The original topic was supposed to be about the recent 50 game suspension of Los Angeles Dodgers outfielder Manny Ramirez, but sports anchor Rick Willis is a big marathon fan and decided to focus more on the healthy aspects of running and training for running races from the local 5 km fun runs to the San Diego Rock and Roll Marathon.

Note that Dr Martinez had to slouch down to fit in the camera shot, and if the beginning seems a little disjointed – apparently the wireless microphone box kept unclipping and falling to to ground as they were about to come back from the commerical break!

While the authors note that it was not possible to draw a direct correlation between the lower-fat intake and the increase in running injuries, there are a could of potential reasons that come to mind.

If overall fat intake is decreased, then there would also probably be a decrease in the healthier poly-unsaturated fats (PUFAs) such as omega-3 fatty acids. PUFAs have been shown to have a role in decreasing inflammation, so if there was a decrease in total fats as PUFAs, there could be a resultant increase in inflammation to tendons, muscles and ligaments than may predispose the femal runners to running injuries.

Another possible reason is the impact of a lower-fat diet on overall endurance. A previous study had demonstrated that runners on a lower-fat diet also had decreased endurance and increased fatigue. The diminshed performance capabilites could lead to biomechanical-related issues that could lead to increased injuries (Just think how well you run after you ‘bonk’ during a long run…)

Other mechanisms proposed by the authors include the potential impact of decreased absorption of the fat-soluble vitamins in the female runners on a low-fat diet. Vitamin K is a fat-soluble vitamin that is not only important for managing the blood clotting cascade, but is also used by the enzyme osteocalin in the mineralization of bone. Lower levels of Vitamin K would result in lower osteocalin function and a decrease in bone mineralization, potentially resulting in an increased risk in stress fractures.

How much dietary fat should female runners have in their diet – in this study, the authors conclude that women runners with 30% of total daily calories from fat appeared to have less running injuries.

Pass the canola and fish oil…

Dealing with a running injury? Let the San Diego sports medicine doctors at Coastal Sports and Wellness help get you back on track.

What is Kinesio tape?

Kinesio tape is an adhesive cotton athletic tape with an elasticity that allows it to stretch up to 120% to 140% of its original length without any tension. The Kinesio tape is claimed to reduce swelling, pain and decrease muscle spasm. Invented by a Japanese chiropractor, Kenzo Kase, his taping technique has been used by sports medicine professional world-wide.

Research on Kinesio Tape

There is some limited published research on the effects of Kinesio tape and muscle or athletic function. We have reviewed several of the studies below:

A 2007 study from the Department of Rehabilitation and University of Warsaw, Poland looked at the impact of Kinesio taping on muscle activity of the vastus medialis (part of the quadriceps muscle) in healthy adult volunteers. A total of 27 subjests had EMG (electromyography) testing of the vastus medialis before and after application of the Kinesio tape to determine if the tape had any effect on measurable muscle activity. The researchers measured muscle activity over 5 repetitions of 3 seconds of muscle contraction followed by 3 seconds of muscle relaxation. On the first day of taping, they did not see an appreciable difference in muscle activity in the short term (ten minutes after applying the Kinesio tape). However, after 24 hours of wearing the Kinesio tape, they did see a measurable increase of muscle activity of 54% from initial testing. This increase in muscle activity and peak torque from the Kinesio tape would be higher than expected due to simply day-to-day fluctuants of muscle activity as reported in previous studies. After 24 hours, the researchers removed the tape and continued to measure peak muscle torque at 72 and 96 hours to determine if there was a lasting effect from the Kinesio tape. Interesting, they found that there was still an increase in the peak muscle torque and muscle recruitment at 72 hours from the initial Kinesio tape application and 48 hours after removing the Kinesio tape. This finding would suggest that the mechanical properties of the Kinesio tape itself while on the skin are not the only contributing factors to increasing muscular activity. This study, while apparently well done,  only targeted subjects without any knee pain or injury. It would be have been interesting to compare uninjured and injured groups in this study.

A more recent study published in the Journal of Sports Physical Therapy in July 2008 by US Army physical therapists found the Kinseo taping helped with increasing shoulder range on motion in subjects diagnosed with rotator cuff tendonitis. The subjects studied either had Kinesio tape applied in a specific pattern to the affected shoulder or had  ”sham” Kinesio taping to the shoulder that was not designed to facilitate and improve shoulder range of motion. The Kinesio taped subjects demonstrated n immediate measurable increase in their pain-free range of motion following taping in comparison to the “sham” Kinesio tape group. The study would suggest that Kinesio taping of patients with rotator cuff tendonitis may experience an immediate measurable improvement in their pain-free range of motion. It would be interesting to continue the study for a longer time period to quantify how long the improve lasts – if only for the duration of the Kinesio tape application or longer as demonstrated in the first study.

Another recent study form the Journal of Science and Medicine in Sport looked at the effect of Kinesio tape on muscle function and strength of the anterior knee and thigh of healthy college kickboxers from the National College of Physical Education and Sport in Taiwan. Any athletes with a history of knee pain or injury within 3 months of starting the study were excluded from the study. 

