Self-Care Tips for Athletes with Joint Swelling

I saw a physical therapy patient this week with a chronic knee injury.  His knee was swollen and stiff, much more than normal.  I know his knee well and it typically has only mild swelling with good muscle tone.  His diagnosis is Grade 1 chondromalacia or irritation behind his kneecap.  It’s an issue which most of us, myself included, over 30 years old commonly have behind our patella or kneecaps.

Puzzled with how his knee looked, I asked: “What have you done to make your knee so cranky?”  “Nothing different Doc,” the 42 year old cross-trainer said frustratingly, “Same damn workouts I’ve done for the past 6-7 weeks.”

Here comes my big question: “What did you do after your workouts in regards to cooling down, rollers, stretching and ice?

There it is….the look of a cow looking at a new fence post!

The answer was clear even before he embarrassingly replied: “I didn’t do anything…I didn’t have time.”  It’s a lame excuse and a common practice for athletes of all ages.  It’s my mission with to change that mindset and behavior.

The Truth about Joint Swelling

There are many sources of joint swelling or effusion.  The extra fluid inside a joint can come from the inner lining of the joint, the bone itself or from an infection.

It’s much easier and less painful to keep swelling out of a joint than it is to get the swelling out of a swollen joint.

The important part to note here is to minimize the reason for the swelling instead of trying to convince your body to reabsorb the fluids after they have filled the joint.  I think of process as similar to a flooded bathroom: fixing the leaky pipe under the sink is a much easier solution than mopping up 20 gallons of water covering the floor and soaked under the cabinets.

Tips to Control Joint Effusion

  1. Roll – using a roller on your muscles before and after a workout is a simple relax muscles and to allow your joints to move normally and to do their job.
  2. Stretch – Five minutes of lengthening muscles and fascia before and after a workout improves blood flow and promotes the drainage of waste products from your hard-working muscles.
  3. IceIce is your best friend so start spending more time with it.  If a joint or soft tissue is either overly warm, red in color or sore after a workout, ice it for 10-15 minutes.  Ice quickly decreases the metabolism or joint activity while also decreasing pain.  Both are important.
  4. Posture – As most of us do after our workouts, sitting in a car or at a desk for prolonged periods of time is not good for our spine or joints.  Sitting shortens some of our major muscle groups like our hip flexors and chest muscles. If you have to sit after a workout, make a point to do some of the following:
  • Use perfect spine posture
  • Consistently engage your core muscles
  • Kneel on one knee every 20-30 minutes
  • Sit on a large therapy ball instead of a chair
  • Get up every 20-30 minutes to stretch hamstrings, hip flexors and chest muscles

These are simple steps which don’t require much time or effort. Keeping our bodies healthy is important for many reasons.  Controlling inflammation and swelling should be a top priority for athletes with the common bumps & bruises and wear & tear that comes along with aging and the sports we love.

Runner’s Guide to Managing Calf Pain

Source: Pixabay
Source: Pixabay

It wasn’t a good workout but it was a great run.  I just finished a 5:30 AM run in Santa Clara, CA for 3 1/2 miles and I was thrilled.  Sure, it was only 58 degrees with no humidity, a nice treat from the Florida heat I’m used to, but my excitement was from the fact that I was able to run without calf pain.

I’m out in California with the Jacksonville Jaguars as we prepare to play the Oakland Raiders tomorrow.  I had a few quiet hours this morning before rehab for the players so the timing was perfect for my daily workout.  I didn’t run hard nor did I even burn many calories but I RAN and that was the best part.

Calf Strain Made Easy

Ten days ago I started my day with a calf strain 3 miles into an early 5 mile run.  When I look back at the run that started the pain in the calf, the reasons it happened were obvious.  I suffered a calf strain because I did the following stupid things:

  • Poor Warm-up – I got out of bed at 4 AM and was literally running 11 minutes later.  I skipped my morning soft tissue rolling and stretching routine.  I had to be at the Jags’ EverBank Field earlier that day so was trying to save some time.  Big mistake!
  • Shoe Change – I ran in a new pair of running shoes.  “It wasn’t the time to be breaking in new shoes, Einstein.”
  • Started Too Fast – I was convinced I could finish my 5 mile run in record time and that mindset started as soon as I took the key out of my front door.  I have a steep downhill incline at the end of my driveway.  I remember feeling both of my calves and hamstrings tighten as I ran down that section of my driveway at a 5:30/mile pace 20 yards into my run.  How smart am I??
  • Ignored the Blinking Light – I recall feeling leg pain in both of my calves along with low back tightness about 1 mile into the run.  What did I do?  Nothing.  The dashboard warning light was blinking and I ignored it.  It proved to be the final step in a bad sequence of events on my part that resulted in a calf strain.  I knew better and I only have myself to blame.

