Just wanted to introduce myself and be a resource for this community. I’m one of the CFE Coaches out in San Diego and one of the coaches at Forca Kai/San Diego Anareobic Endurance. I’m also a board certified family medicine/sports medicine physician, so if anyone has medical/injury/injury prevention questions, please feel free to ask on this thread.
Like training methods, there is no "correct" way to treat something. Our job is work together, pool our knowledge and observation to see if we can formulate plans that will work really well for most people most of the time. I encourage feedback, interaction, criticisms… discussion is what furthers our knowledge.
I’m also asking that any CFE coaches out there who have had athletes with injuries to jump in and share what they did with the athletes and what got the athletes better. Medical training is focused on the downstream.. people come to see me when nothing else has gotten them better. I’m interested in what is going on upstream.. what are you guys doing in the gyms/track that are getting people better before they access medical care?
I have an athlete that gets pain in the middle of the ball of his foot just behind the toes when he runs. His doctor put him in an orthotic that has an indent where the pain is. The Doc says its a nerve and he wants to keep the pressure off of it. As you can guess it is not working. So rather then treat the symptom I though I should fix the problem. Any ideas?
Is the pain at all the toes, or just one or two? I don’t know if you can attach pics to this, but if you can take a picture and point to where it hurts, it will help a lot. A pic is worth a thousand words.
It sounds like he has either a Morton’s Neuroma (nerve issue, as you said) or Metatarsalgia (joint/capsule issue). Treatment depends on how aggressive you want to be. For example, if he is an elite level athlete, has a huge race coming up in a month that he feels he cannot miss because of standings, financial implications, etc, then I’d do a steroid injection, shut him down for about a week, get him the pads, start correcting his form the best you can and get him through the race.
Totally not ideal… as you said, we want to correct the underlying cause, but I wanted to give you an idea of your options if this is someone’s profession and you don’t have the luxury of time. This is, of course balanced with the long term risk. For someone where time isn’t a huge issue, modify their WODs (row, bike, swim) based on pain, and start working on their mobility and flexibility until the pain resolves, and then start working on their form. Reason is because if someone is in pain, the body will compensate for the pain, and you can try and scream all you want but usually the body will win.
For a Morton’s Neuroma, you might want to start by getting him off the big-heel-air-cushioned running shoes. The added height on the heel shifts a lot of weight to the ball of the foot, causing more pressure up front. Also, look to have wider shoes so pressure isn’t applied to the sides of his foot compressing the nerve.
Have him build up his arches as well. A flat foot slides medially (towards the inside of the foot), and puts pressure on the nerve. The CFE/BMack’s warmup exercises that builds up arch strength will be really good for this.
Form wise, look to see if he is letting his heel kiss the ground after the foot strike, and if he’s really high up on his toes all the time, maybe even get him to shift his landing point to more mid-foot. Have him imagine that he’s running on hot coals… touch and go with his foot. It’ll get him to be lighter on his feet and less pressure on the area.
For Metatarsalgia, the injury process is different, but the form correction will be similar.
Sometimes, when people first switch to the running mechanics that we teach, they usually have a lot of calf soreness, and often will have issues initially with pain at the balls of their feet because they are so used to heel striking. Keeping the calf and the soleus muscle stretched out generally helps with pain in the foot (remember at the cert, when people stepped on the trigger point/lacrosse balls for a few minutes, and all of a sudden the people are able to touch their toes? Same concept… that entire muscle group posteriorly is connected…)
I actually have a lot of people with muscleskeletal injuries go get acupuncture. Those crazy Asians. The whole chi, meridians, etc make no sense to me from a Western med standpoint, but it works. I can recommend one to you if you are in the San Diego area.
p.s. If anyone has anything to add, please do. What I can really get help from the community is getting feedback about what you guys are doing out there. The more stories/data points I can learn from, the better. So, if you are have someone who had a similar complaint or had a similar diagnosis, and tapping their toes 8 times and having a paleo treat cookie twice a day works, please share! Thanks all…
Thank you so much. This athlete signed on with me last week and has the Disney Half Ironman in a few weeks.
We just heard back from his doctor and he believes it is Mortons Neuroma.
I already have him building his arch’s and introduced him to trigger point last week.
Our next session is Tuesday. I will start working on his running and talk to him about shoes.
I live in CT so I will have to find an acupuncture practitioner here.
What are your thoughts on Active Release Therapy, ART?
Thanks again for the post. It was insightfull and incredibly helpfull. If you ever have any questions for your triathlon guys I would be happy to help.
