Muscle Injuries: How to deal with a pain in the butt

By Doug James (Physiotherapist and Podiatrist)

What are “the glutes”?

The Gluteal muscles (also known as “the glutes”) are your backside muscles, found on your posterior pelvis. They play an important role in standing, walking, running and jumping. There are three different Gluteal muscles:

The Gluteus Maximus – which is the largest of the group – works with the hamstring muscles to move the thigh in a backwards movement during running. It is a large, thick muscle and can generate a lot of power particularly during sprinting, squatting and jumping.

The Gluteus Medius and Gluteus Minimus muscles – These are relatively smaller and help to keep the hip steady while standing, walking or running and can rotate the thigh and knee inwards and outwards, and move the thigh out to the side (abduction). These two muscles are found on the upper part of the hip bones towards the outside. When you place your hands on your hips, your thumbs would rest on these muscles).

Who is at risk of a glute injury?

In distance runners, a vast majority of Gluteal muscle injuries will occur to the smaller Gluteus muscles (the Medius and Minimus) or their tendons. The Gluteus Maximus may occasionally become strained or torn, but this is more likely seen in sprinters, weight lifters, or jumping athletes performing powerful explosive movements.

The Gluteus Medius and Minimus are important muscles for runners because they largely provide stabilisation on every step you take. They tend to be more likely injured in female runners and runners over the age of 40. The injuries that can develop in these muscles ranges from relatively mild injuries such as strains or slight tears; through to a full rupture of the muscle or tendon (which is more severe but thankfully much less common).

Types of Gluteal injuries

TENDONITIS:

Tendonitis usually occurs when the amount of load (training stress) is greater than the capacity (strength) and healing capability of the tendon. These types of injuries, tendonitis of the Gluteus Medius/Minimus tendons, can be slow healing and nagging as they are often ignored or poorly managed. Healing capability is also affected by a number of factors including age, overall health, nutrition, stress and sleep.

BURSITIS:

Bursas are fluid filled sacs that usually exist peacefully in the human body. They have a role in protecting tendons from rubbing on bone. Bursitis develops when the bursa becomes acutely or chronically irritated. Gluteus Medius tendinosis (the chronic form of tendinitis) can become complicated by developing bursitis (swelling) on the bony part on the outside of the hip joint called the greater trochanter. Greater Trochanteric Bursitis is usually painful to touch or lay on, and can get irritated by running.

Most injuries to the Gluteus Medius / Minimus are due to overuse or weakness.

Overtraining by dramatically increasing the distance of a run, or the number of times each week that you run will cause your muscles to fatigue and become sore. Due to their relatively small size, the Gluteus Medius and Minimus are likely to fatigue earlier than the Gluteus Maximus, Hamstrings and Quadriceps (thigh) muscles. As these muscle fatigue, they can become damaged, and the risk of knee and ITB injuries increases.

Muscle imbalances can also increase the risk of Gluteal muscle injuries. Tight hip flexors and weak Gluteal muscles may cause the pelvis to tilt forward putting strain on muscles and joints in the hips and lower back. In some cases excessive foot pronation (rolling in) or incorrect footwear may contribute to Gluteal muscle injuries.

WHAT ELSE COULD IT BE?

While the gluteal muscles and tendons are a common source of discomfort in distance runners, there are a number of other conditions that can be occur. Deep Gluteal Syndrome or Piriformis Syndrome are complex conditions that affect a different group of muscle and nerves in the gluteal region. These syndromes tend to be felt deeper and lower in the glutes (further towards the hamstrings) and may have referred pain and numbness into the back of the thigh or legs.

Bone stress injuries to the pelvic bones, sacrum (lowest part of the spine) or the neck of femur (where the thigh bone become the hip joint) are rare but shouldn’t be overlooked, particularly if pain becomes worse with running and lingers for days afterwards.

How to deal with a pain in the butt?

There are three key strategies to manage gluteal injuries.

1. Calm the injury.

2. Rebuild strength

3. Sports specific conditioning

The mainstay of most sporting injuries is to initially calm an injury down, rebuild the strength in the affected and surrounding tissue, then focus on sport specific conditioning. If you are suffering a muscle or tendon injury, this may mean a relatively short period of reduced running volume before resuming regular training. With these ‘soft tissue’ type injuries, as long as some rehabilitation exercises are being undertaken, these shouldn’t significantly impact your running. If however you are suffering from a bone stress injury, this can take a number of weeks, to possibly months to heal particularly if adequate rest doesn’t occur in a timely manner.

The key here is to getting the correct diagnosis early, which can be achieved with clinical testing, and if necessary, an MRI scan (a Physiotherapist can refer you for this if deemed necessary).

For most hip and glute injuries, preventing these injuries involves making sure that the hip stabilising muscles (namely the Gluteus Medius and Minimus) are strong and have good endurance. Strengthening these muscles, along with your core (e.g. through Pilates type exercises) can not only help to reduce Gluteal muscle injuries but also reduce your risk of hamstring, ITB, and knee injuries. Making sure your hip flexor muscles are sufficiently flexible may also help. Having a proper biomechanical assessment of your running technique, footwear and hip strength and flexibility can identify risk factors and give insight into how to avoid or fix Gluteal injuries.

COME IN AND SEE OUR TEAM

Like any niggle, the sooner you get this checked and treated, the better outcome you will have. The intraining running injury clinic can help diagnose and treat your Gluteal (and other) injuries. Running shoe and biomechanical assessments can be performed by the experienced podiatrists and physiotherapist to help get you back running sooner.

