The point at which you can run will depend hugely on the individual, but once you feel confident with the stability, strength and flexibility of your ankle then you can begin to jog and then run. Start on a treadmill or find some flat grass – avoid uneven and bumpy surfaces. In reality it takes around 12 weeks for ligaments to heal up, so even if you feel OK, do take care for three or four months.
Hips and spine
Q I’ve heard other runners talk about piriformis syndrome. What is it?
A Piriformis syndrome is quite literally a pain in the bum! The piriformis is a muscle which runs from your lower spine (sacrum) out to the top of your thigh bone. It’s located behind the gluteus maximum muscle, but is much smaller than this giant. You have one on each side of your body and its job is to help rotate the hip and turn your legs outwards. If the muscle becomes tight, swollen or spasms, then you can get buttock pain. You might also get pain down the back of your leg and tingling or numbness due to irritation of your sciatic nerve, which runs close to the piriformis. The pain can be worse if you’ve been sitting for a while and it can also be triggered by running, particularly uphill, and going up stairs. We don’t really know why it happens, but prolonged sitting is certainly a risk factor. Treatment focuses on stretching out the piriformis. You can do these lying or seated.
You may need input from a physiotherapist if simple home stretches aren’t enough to ease your symptoms.
Did you know?
The sciatic nerve is the longest nerve in the body. It is the widest too, measuring 2 centimetres at its widest point.
Q Can I run with sciatica?
A No. To understand this answer, it helps to know exactly what sciatica is. Running irritates sciatica, but it doesn’t directly cause it. The sciatic nerve comes out from the lower part of the spinal cord and travels down through the buttock, down the back of the thigh to the calf and under the foot. When it is squashed it causes pain, tingling, numbness and occasionally weakness in the area below the compression. It most commonly becomes compressed at the spine by a ‘slipped disc’. Discs are basically gel pads acting as shock absorbers between each of our vertebrae (back bones). When a disc ‘slips’, some of the disc bulges out (prolapses) and compresses the nerves at their root. This can then cause symptoms anywhere along the nerve. Remember, the sciatic nerve can be compressed by the piriformis muscle too. Sciatica tends to cause a pain in the buttock and down the back of the thigh, but it can extend down to the lower leg and under the sole of the foot, and be associated with reduced sensation and tingling.
Knowing this, it’s easy to see why running is not a good idea if you have sciatica from a prolapsed disc. The impact of running will put extra stress onto the bulging disc and further compress the sciatic nerve. It’s not all bad news, though, because not all cases of sciatica are from prolapsed discs. Most will resolve and we know that generally being active helps to prevent back pain. Plenty of runners have had sciatica in the past and are no longer bothered by it. What is crucial is that you don’t try to run through any pain and you allow long enough for the sciatica to settle (four to six weeks). A physiotherapist to identify the cause of your sciatic nerve irritation, and help you properly rehabilitate and return to running gradually, is invaluable.
Q Why does running give me pain in the back of my neck?
A Do you wake up the day after a long run with pain and stiffness in the back of your neck? This is another perfect example of how what goes on in one part of your body affects another. Running is a high-impact activity and pain in your neck suggests that your running posture isn’t ideal. Sometimes the pain is purely muscular, but it may also be from the cervical spine (neck bones) and surrounding structures. It suggests that the way you are landing when you run is placing excess stress on your neck. This is most prevalent in people who run with a marked heel strike. Working on your running posture should help. If your pain is persistent, not purely caused by running, or you have symptoms such as numbness or tingling in your arms, then see your GP for an assessment.
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Running posture tips
Running with good posture will help to minimise your risk of injury, improve your running technique and make you a more efficient runner. Try the following tips. You could focus on one each time you run until you have mastered them all:
• Stand up tall.
• Make sure your shoulders are back.
• Hold your head up high.
• Engage your core muscles.
• Tuck your bottom under.
• Keep your hips strong and level when you run.
• Lean forwards slightly from your ankles not your hips.
• Don’t over stride. Try to land with your body balanced directly over your foot.
• Let your arms swing in a forward and back motion, at your side and close to your body.
Q Why do lots of runners get ITB problems?
A Most runners will have heard of the iliotibial band (ITB) as it’s frequently blamed for injuries and discomfort. It’s a thick band of dense tissue, which runs from the ileum bone in the pelvis down the outer thigh to the outside of the knee, where it attaches to the tibia bone below the knee cap. It helps to stabilise the hip and knee, and works with the hip muscles during movement. Pain from the ITB can be felt anywhere along its route, but is most commonly felt at the side of the knee. Iliotibial band syndrome (ITBS) is experienced by up to 14 per cent of runners, with the highest risk groups being those who are increasing their distance, running high mileage and those with biomechanical issues. The pain tends to come on at about the same distance each time you run and is often worse when running downhill.
