How to treat and beat your plantar fasciitis- By Melissa Biffi, Biokineticists

The plantar fascia is a thick band of ligaments connecting the heel bone to the toes. It works with the Achilles tendon to store and return energy during specific movements and supports the arch of your foot. For most of you runners suffering from this acute, sometimes chronic heel pain, you’d wonder what the need for your plantar fascia is, if it just causes pain! It does in fact have an important function, to stabilize the forefoot as the force during push off increases.

So if it’s there to help you, why would it cause pain? Often pain results due to strain of the plantar fascia thus causing inflammation, weakness and swelling, making it hard to get around. Why would this happen? Many plantar fasciitis cases are the cause from factors such as tight calves and repetitive hill workouts, however the largest factor is owing to fallen or collapsed arches. Flat footed individuals are more likely to develop and suffer from this condition as collapsed arches places more tension on the fascial ligament thus overloading the attachment at the heel bone.

The most common sort after treatment is to mash your foot out with a ball or an iced bottle. Yes this may help relieve the tension and loosen up the ligament; however this is only temporary, providing an invitation for the pain to return at a later stage. So why deal with the chronic pain when Biokinetics and exercise therapy can completely stomp out that plantar fasciitis. Biokinetics aims to find the cause and deal with it using an individualized and specific exercise intervention. Often enough, the flexor digitorum brevis muscle, or more simply put, the muscle in the sole of your foot is weak, allowing for collapsing in the arch. This may also be combined with overall weakness in the lower limbs and general tightness that needs to be dealt with appropriately and conservatively to prevent further aggravation and even possible heel spurs (bony outgrowths on the heel).

As for you runners looking for a quick fix, it is important not to rush the process and seek proper medical advice and initial supervision when it comes to rehabilitative exercise, whilst trying your best to avoid those corticosteroid injections and surgery to relieve the pain. As biokineticist’s it is our job to treat conservatively and to determine faults in your running technique that may be contributing to your pain. Since foot strike patterns significantly increase tension in the plantar fascia, it is important to avoid mid or forefoot strike. While recovering from the condition, it is recommended that you decrease your stride length and increase your cadence and to wear appropriate shoes with enough support for shock absorption.

With correction in form and general activity and the combination of a rehabilitative exercise program, you may just be able to stomp out your plantar fasciitis and enjoy the open roads and trail runs pain-free. 

Can walking be as effective a form of exercise as running? - Tony Paladin (Paladin Biokineticists)

Whenever we are going to relate things to one and other, it is always best to adopt the old adage of “comparing apples with apples”. Comparing apples with say bananas makes for good conversation; but it doesn’t actually address the cold, hard facts.

The debate about walking vs. running and the respective health benefits of each has swung like a pendulum for decades between Doctors, Surgeons, Biokineticists, Physiotherapists, Athletics coaches and Personal Trainers.

Before we can critically comment on whether walking can be as effective as running we would need to define what exactly: “form of exercise” means. If we loosely reference the World Health Organisation’s definition of “exercise”, we can break the components into functional / balance, flexibility, strength and cardiovascular.

If we use these components as indicators, we can critically assess whether walking is as “effective” as running.

From a functional / balance perspective, the slower the movement the greater the stimulus. Generally walking is a good choice for people who need to improve basic function, increase activities of daily living and enhance balance. The function / balance components can be respectively varied in difficulty by offering assistance or creating instability. Verdict = when it comes to training basic function and balance, walking wins.

Flexibility. Unfortunately on this front, neither walking nor running has much to offer in terms of increasing muscle and joint range of motion. If I had a loaded gun to my head and was asked to make a call, I would have to say that across the walking / running echelon, sprinting would probably elicit the greatest effect on flexibility due to the ballistic and elastic components of the activity. Verdict = Do Yoga or full range of motion exercises such as squats in conjunction to your walking and running program.

When we introduce strength into the walk / run debate, we end up with a chicken and egg situation. Does one need to be strong to walk and run or does walking and running make you strong? Lets make walking the chicken and running the egg. Walking is the most elementary form of movement; it is literally one step harder than sitting. From the perspective of rudimentary movement, it is logical that one should start with the basics prior to advancing the activity. The “basics” in this case, is walking and when advanced, is running. Strength however, nestles itself quite firmly in between the two activities: you need to be strong to run. Do we go with the chicken or the egg? Since neither walking nor running really develops strength, it is advisable to include other movements in your program, which do. Verdict = Walking should be progressed to incline walking which should be progressed to fast incline walking which should be progressed to running. Strength exercises should be included across the entire stratum.

Then we have the cardiovascular component. In short, the faster your heart beats, the more “cardiovascular” the modality of exercise is. One could argue that it is a no brainer that running elevates your heart rate more than walking does, but does it really? Running sloppily on a flat surface at a slow pace versus brisk walking with a backpack up a hill is like comparing apples with bananas. If we compare apples with apples; as a general rule running elicits more of a cardiovascular response on the body due to the speed of the activity. The body needs to work harder to run than to walk. If we are going to get walking to obtain the same level of work, we need to make it more difficult. This can be done with speed, resistance, hills and direction. Verdict = from a cardiovascular perspective, walking with purpose has the potential to topple lackadaisical running.