Call today for an appointment with out team: 3367 3088.Re

Doug James, Physiotherapist and Podiatrist

Do You Need a Trail Shoe?

Posted on May 3, 2023May 4, 2023 by intraining

Three reasons why trail shoes make a difference

By Steve Manning “The Footman” – intraining Podiatrist & Lvl 4 Running Coach

Trail running has become more popular over the last few years as is shown by the success of the intraining Trail tribe sessions and trail events. Most weekends there are now multiple trail races you can run.

If you have considered trying out the trails then the first question you might have is whether you need to get a specialist trail shoe. The answer depends on the trail you want to run. Many of Brisbane’s trails are well maintained and will be Ok to use a road shoe for an occasional run. However many trails are too rough and you may risk injury if you do not have a trail-specific shoe.

Below, I’ve given you three reasons why trail shoes can make your runs much more enjoyable than if you ran with road running shoes.

1. DESIGN: How are they different from running shoes?

2. BENEFITS: Why should you use trail over road shoes?

3. ADVANTAGES of Trail running for you

If you have any questions, make sure you come into intraining Running Centre and chat with our running team. Or you can drop us an email at [email protected], or call our team on 33673088.

How are trail shoes different to running shoes?

DESIGN: The structure of trail shoes have:

Larger lugs on outsole.

- Trail shoe outsoles must deal with loose or muddy ground. The higher profile lugs on the outsole help to improve traction on these surfaces. This is perhaps the most important and most obvious difference between road and Trail. On the road trail outsoles may have decreased traction and the lugs will wear off more quickly than a road shoe.

Lower stack height and heel drop.

- The uneven ground on trails have a greater risk of tripping or spraining an ankle. The thicker the midsole the greater the instability and more risk of a sprain. Trail shoes thinner midsoles are more responsive and will give you a better feel for the road.

Tougher toe caps.

- There is a risk of kicking a stick or rock running on trails. Most trail shoes have some extra protection in the toes to reduce the chance of tearing the upper. This also helps protect your toes.

Rock Plates.

- Many trail shoes have a forefoot plate that will stop a sharp rock from piercing the sole and cutting your foot. This may reduce forefoot flexion however it is not the same function like a supershoe that is designed to stop forefoot flexion.

Neutral only.

- Trail shoes must deal with more lateral movement than road shoes. For this reason almost all trail shoes are neutral. That means they have the same support on the inside and outside of the shoe. About half of the road running shoes are neutral as the extra support on the inside of stability shoes helps control excessive pronation.

Water resistance.

- Some trail shoes have Goretex uppers that are waterproof. However, most trail shoes have a layer of waterproofing around the base but are more water resistant in the rest of the upper. This keeps your feet relatively more dry if you are running through wet grass and puddles.

Why should I get trail shoes?

Here are 3 key reasons:

#1 Durability.

The most important reason to get a trail specific shoe is that your shoes will last longer. Each shoe is designed with regards to the specific type of stress they must endure. Outsole components may be torn off a road shoe when they run over rocky terrain. A road shoe midsole is less protected and softer so will degrade quicker on trails. The softer upper materials can be easily damaged by rocks and sticks.

#2 Better traction.

Running on trails has an increased risk of falls. This is increased significantly if you have diminished traction. It is also very frustrating slipping around on loose surfaces. Even calf and hamstring tears will be greater if you are slipping as you push off and slip.

#3 Improve stability.

The midsole upper and outsole combine to offer better stability running on trails. You are trading softer midsoles and anti-pronation features in road shoes for a firmer ride of a trail shoe.

Advantages of trail running:

Aside from the enjoyment factor, adding some trail running into your routine can give you additonal strength for your road running goals.

Here’s how:

Increased strength

Running on uneven ground works the little stability muscles in your feet, legs and core. This creates greater strength outside of the limited range of motion from road running. This then leads to reduce risk of overuse injuries.

Changing Body Stresses

If you are having to manage a degenerative injury like osteoarthritis, you may find that you are able to run further with no pain on the trails. The constantly changing stress helps distribute the strain away from the damaged area offering a level of relief.

Focus on effort rather than pace

Running off road means you can commune with nature rather than dodging cars. Because of the changing surfaces and hills the emphasis is off of your pace and more on your effort. This creates a sense of being in the moment that is similar to the benefits of meditation.

Getting the right shoe specific trails lets you truly maximise these advantages.

For shoes: You will want to come talk with our team instore. They will take you through the shoes available and of course let you test run them in-store. Like any shoe, it’s good to run in them while choosing the one for you.

For training: intraining Running Centre has a thriving trail community with midweek and weekend sessions for all abilities. You can find more information about this HERE and contact our trail coach Tracy Baker if you need more information.

Happy running!

Steve

Steve Manning "The Footman"

Steve has been a running shoe aficionado for the last 4 decades and as the owner of the intraining Running Centre has helped thousands of runners find the perfect shoe. He is a member of the Footman Biomechanics Group of the International Society of Biomechanics and a previous President of the Qld branch of Sports Medicine Australia. As a Podiatrist specialising in running sports injury prevention, he utilises footwear prescription and modification to keep you running. Contact Steve at the intraining Running Centre, [email protected] for all your footwear questions.

Why do my calf muscles hurt?

Posted on March 29, 2023March 29, 2023 by intraining

Understand calf pain and what to do if you feel pain while running.

