Runners : Foot or Knee pain? The runners "tooth brush" to the rescue

By: Chris Shah

Strength and Conditioning Specialist, Corrective Exercise Specialist

Runners:  Do you have foot or knee pain?

The runners “Tooth brush”:  A must have! Can a simple tennis ball help alleviate your pain problems?

If you are like many of the people I coach nothing can stop you from running. It is a window where you lose track of time and problems are temporarily forgotten in exchange for strides on the ground.  These repetitive strides on the ground tend to open the door to those unwanted foes of foot pain (i.e., plantar fasciitis) and knee pain.

You know the conversation very well because you tell it to anyone who will listen.

“Man, I had a great run but my foot and knees hurt. I don’t get it I’m in great shape.”

The runners “tooth brush” or tennis ball is one of many tools that all runners MUST have in their tool box. In order to be a skilled tool user we need to know the principles behind the tool.

I’m getting ahead of myself here.  Before we go any further, take a look in the mirror. As endurance athletes and enthusiasts you can be the most stubborn people on the planet.

I would imagine most of you reading this are watching movies at home on at least a DVD player?  Once upon a time we watched movies on this thing called Beta-Max.  You remember Beta-max don’t you? Big, clunky and low quality video.

With each passing few years more efficient technology comes out and we upgrade. With each passing two years our knowledge of fitness and injuries is increasing at an equally great rate.

Just as technology replaces itself with the emergence of new research, fitness information evolves through the experience of great coaches, altering what we once believed was safe and efficient.  Imagine if you applied the same logic most runners do to technology.

You would still be watching movies on Beta-Max. It’s time to upgrade!

 

The best runners in the world that finish marathons in less than 2.5 hours all have one thing in common…They are more efficient energy users. That means they expend far less kinetic energy covering the same amount of ground you do.  They are able to do this because their muscles are more elastic enabling them to store and use efficient energy, much like a stretched rubber band can store and use energy. The foundation of Elasticity is mobility and stability (to be covered in future articles). BUT without adequate tissue quality or tolerance, your mobility and stability will be limited along with your energy efficiency and ultimately your running times.

Back on track:  The principle of “Soft tissue quality/tolerance”

When you feel pain or have an injury you have exceeded your tissue tolerance. The load or stress is greater than the tissue’s ability to tolerate it. This limits your mobility and stability as well as elasticity. Knots start to develop and your tissue communicates this to you by spasms and tightness. Imagine stretching a rubber band with knots in it. Its ability to expand and store energy is diminished. Now, you are expending more energy running to make up for the muscle’s diminished elasticity. Muscles with knots in it do not contract normally and can alter joint biomechanics opening the window for pulled muscles and excessive stress on the joints. Most common being hamstring or groin strains.

Need proof of the effects of working on your tissue quality?  Let’s put the “runners tooth brush to the test.

(Figure-1) Take off your shoes and do a forward bend, as if to touch the toes with the knees straight.  Take note of how far you are able to touch down.  (Figure-2) Next take the “runners tooth brush” and start to roll out the entire surface of your foot.  Start at the ball of all five toes, and then back to the front edge of the heel. If you feel a specific tender spot or knot pay little more time and attention to it. Roll out each foot for at lest one minute.

(Figure-3) After rolling out each foot for at least one minute, again do a forward bend, as if to touch the toes with the knees straight. Take note of how far you are able to touch down compared to the first time.  It is not uncommon for someone to gain 4-6 inches of flexibility.  

(Figure- 1) Before   

(Figure- 2) Rolling out

(Figure- 3) After rolling out 

Minus the geeky science, let’s just say your entire posterior chain is a one connected can of tissue that shares tension and strain. Roll out and improve the tissue quality of the bottom of the can (foot) and you improve the entire can all the way up to your head.  An increase in 4-6 inches of the posterior chain increases your stride length! Now you’re using less energy to cover the same amount of distance.

 Using the “runners tooth brush” to help alleviate anterior knee pain.

In my experience, along with the experience of countless strength and conditioning coaches, there is a direct correlation with anterior knee pain and the lack of hip strength. (1) (Specifically addressed in this article are tenderness trigger points in the Gluteus Medius. (side of your hip)

It goes a little like this:

Mary: Chris my knee hurts, I don’t understand?

Chris: Where exactly does it hurt? Can you point to it? Did you hurt it falling down or was there any impact?

Mary: No.

Chris: Let’s take a look at your hips.

Mary: Chris I said my knee hurts NOT my hip!

Chris: I know but trust me on this…

This is where, as a collective, both runners and coaches, alike, have and continue to completely miss the boat. We are chasing the pain with a symptoms based mind set. When it comes to non-traumatic injuries and or pains this is akin to running around in circles thinking you are going somewhere.

We need to chase the causation of the pain and or injury.  Imagine a water leak on the roof. If you simply paint over the water damage leak (chasing the pain) but neglected to investigate the causation of the leak, which was a busted pipe from across the room, the following day the water (pain) would still be a nuisance.

Now back to your hip, Mary.

Chris: I want you to put your open hands vertically on the side of your hips and sway your hips side to side. Do you feel that muscle moving in your hand on the same side your knee hurts?

Mary: yes.

Chris: Good. Let’s replace your hand with this tennis ball. Press this tennis ball and your hip up against the wall and roll out that area. (Figure-5)

Mary: Ouch!

(I can’t help but grin a little because I see it 9 out of 10 times with runners with knee pain.)

Chris: Roll that bad boy out for at least a minute and we found your busted pipe!

Most runners at some time have heard the words “IT band”. This glute meduis trigger point Mary is rolling out with the “runners tooth brush” actually pulls this long IT band muscle out of alignment which is attached to the knee that is hurting. This can result in a condition called “IT Band Syndrome”.

The IT band exerts a force all the way from the hip to the knee. If our knee is pulled out of alignment, it is much like a car tire out of alignment. It is going to wear unevenly and breakdown prematurely. In runners, the breakdown results in pain.

 (Figure-5)

Look at Figure 6. My neck hurts because of the band pulling on my neck. If you just chase the pain all you would do is address the neck. But if the person pulling on the band (the causation) releases the band, my neck no longer hurts. Figure- 7.

This is the same relationship I see all the time with knee pain and the IT band/glut trigger points.

 (Figure-6) 

                

(Figure-7)

If you have time to brush your teeth you have time to brush the bottom of your feet.

I recommend runners put the tennis ball in their shoe and roll out at the same time they are brushing their teeth.  Also, constantly be proactive and do preventative maintenance on your hip.  Pre as well as post rolling out will increase and maintain your specific tissue tolerance. If you do preventative maintenance on your replaceable car I would hope you do preventative maintenance on your irreplaceable body.

References:

Anatomy trains- Myers

Advances in functional training- Mike Boyle

Footnote: 2003 Journal of Orthopedic and sports physical therapy, Ireland, Wilson

Special thanks to my assistant coach Ami Hodge for all her help.