Core3 Massage

Muscle cramps are acute involuntary muscle contractions that generally last for several minutes.  As many of you know, they can be very uncomfortable.  It has been thought that muscle fatigue, dehydration and electrolyte imbalance are involved.  And to get rid of a cramp once it starts, it has been suggested that one stretch the cramping muscle.

A recent New York Times article http://well.blogs.nytimes.com/2010/06/09/phys-ed-can-pickle-juice-stop-muscle-cramps/?src=me&ref=homepage  reports on new research regarding muscle cramping. New studies have shown that muscle fatigue probably is the casue, and drinking pickle juice (or vinegar) can help to shortern thier duration (along with stretching).

The article states that certain mechanisms within muscles have been found to start misfiring when a muscle is extremely tired.  And pickle juice may help alleviate these cramps, says one of the scientists (Dr. Miller) cited in this article, “by countermanding the malfunction. Something in the acidic juice, … , may be lighting up specialized nervous-system receptors in the throat or stomach, he says, which, in turn, send out nerve signals that somehow disrupt the reflex melee in the muscles. Dr. Miller suspects that ultimately, it’s the vinegar in the pickle juice that activates the receptors.”

Although it is only speculation, it gives us an idea of how to reduce the chances of their occurrence, as well as what to do once they start, if they do occur. They concludes that if muscle fatigue is the cause, “then training properly, building up your mileage slowly and perhaps adding strength training that focuses specifically on muscles that have cramped in the past, may help. In the meantime, if your calf or other muscle suddenly, painfully catches, “try stretching it,” Dr. Miller says. Doing so has been found in laboratory studies to significantly shorten the duration of a muscle cramp, most likely by shaking up and resetting the misfiring muscle and nerve reflexes. And perhaps, if you can stomach the idea, pack a few ounces of pickle juice on your next training session.”

Food for thought as we start the summer – hopefully with no (or less) muscle cramping.

My last post was on ice baths, and I am still on the icing kick.   However this time I will address the icing of specific areas. This type of icing  is obviously a little  less “painful” than ice baths, but still a great injury prevention tool. We all have those times when we come back from a workout and something is bothering us. It could be your feet, your shins, or that pesky hamstring…..you name it.  Icing the area right away will increase your chances that the same area will not be as painful tomorrow.

Icing right after you workout is best.  But for those of you in a hurry, you might not get to it until you are at work and sitting at your desk. For others it might not be until the evening while watching TV.  It is all good.  Better to ice later than not at all. Time-wise, the goal is 10-15 minutes of ice, but if you only have time for 5 minutes – 5 minutes it is. 

There are a lot of ice packs out there, and it is worth it to invest in one. They come in different sizes and shapes, depending on the area of the body that it is used on.  To check out the variety of ice packs available, click here: http://www.massagewarehouse.com/Category/hot-and-cold-therapy/hot-cold-packs/104203303 . 

I have one of the elasto-gel wrist wraps (for after those long hard hours at the massage table) and really like it. It conforms to the area to be iced (my wrist) and has a velcro band to keep it in place (useful if you are trying to do something else, like work, while icing). They are also nice because you do not need a towel between the pack and your skin. For more info on the ice/heat packs they offer see http://www.elastogel.com/index.php . Note that these (and many other ice packs one can purchase) can also be used as heat packs.

In general, unless you have specific needs, an all purpose ice pack in the 10” x 15″ range is good.  However, one certainly can use a bag of frozen peas or just a plain old bag of ice instead.

In most cases (no need if using one of the elasto-gel packs) it is best to put a towel (not too thick a towel – or you won’t feel the cold) between your skin and the ice, to help you avoid frostbite or frost-nip.  My experience with this, is that an area will turn white and hard. So check in with your skin as you ice, especially if you are going for 15 minutes. You can overdo it.

Ice massage is also a great tool. Freeze a paper cup filled with water. When frozen, peel off the top inch or so of paper to reveal the ice. Hold the cup in your hand and use the exposed ice to massage the sore area. Ice massage is great on shins.

Then there is that bucket of ice water for your feet/lower legs. This is great when you have a general soreness in your feet/lower legs – and are not up for a full ice bath.

If you are having plantar fasciitis issues (pain in the arch of the foot and going into the heel) a plastic water bottle filled with water and then frozen, can be great. Use the frozen water bottle to roll under your arch.  A little ice massage to to reduce the inflammation and sooth the pain.

Icing can be a great way to reduce post workout/race soreness and pain, but unfortunately it is not a cure-all.  If the pain persists and causes you to stop working out, or negatively effects your ability to workout (for example, if you run, it effects your stride so that you run differently), you should have it checked out by your favorite health care professional. 