By Doug James, physiotherapist and podiatrist at intraining Running Centre

Do your calf muscles hurt from running?

Calf muscles have an important role in helping you to run.

- They help with absorbing shock when your foot lands on the ground
- Then help to stabilise your leg before providing power to help propel you along.

Unfortunately, these high-impact movements can lead to any number of painful injuries that can hamper your running

Know your calf muscle Anatomy

Each calf comprises two main muscles – the Soleus and the Gastrocnemius. The Soleus has a long, wide muscle belly that extends the length of the back of the Tibia (shin) bone. The Gastrocnemius is the muscle on the top half of the calf and comprises a medial and lateral head which both overlay the Soleus. Together the Soleus and Gastrocnemius join to form the Achilles tendon, which attaches to the heel bone allowing us to push off when we walk, run and stand on tip-toe.

5 Calf Muscle injuries

1. Delayed Onset Muscle Soreness

Delayed Onsets Muscle Soreness (aka DOMS) is often felt as stiffness in muscles following a harder-than-usual session. It may start anywhere from 2 hours to 2 days after the activity and can last a few days. For newer runners, this could arise after any session, but more experienced runners might feel it after a session that is longer and/or faster than usual. DOMS may also be felt if starting a new activity – such as calf raises in the gym – or doing a new drill such as hill sprints or skipping.

DOMS is generally nothing to worry about; in fact, it may actually be somewhat beneficial. It’s been found that experiencing DOMS once and then training again within a few days can help to reduce it coming back the next time. Interestingly, taking anti-inflammatory medications (such as Nurofen or Voltaren Rapid) can reduce the discomfort of DOMS initially but you are more likely to experience DOMS again as your body hasn’t learned to adapt to it.

2. Calf Muscle Tightness

Calf muscle tightness from DOMS should settle down within a few days after the aggravating activity. Some runners however may experience an ongoing sensation of tightness which can be due to:

- - Insufficient recovery between sessions
  - Too much intense exercise
  - Poor calf muscle flexibility or endurance
  - Incorrect footwear
  - or some combination of the above.

Ensuring adequate rest (and getting enough sleep) between high intensity sessions (e.g. intervals, hills, gym) should help to reduce the feeling of tightness. If calves feel tight even after easy-paced running then it may be worth looking at whether your shoes suit your feet and legs. You can test your calf muscle length by standing barefoot with the front of your toes 10cm away from a wall. You should be able to comfortably squat and touch your knees on the wall without lifting up your heels.

Runners with a reduced calf muscle length may struggle to wear shoes with less than an 8mm heel-to-forefoot drop. Calf muscle stretches may help somewhat, but adding a heel wedge under the insole can give instant relief.

3. Calf muscle tears

Calf muscle tears are fairly common in runners and can result in pain and an inability to run or walk comfortably. They often strike at inopportune times – such as during the sprint finish of a race and can leave the runner unable to run for weeks, or even months. With correct care, healing time can be reduced, safely returning you back to running.

4. Acute muscle tears

Small muscle tears (microtears) occur nearly every time that we run, however they are usually so small that they heal by the next time that we run. Much like DOMS they can help us to become stronger once they heal. More substantial acute tears can happen when there’s insufficient healing time between running sessions, or more stress is put on the muscle than it can handle – often during sprinting and running uphill/stairs and greater damage occurs.

Risk factors for acute muscle tears include:

- - Inadequate warm-up
  - Incorrect or worn out shoes
  - Running on a steeply cambered road or steep hill
  - Tight and/or fatigued calf muscles
  - Running with increased speed or power

The tear may feel like a burning sensation, and intense tightness and is sometimes accompanied by a ‘pop’ sensation as it tears. Depending on the severity of the injury, normal walking may feel slightly uncomfortable to near impossible. The medial (inside) head of the Gastrocnemius is a common site for acute muscle tears but can occur in either of the calf muscles.

5. Chronic muscle tears

Poorly healed acute muscle tears are likely to continue causing pain due to scar tissue which forms during the healing process. Scar tissue is less flexible and can pull on surrounding healthy muscle tissue creating further damage. Running with pain in a muscle will mean that it doesn’t function properly and can expose you to risk of other injuries.

In addition to the risk factors for acute muscle tears, the following may contribute to chronic muscle tears:

- - History of the poorly healed calf muscle or Achilles tendon injuries
  - Leg length difference
  - Muscle strength imbalance
  - Poor foot biomechanics (excess or insufficient pronation)
  - Training program errors

How to treat a calf muscle tear

Immediate treatment for calf muscle tears involves:

- the use of calf compression
- intermittent ice packs
- ceasing pain-provoking activities (including running) for 2-3 days.

After the first few days:

- See a physiotherapist to help judge the severity of the injury and begin a rehabilitation program.
- Consider massage as it’s useful to help encourage faster healing and reduce scar tissue in the muscle.

Strength exercises:

The different calf muscles each need their own specific strength exercises. The goal of rehabilitation is to help strengthen and regain flexibility in the muscle in order to return to running and avoid injury reoccurrence.

Chronic or Recurring tears:

In cases of chronically reoccurring muscle tears, it is useful to see a podiatrist at intraining to have your biomechanics, footwear and gait assessed as potential causes of injury.

Two injuries that mimic calf pain

Here are two other ‘not to be missed’ injuries that can mimic calf pain.