The exact cause of the pain and the treatment for ITBS is actually poorly understood, with limited evidence to back up theories and treatment plans. It’s probably more complex than simple friction and inflammation of the band. It’s more likely to happen if you have weak hip muscles, a tight ITB or an uneven running style. It’s thought that women may be affected more than men because their wider pelvis and the angle of their thigh bones puts the ITB under more tension.
Thankfully ITBS usually resolves. Around half of runners will be back running after eight weeks and only 10 per cent will still be off running after six months. When it first happens you should reduce or change your activities. Don’t do anything that causes you pain, which means you will probably have to stop running and switch to swimming or walking for a few weeks. There is some controversy over whether stretching or massaging your ITB (including with a foam roller) will help. Try stretching your ITB with a banana stretch to see if it gives you any relief. Cross your affected leg behind your healthy one while standing up tall and, with your arms raised above your head, lean away from the affected leg to make yourself into a banana shape. You should feel the stretch right up the outside of your hip, thigh and knee.
Like most running injuries it’s important to correct any underlying cause, so look for exercises that you can do regularly to help build up strength in your hip muscles. Resistance bands are perfect for this and a few minutes every day using a band will be time well spent.
You can gradually build up your running distance again, but keep going with the strength exercises. Listen to your body. If you feel your ITB start to twinge then cut down again. If you think it’s more than just a case of running too much too soon, get a gait analysis to make sure you have the right shoes, and if you have recurrent ITBS, then see a physiotherapist for an assessment.
Real-life runners
At the beginning of my running journey, I had ITB issues. After a lot of research and seeing a running physio, I discovered I had weak glutes and weak foot arches. Initially I tried custom-made insoles but they seemed to cause more problems and didn’t correct the root cause. Doing specific strength exercises focusing on my glutes, core and foot strength gradually started to pay off, and over time I found my gait changed and my pain disappeared.
Lisa Ruggles, runner, coach and d
irector of 261 Fearless Club UK CIC
Q My knees are fine, but running seems to cause pain in my hips. What could this be?
A This could be Greater Trochanteric Pain Syndrome (GTPS), which can often afflict women who are between 40 and 50. Pain is felt in the outside of the hip. It’s worse when you lie on it, cross your legs or do repetitive movements, such as walking, cycling or running. You might have heard it called trochanteric bursitis, because it was thought to be due to inflammation of the bursa or fluid-filled cushions around the greater trochanter, a large bump at the top of the thigh bone. We now know that it isn’t as straightforward as this and likely involves small injuries to the muscles and tendons around the trochanter too. While also being caused by being overweight and sitting for too long (particularly with crossed legs), the repetitive movement of running is a clear trigger and runners who are rapidly increasing their distance are at particular risk.
Treatment involves a period off running, usually a few weeks, to let any inflammation settle. Try to keep doing light exercise and stick to your normal daily routine during this. You may need to use some painkillers such as paracetamol and you can apply ice to the sore, tender areas. Follow this with strengthening exercises to address any weaknesses in hip and thigh muscles, and follow that with a gradual return to running. Exercises can include glute bridges, single leg stands, wall squats and hip abduction exercises, which involve keeping your pelvis still and moving your leg sideways away from your body. You can use a resistance band for this movement too.
If your pain is not settling, then sometimes corticosteroid injections are used and you should see a physiotherapist or doctor to check the diagnosis and discuss further options.
Top tips for a healthy runner’s musculoskeletal system
• The musculoskeletal system can seem complicated and overwhelming, but there are some simple things you can do to help keep yours in good shape for many happy running miles:
• Always increase the volume and intensity of training gradually.
• Allow enough recovery days.
• Wear correct footwear, professionally fitted if possible.
• Use strength and conditioning to give you a strong and balanced body.
• Be aware that strength and balance training become more important as you age.
• Warm up with dynamic stretches rather than static ones, which should be done after a cool-down.
• See a health care professional for a diagnosis if any pain is not resolving.
• Maintain a healthy weight.
• Eat a balanced and varied diet so your body has the building blocks it needs for growth and repair.
• Find a good physiotherapist who is experienced in helping runners – they’re worth their weight in gold.
Further help and advice
Royal Osteoporosis Society: www.theros.org.uk
Versus Arthritis: www.versusarthritis.org
Running Physio: www.running-physio.com
General advice on conditions: www.patient.info
Find a physio – Chartered Society of Physiotherapy: www.csp.org.uk/public-patient/find-physiotherapist/physio2u
Chapter 8
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The Skin
If you could design the ultimate running kit it would be comfortable, waterproof, breathable, both warm and cool, fit snuggly and stretch when you need it to. Skin is perfectly designed for use during running, given it meets all of these criteria and has many more functions too! Despite this, though, there are issues that crop up and problems that arise with your skin that can be minor inconveniences or total game-changers, preventing you from taking even a single step. Let’s look at the body’s largest organ, learn more about how it works and what we can do to look after our most precious running kit.
Skin is incredibly clever! Here’s a list of just some of the roles that skin has:
• Holds us together.
• Protects the tissues that lie underneath.
• Controls body temperature.
• Keeps out infection.
• Prevents damage from ultraviolet light.
• Gets rid of toxins.
• Allows us to touch and feel.
• Makes vitamin D.
• Allows movement.
There are three main layers to the skin: the epidermis, the dermis and the hypodermis.
The epidermis is at the surface and is made up of layers of epithelial cells. Where your skin is thin, for example on your eyelids, there will be fewer layers than where it’s thick, on the soles of your feet and palms of your hands. The top layer of epithelial cells dies and sheds continuously, and is replaced by newer cells moving up from the deeper layers. Skin pigment cells called melanocytes are found in the deep layers of the epidermis.
The dermis is a much thicker layer and contains sweat glands, nerve fibres, blood vessels, hair follicles and defence cells to prevent infection. These structures are all held together by a mesh of connective tissue containing collagen and elastin fibres, to give it both strength and stretch.
The hypodermis is also called the subcutaneous layer and is largely made up of fatty tissue called adipose tissue. It’s not strictly part of the skin, but it links the skin to underlying muscles and bones, supports the skin’s structures and provides an insulating, cushioned layer that is important for temperature regulation and protection.
Once you’ve got your head around basic skin anatomy and function, it not only gives you great respect for it and an appreciation of its complexity, but also a good base to work from when trying to understand and solve running-related skin issues. Let’s move on to some frequently asked questions, starting with skin damage and moving on to infections, followed by long-term skin conditions.
Did you know?
Skin is the body’s largest organ and on average weighs 3.6kg. If you stretched it all out, your skin would cover approximately 2 square metres.
Skin trauma and damage
Q How can I stop my skin chafing on long runs?
A Sometimes you can grin and bear a bit of chafing when you run, but when you get in the shower afterwards, even the faintest red patches can cause searing pain! Chafing is caused either by skin rubbing against skin, such as between your thighs, or fabric rubbing against skin, such as under bra straps or waist bands. Adding in the dampness caused by sweat is a recipe for chafing. Skin sheds its top layer of epithelial cells naturally, but when friction and rubbing accelerate this loss, then lower layers of cells become exposed. These cells are not designed to be, or haven’t matured enough to be, on the outside. Nerve endings and small blood vessels are exposed and surrounding skin gets angry and inflamed too. Chafing can be treated, but the best bet is prevention.
Well-fitting clothes in the right fabrics will make a big difference. There’s a reason why runners wear Lycra! Close-fitting kit that sits snug to the skin tends to rub less than baggier clothes which move around more. Lycra shorts or leggings will stop thighs rubbing against each other, because, let’s face it, how many of us actually have a thigh gap? Many men however report they chafe less in loose fitting shorts so it can be trial and error. Sports bras can be trickier as there’s a lot of natural movement (see here), but the best fit possible with soft, seam-free fabrics generally helps. Wet clothes rub most so choose a fabric which wicks well – this means it draws sweat away from the body and dries quickly.
For problem areas which always seem to rub, apply a skin-protecting lubricant before running to add an extra layer. This is especially useful if you’re going to get wet. In sweaty areas, you can also try using your antiperspirant.
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Treating chafed skin
If, despite your best efforts, you find yourself with an area of sore, inflamed skin, here’s what to do:
1 Clean the area thoroughly with warm water and a mild soap. Avoid anything too strong or perfumed.
2 Pat the skin dry with a soft, clean towel.
3 Apply a soothing antiseptic cream or protective balm. Nappy creams that contain zinc oxide are ideal.
4 If possible, allow the skin to be exposed to the air. Baggy clothes are best.
5 Protect the skin from further damage. This may mean covering it with a sterile dressing to stop it sticking to clothes or getting rubbed again.
6 Skin will heal in a few days. While a bit of itching is normal, watch for signs of infection, including a sticky discharge, an unpleasant odour and increasing redness around the wound.
Q No matter what I try, on my longest runs my nipples always end up really sore and bleeding. What can I do?
A Runner’s nipple is common in men because of friction between t-shirts and protruding nipples. It’s less common in women due to sports bras acting as a barrier. Try following the advice above about chafing. You might find that a very close-fitting base layer that clings to your chest like a second skin will help. If you feel self-conscious wearing one, then choose a vest style and wear a t-shirt over the top. Protective lubricant is essential and consider putting a small pot in your running belt so you can re-apply mid-run. If you’re still struggling, then you can stick tape, plasters or pads over your nipples to protect them. There are a variety of products available, from basic surgical tape to specially designed nipple pads for runners. It’s always difficult to guarantee they’ll remain in place, particularly if you sweat heavily, and they can be painful to remove from hairy chests but they’re certainly worth a try. If you’re a new runner, you’ll probably find your nipples toughen up with time.
Run Well Page 16