Note:  Got some feedback about ice baths. A  few personal tips I will pass on:

1) “I fill up the tub and dump in the ice right before I get in, but then I soak a medium-sized towel in warm water in the sink, and tuck it between my legs (kind of like a diaper) to protect certain parts of the anatomy that are most affected by and least in need of an ice bath.  It makes the entry SO much easier!!”

2)”I’ve actually been sitting in my ice bath for up to 20-minutes, doing Sudoku puzzles with a heavy fleece on my top!”

I (Julia) read and wear a long sleeve shirt that I don’t care about getting wet. I need something to cover my tender tummy area.  

Anything to get you through.

Enjoy!

Icing is one of the most underutilized training tools. It takes time and is zero fun. You have just finished the discomfort of a hard workout or race, and the idea of more discomfort is not appealing. However, I believe that it is a great tool in helping you recover from those hard workouts or races.

I break icing down into 2 types: 1) icing a specific area and 2) “large-scale” icing to help general muscle recovery. I’ll deal with the specific area icing, usually applied to deal with a specific injury concern, at a later date. This post will deal with the overall icing of ice baths.

When you push yourself  physically, you are stressing your muscles and causing micro-tears. In the long term this is a good thing, because when the muscles heal, they are stronger. However,  this muscle damage can cause soreness a day or 2 after the hard effort. 

The research that has been done on cold water immersion appears  to be inconclusive.  The theory is that the cold water helps to reduce the muscle  inflammation, relieving the post- race/workout soreness, and speeds up recovery.  However, enough people ( like me) have tried their own experiments of one and found the cold water to help, hence the reason so many athletes are willing to subject themselves to it.

If you are one of the lucky few who can end their hard workouts near a body of water, getting your legs into the cold ocean/lake/stream/pond is perfect. Wade in up to the tops of your legs and enjoy the cold for as long as you can stand it (5-15 minutes).  However, most of us don’t have that luxury. So to the bathroom we must go.

If you have ever attempted ice baths, you know how difficult it is to motivate to actually get in one. Kurt Perham, coach extraordinaire of Personal Best Multisport Coaching ( http://www.pbmcoaching.com/), suggests what I think is pretty reasonable, considering this difficulty:

Sit in the tub, with bucket of ice (I am thinking a few trays of ice) next to the tub and allow the cold water to slowly cover your legs. Once the water just covers your legs, turn it off and dump in the bucket of ice. Sit in it for 5 minutes, after which you can get out and drain the tub. However, if you are hard core enough, you will continue to sit in the tub as the water slowly drains out. Total time in ice bath: 10-15 minutes.

Kurt is not the only coach to suggest ice baths to his clients. I know many other coaches who do, as did mine back when I was running marathons. My coach, who lived in Boulder, CO, talked of runners wading into cold mountain streams. Sounded idyllic, but I had to settle with an ice bath in a tub. I should have succumbed to the tub more often. Sometimes in the summer (as lame as it sounds) I would just run the cold hose over my legs for a few minutes. If you can’t do the full 10 minutes in the tub – a few minutes of some sort of cold water is better than nothing, I think.

So, if you are looking for that extra edge that helps you recover quicker – try an ice bath, or ocean/lake soak.  If your legs feel better then next day, then  great! If not, then at least you can boast to your buddies about how hard core you are.

A lot has been written recently about barefoot running, as well as minimalistic running (running in a “minimal” shoe – one that is thin and light-weight).  I think it is great, but I urge a note of caution. 

The big push for barefoot/minimalistic running comes from the idea that it will reduce running injuries and encourage our bodies to run more efficiently. Efficient running consists of:  short, quick strides/your feet landing lightly under your body on the midfoot-forefoot area (the ball of the foot, but not the toes)/a slight lean forward/relaxed arm swing.  Check out this cool video to get a visual: http://www.newtonrunning.com/run-better/optimal-running-form

It is true that running in your bare feet or in a minimal type shoe does help you have a better running form. However, please build up gradually. I suggest slowly adding some barefoot running into your schedule – starting with just a few minutes in the grass once or twice a week. I wrote about this in a 2008 blog post http://www.core3massage.com/blog/?p=12 , mentioning that running barefoot helps strengthen the tendons and muscles of the foot.

The same is true for minimal type shoes – build up to it. You will be recruiting some leg muscles that are not used to working out as much, so take it slow.  I will not go into the various shoes that one might call minimalistic (Newton, Vibram Fivefingers….) since I have not tried them myself. I will leave that to those more experienced…..which leads me to a Tri Clinic that Tri-Maine is hosting with the city of Portland. Someone from Maine Running Company will be there presenting a talk on Minimalistic Running. They’ll give you a much better take on the whole barefoot/minimalistic issue.