1. Tibial Stress Fractures

If you’ve been running for at least a few weeks and calf pain develops without a clear cause other than an increase in running training, it is unlikely to be DOMS, but may be due to a stress injury to the Tibia (shin) bone. When these occur on the posterior (back) side of the bone they can easily be confused for calf muscle injuries. If not managed well, bone stress injuries can progress to stress fractures which require complete rest from impact activities such as running for around 2 months.

2. Calf compartment syndrome

Compartment Syndrome refers to an increase in pressure in a muscle compartment. Calf muscles are surrounded by a thin layer of strong tissue (fascia) that has a limited ability to stretch and expand. Compartment syndrome tends to occur more commonly in runners that are new to the sport or have dramatically increased their training. The compartment pressure increases due to a combination of recently increased muscle size, and/or the presence of either more blood or swelling in the muscle. Calf compartment syndrome may develop from calf muscle tears or tibial stress fractures due to increased swelling from these injuries.

Calf compartment pressure usually reduces after exercise has stopped. The pressure that doesn’t reduce shortly after exercising is a medical emergency particularly if feelings of coldness or numbness are felt in the foot. This should be treated urgently in a hospital setting.

Enjoy your running but take care!

If you are new to running or starting back after some time away from the sport, it is important to take care of building your running distance and speed gradually. Calf soreness can be a sign of one of several injuries and is best treated early,

Finally, if you are still baffled as to why you are getting calf pain… check your shoes. You’d be surprised at how often old or the wrong shoes are the culprit!

Stay injury free, and keep your routine for a great year of running.

Doug James, physiotherapist and podiatrist

If you have developed a running injury, contact 07 3367 3088 to book an appointment today.

Doug James, Physiotherapist and Podiatrist

3 Reasons To Use Stability Shoes

Posted on March 21, 2023March 23, 2023 by intraining

By Steve Manning “The Footman” – intraining Podiatrist and Lvl 4 Running Coach

3 Reasons To Use Stability Shoes

Manage injuries related to pronation
Better support for slower running
Increased shoe durability

Many runners have struggled with the soft, thick, neutral midsoles in modern shoes. Especially if they need some medial stability. If you have been experiencing knee, shin or foot pain you might want to reconsider adding a stability shoe to your running rotation.

There has been a massive evolution in footwear design and technology over the last 10 years. Accompanying this has been a deeper understanding of optimal running biomechanics.

Initially these changes occurred during the minimalist running phase. Shoes became lighter but also moved away from blocking the foot towards foot guidance. Lower heel height to forefoot height differences became the trend. Shoes generally were more flexible to let the foot move “naturally”. The Motion Control category of running shoe became extinct while Neutral shoes went from being one third of the shoes sold to being more than half the shoes sold.

More recently the minimalist fad has been turned on its head with the emergence of the supershoes and maximalist shoes. These shoes have maximum stack heights up to 5cm, have rigid soles that do not flex and prevent the foot from having a “natural” action. Some features from minimalism have still been adopted by this new phase in shoe design. That includes the low heel height and light weight. However, none of these supershoes have any medial control to reduce the amount your foot rolls inwards.

For most runners current running shoe technology has resulted in faster times and lower injury incidence. Unfortunately when a new fad becomes popular it does not suit every runner. While neutral shoes have become preeminent they have lead to increased injury risks for some runners. Softer midsoles feel nicer but can also facilitate sideways translation of the foot on top of the shoe. This can lead to increased muscle and bone stress and even injury.

There is no ideal running style or foot structure for all runners. Really there is no normal when it comes to how to run. Instead there is an ideal way of running and shoe design that suits each individual runner. Ideal can change significantly between runners and even between the same runner at different speeds. That is why there are so many different shoes with different amounts of stability and cushioning

Here are 3 reasons why you should consider including a stability shoe in your shoe collection.

1. Manage injuries related to pronation

Soft, thick midsoles allow for more pronation or rolling inwards during the weightbearing part of the running stride. This can lead to increased knee rotation and knee strain. The muscle alongside your shin will also be strained as it resists the rolling action and collapse of your arch. Pronation may also shift your bodyweight to the inside of your foot blocking your foot function in propulsion. A firmer density on the inside part of your shoes midsole will reduce the work your leg needs to do to control this action. This can minimise muscle fatigue that may lead to injury.

2. Better support for slower running

The faster you run generally the better your biomechanics. Ground contact time is reduced minimising the opportunity for pathological movements. The opposite is also true. The slower you run the more support you may need in a shoe. For easy recovery runs and long runs many runners will benefit by the improved assistance offered by a stability shoe. Using the lighter supershoes for speedwork and races can be complimented by having a stability shoe for most of your other training.

3. Increased shoe durability

If you pronate even mildly you may be putting extra stress on the inside midsole of your running shoes. Over time this increased compression can lead to a permanent reduction to the resistance in the midsole. This can be seen if you look at your shoes from behind and the heel counters are leaning to the inside. Stability shoe midsoles are stronger on the inside so will be able to cope with the increased forces from pronation. For some people this can double the viable life of their shoes.

Even within the stability shoe category there have been many changes. All shoes have become softer and lighter. If you have not tried on a stability shoe recently you might be very surprised how comfortable they have become. The emphasis on guiding the foot rather than blocking the foot has made for a smoother transition from footstrike to toe-off. Each brand has rejuvenated their stability shoes to make them more comfortable and more functional.