Managing Calf Pain

When an athlete hit the 3 decade mark in life, leg pain isn’t too far away.  Calf pain and a pulled hamstring are at the top of the list.  Managing a calf strain is not difficult if you start the sports medicine the right way immediately after the injury.  If not, the pain in the calf becomes chronic and the recovery time is tripled.

  • Ice Immediately – Stop the bleeding and minimize the inflammation.  Pack it in ice for 15 minutes or ice massage it for 10 minutes as soon as possible.
  • Shorten the Heel Cord – Adding a bilateral 1/2″ heel lift in both shoes will decrease the tension on the heel cord – includes the Achilles tendon and the two calf muscles – when walking throughout the day.
  • Apply Compression – Compressing an injured muscle is always a positive thing to do.
  • Lengthen to Strengthen – With a calf strain, gradual lengthening of the fascia and muscles should always take place before calf strengthening begins.  I love the downward dog stretch for this injury to elongate the fascia from the low back to the arches.  This is a key step to decrease calf pain after the initial symptom of muscle “grabbing” is gone.
  • Think Functional – Avoid the urge to aggressively stretch and strengthen a calf strain. Boring functional activities like bike riding and walking will get you pain-free sooner than trying to run while the muscle continues to “knot-up” or “grab”.
  • Soft Tissue in Time – Any early massage or soft-tissue work should be minimal for the first 3-4 days post-calf strain. Trust me, I’ve been there with the mindset: “If I could just get this little knot in the calf muscle to relax, I’ll be fine”.  Digging into the muscle early on will only delay the healing and triple the length of your time to return to pain-free running.

Avoiding Pain in the Calf

Calf pain sucks.  Preventing leg pain is a high priority for Here are a few sports medicine tips to help you avoid calf pain:

If the Wrong Shoe Fits, Give it Away – Use common sense when it comes to shoes, athletic and dressy.  Why use a “light weight” racing shoe for a training run?  Maybe that new minimalist shoe feels good walking around the house but is it the best shoe to do a CrossFit workout after work?  The pretty dress shoes may look good but spending 8 hours a day in a high heel will benefit the foot doctor’s W2 more than it will your 10 km time this weekend.

Rule-Out a Blood Clot – If deep calf is experienced, especially after prolonged inactivity or a surgery, see your doctor ASAP to ensure the pain in the calf is not a blood clot.  This is a very important point to stress.

Spend Time With Man’s Best Friend – The downward dog stretch should become part of everyone’s daily routine.  That’s how strongly I feel about its effectiveness in keeping calves healthy for athletes of all ages.  Stretching may not be as sexy as doing curls for the girls but if you want to keep running pain-free, flexibility needs to part of your plan.

Support Early & Often – Whenever possible, calf-high compression socks should be worn.  To work, especially on an airplane and during workouts, compression socks/sleeves will help support the entire shin and keep your calves happy.



Running Foot Pain or Stress Fracture?

Running Foot Pain or Stress Fracture?

Pain is often a runner’s most loyal training partner, free from the busy social calendars or alarm clock failures that leave you pounding the pavement solo during those early-morning 5 milers.

Differentiating “normal” pain from one that merits a visit to your local sports medicine specialist is the tricky part of that relationship.  Let me help you address this problem to keep you healthy and happy…and running pain-free.

The Inside Scoop on Foot Stress Fractures

Stress fractures located in the foot are usually characterized as an overuse injury to weight-bearing bones.  High-impact sports that involve running and jumping contribute to simple foot pain and, if left untreated, can lead to a more serious problem like stress fractures.

Bones generally respond to stress by hardening along their outer margins.  When suddenly exposed to strong forces or ongoing stress, there is little time for bones to adapt. Meanwhile, muscles associated with the feet lose their shock-absorbing capacities when fatigued. These uncontrolled forces inadvertently transfer to nearby bones, possibly resulting in small cracks that are better known as stress fractures.

Stress fractures commonly occur in distance runners along the outer ridge of the forefoot over the fifth metatarsal bone. This is often referred to as either a Jones fracture or a Dancer’s fracture, depending on location.

Statistically, women are more prone to stress fractures than men due to biomechanics, nutrition and possibly menstrual cycles. Running an excessive amount of miles in a short time span with insufficient rest increases the risk of generalized foot pain, plantar fasciitis, turf toe, metatarsalgia and stress fractures.

