Heel Pain in Runners

Heel pain in runners is common. It is especially prevalent in new runners, experienced runners getting back into running, and runners who have started a new program or increased their running volume.

If you are experiencing heel pain, I don’t have to tell you how frustrating and painful it can be. It often sidelines runners and is rarely a quick fix.

Here are some things you should know about heel pain in runners and how we approach heel pain here at our sports rehab clinic, Base Camp Chiropractic in Vernon.

Types/Causes of Heel Pain

Heel pain commonly comes from 3 or 4 different sources.

Plantar fasciitis

If you are a runner and haven’t heard of plantar fasciitis, you have clearly been spending too much time with your headphones in, because I guarantee someone you know has it or has experienced it.

Plantar fasciitis is when the fascia (connective tissue that supports your arch) is over-stressed and becomes inflamed and irritated. It is typically worst in the morning and while you are running. The onset is often sudden, and you just wake up one day with heel pain.

You can test your plantar fascia by pressing on point 1 (in the picture) and passively extending your big toe with your other hand. If this is extremely painful, there is a chance you have plantar fasciitis.

To deal with this, try this stretch every morning: Plantar Fascia Stretch

… and check out this article on foot strengthening exercises: Foot Strength for Runners

You can also try things like orthotics or a heel lift to change the load on your heel as a temporary change to deload the irritated tissues.

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Achilles tendonitis

Achilles tendonitis is common in runners who have started to introduce a lot of uphill running. The Achilles tendon becomes overloaded and irritated, and can no longer recover from your running. Pain can be located along the calf, between the muscle and the heel. For some people, that pain can radiate down to the bottom of the heel and foot as well.

To work on this, you need to work on your calf strength and ankle range of motion.

Start working on your calf using calf raises. If calf raises are painful, you can limit your range of motion to start (see the video below).

You can also work on calming down your calf muscle tone by using foam rolling and the 3-direction ankle mobilization (the other videos below).

You can also try things like orthotics or a heel lift to change the load on your heel as a temporary change to deload the irritated tissues. I often recommend limiting your uphill running when the Achilles is really irritated. In general, shoes with a larger drop (an elevated heel relative to the ball of the foot) will decrease your chance of developing Achilles pain and improve symptoms.

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Stress fracture

Stress fractures happen when the stress we have put the bone through is more than it can recover from. These injuries happen over time.

There is only one solution to stress fractures: rest.

Unfortunately, if a stress fracture is the cause of your symptoms, then you have to stop running for a few weeks and wear an air cast until the bone has healed.

Stress fractures are often very tender to the touch, you may have redness or swelling, and trouble running or walking at all.

If you think you might have a stress fracture, you need to go see a chiropractor, physician, or physiotherapist in Vernon who works with runners.

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Sciatic nerve

I see a lot of cases of heel and foot pain that have been diagnosed as ‘plantar fasciitis’ when in reality the problem is coming from the lower back. The sciatic nerve starts in the lower back and goes down to the bottom of the foot. In this case, the foot is not the primary culprit, even though the symptoms are in the foot.

TRY THIS STRETCH:

If this stretch makes your foot BETTER then we can be pretty confident that the lower back is involved. If this is the case, it is worth getting assessed by a physiotherapist or chiropractor in Vernon who can help you work on the lower back and whatever might be causing the symptoms.

(PSA: it is NOT because your pelvis or hips are out).

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Don’t let your pain or injuries hold your back. Book a free consult with Dr Mark to get you back on the trails and stay injury free this running season.

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc

Foot Strength: Exercises Every Runner Should Be Doing

Runners who do foot strengthening exercises are 2.4x less likely to get injured than runners who don’t do them.

That sounds like a pretty big deal to me…

The primary goal of foot exercises is to improve how well your foot absorbers and handles forces throughout your run.

Here are some of the specific foot strengthening exercises I recommend to my running patients to help prepare them for the demands of running:

Diagonal Calf Raises

The calves absorb MULTIPLE TIMES your body weight in force every step while running. Preparing your calves for this is extremely important. The diagonal calf raises adds multi-planar stability, which is essential for trail running.

