First and foremost, it is important from a philosophical standpoint to approach adversity with an eye directed at what you can control. Except for a number of individuals, we cannot directly influence or change problems such as the economy, politics, or public health policy. For many, even their employment may not be directly under their control. But in that apparent absence of control is an important lesson – use our experience as runners to reinforce the importance of focusing on what you can control. Let me explain. When we are out for a run we cannot change or alter the steps we took five minutes ago and we cannot immediately influence what we’ll do in five more minutes. Running teaches us to focus on the moment at hand and let go of concerns about factors outside of our immediate control. Therein lies a lesson for handling the psychological challenges of this current crisis.

Dr. Williams was recently interviewed by NBC Journalist Gwen Aviles regarding running during this current pandemic. He discussed several facets of running during this crisis with Gwen and you can read that article here: https://www.nbcnews.com/pop-culture/pop-culture-news/you-can-still-run-outside-during-coronavirus-pandemic-here-s-n1179356.

Plantar fasciitis means inflammation of the fascia. But, this term is a bit deceiving because the fascia itself never really becomes “inflamed.” Rather, inflammation develops around the fascia, in the arch muscles, and on the surface of the heel bone. Research is not clear on how long the fascia remains inflamed, but best estimates are 4-6 weeks on the short side and a few months on the long side. If this inflammation does not resolve, then the plantar fascia will eventually become damaged. When this occurs, the term we use is plantar fasciosis rather than fasciitis. Scar tissue begins to develop in the fascia and replace the normal collagen matrix. As this damage worsens, the fascia thickens – I commonly see fascia two to four times thicker than normal under the heel bone. Consequently, many people with long-standing heel pain describe the feeling of stepping on a rock. 

Causes of heel pain are multi-factorial, meaning several problems tend to congregate together and cause the pain. One factor that appears to be the most prominent cause is reduced flexibility in the calf muscles. Research has shown that tight calf muscles are present in 80-85% of patients with heel pain. Consequently, one simple method for treating – and preventing – heel pain is to improve calf flexibility through stretching. 

So, how do they become tight? Most of the tight calf muscles I see are related to lifestyle. We spend a lot of our days sitting with the knees bent. Because the gastrocnemius muscles cross the knee joint, bending the knee relaxes the calf muscles. Spend most of your day like this and the muscles naturally shorten. In addition, as we sleep at night we naturally point our toes downward under the covers thus shortening the calf muscles. (Ever wonder why heel pain is so common when standing up after resting or getting up in the morning? There you go.) There are genetic variances as well with some individuals lacking flexibility for most of their lives.

If you find yourself suffering from heel pain, or just want prevent heel pain, then try stretching your calf muscles. Chances are you’ll find a significant improvement your pain. There are two primary muscles you’ll need to stretch: gastrocnemius and soleus. Two different stretches should be performed twice each day. These are called static stretches and are ideal for improving flexibility. As a general rule, however, static stretches should be avoided prior to exercise. Why? Research has shown static stretching reduces muscle force output (not what you want to do before a run.) Dynamic stretches prior to exercise are ideal. We’ll cover that subject in a future blog. Here are two videos demonstrating stretch techniques for the calf muscles. Now, run safe and run smart!

Admittedly, there are several reasons we choose to run.  For some, running is a form of therapy to keep the mind clear of daily stress.  Perhaps its the social aspects of the running community.  For others, it’s all about the health benefits, including weight loss or weight control.  Thankfully, there are no wrong reasons to want to run.

You’ve most likely heard the phrase, “You can’t out exercise and bad diet” and this is true.  No amount of movement can compensate for poor food choices. This has led researchers to theorize that weight loss is more about how we eat and keeping weight off is more about exercise.  New research supports this theory.  A study published in the journal Obesity in 2016 found that weight loss increases appetite.  For every kg of weight they lost, patients in the study consumed an extra 100 calories a day — more than three times what they would need to maintain the lower weight.  This increase in appetite may explain why loosing weight and maintaining weight loss over the long-term are so difficult.  Senior author Kevin D Hall, MD, from the National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, in Bethesda, Maryland stated, “… our new results suggest that proportional increases in appetite likely play an even more important role in weight plateaus and weight regain.” He did caution that these results need to be confirmed by future research, but this study does provide context in which to understand how running may affect our appetite and our weight.

The take home message from this study is that we can expect our appetite to increase with greater physical activity.  With that increase in appetite comes a greater need to monitor our diet.  As runners, we must not neglect the food-intake side of the equation.  For those struggling to control appetite, a consultation with your doctor may give your access to options such as appetite controlling medications to gain control of weight loss or maintenance of lost weight until dietary habits can be solidified.  But, we should not use medication as a substitute for healthy food choices.  The most important factor when considering weight loss and exercise is the need for patience.  Give yourself time to learn what your body needs and most importantly, listen to your body. What we’re looking for is a lifestyle of healthy eating and exercise balanced in a way that produces a happy and long life.

Gastrocnemius Stretch

Soleus Stretch

McNamee MJ et. al. Analysis of plantar fasciitis risk factors among intercollegiate and recreational runners. J Athl Train 2017; 52(6 Suppl):S110

Findings from a recent study suggest that, although barefoot running by definition involves zero drop from heel to toe, other shoe design features play a more significant role in barefoot-like running. Investigators from the Luxembourg Institute of Health randomized 553 runners to six months of running while wearing one of three experimental, cushioned shoes with varying degrees of shoe drop: 0, 6, and 10 mm. The zero-drop shoes had a 21 mm cushioned sole. For the group overall, during six months of running in the experimental shoes, there were no significant differences in injury rates among the runners. However, there were small differences in injury rates between occasional runners and regular runners. The researchers concluded, “It seems safe to recommend low-drop shoes for occasional runners but not regular runners.”

While this study demonstrated increased injury risks in regular runners, the results do not indicate that runners should avoid zero-drop shoes. In fact, evidence in the medical literature points to self-selection as the best criteria when selecting a running shoe – use the shoe that feels best on your feet. If a zero-drop shoe works best for your running style, then stick with it. Other research evidence, however, is pretty clear in pointing out that altering individual components of a shoe does not consistently alter a runner’s injury risk or the biomechanics of running. This is true for midsole thickness, shoe stiffness, or in this case the heel-to-toe drop. Therefore, caution should be exercised when selecting a shoe based upon any one component. Now, there is evidence that injury rates differ among some runners when several components of a shoe are changed, not just individual components. These differences have been noted when comparing runners using minimalist, neutral, stability, or motion control shoes. These differences must take into account an individual runners foot posture and biomechanics and it takes a trained eye to determine if one shoe type is better than another for a runner. Our recommendation is to use fit and comfort as the two primary guides when selecting a shoe, but don’t be afraid to try out different brands and models. You never know what the next shoe may feel like when you run.

Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up.

Running decreases knee intra-articular cytokine and cartilage oligomeric matrix concentrations: a pilot study; Eur J Appl Physiol, 2016, Oct 3.