Ask the Practitioner: Can Graston Technique Fix My Aches and Pains?Written by Dena Evans October 16, 2012
Rikke Johansen, D.C., is the founder of Health Logic and has 18 years of experience in practice as a doctor of chiropractic medicine. Dr. Johansen is a Certified Chiropractic Sports Physician (CCSP), a Certified Strength and Conditioning Specialist (CSCS), and has completed the educational requirements to qualify her as a Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP) and as a Diplomate of the American Chiropractic Board of Radiologists (DACBR). She is also a USA Triathlon Level I certified triathlon coach and a USA Cycling Level II certified cycling coach. rc: What are the types of physical complaints Graston technique is effective in addressing?RJ: The most common complaints in my practice (we see a high percentage of endurance athletes) where patients specifically come in or are sent by their medical doctors to get Graston are: Plantar Fasciitis, Iliotibial Band Tendonosis, and Achilles Tendonitis. Another common issue is post surgical scar tissue, i.e. after shoulder or knee surgery. The chronic high hamstring tear is also effectively addressed with Graston.
rc: What makes Graston different than other popular techniques, such as manual deep tissue sports massage and Active Release Technique? RJ: It is important to remember that all techniques are only as good as the overall assessment of the athlete as well as proper diagnosis of the kinetic chain and faulty bio-mechanics. A knee problem is rarely an isolated knee problem. It is important to correct muscle weaknesses, range of motion challenges, etc. We certainly use a combination of myofascial techniques, but with the Graston instruments we are able to more specifically locate adhesions, get a sense of severity and create the localized controlled 'trauma' that will aide in normalizing the tissues.
rc: What does Graston feel like and how effective is it? RJ: Everybody has different pain thresholds, and different body areas are more sensitive. Graston can be slightly painful, but more often in a 'good' way. It is often described as a rolling pin, when done on the back with a large instrument. Some people describe the smaller treatment edges as metal brushes. The technique is modified to each individuals comfort level and pain is not necessary to get results. As to effectiveness, generally we take care of 85-90% of chronic conditions, such as those mentioned above, in 4-6 visits.
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Injury Prevention
Tips for New Parents on the RunOctober 16, 2012
Few life changes will have a greater impact than the arrival of a newborn. Both the physical challenges for mom, as well as the stark changes in family schedule and breadth of responsibility for both parents can justifiably upend priorities. This can wreak havoc with the comfortable patterns of habitual runners. Chances are, unless you have had a very quickly moving adoption, you have been well aware that changes in your running routine await the arrival of the new bundle of joy. Very likely, transitions have already occurred for mom with the ups and downs of pregnancy. Whether a quick return to work or flexibility for extended parental leave is on the horizon, here are a few tips and ideas for runners in the throes of new parenthood: Consider how baby gear purchases, such as a stroller, can assist you in the eventual pursuit of a return to running. Yes, that sounds crass – you are about to enjoy one of life’s greatest blessings, and running should come to mind? Well, if there is anything that you intend to continue doing on a regular basis after your baby comes, it probably saves time and money to anticipate how you can manage that practice within the context of your baby’s first few years at home. For example, many running families use a jogging stroller (or a stroller with that capability) for their primary stroller. Initially, it can be used for regular stroller duty, particularly now that many jogging strollers can attach baby carriers and inserts allow for extra padding with newborn babies. When eventually jogging becomes appropriate with the little one, everyone is used to the new gear, how it fits in the car, the baby finds it to be a smooth transition, and more enjoyable / contented baby running might result. Moms: set a completion goal, but no sooner than 6-12 months after giving birth. Dads: choose flexible goals in the first year. While the experience of every mother is different, having a goal to shoot for can often inspire (to lose weight, to re-grasp a feeling of independent personhood, etc) when life seems completely turned on its head. Set a goal too soon, and it may