I have experienced pain on the outside of my right knee during extended runs. It seems to be caused by long downhills or difficult trail terrain that requires a lot of directional change or unstable footing. I ran a 50k in 6" of snow in February and started feeling pain in the right knee at around mile 26. I ran a mountain 50k in March and started having pain in the right knee around mile 13 after running a long 4-5 mile downhill. I took an ibuprofen when the pain started then another a few miles later and this seemed to help. I have been running for a couple of years, but I’m new to ultra marathons. I have been following the CF/CFE workouts since last summer and rarely run over 15 miles in a week with most weeks at 10 or less.
I believe my large size (76"/235#) could be causing inflammation in my knee during extended runs because of the pounding on the knee joint. I’ve lost 10 pounds in the last couple of months and should be able to drop my weight another 15-20 pounds with CF/CFE and proper nutrition, but this may not be enough to make a huge difference. I plan to continue to strength train and focus on nutrition, work on improving my running form on the tough trail sections, and carry ibuprofen in case of emergency, but I’m wondering if there are other things that can help support the knee joint. Are there any recommended braces or taping techniques that I can use during a race to avoid this problem?
Sorry for my really late reply. I thought I had subscribed this thread so that I’d get any updates on new postings, but I guess I’ll just check it more frequently from here on out.
I really like ART, but then again I like a lot of modalities. There are a lot of people doing some really cool things, and it’s all about finding the right tools for the job. I’m still learning all the time, and it wasn’t until I started to get out outside of my traditional clinic setting where I started to learn more about all these tools.
If you have someone who is tight has heck, ART is great. It works out a lot of the adhesions that develop from abnormal scarring throughout the range of motion. ART, in combination with something called Graston Technique does a good job of getting the body to put down scar tissue in an organized manner. Graston practitioners may charge a bit more (it’s patented, and the tools that are pretty much just polished bars cost $3000 or something stupid like that), so if you’re looking for an affordable option, look into a Gua Sha practitioner. Gua Sha is pretty much the Chinese version of Graston, except it’s been around for hundreds of years. (as an aside, I’m thinking I should just go over the Asia and learn some eastern med techniques that have been around for centuries and just bring it back to the US and patent it as a new technology with shiny tools… and I wonder why our health care costs so much…)
ART to break up the adhesions, Graston/Gua Sha to get the body to rebuild the injury in an organized manner, and then you can look to see where your athlete may be weak that is causing the problem area to get flared.
Sorry for the rant. =) As a physician, I’m just really clear that what is going to make a difference in the health and wellness of our country is all of you out there coaching, training, and sharing with others about eating well, taking care of yourself in mind/body/spirit, etc. All of you out there, keep up the great work.
Jay, I am sure we’ll be getting your expertise in the upcoming months on tri athletes. We are starting our tri program out here next week!
It sounds like your knee pain is from something called iliotibial band syndrome. Is the side of your leg tight as hell?
The iliotibial band (ITB) is a tough band that runs from the side of your knee up the side of your thigh, and it fans out and inserts in your hip. You know the tough whitish looking material on meat that is tough to chew through and you gotta spit it out? An ITB is kinda like that.
The usual stretching (figure four, pigeon from yoga, etc) will help with it, as well as rolling it out will help with the tightness.
The tight ITB is usually compensating for weak gluts. As BMac would say, work that ass! Using the bands and putting it around your legs while you squat and pushing outwards, or doing the same thing and walking in a squat position will help strengthen those gluts.
As for the taping or the brace, I love KT Tape or kinesotape. It’s really easy to use, and it works GREAT!!! We used it for our Ragnar Relay Race, and the runners we used it on loved it. You can feel the difference immediately, and we even had one runner who had her tape pop off and she said the instant the tape came off she could feel the tug on her knee again. The tape is less bulky than a brace, and it stays on really well.
I hope this helps. Let me know if you need anything else, and again, I apologize for the late reply.
I have recently gotten a mild case of plantar fiaciis (sorry for the bad spelling). I got it from not streching my calves enough after runs and not wearing proper shoes and landing to hard when doing double unders. I have been running for 2 years now and got introduced to pose running a couple months into first starting running so I’m pretty sure running form is good. Also I started cfe 5 months ago an worked slowly to add work outs an move from short distance to long distance.
I went to a doctor who treats people with PF he has been giving me massages and I have been taking tylenol and iceing it by rolling it with a frozen bottle. Also I took a week off running an have been biking for my cfe work outs. So far my feet feel great no pain in my heal or stiffness in my arch.
My question is how long do you think it before I can start running again? I have a marathon in 4 months that has been my goal since I started crossfit a year and a half ago, but I don’t know if it is possible if I have to a month or longer off.
Thank you very much,
Again, sorry about the late reply. I promise I’ll get my email and this subscription thing figured out. I jump on here periodically, but sometimes I forget just how long it has been.
It’s been a little over a week since you posted, so hopefully you have started your running.
It’s really tough to predict when you can start running again. So much of it depends on the individual. First, I think you’ll have plenty of time to train for your marathon if your goal is to finish. I would start off by working in one CFE interval run WOD per week first, while keeping the others on a bike. If you feel pretty good after the first week, ramp it up to two intervals. I would probably not get into the tempo runs until you’re pretty comfortable on the interval based workouts. If you feels solid on those, start adding on the tempo. It’ll probably be the tempo runs with the longer distances that may trigger some of your symptoms. Make sure you roll out those calves and really stretch them out after your runs.
Also, what shoes are you wearing? Conventional medicine says to get arch supports, and that will help, but it doesn’t solve the underlying problem. Get the flats or the shoes with less heel, and it’ll start to get your arches and your foot stronger before you start heading out on your longer runs.
Hope this helps. Keep me posted on how you are doing, and if you need anything else, holler!
Thanks for the reply and the advice.
First of all, thank you very much for offering to answer these questions, it’s really helpful. I’ve got a quick one, and honestly there may not be a good answer, but I figured it was worth a shot. I just ran a 1/2 marathon today and it went pretty well. I’m preparing for a 70.3 on July 11th so I was using it as a tempo run for that. It’s definitely the longest run I’ve done in quite a few months. The limiting factor for the day started to creep in around mile 8 or 9. It was pain throughout both feet, and primarily it was forward of the ball of each foot, kind of spread out. I’d say the pain was the worst in two of my left toes (the two left of the big toe). I’ve never had this type of pain, although I transitioned to Pose running about eight months ago, and this was the longest run I’ve done since. I’m hoping it will clear up, but I just wanted to see if this was somewhat normal and if there’s anyway I can mitigate it. Any insight or possibilities would be great to learn about. Thank you very much again.
Any thoughts on the use of slideboards for ITBS? I’ve been building it into my warmup a few days a week and I’ve definitely noticed some improvements. I’ve just been kind of going for 5-8 minutes at a time; I thought the lateral movement would be good to build in, but don’t know how long/how much to make it part of what I do.
Thanks for getting back sorry I did not get back sooner been having some problems with internet.
Anyways an update on the feet, they have healed up very well problem was tight calves and running on black top to much. I have since switched to a school track and grass running. Also doing a lot more streching.
However I have now started to get a new problem, two weeks ago I had to stop lifting weights because of sudden groin pain which at first I thought was a herina but turned out to be my prostate. Anyways to make a very long story short my doctor advised me to just do areobic activites until the pain went away. Well I followed his orders an started running and swimming until my pains went away. Well it left but now my knee is starting to bother me a bit. It aches on the inside of the left knee it does pop when I ride my bike or lift it up an bring it to my chest it hasn’t swelled at all though an does not hurt to touch. I went back to my doctor who wasn’t really concerned about it, he said that it could be just the added stress of longer runs. I thought that mabey I would ask you to get some advice on mabey what it could be. My doctor did say that I could return to lifting this week to.
Also the shoes I where are asicis gell.
Thank you for any advice you can give me,
Longtime runner/cyclist/fitness enthusiast/coach. I have been crossfitting on main site for several months and supplementing those workouts with mostly biking and running. I have just started doing the crossfit endurance workouts on either bike or run, alternating days. I like the intensity.
I have been trying to change my running form as per CFE guidelines, which means I’m trying to move from footstriking to midfoot striking.
Both of my feet are killing me! I limp around the house when I get up in the morning. pain is on the outside of the foot (first metatarsal?) and also in the muscle in the arch and back toward the heel (tibial tendon?)
I was sore Saturday before I did a beach run (in barefeet) but I started easy and hoped it would warmup. It did and the run was fine. Later that day though!!
So yesterday I biked and I’m about to go out and run. I’ll be using my old footstriking method and see what happens.
Best to work on changing footstrike gradually in little segments of each run? Is this transition pain normal? Am I going to break my foot?
Oh, by the way, I’m male 44 6’1" 200 lbs.
Best advice is to attend an Endurance Cert. You will be filmed twice and will see what you are actually doing vs what you think you are doing. You will learn many drills and which drills address the technique changes you need to make.
You probably have an active landing.
Pain is an indication that you are doing something incorrectly.
Running is the sand is much different than running on pavement. This is something you will need to build up to as you will be using some muscles that you may not use when running on pavement.
Running barefoot is also something you need to build in slowly. You need to build muscle in your feet so they are able to make the needed corrections without having a shoe to make the corrections for it.
Are you rolling out or stretching? These are things you should be doing before and after you run.
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