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Ever since 36-year-old Francie Marchand of Ottawa injured herself running on icy sidewalks several winters ago, she is extra careful about when and where she runs. And, she says, "If something is starting to get sore, I ease up and won't push through it."
What is plantar fascitis?
As Francie ran on slippery sidewalks, each time she pushed off with her foot, it slipped back on the ice and pulled her plantar fascia (the tissue that runs along the bottom of the foot from the heel to the ball). She developed plantar fasciitis, a condition in which the plantar fascia is continually pulled and becomes inflamed. She finally saw a sports medicine specialist, who sidelined her for several weeks until it healed.
It was a painful lesson for Francie, who has been running for 15 years and says it's the best-quality workout you can do in the shortest amount of time. A wife, mother of three kids (aged three, eight and 10) and full-time guidance counsellor at a private girls' school, she fits in her runs at lunchtime and always makes time for a longer run on the weekend. And now that she knows how to avoid overtraining, her runs are uninterrupted by injuries.
Now that the snow has melted, many of us are also thinking about taking to the streets for exercise. Whether you're keen to start running or fitness walking, it's important to train properly so your experience remains positive and you remain injury-free. Done right, running or walking is the perfect exercise for today's busy lifestyle. It's convenient -- you can do it anywhere and anytime -- and it's also a natural motion, so there aren't a lot of special skills to learn. And frankly, it's relatively cheap -- all you really need is a good pair of shoes.
Page 1 of 7 -- Running can be a tough sport to start, but the health benefits exceed the effort required. Find out exactly why running is so good for you on page 2.
Why running is so good for you
At the same time, these activities are good cardiovascular workouts, says Dr. Grant Lum, the medical director of Athlete's Care Sports Medicine Centres in Toronto and a member of the medical team for the annual Canadian International Marathon in Toronto. They're weight-bearing, so they help prevent osteoporosis, and they help build the body's largest muscles in the legs (the quadriceps and gluteal muscles), which burn the most energy -- and calories.
The big-picture benefits are impressive, too: regular exercise reduces the risk for stroke and many diseases, including heart disease, hypertension, Type 2 diabetes, colon cancer and breast cancer. It also improves mood and fights mild depression.
Just remember that despite good intentions, a wintertime couch potato won't get far running full-out, several times a week, right off the bat. Doing too much too soon is the No. 1 cause of running injuries. While the impact is lower, fitness walking also carries the risk of the same types of injuries. Muscles, joints, ligaments and especially connective tissues in the lower body need to be conditioned to take all that pounding. A long list of potential injuries includes strains in hamstring, quadriceps or calf muscles, and foot, knee and back problems.
New to running? Start slow, suggest experts
"Start low and go slow, and see what your body is able to tolerate," advises Dr. Chris Johnston, lead author of "Preventing Running Injuries," a paper published last year in Canadian Family Physician. The paper reviewed current literature written about ways to prevent running injuries. The best running program gradually increases distance or time and figures in appropriate rest and recovery periods of 24 to 48 hours between workouts.
Johnston, who is also a doctor at the Canadian Forces base in Halifax, cites one study that shows that novice runners reduced their injury rate significantly by running one to three days a week for 15 to 30 minutes each day -- rather than five days a week for 45 minutes each day -- and still got a great workout. His paper also shows that surfaces, shoes, muscle weakness, inflexibility and leg alignment problems that may be undiagnosed (such as having one leg longer than the other) can be associated with injuries. Of course, slips and falls cause injuries, too.
This spring, ease into running – and avoid injury -- with Canadian Living's doctor-approved program (found on page 7). If you have a history of heart disease, diabetes or other chronic illness, consult your doctor before you begin. You may also choose to do a pre-activity screening with a fitness professional to flag any potential problems, such as foot or alignment problems.
Page 2 of 7 -- Will any old sneaker do? Find out on page 3.
A good shoe helps protect your body and helps the foot adapt to changing terrain, says Arnold Tse, a field support supervisor at New Balance Canada in Mississauga, Ont. When you run, each foot strike generates an amount of force that is equal to about three times your body weight; when you walk, it generates one-and-a-half times your body weight, so you need a shoe that will help you absorb that force. Running and fitness walking shoes have synthetic and mesh uppers for the most part. They're lightweight, breathable and longer-lasting than leather, which cracks and wears down more easily when exposed to outdoor elements.
Both running and walking shoes have built-in cushioning but are designed differently to accommodate the motions of the feet depending on whether you're running or walking. For example, since your heel strike is heavier when you run, running shoes have more pronounced -- and more shock-absorbent -- heels than walking shoes. Walking shoes, on the other hand, are designed to allow your foot to move with a natural, rolling motion from heel to toe, which accommodates the forward rolling motion of fitness walking. Talk to an athletic footwear specialist about other shoe features that can help you run or walk better.