The researchers used a Y-shaped Kinesio tape on the dominant-side quadriceps following Kenzo Kase’s Kinesio taping manual and tested concentric and eccentric quadriceps and hamstring contraction two different speeds. The measurements were taken before Kinesio taping, immediately after Kinesio taping and then 12 hours after the Kinesio tape had been applied. 

The researchers found that there was no significant measurable difference in quadriceps and hamstring muscle strength before and 12 hours after Kinesio taping. The researcher did attempt to determine if there was facilitation or inhibition of the quadriceps by also measuring the antagonist hamstring muscle group. One limitation of the study is that it did not measure a longer time interval after the Kinesio tape application to determine if a longer time was required before a measurable difference was found. 

The most important prevention tips are wearing shoes that fit properly, using synthetic rather than cotton socks, and keeping the socks and shoes dry during race. Some runners use a moisturizer such as Vaseline to reduce friction in blister-prone areas such as the heel and the big toe. Body Glide or other solid lubricants can also help prevent chafing or blisters in friction-prone areas.

Post-race Blister Care
Blisters are a separation of two layers of the skin due to friction which then fill with fluid, or in some cases, blood. Most blisters will heal on their own if protected. The overlying skin on the blister does provide some protection from infection, so the first goal should be to try to maintain the integrity of the skin and not pop or tear the blister. If the blister is large or causing a lot of pressure, a small hole can be made in one side with a sterile needle to drain the fluid. Don’t remove the outer layer of skin – allow it to act as a barrier to possible infection. Make sure to apply an antibiotic ointment and a sterile band-aid or gauze to further protect the area.

Runner’s Black Nails
Most marathon runners have developed a “black nail” due to repetitive trauma of the nail against the end of the shoe. The main cause is a shoe that fits too tight or a foot that has swollen slightly during the run. The discoloration is caused by a small amount of bleeding or bruising under the nail and will usually resolve in one to two weeks.

If the nail is painful, or uncomfortable, wearing an open-toed shoe such as a sandal or brief periods of icing the foot can help decrease the pain. Over the counter pain medications such as ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) can be taken as directed for added pain control. If the pain persists, it may be time to see your doctor to have the blood released from under the nail with a cautery – painful for a second or two, but then followed by some much needed relief.

Symptoms
Typically, there is pain in the front portion of the shin above the ankle. Pain is usually present at the start of a run or exercise but may gradually improve. Stress fractures in the tibia The painful area involved in MTSS is usually 3 to 5 inches in length along the edge of the tibia. Pain that is concentration in a smaller area on the tibia or pain that continues to get worse with prolonged running may represent a stress fracture of the tibia. Shin pain that does not improve or continues to worsen should prompt a visit to your physician.

Symptoms
Pain at the outside part of the knee that is worse when bending the knee. Also may present as pain on the outside part of the hip over the greater trochanter.

Causes
Tightness in the iliotibial band is a common cause. Other causes include weakness in the muscles around the hip and buttocks (gluteus muscles), running on a sloped surface such as the beach or road or excessive pronation or rolling in of the foot.

Prevention & Treatment
Ice massage to the painful area for 10 to 15 minutes after workouts can decrease the pain. Stretching of the iliotibial band is an important component if the tendon is tight.

One stretch is to stand and cross your injured leg behind your uninjured leg and bend over to touch your toes.
A second stretch is to sit or lay on the floor with the legs out straight. Bending at the hip and knee, take the injured leg and cross it over the uninjured leg. Slowly extend at the knee to increase the stretch.

Strengthening the gluteus muscles is also important. Step lunges and leg squats can help increase gluteal muscle strength.

A rupture of the Achilles can occur during a forceful push-off. Typically there is a “pop” or ripping sensation in the back of the calf, followed by pain and decreased movement of the ankle.

A suspected Achilles rupture requires evaluation by a sports medicine physician and may require surgery or prolonged immobilization in a cast or walking boot.

Causes
Common causes of Achilles tendinitis include: tight calf muscles, recent increase in running mileage or running up hills. Over-pronation (rolling in of the foot) as well as high foot arches (pes cavus) and flat feet (pes planus) can also cause Achilles tendinitis.

Prevention
Prevention includes proper stretching, slowly increasing your mileage and proper running shoe selection.

Treatment
Ice decreases inflammation, pain, and swelling. Apply ice for 10 to 15 minutes three to four times a day. Anti-inflammatory pain medications such as ibuprofen (Motrin or Advil) or naprosyn (Aleve or Naproxen) as directed by your physician.
Gentle range of motion and calf stretches can be helpful. Eccentric calf exercises can be helpful in recurrent cases.

These exercises are done by standing on a step or stairs with the toes on the step and the heels hanging off the step. Slowly lower your heel so that it drops below the step. You should feel a slight stretch in the calf. This movement is the eccentric or lengthening movement. Slowly return to the starting position. Repeat 10 to 15 times twice a day.