become a needless stressor, both logistically, and physically, when the body is out of shape and sleep is minimal. Set a time goal too soon after giving birth, and the unpredictable physical aftermath of motherhood can create frustration. By a year, many moms are beginning to recognize their bodies again, and having a date to look forward to (as a return to the experience of being an athlete) can be a very motivational tool. Just enjoy your first goal race after baby to celebrate how far you have come. Use subsequent goal races to return to previous fitness and pace levels. New dads are also saddled/ delighted with the many transitions of fatherhood, but many times must navigate a tricky landscape of an initially supporting role in the physical sense. Without the obvious setbacks of pregnancy and giving birth, it may be enticing to set a big goal, almost in celebration of the new family member. However, in this particular instance, it is worth considering flexible goals. Neither of you quite know how you will feel physically or rest-wise as these dates get closer, and the last thing needed is more stress. One option to keep dad on track could be to pick a distance goal with three or four options in 60 day range. Have patience with your body after baby (yes, dads too!) For many first time parents, the adrenaline of new parenthood eventually wears off, but many nights of limited sleep remain. Schedules change and keep changing. Things like foam rolling, stretching, strength routines, and other ancillary activities may be cut out to preserve what little time remains to run. Unsurprisingly, aches and pains might crop up, and the legs might not recover as fast. Control what you can control. Consider occasionally modifying your running routes and other patterns to avoid a fruitless comparison contest with your well-rested self. For moms in particular, resist the urge to return to serious training until you are cleared to run by your doctor. Be sure to progress incrementally. Just like a marathon recovery that is too short, a postpartum running injury may not crop up immediately. Rather it often surfaces after the premature progression has been established over several weeks or months. Shop and prepare for running with body after baby. One of the most common roadblocks to a successful return to pre-baby running fitness can be the first few efforts out the door. For many moms, postpartum bodies feel like complicated new appliances with misplaced instruction manuals, what with the likely weight gain and the new demands and dimensions of various body parts. All of us know better than to establish self-esteem from outside appearances, but without a couple running items that fit, it can be that much harder to get out and get started. Having a high impact / supportive sports bra and shorts that fit your current size can make a difference, and are worth shopping for even in advance when you have more flexibility in your schedule. When it comes time for stroller jogging, find the bike paths. Just as parents at their wits’ end will drive a baby around the block, hoping to induce sleep, the stroller experience for your baby / toddler can vary wildly from soothing to disruptive, which in turn may have a direct impact on your ability to reintegrate running positively into your daily life. Bumpy roads, streets with many stop lights, turns or undulations may be your only options, and by yourself, you might barely notice these parts of the route. However, the stroller years might also serve as a chance to get to know the flat, off street routes in your region better than you might have before, and allow the jogging stroller experience to emerge as a positive parenting interactive time rather than a struggle of wills.
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Training
Can Yoga Help Your Running?October 03, 2012 Stephanie Lee (pictured) has been practicing yoga for over 12 years in a variety of diverse settings that include Hawaii, Greece, Italy, and Thailand.RC: Yoga is a commonly mentioned term these days, but what exactly is yoga and what is it intended to do? SL: There are many types of yoga practices, each offering something different, but all with a common strand. Yoga can be your own sanctuary outside of the madness of the day's routines. It's a safe, non-chaotic environment where you can find peace in your body and mind. When you leave the studio, you can take those learnings with you and apply to everyday life situations. Once a yogi, always a yogi. Yoga can help you build a healthy lifestyle that complements Western Medicine. It's a loving and comfortable environment to discover the connection of your physical, emotional and spiritual body.