Walking shoes sell for about $120; running shoes can cost up to $160. Higher prices often reflect new control and cushioning features in shoes, says John Grandy, assistant manager of the Running Room in Toronto. The key isn't how many bells and whistles they offer but how the shoes fit your feet.
Also useful in avoiding running or walking injuries are specialty running socks, which are made with materials such as CoolMax polyester microfibre that draw moisture away from the skin. They help keep your feet comfortable and blister-free.
Page 3 of 7 -- Are you running to your full potential? Find out how to gauge the intensity of your workout on page 4.
Walk or run on the softest, most even surface you can find. A road (usually made of asphalt, which is a mixture of gravel, tar and crushed rock) is better than a concrete sidewalk (which is much harder than asphalt). A school track is even better than the road (synthetic materials, such as rubber-asphalt mixtures, absorb the most shock). Shoulders of roads are usually soft but they're often slanted, too. If you're running consistently on a slanted surface, injury risk increases.
Don't worry too much about the old running rule to land firmly on your heel and roll forward, says Johnston. Landing on a flatter foot may actually decrease the amount of stress that the body has to absorb every time your foot strikes the ground. And until there is a definitive guideline on proper posture, says Johnston, wear supportive footwear and run in a natural posture that feels comfortable.
Here are a few simple ways to measure intensity when you run or walk.
• The talk test. If you can say two or three sentences without gasping for breath, says Cathy Simon, a licensed physiotherapist at Active Physiotherapy in Saint John, N.B., you're in a good range.
• Perceived level of exertion. Think about how hard your workout feels. Zero is what you'd feel like if you were sitting on the couch, and 10 is what you'd feel like if you were working so hard you couldn't breathe. Aim for about six.
Be careful not to overstretch your stride length -- this can tighten hamstrings and stress knees and other joints. Follow the natural distance and swing of your legs. Simon provides the following test to find your ideal stride length. Stand with your feet together. Slowly lean forward at the ankles until you have to take a step forward to keep your balance. Repeat a few times to see how far apart your feet fall naturally when you step. Use that as a guide for how long your stride should be.
Warm-up and cool down
Always warm up your body by walking or jogging lightly for five to 10 minutes. After exercise, cool down by gradually slowing down and walking more slowly for five to 10 minutes. This helps muscles and tendons relax and loosen, advises the Canadian Physiotherapy Association, and stops them from becoming stiff and tight.
There's no scientific evidence that stretching before exercise makes a difference in terms of injury rate. However, you should always stretch after (not before) you run, when your muscles are warm. Stretch the calves, hamstrings, quads, buttocks, hip flexor, groin and iliotibial band (the tendon tissue that runs from your hip across your thigh and to the top of your shin) for 20 to 30 seconds each, repeating two or three times. Here's a quick visual guide to these stretches.
Page 4 of 7 -- When starting a walking or running program, you may feel a little stiff and sore. We identify how much pain is normal, and when you might want to check-in with your doctor on page 5.
Expect mild stiffness and soreness the day after activity, says Lum. You are causing muscle breakdown and inflammation, which stimulates muscles to grow and get stronger. But you should be pain-free before you do the activity again.
If discomfort continues (for example, your knees are so sore that it's hard to walk downstairs), see your doctor, a sports medicine physician, a physiotherapist or other health-care professional. You may have an injury, or the way your foot or body is built may be causing problems. For example, many people have flat feet that overpronate; that is, when they walk, their feet naturally roll inward from the outside edge of the heel in to the big toes instead of rolling straight along the bottom from heel to toe. If you overpronate, various leg and knee injuries can result.
Can new shoes help with aches and pains?
Certain exercises can help, and there are athletic shoes specially designed for overpronators and supinators (whose feet roll outward, the opposite of pronators). A health professional might also recommend orthotics, which are custom-made insoles that you wear in your shoes. They can correct or reduce improper foot motions that lead to chronic injuries; overpronators or people who have a significant difference in the length of their legs can often benefit from using them.
Some women have knee problems when they run, says Kevin Longpré, a certified athletic therapist at Concordia Sports Medicine in Montreal. "Different muscular and structural imbalances can affect the knee, and women's naturally wide hips - and the angle from the hip down to knee - make women especially susceptible to knee strain."
But don't nix running altogether, says Longpré. "What's important is a balance between having good flexibility, proper strength and knee stability -- so it can handle the load you're going to put on it." Stretching regularly helps -- when you don't, you lose your range of motion because the muscles become too tight.
