Brian Schiff’s Blog

Manufacturers tout the benefits of compression stockings by telling runners they improving running performance via aiding or increasing venous blood return.  They assert that the compression around the calves increases the calf muscle pump mechanism thereby increasing end-diastolic volume and cardiac output during exercise and allowing for higher intensity output.  However, research to date has not supported this assertion.

Running a marathon presents a large physical challenge as a runner needs more than 30,000 foot strikes to finish a 26.2 mile race.  Studies to date have revealed that compression stockings may reduce muscular vibrations and oscillations in the calf with prolonged running.  They may also help decrease subjective feelings of pain following exercise bouts, but the use of them is still controversial as science also suggests they do not alter running performance.

A recent study in the Journal of Orthopaedic and Sports Physical Therapy sought to investigate the benefit of wearing graduated compression stockings for running pace, prevention of muscle damage and maintaining muscle performance during a real marathon race.  They had 34 experienced runners (running at least 5 years and completed no less than 3 marathons) take part int he study: 17 in the control group wore socks, while 17 runners wore foot-to-knee graduated compression stockings.

Runners were excluded if they were on medications in the 2 weeks prior to marathon, suffered a musculoskeletal injury in the 3 months prior to competition, and not completing the marathon.  The stockings were commercially available (NRG Energy – Medilast Sport) and covered from the foot to the inferior pole of the patella with graduated pressure.

Participants were given a pair of stockings 2 weeks before the marathon and encouraged to wear them at least 3x prior to race day.  Forty eight hours prior to the race a blood sample was taken, O2 saturation was measured, lower leg volume was assessed and maximum countermovement jump height was assessed.  On race day, participants wore their selected garments and were not given any instructions about food or drinking, while running at their own pace.  The same measurements taken pre-race were again measured following the race.

Results

• Total race time similar between groups
• Average running pace similar throughout the race
• Change in body mass during the race was similar
• Perceived exertion and lower limb soreness the same immediately after the race
• At 24 hours post-race soreness was reported to be less in stockings group, but this difference was no longer present at 48 hours
• Blood and serum responses were not different between groups
• Blood markers for muscle damage revealed no differences between groups in pre-race and post-race values
• Lower leg volume and countermovement jumps decreased in both groups after the race and no statistical differences or benefits to wearing the compression stockings

Summary

The use of compression garments in experienced runners is an ineffective strategy to reduce muscle damage over the course of a marathon.  Further, they do not reduce immediate post-race perceived soreness, nor do they increase performance compared to those runners wearing socks.  This is the first study to look at garments in a real race covering this distance.  Additional studies should be done to look at the impact of these garments on novice or less experienced half and full marathoners.

If you want more information on how to prevent injuries, resolve common running related pains and maximize your running, be sure to check out my comprehensive guide at www.FitForRunning.com.

Reference: The use of compression stockings during a marathon competition to reduce exercise-induced muscle damage: are they really useful? Areces F et al. J Orthop Sports Phys Ther. 2015 Jun;45(6):462-70.

I am pleased to announce that my new e-book on overcoming knee injuries and maximizing running performance is now available!  As someone who has run 4 half-marathons, a full marathon and several 5Ks, I know firsthand how frustrating an injury can be. Perhaps worse than the injury itself, is the fear of re-injury when every step brings trepidation in the back of your mind that the same pain could come back at any moment.

Over the course of my fitness and therapy career, I have worked with hundreds of runners ranging from beginners to competitive runners.  Many have been sidetracked by anterior knee pain and IT Band Syndrome.  While there is no way to prevent all injuries, I have found that learning to assess the body and incorporate corrective strategies to eliminate asymmetries and imbalances along with proper conditioning allows individuals to run faster, longer and relatively injury free.

Up to 50% of all lower extremity injuries with runners involve the knee.  I have been working on a manual that summarizes my approach to injury prevention, rehab and training for runners.  You see, many people are not really fit to run when they start running. If more people knew how to detect potential issues and train adequately to prepare their bodies to run, injury rates would decrease and performance would subsequently increase.

As such, I wrote Fit For Running: Overcome Knee Injuries and Maximize Performance.  This 70 page e-book covers assessment, stretching, strengthening, soft tissue mobilization, plyometric training and injury recovery guidelines.  It focuses on preparing the human body for optimal performance – a manual for physical readiness if you will.  It is perfect for runners of all ages and abilities, running coaches and fitness trainers working with runners.

While my book aims to target knee pain, it really offers considerable knowledge and insight that would help a runner with any overuse injury. Given the proportion of knee injuries, I chose to focus the injury/rehab portion of the manual on this topic.

Click Here to download a free sample and learn more about this great new resource.

So, a very common issue I see in runners is iliotibial band (ITB) syndrome.  In a nutshell, it involves excessive rubbing or friction of the ITB along the greater trochanter or lateral femoral epicondyle.  It is more common along the lower leg just above the knee and typically worsens with increasing mileage or stairs.

The ITB is essential for stabilizing the knee during running.  Several factors may contribute to increased risk for this problem:

• Muscle imbalances (weak gluteus medius and deep hip external rotators)
• Uneven leg length
• High and low arches
• Increased pronation leading to excessive tibial rotation = friction of the band
• Improper training progression
• Faulty footwear
• Poor running mechanics
• Limited ankle mobility (specifically dorsiflexion)
• Tightness in the tensor fascia latae (TFL) and glute max

Related information on this topic include a 2010 study published in JOSPT on competitive female runners with ITB syndrome:

Click here to see the abstract of the study

Click here to read an earlier blog post analysis of the above research article

Common signs and symptoms include stinging or nagging lateral knee pain that worsens with continued running.  Hills and stairs may further aggravate symptoms.  Some runners even note a “locking up” sensation that forces them to stop running altogether.  How do I treat this?

Continue reading…

Unearthing the cause of anterior knee pain and ridding our patients and clients of it is one of the never ending searches for the “Holy Grail” we participate in throughout training and rehab circles.  I honestly believe we will never find one right answer or simple solution.  However, I do think we continue to gain a better understanding of just how linked and complex the body really is when it comes to the manifestation of knee pain and movement compensations.

We used to say rehab and train the knee if the knee hurts.  It was simply strengthen the VMO and stretch the hamstrings, calves and IT Band.  Slowly, we began looking to the hip as well as the foot and ankle as culprits in the onset of anterior knee pain.  The idea of the ankle and hip joint needing more mobility to give the knee its desired level of stability has risen up and seems to have good traction these days.

Likewise, therapists and trainers have known for some time that weak hip abductors play into increased femoral internal rotation and adduction thereby exposing the knee to harmful valgus loading. So, clam shells, band exercises and leg raises have been implemented to programs across the board.

Single Leg Resisted Hip External Rotation

As a former athlete who has tried his hand at running over the past 5 years, I have increasingly studied, practiced and analyzed the use and importance of single leg training and its impact on my performance and injuries.  As I dive deeper into this paradigm, I continue to believe and see the benefits of this training methodology for all of my athletes (not just runners).

As a therapist and strength coach, it is my job to assess movement, define asymmetries and correct faulty neuromuscular movement patterns.  To that end, I have developed my own assessments, taken the FMS course, and increasingly observed single leg strength, mobility, stability and power in the clients I serve. Invariably, I always find imbalances – some small and some large ones.

What are some of the most common issues I see?

Continue reading…