RC: What generally about yoga might make it beneficial for runners? SL: There are a wide range of benefits from practicing yoga. Not only is it physically challenging to your body, it's an opportunity to relax and focus the mind with wonderful benefits to all of the internal organs in need of repair and detoxing. Yoga improves your posture and blood flow, it lowers cortisol [hormone released in response to stress], releases tension, provides an immune boost, helps regularity and most of all aids in peace of mind. It's an inner balance. Yoga, paired with running, can create more flexibilty, strengthening of the joints and muscles, and gains in your ability to stay focused. It can enhance your breathing and provide you with a better night's rest. In all yoga practices, you need to spend that time within your own body on your mat. In some practices like Bikram, you are facing obstacles such as remaining in the studio throughout the entire 90 minutes with absolutely no talking in extreme heat. It is a very challenging environment as at times there can be up to 60 people in some classes. This is where you need to pull your wandering mind back in and focus on being present within yourself and your own abilities to complete the class.
RC: What are a couple beginner poses or exercises a runner might try to explore these benefits? SL: Some basic, yet very beneficial poses a runner may be interested in incorporating to their workout are the following: Half Moon, Eagle, Separate Leg Stetching (which are all in the standing series), plus Wind Relieving Pose and Half Tortoise, which are a part of the floor series [ed note: Runcoach does not have an association with or specifically endorse any of the sites used to illustrate each pose]. It would also be advised to incorporate controlled breathing and meditation as these can go hand and hand with a runner's world.
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Training
Tips for Racing Half Marathons, 10 Milers, and 15KsApril 01, 2022Race day is almost here! Remember to lay low and stay off your feet the days before the race (no Expo attendance for longer than 1 hour). Your reward is race day itself and the challenge of running. . . . Arrival Make sure you get outside and feel the air. Go for at least a 20 minute walk or jog on either the day before, or two days before (or whatever is on your schedule). Think about what you did, not what you didn’t do in your training. When you go to pick up your race number and run into old friends, family etc. everyone will want to ask about your training so they can tell you about theirs. Forget about theirs and don’t compare yourself to anyone. You followed a terrific training schedule and are well prepared. On race day eat a light breakfast of 200-300 Kcal of carbohydrates including the sports fluid you drink. If you have a normal pre-race breakfast then stick with it. Don't try any new foods before the race. Drink gatorade (or any sports drink that doesn’t include protein) and/or water frequently to assure you are hydrated (clear urine is a good sign). You should stay well-hydrated throughout the morning before the race. At some point prior to the race stop drinking so you can empty your bladder before the start. It is important to refrain from over-consumption of water alone, as that will drain your body of needed electrolytes. I suggest you take some throw away warmups to the start especially if it rains or will be cold. This could be an old t-shirt or old sweat pants. Also old socks will keep your hands warm. Some runners will even wear a t-shirt for the first couple miles of the race until they warm up and then pull it off and throw it away. This is a good strategy to prepare for all temperatures. Take a bottle with gatorade/sports drink to the start with you and right before (less than 5 mins) the gun goes off drink 4-8 ounces. This is your first water stop. If you drink close enough to the start you shouldn’t have to pee – the fluid should only drip through your kidneys because most of your resources (blood) will be in your legs and out of your gut as soon as the gun goes off. I suggest that you start 15-30 seconds per mile slower than your goal pace. Your second mile should be 5-10 seconds slower. By the third mile you should reach goal pace I recommend this approach as it may activate (and utilize) a higher percentage of fat fuel over the first couple miles. Remember we are trying to conserve glycogen and muscle for as long as possible. Stay on top of hydration. Drink early and often (4-8 ounces every 20 minutes). It is better to consume enough fluid early and sacrifice the later stops if necessary. Remember the 3 ‘C’s’ Confidence: Have confidence in your ability and your training. Remember all those hard workouts you did. Remember those early mornings, late nights, sore calves, tight hamstrings etc. - they weren’t in jest. Control: You must relax yourself early in the race. You absolutely must go out under control and run easy for the first 8-10 miles. Remember the 1/2 Marathon is evenly divided into three sections of equal effort: first 5M, second 5M and last 5K. We want to save a little bit for the last 5K (Miles 10-13). Collection: Keep your thoughts collected and on your objective. There will always be lots of distractions on race day. The further you get in this race the more you need to focus on yourself, goals and race strategy. Don’t let the fans and competitors into your zone. The Ebb and Flow I said before that I can’t guarantee anything about the training or the race itself. Well, I can guarantee this: you will feel good at some point and you will feel bad at some point within the race. Races usually ebb and flow, runners rarely feel terrific the entire way. We always hit little walls. If you hit one just focus on the next mile, don’t think about the end of the race. If you take each difficult moment one mile at a time you will usually feel better at some point. It always comes back because. . . You Always Have One Cup Left That’s right – you always have one cup of energy left. The difference is that some people find it and some don’t. Remember what normal, untrained people do when they feel discomfort – they slow down and feel better. You are not a normal un-trained person. You are a runnining machine! You are programmed to give your personal best so. . . Go get that last cup!
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Racing
What is the Right Cross Training Exercise for You?September 19, 2022
There are almost unlimited ways to get an enjoyable workout in when you are in a recovery cycle, need to give a running related sore body part a rest, or when you are hoping to add activity without additional running mileage. In the chart below, we focused primarily on activities which function as running replacements in terms of cardiovascular stimulation vs activities like yoga, which may have other helpful primary benefits such as flexibility, etc.
Have a question, comment, or recommendation on your favorite cross training exercise? Write to your coach!  Updated by Cally on July 15, 2023
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Training
 Dr. Waite holds a B.S. in Exercise Science from Creighton University and a Doctorate in Chiropractic Medicine from Palmer College. She has treated the knees of professional cyclists, the hands of musicians, the backs of police officers, the shoulders of golfers, and the feet of marathon runners. Dr. Waite is a certified Active Release Techniques (ART) and Graston Technique provider, and specializes in the treatment of all manner of soft tissue and repetitive strain injuries. rc: Many recreational athletes struggle with periodic back pain. What are a few of the most common problems you see as people seek treatment in your office? AW: Low Back Pain due to Psoas (long muscle along the lumbar region) tightness, Paraspinal Lumbar tightness (knots in the low back in muscles adjacent to the spine), and Sacroiliac joint pain due to ankle instability avoid to in order to reduce the chance of developing periodic back pain? AW: Common causes of low back pain include sitting for long periods of time and continuing to use your running shoes beyond 300 to 400 miles. Since running is a repetitive motion exercise which can lead to repetitive strain injuries, don't put off making an appointment for myofascial release such as Active Release Technique. Make sure you stay hydrated and don't over train! rc: What can you do at home to encourage maintenance of a healthy back? AW: Simple things we can do include maintaining a daily stretch routine, getting up and moving around every 20 minutes if you have a desk job, going to a Pilates or Yoga class once a week, using your foam roller on the hamstrings, adductors, quads, and IT bands, and making sure you cross train as an increase in overall strength and core strength will give you a more efficient stride.
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Injury Prevention
Many runners have a tough time sticking to beneficial patterns of eating because the rest of life outside of running doesn’t always cooperate with that intention. What to do?
Here are a few tips to help keep up with nutritional demands in the midst of a hectic daily schedule:
The best way to ensure you act on good intentions is to eliminate the obstacles holding you back. You may forget a water bottle at home and/or yet again arrive to the start of your run, under-hydrated. In an ideal world, you should hydrate systematically throughout the day, with sports drink as well as water. Be sure that your blood has plenty of electrolytes and that you have replenished sufficiently from perspiration in your last training session. Failing that scenario (and that scenario is often failed), make sure that you’ve at least given yourself a fighting chance by getting some H2O down the hatch before you do or eat anything else.