Obviously, any underlying bone disease or disorder will drastically increase one’s risk for these conditions. Outlined below are key characteristics and recommendations with respect to these aches and pains:

Signs & Symptoms of Stress Fractures in the Foot

  • Localized foot bone pain that is dull, aching or sharp and occurs during activity (especially running) and/or periods of rest
  • Mild widespread foot swelling and tenderness
  • Pain that worsens with prolonged exposure to ice and during sleep
  • An initial sensation of sharp pain followed by intensifying aching
  • Related lower-extremity symptoms such as lateral thigh/knee pain, low back tightness and/or Achilles tendonitis due to altered foot mechanics sometimes observed in runners

Professional Treatment for Foot Pain in Runners

  • Get plenty of rest and apply ice.
  • Avoid placing excessive weight on the affected foot.
  • Wear shock-absorbing footwear, and if symptoms worsen, use a walking boot to help mitigate stress on the injury site.   
  • Eat healthy and ingest the Recommended Daily Allowance (RDA) of calcium and vitamin D to help restore bone integrity.
  • Engage in strength training for the arch, toe flexors and weak muscles, which may have contributed to the initial injury.
  • Maintain an ideal range of motion for surrounding muscles and joints, specifically the Achilles, calf, plantar fascia, great toe and ankle joint.

Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask a sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. What do you believe is the main reason(s) why this injury occurred?

2. How can I best manage this pain and safely return to running?

3. Do I need orthotics and if so, which foot doctor(s) do you recommend I discuss treatment with, specifically as a runner?

4. Should I concern myself with any potential long-term issues associated with this pain?

Elite Sports Medicine Tips from Mike Ryan

  • Time is of the Essence – Visit a sports medicine specialist as soon as symptoms appear to best manage foot pain from the onset.
  • Rest Rocks – It’s boring, but REST is the #1 tool to tame a stress fracture.  For how long, you ask?  Prepare yourself for 2 to 6 weeks of inactivity if symptoms persist.
  • Be a Turtle, Not a Hare – Resume your running regimen slooooowly. Include pool running, run/walk routines and off-road routes while increasing your miles by no more than 10% per week.
  • Mix It Up – Cross training is king. Add varied activities such as biking, swimming, yoga, strength training and elliptical training to stay in shape and save your “marriage” during this break from running.
  • Smooth and Steady – Wear stable and proper-fitting shoes to protect your feet.
  • No Big Break – Stress fractures can easily develop into typical bone fractures if left untreated.  Setting limitations from the get go can help you avoid the “big break.”

Tame Heel Pain Flareups From Plantar Fasciitis

Tame Heel Pain Flareups From Plantar Fasciitis

Understanding Plantar Fascia Strains

Plantar fasciitis causes localized pain in the backside portion of the arch that attaches to the underside of the heel bone, or calcaneus.  It often results from overstretching, overloading or tearing in the arch origin that runs from the heel to the front portion of the foot, under the toes.

This band of tissue helps stabilize and propel the foot forward during movement and stretches each time weight is applied when standing or walking. Plantar fascia strains occur when the band experiences excessive trauma or if the arch is exposed to persistent stress. A plantar fascia strain usually gives rise to sustained inflammation in the front of the heel and back portion of the arch. This creates a high level of localized pain, particularly after a prolonged period of rest during non-weight bearing activities such as sleeping and sitting.  The band simply tightens when not in use, and if left untreated, a plantar fascia strain can become a chronic and troubling ailment.

Causes: The most common cause of plantar fasciitis is wearing inadequate footwear while running, walking and/or jumping. Additionally, beginners who go overboard doing new physical activities may inadvertently overstretch the band.   Additional factors include obesity, sudden weight gain, flat feet, and excessive exercise with insufficient levels of progression.  Heel bone spurs may also result as the band continues to pull on the heel bone, causing chronic arch pain.

Signs & Symptoms of Heel Pain From Plantar Fasciitis

  • Burning, stabbing, or dull aching pain in the front of the heel and along the tissue band in the backside of the arch
  • Difficulty placing weight on the foot while barefoot
  • Arch pain that occurs with heel raises or flat-footed squatting
  • Localized swelling and tenderness under the heel and arch

Professional Treatment for Plantar Fasciitis

Plantar fascia strains usually respond well to conservative treatment methods. However, recovery time does vary from individual to individual. Be sure to:

  • Rest and avoid weight-bearing activities to lessen heel pain.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Ice the arch and toe flexor tendons in a stretched position on a consistent basis to reduce inflammation and pain while elongating the sore plantar fascia tendon. 
  • Always wear the proper footwear for your sport(s).
  • Tape the foot to assist in arch support, reduce inflammation and decrease the risk of further injury.
  • Massage the posterior arch with progressive, aggressive transverse-friction, applying more moderate pressure to the ankle and lower shin.
  • Perform strengthening and stretching exercises for the neighboring arch and calf muscle.
  • Buy arch support shoe inserts.
  • Properly tape the arch to provide effective support and reduce heel pain when performing weight-bearing activities.
  • Minimize weight-bearing activities.
  • Work to shed excess pounds, if overweight or obese.

Ask the Right Questions like a Pro

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1)   Is this heel pain related in any way to my pelvis, lower extremity or foot alignment?

2)   Which types of physical therapy are best to quickly resolve this problem so I can get back to my sport(s), pain-free?

3)   Are non-surgical treatment options available?

4)   Can this problem cause any long-term complications?

5)   Will anti-inflammatory medicines provide relief?

6)   Is my painful heel a result of some other biomechanical abnormality that must be addressed?

Elite Sports Medicine Tips from Mike Ryan

  • Fast Treatment=Fast Recovery: The sooner you address plantar fascia strains, the sooner they resolve.  Seek treatment quickly to avoid a chronic problem.
  • Defy Sir Isaac Newton: Aggressive weight-bearing activities prolong recovery time and increase the risk of long-term complications.
  • Embrace that Après Workout Life: Immediately following your workout (or related treatment):
    • Elevate your foot for 3 minutes
    • Stretch for 5 minutes
    • Ice your arch and heel for 7 minutes
  • Unleash Your Inner Gumby: Aggressively stretching your calves, arches, big toe and toe flexor tendons will go a long way toward maintaining healthy tissue in the entire foot.
  • Eat and Drink Right: It’s easier and safer to control inflammation and promote healing by staying well hydrated and maintaining a healthy diet rather than popping pills to manage the problem.

Tips for Fast & Healthy Running

The big race is this Saturday…the Gate River Run 15 km USA Championship Race.  This race goes well beyond a local “bragging rights” race by being one of the most organized sporting events in the country, thanks to Race Director Doug Alred and his 1st Place Sports staff.

I ran my first River Run in 1995 and I try to compete in the very challenging race every year.  What I’ve learned from this race is that the distance, the large number of turns and, of course, the bridges make it a race that can easily leave me sore.

In an effort to help my readers to experience a successful race and a healthy finish, I’ve put together my sports medicine tips for healthy running.

Pre-Race Checklist

Train Smart – It’s too late to make any significant gains this late in the week for a Saturday race.  My rule of thumb is the best thing to do to help myself during race week is to ensure that my legs are FRESH.  Be smart and allow yourself to relax and rest more than squeezing in the last few dangerous miles…..and your legs will thank you on the Hart Bridge.

Grease the Dogs – A 1/2 inch blister can ruin a great race.  A light coat of Vaseline or petroleum jelly on toes, arches, heels and anywhere you may experience chaffing will help you run comfortably during the day and give you a great reason to dance painfree that night.

Drink Early & Often – In cool or hot weather, you still need fluids.  A consistent habit of consuming a 50% water and 50% sports drink mix starting 24 hours before the race will keep you fast and safe.  Keeping the same plan both during and after the race is always smart.

Recovering From the River Run

Your recovery starts the minute you cross the finish line.  It doesn’t take much effort on your part but if you implement these tips to supercharge your recovery, you’ll be thankful that you did come Monday morning as you head back to work to brag about your record time in “the big race”!

Push the Fluids – I know that the post-race beer trailer sure looks more inviting than the Hart Bridge but it might not be the best option for you 90 seconds after hitting the finish line.  Drink extra water and sports drinks to replace the fluids, calories and the ever-important electrolytes before you toast a cold one with the crew.

Carb Time – Carbohydrates have gotten a bad wrap in the weight-loss world but after any hard race or cardio workout, they are your best friend. Healthy running needs good sources of calories and carbs is the key to that fuel.

Drain Your Legs – Elevate your legs straight up in the air and pump your ankles within 20 minutes after the race for 5 – 10 minutes.  Use gravity to your advantage to help your lymphatic system to drain “the bad stuff” from your hard-working legs.

Run Out the Pain – Trust me on this one….run the next day after every race and every hard workout.  It may only be an easy 1 mile trot on the soccer field or a 10 minutes of light side-shuffles and agility drills on the soft beach but its extremely helpful to force your legs be lightly loaded the day they are pushed aggressively.

Massage and Stretch – Get your legs, feet and hips massaged and stretched as soon as possible to keep the natural waste products from the race to become embedded in the membranes of your muscles.

Pain Relief – If you have no medical complications, taking a small dose of over-the-counter anti-inflammatory medicine a few hours after the race and before going to bed the night after the race will help put some skip in your step when the sun comes up in the morning.

Ice and Compression Sure ICE therapy hurts but it’s necessary if you’ve raced hard.  If your legs hurts, ice them for 15 minutes and follow up with a compression sleeve when walking or running for the next few days.  This is a great way to control extremity edema and accelerate your recovery.

I hope that you’re as excited about the race as I am.  I hope these sports medicine tips from Mike Ryan Fitness help you to have a fun River Run with a fast recovery.

Stay healthy & happy and I’ll see you on the road this Saturday!