ASICS:

The GT2000 v11 has significantly increased the cushioning by adding an extra mm of stack height and incorporating FF Blast into the full length of the midsole. Over decades this has been one of the most popular stability shoes ever created. The newest version feels more responsive and smooth not just because of the change in midsole but also tweaks to the LiteTruss dual density midsole and a drop in overall weight.

The Gel Kayano 29 is the premier stability shoe from Asics. There has been a step up in cushioning with a 2mm increase in stack height as well as full length FF blast like the GT2000. The slightly increased weight is offset by increased durability, cushioning and control. While using LiteTruss like the 2000 it feels like there is more stability on offer from the Kayano as the dual density is a bit firmer and larger. The heel counter has an extra thermo plastic heel counter collar for extra stability.

The Gel Kayano Lite 3 is a modified version of the Kayano. The heel drop is a bit lower and the midsole is flared on the sides and back. The midsole seems softer and lighter although the stack height is actually less than the Kayano. The main difference is the full FlyteFoam midsole and Guidance Line rather than LiteTruss technology. This makes for a softer and more subtle amount of stability compared to the GT2000 and Kayano.

BROOKS:

The Brooks stability shoes have the GTS suffix attached to them and incorporate Guiderails technology. Guiderails are a firmer density that is embeded into the midsole that cups the foot but is thicker on the inside of the shoe. This helps to increase pronation resistance the more you roll in.

The Brooks stability line starts with the Launch GTS 9 which is a lighter weight mild stability shoe. This shoe can double up as a training shoe or a racer. The midsole stack height is reduced and the midsole has a firm responsive feel in propulsion. This is an excellent versatile shoe for mild to moderate pronators.

The Adrenaline GTS 22 has been our most popular stability model in our store. You can see why when you have a run in this shoe. It seems to be a perfect combination of softness and control. The guiderails help to smoothly direct the foot from heelstrike to forefoot loading.

The Glycerin GTS 20 is the most cushioned and stable Brooks GTS shoe thanks to increased midsole stack height and flare as well as the supersoft DNA Loft v3. While slightly heavier and more expensive than the Adrenaline it makes up for it with the extra protection it offers.

HOKA:

Most of the HOKA shoes give stability through wide, firm midsoles. The midsoles are wrapped up to cradle the foot. The Arahi 6 is the only HOKA that has the added dual-density midsole. In the Arahi the firmer density cradles the heel and is extended through to the forefoot on the inside if the shoe. This makes it currently the only runner with specific medial control in the forefoot.

MIZUNO:

The Wave Inspire 19 has a softer feel than the v18 with increased stack height and Enerzy midsole. The wave plate is also a bit more subtle then the previous version. This has translated to a much improved transition from heel strike to forefoot loading. However it still is one of the most stable and durable stability shoes around thanks to a firmer, more supportive feel than most other stability shoes

The Wave Horizon 6 is almost a motion control shoe. The Foam Wave is extended the full length of the midsole. There is full ground contact through the midfoot. Of even more significance is the full length Enerzy Core midsole insert that offers superior cushioning and energy return. This is a solid stable shoe that does not need to compromise its cushioning.

NEW BALANCE:

The Fresh Foam X 860 v13 is the recent upgrade to a successful stability shoe. A Dual density wedge in the medial midsole offers extra arch support and rotational stiffness. It has the added advantage of good upper depth and a variety of widths to fit problem feet. This is one of the more stable stability shoes.

The Fresh Foam X Vongo v5 has a larger dual density post that extends from the sole to the upper. However the shoe itself feels smoother and more streamlined than the 860. It has the stretchy toe upper of the 1080 so can conform to different toe and forefoot issues.

SAUCONY:

The Guide v16 has a thermoplastic insert in the medial midsole. This increases the durability of the inside midsole. The guide has a more traditional firmer feel that can suit heavier runners who hit the ground hard.

The Tempus is one of the most under-appreciated stability shoes. It bridges the gap to the Semi-Supershoe category by using Pebax Foam inside a supportive Frame of firmer PWRRUN EVA. This is perhaps one of the softest most comfortable stability shoes available. It gives you control without blocking foot motion.

Come and try to test run a pair on our indoor 25m runway. See you at 535 Milton Road, Toowong

Steve Manning "The Footman"

RISE OF THE SEMI-SUPER SHOES

Posted on February 28, 2023March 1, 2023 by intraining

By Steve Manning “The Footman” – intraining Podiatrist and Lvl 4 Running Coach

The introduction of the Supershoe category has transformed race times over the last 5 years. They have been effective at rewriting the history books with new records but also unprecedented depth of fast times.

Last week 52 runners broke 4 minutes for a mile in the one track meet. The recently announced new qualifying standards for the Olympics are a 2:08 marathon for men which only Deek had done for Australia in 1986 until Brett Robinson ran under 2:08 in December.

The 3 main features of super-shoes are:

A stiff forefoot that restricts flexion via a plate made most commonly with carbon-fibre. This improves running efficiency as described in the Mass Spring Model. Click Here.
Super cushioned co-polymer midsoles with the combined properties of being light while having superior energy return. These midsoles improve power production but also save the runners legs over long distances.
Maximal stack heights up to 5cm allow aggressive toe springs in the shoe where the midsole tapers from full thickness at the ball of the foot to nothing at the end of the toe. The result is an improved mechanical efficiency and a rocker sole that makes you feel like you are falling forward during propulsion.

These maximallist supershoes have killed the traditional minimalist racing shoe. However, their success has also had a positive impact on the training shoe category. There are a number of shoes that are now available that have some of these features while offering more durability and stability.

These Semi-Supershoes will continue to infiltrate the traditional training shoe category. They offer superior performance to most trainers while offering extra support and injury reduction compared to their supershoe counterparts. I highly recommend you come and try on shoes from this new category of runners when you buy your new shoes for the season. They can be used for normal training, speedwork or races. Remember to pick up your Free Running light when you buy your shoes from intraining.

Steve Manning "The Footman"

Plantar Fasciitis

Posted on February 15, 2023February 15, 2023 by intraining

Plantar fasciitis – that pain in the heel

By Doug James – Podiatrist and Physiotherapist – intraining Running Injury Clinic

A lot of runners fear stress fractures. Sure they are painful and can prevent you from running for 6 or more weeks while they heal, but this is a relatively short period of pain compared to some injuries. In fact, there are particular running injuries that commonly last for well over a year. One of the more unpleasant of these long-term injuries is Plantar Fasciosis.

Well, I’ve heard of Plantar Fasciitis before…

Plantar Fasciosis (pronounced “Fash-ee-oh-sis”) is the more medically accurate term for chronic Plantar Fasciitis (“Fash-ee-eye-tiss”). Plantar Fasciitis is a painful injury to the Plantar Fascia which is found in the sole of your foot. The injury often begins after the Fascia is overloaded beyond what it’s capable of handling, and a strain or small tear may occur. The body tries to heal this, and in many cases successfully, but it becomes “chronic” if it hasn’t healed within a few weeks of onset and begins to develop certain changes within the tissue (discussed later). In the more acute “Fasciitis” phase you may feel moderate to strong pain that is often worst when first standing after sleeping or prolonged sitting. For a majority of cases the pain will be located where the arch meets the heel bone (calcaneus), but is occasionally felt along the arch or outside part of the foot.

So, what does the Plantar Fascia do?

The plantar fascia is a long piece of connective tissue, much like a tendon, that runs from your heel bone towards your toes. It provides important structural support when standing, and along with the Achilles tendon it absorbs impact force then assists with creating propulsion for push off. Given the location and importance of the fascia, it can make life quite unpleasant when it is sore.

Why did it happen? Why me? (It isn’t fair).

It’s not well understood what causes Plantar Fasciosis, but there are a number of risk factors for its development. With around 10% of the general population likely to experience Plantar Fasciitis, this rate is closer to 18% in runners – and it is likely due to the impact that is experienced in the foot while running. It is more likely to happen if there has been a notable increase in the activity level undertaken recently, and if the shoes are inappropriate (wrong style, and/or worn out). In the general population Plantar Fasciitis commonly strikes if people do a lot of walking in unsupportive shoes (or barefeet) as often happens during a holiday at the beach. In the running population, Plantar Fasciitis may develop if someone has increased their training volume or intensity too quickly, and/or are running in worn out shoes. In general, females tend to be more likely to develop Plantar Fascia injuries, and it is more common between 40-60 years of age as our connective tissue repair is less effective.

I’ve had it for months, will it ever get better?

This is a really common question. While it may feel like it may never get better, studies show that most cases (95%) will resolve within 18 months. This may seem like a really long time, but should offer some hope, especially as the pain tends to diminish in the later stages of the injury.

How do I make it feel better?

The 3 main goals once the acute phase has passed are to manage any pain flare ups, rehabilitate your foot, and avoid irritating it further. Flare ups can occur if inappropriate footwear is worn (usually unsupportive or worn out) or if too much activity has occurred. Ice packs and pain relief medication can be helpful for managing flare ups. Rehabilitation requires a personal assessment to determine causative factors. This should involve some sort of strength exercises, identifying any footwear issues, and if orthotics are needed. Avoiding flare ups / irritating your injury usually involves making sensible footwear choices. Intraining is now stocking a number of great products that can assist with managing Plantar Fasciosis. Slides and sandals from Oofos, Hoka and Lightfeet are invaluable for wearing around the house, casually or to the beach. They each offer a comfortable amount of cushioning with the different brands each offering a different amount of arch support.

Strapping tape can help provide excellent short term relief, but if you aren’t able to tape your foot (allergic to it, or find it difficult to do) wearing Feetures Plantar Fasciitis relief socks provides a good alternative.

While Plantar Fasciosis can be a long lasting injury, it needn’t get in the way of your running goals. A thorough assessment can help to accurately diagnose your injury and get you back on track sooner, and with less pain. For a personal assessment and personalised treatment plan of your heel pain, or other injury, contact the intraining running injury clinic today. Ph: 07 3367 3088.

Doug James – Podiatrist and Physiotherapist – intraining Running Injury Clinic

Bachelor of Podiatry (honours), Master of Physiotherapy Studies.

Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment.

Doug is also a keen runner having completed the New York Marathon.

3 ways to help your Pain in the heel

Posted on February 8, 2023February 9, 2023 by intraining

Pain in the heels is annoying.

There are several possible injuries causing this, but the most commonly known is Plantar fasciosis (fasciitis) As a podiatrist I like to use a few different products and management strategies before heading down the orthotic pathway
1. Update your Shoes: Check your shoes are not too old. This is the most commom cause, and often it’s our work or dress shoes that contribute to the ongoing problem. You’ll be surprised at how a shoe with fresh or new support will help.