Towel Scrunches

The towel scrunching exercise helps build up strength in the bottom of your foot, decreasing stress on your plantar fascia.

Foot doming

The Foot Doming exercise teaches you how to form a proper arch, which stabilizes and strengthens the foot.

Toe Yoga

Toe Yoga helps you restore the proper function of your foot, the ability to splay. If your foot cannot splay, it is harder for it to absorb the shock of running each step.

You don’t have to do these exercises…

In reality, you do not need to be doing THESE exercises. There are literally thousands of exercises you can choose from, these are just the ones that I like to see my patients and clients doing. But you should be doing SOME form of strength training. Both for injury prevention AND to improve your performance.

In general, I recommend some form of:

• Lower Leg Specific Training

• Hip and Core Specific Training

• Core Training (primarily “anti-rotation” of '“anti-movement“ exercises)

• Compound Movements emphasizing the Posterior Chain Strength Exercises (glutes and hamstrings)

• Basic Upper Body Strength exercises (1-2 pressing and pulling exercises)

• Foot Strength

Cover all these bases and you are bound to feel better and run with more confidence

This is part 6 of our Running Injury Prevention series. Missed the First 5 Parts? Find them here

• Part 1: Lower Leg Exercises for Runners

• Part 2: Hip Exercises for Runners

• Part 3: Core Training

• Part 4: Compound Movements

• Part 5: Upper Body Training

All runners should have 1-2 strength sessions per week if they want to run faster and further while remaining injury-free.

Here are the exercise categories I start all my runners with:

1. Lower Legs

2. Hips and Thighs

3. Core

4. Compound Movements (integrating the trunk and lower body)

5. Upper Body Exercises

6. Foot Strength

Exercises that Every Runner Should Be Doing

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Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc

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Exercises that Every Runner Should Be Doing

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Shin splints- how to tell if you have them and what to do about them

The typical progression for a new runner (or an experienced runner getting back into the seasons) goes something like this: 

You finally muster up the energy to get it done. For the past 3 weeks, you have been crushing it. You haven’t missed a day, and now you are really finding your groove. You might actually be starting to understand why people LIKE running!?! You started at less than 5 miles per week, but now you are up to 25 miles this week!

Then it happens. You are supposed to run 6 miles today, to round out your fourth week, but 30 minutes in your shins start to hurt. It’s a new pain… both shins on the inside of the bone (close to your midline). So you slow down and walk for a minute. The pain gets a bit better, but it is still bugging you. So you totally stop for a minute. It feels a whole lot better. You think to yourself ‘...must just be warming up’ so you get back in gear but then 100 feet later it starts again. 

What the HECK?

What is going on? Why did this pain start all of a sudden?

But then you remember… your friend told you about this. Oh no. They had to stop running altogether. Is this the end of your running career?

At this point you start Googling and come across a runners forum in which they are talking about EXACTLY the same things that you have. SHIN SPLINTS!

Aka the Runner’s Plague (Ok, fine, that might be my own embellishment).

Shin Splints should not be taken lightly, and there is a reason for it. Also known as Medial Tibial Stress Syndrome (fancy doctor words), Shin Splints are on the spectrum of stress fracture (BROKEN BONE) and should be taken seriously.

What are Shin Splints?

• Definition: Shin Splints are the common lingo for an injury called Medial Tibial Stress Syndrome, which is an early indicator of bone inflammation and irritation. If left untreated and unmanaged, Shin Splints can progress to a stress fracture (a really small break in the outer layer of the shin bone).

• Anatomy involved: Shin Splints primarily involve your shin bone (the Tibia) and the muscles that control your ankle and foot. (For the nerds, these muscles are the Soleus, Tibialis Posterior and Flexor Digitorum Longus).

How do I know if I have Shin Splints?

Shin Splints are diagnosed in a clinic using a two-step process

1. History

2. Physical Exam

If you are experiencing shin pain from running, the first thing that a Chiropractor in Vernon, BC will do will be to ask you questions about your symptoms, running volume, and lifestyle. Based on your answers, that helps your clinician decide what to check during a physical exam. 