So… Shall I walk or shall I run? For the non-injured and mostly healthy community, running has the ability to elicit more of an exercise response than walking and should probably be the mode of choice. For individuals with joint problems or who are simply not fit enough to run, walking is a heck of a lot better than bum sitting in terms of exercise response. Even when walking is too easy and running is too hard, walk-running is also an alternative to get the heart rate up but still allow for bouts of rest. The bottom line is your ability: exercise is meant to be both challenging and enjoyable.

With regards to general health benefits, increased fitness, toning and weightloss; the American College of Sports Medicine (ACSM) recommends that adults get at least 150 minutes of moderate-intensity cardiovascular exercise per week; strength train each muscle group two to three days a week; do flexibility exercise two to three days per week; and finally, do functional exercise two or three days per week. Whether you choose to walk or run is your choice, just make sure your heart is beating while you are doing it!

Tony’s Primary areas of focus include: Orthopaedic rehabilitation through strengthening (mainly backs and knees). He works with regaining function in ACL (anterior cruciate ligament) reconstructions and total knee replacement patients.

Tony also has an interest in sport specific testing and training (primarily rowing, cycling, running and triathlon).

Tony can be contacted on 011 807 9877 or tonypaladin@kinetics.co.za. 

In case of an emergency, he can be contacted on 082 921 6776.

Do's and don'ts of running, the common misconceptions - Natasha Eekhout (Paladin Biokineticists)

How hard can running really be? You’ve stretched out, trained your core and finally ready to put your fancy kit on with your ultimate running shoes and hit the road, voila! However has all your training leading up to your run really made a huge difference on your performance?

Stretching and flexibility

We’ve all seen that one runner stretching out those tight biltong strips we call hamstrings but how much does that really help. Initially stretching was seen as a performance enhancer however, recent research shows that it may just hinder it. This all has to do with neuromuscular factors nevertheless, this also depends on the types of stretches performed, static or dynamic. (Have a read through our blog discussing these two). This goes hand in hand with flexibility. The more flexible you are the lower your running economy, due to negative impacts on the stretch shortening cycle.

Distance running strengthens your legs

Actually this isn’t the case. In general, running will either decrease your absolute strength or just keep it, there have been no noted increases as of yet.

Lactate causes fatigue

Lactic acid is produced when the muscles break down glucose during strenuous muscular activity. It is commonly seen as a waste product. Although lactate may correspond with fatigue, it is not the cause and is actually present to delay the onset of fatigue and provide your body with a source of energy.

How important is core strength for running?

It’s good to have a strong core to help with general stability and decrease back pain, however its effects on running performance haven’t really hit the research books, as many runners haven’t really noticed major differences.

You shouldn’t be crashing on the floor after a race?

Nope this one ain’t correct either. So instead of standing around with your hands on your head, like you’ve been advised to, to try ‘recuperate and gather your energy,’ listen to your tired body and give into those jelly legs. Your body needs a break and is battling to pump blood against gravity.

With all of the above stated, it’s up to you and how your body feels. If you’re keen on sticking to your routine or happy to change it up, that’s completely up to you. The main focus is to improve your economy and overall training performance for a great healthy running stride.

At the Starting Line - Natasha Eekhout (Paladin Biokineticists)

You’ve just decided on taking up running as a lifestyle change but where do you even begin? Surely running and building up your pace and distance can’t be that hard? Admit it, we have all pushed until our lungs begin to burn, coughing up blood and the sensation of jelly legs begins to set in. Yes, this might in some torturous way improve your tolerance and endurance, but there really is a better way to do this.

The answer… taking walk breaks in between to allow your previously motionless and rested body to adapt slowly and safely. This is especially important for new runners as these short breaks reduce the ‘out of breath’ feeling and allow for you to actually enjoy the run. For the more experienced long distance runners, this also offers an opportunity to extend their running distances.

Taking walk breaks doesn’t mean you can transform your run into a solid Sunday stroll. The frequency of your walk breaks should be calculated appropriately. If you are just starting out you can use the following guidelines:

For unexperienced and more sedentary ‘almost runners’:

·         Run for 5-10 seconds

·         Walk for 50-55 seconds

For the more physically active but beginner runners:

·         Run for 15-60 seconds

·         Walk for 15-30 seconds

Runners with more experience can adjust this according to their pace per kilometre:

For 5 minute paced runners:

·         Run for 2 minutes

·         Walk for 30 seconds

All of the above also applies to your first race. The run-walk-run method may just be the winning formula to help you complete it, producing better recovery rates, reducing your injury risk and eliminating the slowdown pace that many runners experience just before the finish line. Start inviting the method a little earlier on into your run and skip them during your last third of the race, allowing you to cross that finish line strong!