2. Change your shoes during the day: Give your foot a different ‘mould’ to stand on. Subtle changes in the shoes will give your feet a different sensory feedback, taking the pressure off the ‘sore spots’.

3. Avoid barefee: Wear a supportive thong or shoe at home. Most people have hard floors and it’s easy to kick off your shoes as soon as you get home from work or running. Sadly, being barefooted worsens heel pain. I will nearly always prescribe a sports thong like OOFOS. The cushioning and support in these thongs take the load off your foot and heel. Over time, you are likely to go back to your barefoot habits, but make sure your feet feel good first.

None of these are the silver bullet in curing plantar fascia pain, they’re a great adjunct treatment for sufferers of Plantar Fasciopathy.

Come and see our team of Podiatrists and Physiotherapists at intraining Running Centre to help keep you running.

Article by Margot Manning Podiatrist, coach and runner

Strength training for trail runners

Posted on November 3, 2022November 17, 2022 by intraining

3 key strength exercises to support your trail running.

by Doug James, Physiotherapist & Podiatrist, intraining Running Centre

Trail running is tough! It often requires more strength, flexibility, and balance than road running. Being able to conquer hills, run through creeks, and navigate uneven terrain requires more than just basic fitness – so it makes sense to do additional conditioning exercises. Here are three key strength exercises to keep support your trail running.

NOTE: If you’d like to see Doug’s video next week on how to do these exercises CLICK HERE and we’ll send it to you.

STRENGTHENING YOUR GLUTES

Sore hips and glutes are one of the most common complaints of trail runners.

Running up – and especially down hills – requires more hip stability and glute strength than if you were running in a straight line on flat terrain. Lateral movement is used when navigating uneven rocky terrain and needs a high level of hip stability which comes from strength in the glute muscles on the outer part of your hips. If these muscles aren’t adequately conditioned for the duration and degree of difficulty, they will tend to fatigue and may start feeling tight as a defensive mechanism. Stretching tends not to fix the problem as it only reduces the sensation of tightness but does nothing to improve the strength and endurance of the affected muscles.

Building strength in your lateral glutes can be achieved through a number of exercises, but side lunges have the added benefit of helping improve your knee and core strength.

Exercise: Side Lunges

- - - Start with your feet facing forwards about shoulder-width apart.
    - Step out to the side as far as possible while keeping your foot facing forwards.
    - Transfer your weight across to the foot you just moved and bend the knee to perform a squat movement.
    - Push down through the foot to return to your starting position.
    - Alternate legs and perform 10-12 of these per side for 3 sets.
    - Side lunges are also useful warm-up exercises before a run.

STRENGTHENING YOUR HIP FLEXORS + CORE

Hip flexor muscles help you to lift your thighs and they get a huge workout on hilly runs. Building strength in these muscles is key to surviving runs with lots of elevation, particularly over longer distances. Improving your core strength will also help you to maintain your running form for longer, particularly on uneven terrain. The following is a great exercise to improve both your hip flexor and core muscle strength.

Exercise: Heel Taps

- - - Lay on your back with your knees bent to 90° and your shins horizontal.
    - Press your lower back against the floor
    - Slowly lower one leg down towards the floor then return to the starting position.
    - Tip: If you are new to the exercise keep your knee bent at 90° while lowering your leg. Once you’re comfortable with the movement, straighten your leg out as you lower your leg.
    - Alternate legs and perform 10-12 of these per side for 3 sets.

STRENGTHENING YOUR CALF MUSCLES

Another key muscle group needed to successfully conquer hills are your calves. Strengthening your calves can have the bonus effect of warding off Achilles tendonitis and plantar fascia niggles.

Calf raises are key to developing strong calves, but doing them correctly makes a huge difference. Too often they are rushed and this reduces the improvement offered by the exercise. Aim to keep in time with a slow rhythm taking 3 seconds to rise on to your toes, and 3 seconds to lower back down.

- Perform 3 sets 15 raises

TIP: If you haven’t done calf raises recently, it’s best to start by doing the exercise on both feet at the same time. Once you are comfortably doing 3 sets of 15, then progress to doing one leg at a time.

Challenge yourself:

For an extra challenge, and to improve your ankle stability, try doing calf raises on a soft surface such as a thick yoga mat or a couple of cushions.

Summary

All runners are built differently, and you may find you need extra assistance in a certain area beyond what was listed. The exercises above are a great starting point to improving your strength for trail running but if you’re still having difficulty with muscle soreness or injury then it’s worth booking an appointment with a running specialist at the intraining running injury clinic. We’re able to check that you are performing the exercises correctly and activating the right muscles so you can get the most out of your running.

Doug James – Physiotherapist and Podiatrist, intraining running injury clinic

Doug James – Physiotherapist & Podiatrist

Bachelor of Podiatry (honours), Master of Physiotherapy Studies.

Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment.

Doug is also a keen runner having completed the New York Marathon.

Osteoarthritis of the big toe joint

Posted on August 4, 2022August 5, 2022 by intraining

A painful toe: Osteoarthritis of the big toe joint
with intraining Podiatrist, Steve Manning

Osteoarthritis (OA) also known as degenerative arthritis is very common in people over 50 at around 17% prevalence . The Clinical Assessment Study of the Foot, identified that almost half of the symptomatic OA in the foot that can be confirmed in X-rays is in the big toe joint. (1)

When running and walking all of the body weight may be focused on this joint while it is flexing in propulsion. This may create excessive forces in the joint that can lead to:

degeneration of the joint;
spurring around the joint causing a bunion; and
deviation of the joint causing a condition called HAV.

It has been known for a long time that dysfunction in this joint can lead to changes in the forces and movement up the kinetic chain. (2) When walking the big toe joint requires around 60 degrees of available flexion or else gait compensation may be required that could lead to a secondary injury. This can be significantly reduced when running depending on the person.

Mechanism of action

The mechanism of action when this occurs is that in some people the joint is locked when trying to toe off. This happens because the force from the ground slides the joint slightly causing it to lock. These forces on the bones over time will lead to the spurring around the margin of the joint and eventually fusion of the joint.

The compensation for what is called a sagittal plane block can be flexing off at the joint in the toe, Twisting action of the foot in propulsion, or extra flexion at the ankle, knee or hip. All of these motions can stress weaker structures in ways that they can not cope, again leading to injury.

Conservative Treatment: Orthotics or Footwear?

Intervention with orthotics or footwear may slow the progression of the degeneration of this joint. If there is still function left in this joint then shifting ground reaction force from this joint to the other toes may allow initiation of flexion and prevent it locking.

If there is significant reduction in the range of motion at this joint when not weightbearing, or there is significant deviation of the joint then improving its function may not be successful. In that case we will attempt to stop flexion so as to reduce pain. However the compensatory gait will then need to take the load. In severe cases surgery may be the best option but initially the goal of treatment should be to prevent or delay future surgery.

Unfortunately the evidence for orthotic intervention has not yet been established. (3) Part of the problem is that there are many different types of orthotic prescriptions used and some may only be effective in certain individuals. This may require trialling different orthotic modifications until the best result is achieved.

Footwear intervention has shown more promise to reduce symptoms. (4) Carbon plated super shoes reduce the loads on this joint by preventing flexion and creating a rocker effect in propulsion. These shoes do not work for every runner but there is now a variety of supershoes to select from.

Managing the pain

The pain in these joints may only occur in bouts as the joint is degenerating then stabilising. However, often the pain is caused by an inflammed bursa that occurs after the increased joint size gets extra pressure from the shoe. This can be alleviated by choosing a shoe that puts no pressure on the joint or modifying the shoe with a small cut over the joint. Orthotics may also be effective in reducing pressure on this joint from the shoe.

We have successfully treated many people with problems in this joint at the clinic. If you are experiencing pain in this joint, or just want to have it checked out, then book in to see Steve, Doug or Margot at the intraining Running Injury Clinic, Toowong Ph.3367 3088.

Reference:

Steve Manning – intraining Podiatrist & Level 4 running Coach

Steve Manning has worked since the 1980s to create opportunities for runners of all abilities to pursue their running goals, to establish and maintain a healthy balance of sport, health and work in their lifestyle and to connect with other like-minded and supportive runners. He has done this by creating a community of runners, coaches, sporting podiatrists, physiotherapists and a retail team with a large focus on inclusion and collaboration. He loves runners and what running can bring to people’s lives. Steve is the owner of the intraining Running Centre, a podiatrist, Associate Lecturer QUT, marathoner, Level 4 Running coach, member of the Queensland Sports Medicine board, and doting dad.

Mizuno Wave Rebellion

Posted on June 2, 2022June 2, 2022 by intraining

Mizuno Rebellion Review with Steve Manning: Podiatrist, runner and owner of intraining Running Centre

A new addition to the supershoe category is the Mizuno Wave Rebellion. Supershoes are distinctive by 1. Their thick, light and responsive midsoles; 2. A big taper at the toes creating a rocker effect; and 3. A plate in the midsole to stiffen the midsole in propulsion.

GLASS FIBRE PLATE:

What separates the Mizuno Wave Rebellion from these other shoes is a full-length Glass-Fibre Reinforced Wave Plate rather than the traditional Carbon Fibre plate. This gives real tipping off feeling while walking but seems smoother when running. I also found the plate in the heel added considerably to the sideways stability on heel strike which is not evident in many of the supershoes.

ENERZY Lite MIDSOLE

The Enerzy Lite is Mizuno’s new responsive midsole material. Mizuno says it was created to deliver a higher than ever energy return and softness. The full-length Glass-Fibre Reinforced Wave Plate is sandwiched within the middle of the midsole offering a softer feel at the footstrike without compromising stability.

G3 OUTSOLE:

The outsole design offers almost full coverage of the shoe to ground interface while reducing weight with interconnected lugs embedded on a firm fibrous base. It seems to give excellent traction in a variety of conditions. Made from PU Resin I think it will be one of the more durable outsoles of the supershoes.

ENGINEERED MESH UPPER:

The seamless engineered mesh upper provides a soft, breathable and flexible fit. The fit is a bit deeper than many shoes, able to accommodate a slightly wider foot or an orthotic. The gusseted tongue is a bit more prominent but can be held back by lacing it into the back eyelet.

SUSTAINABLE MATERIALS:

Most running shoe manufacturers are aiming for recycled or recyclable materials. The Mizuno Wave Rebellion uses a Bio-based Wave Plate (38% less CO2 emissions than Wave Rider 23 Wave Plate). It also has Recycled PET Lining Mesh and Recycling PET shoelaces.

THE RUNDOWN:

Mizunos supershoe offering is a good addition to the category, especially for anyone wanting more stability or needing to use an orthotic in their supershoe.

Steve Manning – intraining Podiatrist & Level 4 running Coach