Shin Splints often shows up the same way:

A runner increases the amount they are running too quickly (e.g. a jump of 10 miles in one week), which results in pain along the midline side of the shin (usually about 5cm long) that gets worse with activity (like running or sometimes even standing) and better with rest.

The symptoms we use to diagnoses Shin Splints are:

• Pain along the inside of the shin (usually about 5cm in length, sometimes on both legs)

• Pain that increases with activity, but subsides with ‘rest’ (we will talk about what ‘rest’ actually means later)

• Pain that is reproduced when we press on the muscle or bone

Some people are more susceptible to shin splints than others. One of the real bummers about shin splints is that if you have had shin splints before, you are more likely to get them again, which makes it that much more important to take seriously. Other factors are things like higher body mass index (a measure of weight to height ratio), foot arch height/control, ankle and hip range of motion, and your vitamin D levels.

The diagnosis of Shin Splints is what we call a ‘Diagnosis of Exclusion’. This means that if you have the history and symptoms that match Shin Splints, as clinicians our primary goal is to make sure it is not something WORSE (e.g. fracture, compartment syndromes, infection, etc). Because of this, it can be hard for you to diagnose shin splints yourself from home, so I highly recommend you seek out a chiropractor, athletic therapist, or physical therapist in Vernon to help you. That said, if you have the symptoms described above and ONLY those symptoms, there is a good chance you have Shin Splints. 

How do you treat Shin Splints?

There are multiple ways that a Vernon Chiropractor or Physical Therapist might treat Shin Splints, along with some things you can do from home

The first line of treatment to combat Shin Splints is to manage and eliminate the cause. While every runner is different, the route cause of Shin Splints is VOLUME MANAGEMENT. This means managing how quickly you progress your running volume and making sure you let the tissues rest and ultimately heal. No runner likes to hear the four-letter word... ‘Rest’ is almost as bad as the words ‘surgery’ or ‘cut-the-limb-off’, to some runners. BUT, in this case, we are talking about ‘Relative Rest’. This does not mean complete inactivity. The goal here is to limit the running volume to a frequency and duration you can recover from, but that does not always mean eliminating it all together. Together with your clinician, you can work out how much to run, what kind of surfaces you are running on, different running tempo, alternative footwear, all of which can fall into the intervention of Relative Rest. When in doubt, cut your running volume by 25% for a couple of weeks and see how your body responds.

Once we have a handle on managing Relative Rest, we can talk about the rest. Everything else is supplemental but together can make a difference. A good clinician will help you get out of pain. A GREAT clinician will help you manage your symptoms and keep them from coming back.

Here are a few things we work on when it comes to Shin Splints:

• Increasing ankle range of motion and shin strength using exercise

• Calming down inflamed tissue with the combination of things like mobility drills, soft tissue therapies, nutritional interventions and joint adjustments

• Orthotics for short term symptom relief

• Improving your biomechanics to increase your capacity for load and running

• Vitamin D supplementation to improve bone health, healing, and inflammation

Do I need an X-ray?

The short answer to the question “Do I need an X-ray for Shin Splints” is No. However, if your clinician thinks that your condition may have progressed beyond a simple bone inflammation to the point of Stress Fracture, they may order imaging. The problem with Shin Splints is that the condition they lead to is called a “Stress Fracture” which is a tiny “hairline” fracture that is almost impossible to see on an X-ray until the injury is healing. The good news is though, even if your injury has progressed to a stress fracture, most runners fully heal. The bad news? It takes time.

If you are unsure if you need an X-ray, or you suspect that you have a fracture, give us a call at Base Camp Sport and Spine or book an appointment for an assessment.

Do I have to stop running?

This is the hardest part of the conversation with an active runner.

Before I get into the nuances of the question of “Do I have to stop running if I have Shin Splints?” we need to set the stage. When it comes to people walking through the door into my clinic or scheduling online coaching/consulting with me my goal is ALWAYS to help you keep you DOING WHAT YOU LOVE and not take you away from it. You already know that if something hurts to do and you stop doing that thing you will have less pain. That is not why you need some guidance. You are looking for solutions to keep you doing what you love. Very rarely (in fact, almost NEVER) do I recommend my patients to completely eliminate their favourite activity. In the rare cases that I do, the elimination is TEMPORARY and only if it is absolutely necessary.