Fueling during, before, and after your strenuous training is key to recovery as well as to just accomplishing the task in hand without hitting the wall. Many times we are coming from work or another commitment, heading out first thing in the morning, fitting in a run at lunchtime, or otherwise shoehorning our workout into the sliver of time provided by the rest of the day. Many times, that means we don’t have handy nutrition. As a a result, we end up waiting too long to eat after a run, crash during a workout, run out of energy to even start, or finish with less punch because we ran out of gusto midway through. Next time you are at Costco, Target, the supermarket, or shopping online, instead of purchasing a bar or two for the current instance at hand, purchase a box. (Added bonus - this is often less expensive per unit.) Take a few and stack them in the glove box, your briefcase, your purse, your desk, your sports bag, and in any other household vehicle you might end up driving to a run. You’ll immediately forget about these anyway, and probably still try to address your nutrition needs on a day to day, run to run basis. However, when you inevitably find yourself on a day where you have nothing to eat before, during, or after a run, a light bulb will go off above your head and you will be very glad you have your secret stash.
More than ever, Americans eat meals out of the home. Social, work, athletic and other commitments leave us in need of quick meals or require us to socialize over a meal. We all have been told since childhood that vegetables are an important part of our diet – after all, they provide crucial vitamins, minerals, fiber, and digestion regulation. There will be plenty of times when a healthful set of options is not available. When the opportunity is presented, always order the salad (and eat it without heavy doses of dressing). Many times, salad is an option instead of fries or chips, vegetables are negotiable when ordering a sandwich, or a salad is possible to add on the side of an entrée for a nominal cost. Always take this option, and you will mitigate the effects of the unavoidable bad nutrition situations you must navigate the rest of the day.
If your schedule requires you to eat out, if your office seems to have donuts or somebody’s birthday cake lurking in the break room more than once a week, or even if you are headed to the movie theater or a sporting event, have a piece of fruit or a healthy snack beforehand. Chances are, what you have at home is less processed and better for you than concessions, party food, or sheet cake. It is often very difficult to avoid over-consuming foods that are not helpful to your athletic goals. By taking the edge off with a healthy snack beforehand, you increase the chances that you will make sane choices and employ appropriate portion control. Of course, many non-runners lead busy lives and have a hard time staying on top of good nutrition. Undoubtedly, running a session of mile repeats or a 20 miler on the weekend adds a layer of complexity and urgency to your nutrition needs, while further eroding your discretionary time to take in the appropriate food. While none of us will be able to keep a perfect record on this front for any extended period of time, celebrate the wins when you make a good choice. Don't dwell on the bad choices when you fall short. If you have figured out a path to accomplishing success one time, you can find it again. This will transform a single occurrence into an important habit.
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Nutrition
You already know how to hydrate and how to run. But do you know how to put the two together? It has been proven that proper hydration can drastically improve race results but many runners have trouble drinking water and sports drink while on the move. The constant motion jostles your stomach which is already void of necessary blood resources which are attentive to your leg muscles. This is one of the many reasons that the art of hydration is essential. We use the word ‘art’ as opposed to ‘science’ because there is a limited amount of calories and fluids that can be utilized intra-run (unlike cycling, walking and other activities). Because of this we recommend experimentation to determine the most effective personal hydration routine (ie. Much like runcoach training the below is not a one-size-fits-all assignment. Experiment and find the routine that works best for you). Here are some tips to get started:
For runs longer than 75 minutes or runs in the heat, you will need more than just water. We recommend sports drinks containing sugar and salt in appropriate quantities. Here are some tips to pick the right drink for you:
Start refining your personal art of hydration at least 10 weeks prior to race day and practice before, during and after most runs. Here are some tips for refueling on the run without carrying a water bottle:
The exact amount you need to drink can be tricky and will vary from person to person. Here’s a science project to help you learn about your hydration needs:
Example: if you weighed 160 before a 90 minute workout and then weigh 157, you have lost 3 pounds and require 48 ounces of liquid. Your schedule for a similar event would be 8 ounces every 15 minutes to maintain your weight. Note: This is just an example. Please try this yourself and keep in mind that the amount you need will vary depending on the temperature, humidity and other personal physiological factors. Proper hydration can improve your race results from 5K to the Marathon. Invest some time into the development of your art of hydration.
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Nutrition
Ask the Practitioner: How to Choose the Right ShoeJuly 23, 2012
Claire Wood, Senior Footwear Product Manager (Performance Running) at New Balance Claire Wood has spent a career working in running footwear design and sales. After stints at industry sales powerhouses Mizuno and Brooks, Claire now works with New Balance in their Boston headquarters, leading the development of some of their most popular recent styles. rc: Sometimes when shopping for shoes, a salesperson will ask you to run a bit so he or she can analyze your gait. What types of things are they looking for to help determine the best shoe for you? CW: In this case, the salesperson is looking to identify any biomechanical tendencies – meaning what your body and mechanics by default are doing. This could include the popular overpronation, meaning to roll inward a significant amount that could lead to injury. Overpronation is very common, and a variety of stability shoes address this. Always tell the sales person what prior injuries or areas of pain you often experience. Pain on the inside of the knees or shins could be from rolling inward upon impact and can be easily remedied. rc: What are the key aspects of a shoe that determine what kind of runner it is designed for? CW: Running shoes have gotten so elaborate that it can often be overwhelming to try to figure them out. Running shoes all fall within a certain category, Neutral, Stability, or Control. Neutral means that the footprint and basic design of a shoe is for a runner with a pretty efficient biomechanical gait. A stability shoe would have a higher density of material, found on the medial side of the shoe to bring additional protection to counter forces rolling inward. Control shoes are the highest degree of stability – and are less common than neutral and stability shoes. Always make sure that whatever you’re fit in feels comfortable, as nothing should hurt. In addition to the basic categories, running shoes offer a variety of heights which situate your foot in various positions off the ground. This is called “offset”, and is an important aspect of the shoe. Always make sure you’re never transitioning too rapidly from a shoe higher off the ground to a shoe much lower to the ground, also called a “minimal shoe”. rc: What are some ways in which current shoe technology has evolved to better serve runners? CW: The goal with any running shoe should be to make the experience better for the runner, and let the runner think about the run, not the shoe. Materials in the upper of the shoe have become much thinner and more pliable, allowing for a more secure fit with a much lighter feeling over the foot. The materials that make up the midsole – foams, rubbers, and plastics, are also significantly more innovative. The goal with technology in running shoes is that it improves cushioning, stability and the overall performance of the shoe. This could mean the protective element or the actual feel – be it bouncy or plush.
rc: What are the next frontier(s) for shoe design? What kinds of challenges are you and other shoe designers looking to tackle over the next several years? CW: The next frontiers of shoe design are always focused around the goal of making the run better. Just as our iphones, laptops and vacuums are getting lighter – this is the goal of running shoes. It is important, however, to never sacrifice something in order to make a shoe lighter. For a runner logging a lot of miles or with an injury history – there is often a fine line. That said, the focus of footwear has shifted to not only include what is under the foot and on top of the foot, but the actual position the foot is in throughout the entire gait cycle. Having an awareness of this and helping runners better their overall form – feet, core and upper body included, is all part of what we believe is inclusive to footwear design. Thinking of the foot as an extension of the body, it is our duty to think of the footwear design as an extension of all elements that affect that foot.
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Training
Our philosophy is to train at current fitness level to race at peak performance. For that reason, we don't use goal times. Instead, we use your past race performances to generate your pace chart and training schedule. This is the safest way to progress to the next level. To enter your new race time, follow the steps below:
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Keep a full water bottle on the bed stand and drink first thing in the morning. We know we should hydrate. We also know we shouldn’t rely on coffee or Diet Coke all day, but are inclined to do that in order to stay “up” for the various challenges in our path from 8-5 (or longer). Water also aids in digestion, allowing our bodies to assimilate the good (or not so good) food we consume in a more efficient way.
Buy a box of your favorite bars and stash them everywhere.
Get in the habit of always ordering salad on the side.
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