Natasha completed her BSc Sports Science undergraduate degree at The University of Johannesburg and her BHSc honours degree in Biokinetics at The University of the Witwatersrand. 

She has a passion for a variety of sports in particular soccer, tennis, running and kickboxing which have contributed to a strong interest in orthopaedic rehabilitation and working with athletes. Other areas of focus include diabetic and cardiac rehabilitation, as well as weight loss and a keen enthusiasm for working with children of all ages. 

Natasha can be contacted on 082 476 9727 or natashaeekhout@kinetics.co.za

Pounding the pavement – Can running do more harm than good?

You’ve been told that running sheds the pounds. Your Personal trainer has given you a running program to boost your goals but after the 3^rd week your knees are so sore that you look crippled when walking up stairs.

On the 3^rd kilometer of your track session, you become increasingly annoyed with the Kenyan guy who has lapped you for the 9^th time; not only because he is so unbelievably fast, but because you get a fright every time he zips past you.

If this sounds familiar, then you are not sufficiently conditioned to be running the distances you are attempting. You probably sound like a small elephant with flip flops on when you run because you actually lack the intrinsic lower limb strength to control the dynamic gait of running.

If you compare your lower leg and foot strength to that of a seasoned Comrades runner, you will more than likely find that they are able to do a lot more with their functional bodyweight than you can; such as a one legged squat and an unassisted one legged calf raise.

The best comparison of whether one is potentially doing more harm than good during exercise is the blister analogy. If you start lifting weights without gloves, your hands will blister. If you continue lifting weights and do not give the blisters time to become callous, then your hands will proceed to tear open and become injured.

The solution is common sense. Before you even start running; ensure that you have basic functional lower limb strength such as being able to do a one legged squat. A Biokineticist can assist with this and get you going. Once you start your running program, start with small distances and apply the 10% rule, running no more than 10% distance OR intensity each week.

If you slowly build up, you should see steady improvements over time until you are running comfortably without pain.

Does stretching before, after or at all affect you in the ‘long run?’ - Natasha Eekhout (Paladin Biokineticists)

Does stretching before, after or at all affect you in the ‘long run?’

Have you been advised to stretch before or after your run, but aren’t quite sure what the difference is? Experts surprisingly recommend neither, however it has been suggested that the type of stretching performed may ultimately lead to changes in your running economy.

As runners, I’m sure we’ve all seen the stereotypical image of a fellow runner with one foot on the curb, reaching their fingers down towards their toes and you seemingly feel the urge to do the same. However do you really know what the stretch is effective, or if in fact it is going to help your productivity?

The key points to stretching lies in the types of stretching performed. Research has demonstrated that static stretching i.e. the stretch held in position in order to lengthen the muscles and tendons, generally decreases both power output and strength. An example could include reaching down towards the toes and holding the position, ultimately disengaging the muscle before having them to activate immediately after. Static stretching has received mixed reviews especially from runners, as they feel their energy expenditure exceeds that of the same pace of run performed without stretching.

Research conducted in Brazil indicated that statically stretching before running had no effect on running economy, however participants felt as if they were working harder to complete their route than those who hadn’t stretched. Both groups of participants finished the route at relatively the same time. Researchers concluded that static stretching resulted in decreases in overall explosive force. However studies carried out by Nebraska Wesleyan University observed that those who statically stretched before activity had decreased their overall economy, due to the resulting inhibition of muscle tissue excitability.

As opposed to static stretching, dynamic stretching i.e. the stretch one actively moves through and does not hold in the end position, increases blood flow and functional movement. Examples may include leg swings and butt kicks. These mobility movements allow one to warm up the muscles efficiently and recruit more muscle fibers to activate systematically through specific movement. Dynamic stretching routines aid in training specific muscles, allowing for easy firing in the run to follow and has in recent studies improved mileage in some runners.

Contradicting research shows that stretching in its’ entirety is unnecessary, as a tighter muscle is a better muscle, having more recoil power than a muscle that has been overly stretched.

So in short, the answer to the question actually depends on the individual. If you believe that static stretching will aid in the ‘long run,’ then you are most welcome to do so. However why perform something that may ultimately result in slower starting speed and having you put in the extra effort when you don’t have to. If you must, rather perform static stretching at the end of your run and dynamic stretching before your run to get the muscles ready and waiting to be called upon. Whatever your decision, listen to your body and take notes on the effects and end results of your running
economy.

Natasha completed her BSc Sports Science undergraduate degree at The University of Johannesburg and her BHSc honours degree in Biokinetics at The University of the Witwatersrand.

She has a passion for a variety of sports in particular soccer, tennis, running and kickboxing which have contributed to a strong interest in orthopaedic rehabilitation and working with athletes. Other areas of focus include diabetic and cardiac rehabilitation, as well as weight loss and a keen enthusiasm for working with children of all ages.

Natasha can be contacted on 082 476 9727 or natashaeekhout@kinetics.co.za