Here are a few considerations when we are considering what to do if you have Shin Splints: 

1. How much are you currently running compared to how much you were running 6 weeks ago?

   • Rapid changes in mileage?

   • Changes to your routine?

2. Why are you running in the first place?

   • Running only for fitness?

   • Running in preparation for a race?

   • Running to clear your headspace?

3. What does ‘relative rest’ mean to you?

   • Complete elimination of activity?

   • Alternate activities besides running?

   • Changing your running volume/terrain/cadence/pace?

If you have been suffering from Shin Splints, you already know how frustrating they are. The good news is that THEY DO HEAL. The catch is that it takes direction and a structured recovery program. My goal as a clinician is to keep you running. The reality is that Shin Splints do need Relative Rest. This will inevitably mean a change in your running schedule, but it does not mean the complete elimination of your favourite activity.

So… What do I do if I have Shin Splints?

The first thing you should do if you have Shin Splints is to drop your running/activity volume. If you are not getting significant relief within a couple of weeks, the next step is to search out a qualified Chiropractor, Physical Therapist or Athletic Therapist in Vernon to put you through an assessment and build a recovery plan. If you are outside of Vernon, send me a message and I will help connect you with a clinician in your area. Your clinician will help you decide how to proceed and whether or not you need X-rays or an MRI.

First Things to Try (Weeks 1-4):

• Relative rest (decreasing your running volume)

• Replace some running with other low impact cardio (e.g. bike, swim, row)

Additional things you can start doing from home:

• Foot stretching and strengthening

• Hip stretching and strengthening

• Consider a Vitamin D supplement (almost everyone in North America is Vitamin D deficient. If you are considering taking a Vitamin D supplement, check with your doctor).

• Ice massage can be helpful for managing your pain

Exercises for Shin Splints

• Ankle Mobility Exercises

• Toe Yoga

• Hip strength, mobility, and coordination exercises

• Calf and Shin Foam Rolling

• Calf Raises

• Terminal Knee Extension

• Self Mobilization of the Heel

How long do Shin Splints take to heal?

Brace yourself. It is not going to be an answer you want to hear.

If you do nothing about it and continue to train the way you have been, the most likely outcome is that they will never heal and you will progress to a Stress Fracture.

If you do something about it? Shin Splints can take anywhere from 3-12 months to heal.

This is why Shin Splints recovery can be even more challenging mentally than it is mentally. This is why it is so helpful to have someone to coach you through your recovery.

How long you take to heal is dependent on a few things:

1. How long you have had symptoms before doing anything about them

2. Severity of your symptoms and tissue damage

3. How committed you are to healing and following the proper rehab exercises and protocols

4. Your overall health

Ready to get rid of your shin splints?

If you are ready to get rid of your shin splints, book an appointment with one of our providers. We will help you figure out exactly what is going on, how to manage the pain you have, and how to get back to doing the things you love.

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Chiropractic and Sports Rehab in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc

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Sources:

• A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS) by Messier et al. (2018) The American Journal of Sports Medicine

• Effectiveness of online tailored advice to prevent running-related injuries and promote preventive behaviour in Dutch trail runners: a pragmatic randomised controlled trial by L. Hespanhol, W. van Mechelen, and E. Verhagen (2018) The British Journal for Sports Medicine

Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.

Is this soreness or injury?

How to tell if the pain you are having is just regular soreness or an injury.

As a runner, there is a good chance you have had to ask yourself “is this normal soreness, or is this something worse?”

Chances are good you are sore RIGHT NOW as you are reading this.

It can be difficult to differentiate between regular training-related soreness and an injury. Here are a few things to help you tell the difference.

1) Pain location: muscle vs tendon vs joint

Soreness should be located in the muscle belly. Pain located at the tendon or in the joint is a sign that you have pushed it too far and you may need to back off before making things worse.