Building up muscles in the lower body will also help, says Longpré. This helps stabilize the knee because all the muscles cross the knee. As a unit, strong, healthy and flexible muscles protect the knee. He also suggests trying over-the-counter knee brace products, such as the Futuro Open-Patella Knee Support ($18 to $20 each), which are available at drugstores, grocery stores and mass-market retailers.
Rest and rehab
Most running and walking injuries are curable, says Simon, and you'll heal faster if you deal with them right away. She recommends the RICE formula to decrease pain and swelling.
• Rest and protect the injured limb (most running injuries are in the lower part of the body) from further injury by stopping the activity right away. "Working through" an injury can actually make it worse.
• Ice for the first 48 to 72 hours after the injury. Wrap a bag of ice, commercial cold packs or even a bag of frozen peas or corn around the injured area with a towel, and leave on for 10 to 15 minutes every two hours.
Page 5 of 7 -- Discover the last three steps of the RICE formula for treating injuries on page 6.
• Compress the area to help decrease the swelling. If you are on your feet or walking around a lot, wrap an elastic bandage around the area for the first couple of days. Don't wear the bandage to bed or if you elevate the injured part during the day.
• Elevate the injured limb to promote blood flow and healing and to decrease any swelling.
When should you visit a sports injury specialist?
If there's no improvement after a couple of days of RICE, see a sports-medicine or health professional. Rehabilitation may include medicine (anti-inflammatories, such as acetylsalicylic acid or ibuprofen), manual therapy (mobilizing joints or working on the softer tissue such as muscles or ligaments) and/or exercises to build up strength, balance and flexibility. Your doctor might also suggest ultrasound, which uses high-frequency sound waves to produce deep, healing heat in the injured area.
There are other therapies that are also helpful in treating running injuries. Laser therapy shoots a helium-neon laser into the injured tissue to increase circulation. Transcutaneous electrical nerve stimulation (TENS) sends electrical signals to nerves near an injury site to reduce pain. Interferential current (IFC) uses electric current to stimulate nerve cells to help decrease pain and inflammation.
Another technique is iontophoresis, which uses an electrical current to drive pain medication, such as an anti-inflammatory or cortisone-type drug, underneath the skin and directly into the inflamed area, explains Lum. Phonophoresis uses sound waves to do the same thing. Both techniques may shorten recovery time, and there are fewer side-effects because you're not delivering the drug throughout the body, says Lum. "But we use it depending on the case, and, practically speaking, it is moderate in terms of success."
Unless you are receiving treatment from a medical doctor, there are user fees for many of these treatments. Across Canada, the initial assessment by a physiotherapist will cost $45 to $75, and subsequent visits are $35 to $45.Diet: How to refuel your muscles
A healthy diet for runners and walkers includes carbohydrates for refuelling muscles, protein for rebuilding muscles, and vitamins and minerals to help in recovery after a vigorous workout. Drinking lots of water is important, too. When you are dehydrated, you're more prone to injury.
Page 6 of 7 -- Are you ready to get started on your own running or walking program? Find our exclusive six-week run/walk program on page 7.
The six-week run-walk program
Run for one minute, walk for two minutes. Repeat for a total of 15 minutes, three times per week.
Run for two minutes, walk for one minute. Repeat for a total of 15 minutes, three times per week.
Run for three minutes, walk for one minute. Repeat for a total of 20 minutes, three times per week.
Run for five minutes, walk for two minutes. Repeat for a total of 21 minutes, three times per week.
Run for seven minutes, walk for two minutes. Repeat for a total of 27 minutes, three times per week.
Run for eight minutes, walk for two minutes. Repeat for a total of 30 minutes, three times per week.
• Rest for 24 to 48 hours between runs.
• If you prefer to walk more than run, reverse the running and walking times as the running times get higher.
• Repeat a week if you're not ready to increase the time. Not everybody will progress at the same rate.
• Never increase your mileage by more than 10 per cent per week.
Low-impact exercise: The fitness walk
Fitness walking means one foot is always on the ground (in running, both feet can be in the air during your stride). Keep your head up, shoulders back and lean forward slightly from the ankles -- be sure not to bend forward from the hips or back -- as you walk as fast as you can. Look ahead, not down at the ground. Bend your arms at 90-degree angles and swing them backward and forward -- your hands should never go higher than your breastbone.
Because walking is lower impact than running, Simon recommends landing on your heel as you walk, then rolling through your foot and pushing off with your toes and the ball of your foot.
Strengthening your calves to make running or walking easier
Strong muscles in your legs help absorb the impact of running or walking, says Dr. Chris Johnston, a doctor and running expert in Halifax. Use specific machines in the weight room that focus on the calf, quadriceps and hamstring muscles or try these at home.
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