Check out the info here http://www.tri-maine.com/Races/Clinic.html. It is Sunday April 11th @ the Riverton Pool and Community Center out on Forest Ave.  I will also be there to give a session on Athlete Self Care. I’ll be talking about things that you can do to reduce your chances for injuries as you train. There will be bike and swim presentations as well, so if you are a triathlete (or an aspiring one) – come check it out.

In a previous blog post (October 2008) I wrote about gluteal (butt) tightness. I did not go into the specific muscles involved, but this time I am going to discuss one specific butt muscle – gluteus minimus.

The gluteal muscles are comprised of 3 different muscles: gluteus maximus, gluteus medius, andgluteus minimus. http://www.pilatespatio.com/gluteus_medius_minimus.gif

Gluteus minimus  is the smallest and deepest of these muscles, and so harder to get at.  It is a strong abductor of the hip – which means that it lifts your leg off to the side, away from your body – as well as a internal rotator of the hip. 

My interest in this muscle was recently piqued, thanks to a massage therapist friend of mine with chronic hip tightness.  While massaging her over the past year, she has encouraged me to go deep into the lateral hip. She has also done a lot of deep lateral hip work on me, and I found that it really did help my hips feel looser on my runs.

Being more aware of gluteus minimus, I now notice that many of my clients are tight  in this area.  Tightness in this muscle can reduce the looseness in one’s outer/lateral hip joint.  And if the tightness is left untreated, trigger points (TPs) could develop.  If  TPs form in the gluteus minimus, referred pain could possibly be felt in 1) the more fleshy part of the posterior butt,  2) down the outside of the leg  to the outer calf and ankle, or 3) the back of the hamstring into the upper calf.

I can, and will, get in there with my elbow and thumbs to release the tightness. However, another great way to deal with tightness in this area is by self massage with a tennis ball. Lie down on the floor on your side, with the top leg in front of you for stabilization and bottom leg relaxed on the floor. Place the tennis ball under your hip between the edge of your pelvic bone and the top of the femur (check the above link for specific location of this muscle). Release as much of your weight as possible onto the ball, and roll back and forth. If you find a tight spot, just hang out there and try to relax into it. 

This area is not as sensitive as the illiotibial band (ITB) below it. You might feel some discomfort, but usually it just  feels really good to get in there. The foam roller, used to massage the ITB, doesn’t really get into the gluteus minimus – it is not specific enough to go deep between the bones.

For general flexibility of the area, stretching is also good.  Regularly stretching the outer hip http://www.sportsinjuryclinic.net/cybertherapist/stretching/outer_hip_stretch.php     feels really good. I love doing this stretch after I run, every day.   Another hip stretch I like http://www.sportsinjuryclinic.net/cybertherapist/stretching/standing_outer_hip_stretch.php, is great if you are at work or someplace where you just can’t lie down……like in that coffee shop after your bike ride.

Anybody who is active is going to use gluteus minimus to some degree. I know with my longer runs on uneven ground, I am asking a lot of it. So, keep those hips loose not just because it feels good, but because it could prevent pain in the future.

I recently finished a book titled “Muscle Pain: Understanding It’s Nature, Diagnosis & Treatment”. It is a dense book, with more of a discussion of the nervous system then muscles.  But, pain is all about the nervous system, and the nerves let us know when things are amiss.

Reading it reminded me that there is much we don’t know about the human body, but also how cool it is. So much going on in there, without us ever knowing . Below are some tidbits I picked up from the book and thought were relevant to my clients. Remember that the information below is based on a body of knowledge is ever growing.

Muscle Soreness: Many of you have experienced post workout/race soreness. This sroeness is probably due to sensitization of muscle nerve endings. Mechanical overload (i.e. a race or a hard workout effort) can cause damage to muscle tissues. Substances are released from the damaged tissue during the repair process. These substances can cause the nerve endings to be sensitive. This sensitization of the muscle nerve endings is most likely what causes your pain – not build up of lactic acid.  And what to do about this muscle soreness? Studies have shown that anti-inflammatory drugs provide little relief. Stretching may temporarily reduce the soreness, or not. One study found that stretching had no effect at all on the overall course of muscle soreness.

Nocturnal Leg Cramps: These cramps occur primarily in the gastrocnemius, the largest and most superficial of the calf muscles. They may result from dehydration or electrolyte imbalance.  Stretching of the gastrocnemius muscle can provide relief.  But it has been found that muscles that are prone to cramping may have what are called trigger points. Trigger points (TPs) occur at the junction of the nerve and the muscle – the motor end plate. Dysfunction here is caused by overload of the muscle, and refers pain to areas other than the TP. When these TP are deactivated and suppressed by regular stretching (and/or massage) the cramps are less likely to recur.

Low Back Pain:  A common pattern with low back pain is weak gluteals and strong (tight) hip flexors.  Gentle stretching (and/or massage) can release the hip flexors, and improve the strength of the gluteals.  (This is due to something called inhibition: a strong/tight muscle – i.e.  hip flexor - can cause the antagonist muscle – the muscle the causes the opposite action to the hip flexor - in this case the gluteals,  to be weak). So,  releasing the hip flexors allow for stronger gluteals and hopefully reduce low back pain. Of course there are many other possible causes of low back pain, but I have found that most of my clients with low back pain have some hip flexor and gluteal issues as well.

More can be said on all of these subjects, and perhaps I will revisit them in future posts. But for now, just food for thought.

These past few weeks I have been reading through a book that was recently published – Running Injuries: Treatment and Prevention by Jeff Galloway and David Hannaford DPM. I found it quite thorough- possibly useful and accessible to the regular runner – once I got over Galloway’s stretching paranoia and his walk/run obsession. 

The sections are grouped by body part (Foot and Toes, The Ankle, The Knee….) and the descriptions of injuries include terminology that runners might use, such as: Outside of the Ankle Mostly – But Can Be on the Inside, Various Pains in the Calf Muscle, or Outside of the Thigh from the Bony Knob on the Outside of the Hip, Going Down…..and so on.

The book was given to me by a client who has been dealing with calf issues for a long time.  Her calf issues (perhaps defined as “Various Pains in the Calf Muscles “) had stopped her from running at all for long periods of time. So, they were frustrating for her.

She is now, thankfully, slowly getting back into running, with her calves feeling good. She saw a podiatrist (discovering that yes she does need to wear her orthotics), as well as came in for regular calf focused massages.  But she also started regularly to do calf raises (as the above book suggests, for those runners with persistent calf issues) to strengthen her calves.

The book, like the New York Times article that I mentioned in my last post http://well.blogs.nytimes.com/2009/12/01/phys-ed-how-to-prevent-stress-fractures/  suggested calf raises as treatment for calf problems. They have you start with working up to 25 regular calf raises, and then progress to doing calf raises with your toes pointed in, and then toes pointed out. The goal is 25 of each (toes in, toes out) to give you a total of 50 calf raises.

Not only do calf raises (and overall calf strength) help to prevent tibial stress fractures (as suggested in the NY Times article), but they also help with overall lower leg health.

And as you may remember, the article also suggested decreasing your stride length as well to help prevent tibial stress fractures.  Likewise, the authors of Running Injuries also suggest: “The most efficient and gentle running form is a “shuffle”: the feet stay close to the ground, touching lightly and with a relatively short stride. When running at the most relaxed range of the shuffling motion, the ankle mechanism does a great deal of the work, and little effort is required  from the calf muscle. But when the foot pushes harder and bounces more, and the stride increase, there are often more aches, pains and injuries.”

So, another plug for shorter stride length. And, as some of you may be out running in the snow and ice, shorter quicker strides help you negotiate the messy stuff – and minimizes your foot slipping.

In my many years of running, I have had 2 stress fractures. One in my tibia and one in my upper femur. Stress fractures are not uncommon in runners, and can be a real drag. Once diagnosed, one has to take 6-8 weeks off  from running to let it heal. Runners don’t like not running. It makes us grumpy and miserable.  (It is at this time that we usually discover the pool or the bike to get our exercise fix, and a few triathletes are born)

As dreaded as stress fractures are, at least once the 6-8 weeks is over, the injury is healed. Then you can gradually start running again, and happiness returns to the runner.

Tibial stress fractures were recently addressed in a NY Times article http://well.blogs.nytimes.com/2009/12/01/phys-ed-how-to-prevent-stress-fractures/  , which is what got me thinking about stress fractures again.  Although it has been over 10 years since my tibial stress fracture, I still fear them.  So any tips on decreasing my, or my client’s, possibility of a stress fracture, grabs my attention.

First of all, the tibia is one of the 2 lower leg bones (http://adam.about.com/encyclopedia/Leg-skeletal-anatomy.htm).  In the article, tibial stress fracture prevention was focused on 2 possibilities: 1) strengthening the calves ( primarily found to help women)  and 2) decreasing your stride length.

Strengthening the calves can be as easy as just adding some calf raises to your strength or stretching routine (I know you all have one). As the article states “…rising up on to your toes and sinking back to the floor 10 or 12 times every day, might be enough.”  So , if you are a female runner, this might be something that you want to add into your daily routine.

The other suggestion is to reduce your stride length.  Back when I was the Assistant XC and Track coach at Bowdoin, this was something that all the runners were taught.  Head Coach Peter Slovenski had all his runner count their strides on a regular basis (I will call 1 stride every time your right or left foot - pick a foot - strikes the ground).  The goal was 90 strikes or more per minute. ( You can also try for 30 or more strides per 20 sec – if you can’t focus for that full minute).

As Peter told me, he based this on work  Jack Daniels, a respected running coach, had done.  He noticed that in the Olympics the runners all had a stride rate of 90-110.  So, these are the fast guy/gals – and they all had a short fast stride.

As the article states “The researchers determined that reducing stride length by about 10 percent seemed to reduce the stress on the tibia enough to lower the risk of a stress fracture. “  So, I am guessing that by counting your foot strikes and trying to increase them, one is on their way to decreasing their stride length by 10%.

Certainly more can be said about stress fractures, but in general they are an injury to respect.  They are usually first identified as a very specific area of pain found when pushing down on the bone.  You will feel it when you run, and can be so painful that it alters your stride, or even so that you just can’t put any weight on the bone. Have it checked out ASAP.  And a reminder – the tibia is only one bone where you can get a stress fracture.  The femur, the bones of the foot, and the spine are other examples of areas where stress fractures can occur – and not only with runners.

With all this said, I hope none of you ever have to suffer from a stress fracture ever – or ever again.

Several weeks ago I went to a massage class that focused on the lower leg and foot called “Neuromuscular Therapy and The Dynamic Foot”. Seemed appropriate, since I recently have been working with several clients on calf  issues, and often am working on someone with foot/lower leg problems.

In general I think that I know a lot about the legs, but there is always more to learn (I learned that the Plantaris muscle  – in the calf – has the longest tendon in the body. See  http://www.criticalbench.com/calve-muscles.htm - the muscle is red and the tendon is white) , or to be reminded of.  This class reminded me of the deep calf muscles that are so hard to palpate. The Soleus is one of these, as is the Tibialis Posterior.

One can palpate the Soleus a bit at the lateral and medial sides (around the larger and more superficial Gastrocnemius).   (You can check this pic to see some of the muscles I am refering too – and in this instance, how the Soleus sort of peaks out at the edges of the Gastrocnemius and the Achilles Tendon  http://www.best-leg-exercises.com/calfmuscle.html )   Also, when one massages deep into the Gastrocnemius, one is indirectly working on the Soleus below it. Sort of like a 2 for 1 massage.

The Tibialis Posterior is even more difficult to access. It can really only be worked on by working on the muscles that lay on top it – the Gastrocnemius and the Soleus.

 The calf, as with other areas of the body, has many layers of muscles. Some muscles are superficial, some deep, and some even deeper.  When I am massaging I am usually working on several different muscles, and not just one.

During a massage I think about all the individual muscles I am working on. I actuallysort of imagine what they look like in my head (I really needed to take a cadaver class – where one dissects a cadaver – so I can get a better idea of what all the muscles really look like). I think about the superficial muscles immediately beneath my hands, as well as the muscles that are even deeper below. Toss in the tendons (which attach muscle to bone) that I palate and the overlying fascia that surround all muscles, and there is a lot to think about.

So when I am massaging you, it is never just one muscle that I am working on. And it is usually not just one muscle that is the problem when you have pain. There is lots going on, and hence lots for me to think about when I am giving you your massage.

In my many years as a runner, I have used Ibuprofen to help me deal with occasional pain and soreness. I have been known to pop a pill after a long run to prevent that post “long run soreness”. I’ve even downed a few before a workout when dealing with some persistent discomfort.

 Of course, I have regular massages to help prevent and reduce any of the soreness and pain from hard training…..but you know how it goes – there are just those days when you want to get out there and you don’t want that stubborn soreness to stop you.

I just read an article that leads me to think that I wasn’t doing myself any favors. http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/  According to the article, researchers found more inflammation in athletes that used Ibuprofen before/during activity….. actually inhibiting recovery. And, compared to athletes not taking Ibuprofen, their legs were just as sore post-activity.

Something to think about, and more reason to not use pills to mask your pain.  Keeping those muscles loose and healthy with massage, stretching and proper hydration and nutrition is best in the “long run” anyway.