2) Pain onset: Are you hurting during training or afterwards? how quickly does the pain happen?

Pain from soreness takes some time to come on after training. Delayed onset muscle soreness (DOMS) can take 12-36 hours to come on and can last a few days.

Pain from an injury often comes on immediately following trauma, or even during activity.

Many runners describe a ‘hot spot’ that happens with running and goes away after you have warmed up. This is a sign that you need to be more intentional with your warm-up, and you may be increasing your risk of injury by ignoring it.

3) Pain quality: sharp or dull?

Soreness should feel like a dull ache or fatigue. It should not feel like a sharp or shooting pain. Other symptoms like tingling or weakness are the signs of other types of injuries and should be taken seriously.

4) Modifying factors

What can you do to make your symptoms better? With soreness, you should feel better when you rest, but often the achiness is not totally gone. With an injury, complete rest will often be relieving, but activity will increase the intensity. Some injuries are totally relieved with rest, while others remain pailful at all times.

5) Other Symptoms

Redness? Swelling? Bruising? All of these are signs that your symptoms are related to an injury, not just regular muscle soreness.

Injury is hard to define.

Here is the ultimate rule that I use to determine whether you are injured or just sore:

Does the pain keep you from doing anything that you WANT to do or that you HAVE to do?

If the answer is yes, something needs to change and you need to get your injury assessed.

Soreness is a part of the runners’ journey. Once you have been training for a while, you should be able to tell the difference between your regular soreness and symptoms or pain that is out of the ordinary.

If you are ever concerned about your symptoms or something doesn’t feel ‘quite right’ it is time to get an assessment to make sure it is not something more serious.

don’t get caught in the runner’s injury purgatory.

Too many runners get caught in this cycle.

If you think you might be injured, it is time to get an assessment by a clinician who knows how to work with runners.

Most of the time, getting an assessment early can help keep your injury from getting to the point where you have to take extended time off. It is important to get on top of it early.

Dealing with muscle soreness from running? Here is how to manage it (and it’s not foam rollers and massage guns):

How to manage muscle soreness from running

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Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Chiropractic and Sports Rehab in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc

How to manage muscle soreness

If you have been training for a while, or have recently started a new training program, you have probably experienced one of the less-pleasant side effects of strength training… DOMS!

DOMS stands for delayed onset muscle soreness and is exactly what it sounds like: soreness that comes on 12-48 hours after strength training, and usually lasts for 24-72 hours. It is essentially brought on by microscopic damage to the muscle caused by strength training (which is generally considered a good thing!).

There is no cure for DOMS, other than time, but there are a few strategies you can use to keep DOMS manageable.

4 Strategies for minimizing DOMS and maximizing muscle gain and function:

1) Heat

• Heat can help relax your muscle and clear metabolites from exercise

• Warm water, hot tubs, or a hot shower after exercise are all great options

2) Compression boots or compression wear

• Compression socks or similar are a great way to help your body continue to clear metabolites using a passive mechanism. This can help decrease some soreness on the days following strength training. The Starting Block usually has some great compression sock options

3) Keep moving

• You might not want to… but going for a walk, or a light bike ride a few hours or the day after a strength session can help decrease your muscle soreness. Similar to hear, this helps clear metabolites and potentially speed up the healing.

4) Protein

• GET YOUR PROTEIN! If you are not getting the building blocks for your muscles and tendons to heal, your body has to fight harder to recover from strength training. I recommend aiming for at least 1.5 g of protein per kg of body weight but often recommend even higher amounts. Having a protein shake or high-protein meal within the first 30-60 minutes following your workout will help you maximize your strength and muscle gains!

Ultimately, there is no cure for DOMS, but there are things you can do to keep it from affecting your life. Eventually, you will get less sore from strength training as your body adapts. Many people actually end up chasing that soreness because it ‘hurts so good’.

DOMS should only be experienced in the muscle. If you are having pain in your tendons or joints, then it is time to get an assessment before it progresses into an injury.

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Chiropractic and Sports Rehab in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc