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THE SCIENCE OF PERFORMING IN THE HEAT

By CEO Robert Forster, PT

Exercise in extreme heat puts great stress on numerous physiological systems of the body. It can severely debilitate athletic performances, create bodily damage, illness and, in extreme cases, cause death. Knowing how the body reacts to heat can help you combat this environmental stress intelligently and prevent it from ruining your preparation for a great performance.

You have planned for months for the biggest triathlon race of the year. It is a true test of your fitness and the many hours of preparation you have invested in your training. NOW is the time when it is all supposed to come together for a great day of racing. On race day you barely notice it feels a little warmer than home because you are distracted with pre-race preparation. You are not accustomed to drinking from the tap so forego your usual jump on hydration but make a mental note to drink more at breakfast. You rush through breakfast and suddenly find yourself at the start a bit thirsty. You attribute the dry mouth to nerves but you are already sweating as the time for your wave to go off approaches. As you pummel your way through the crowded water it’s “water, water everywhere but not a drop to drink.”

In transition you take a few gulps of water but rush to get on the bike. As you settle in for the ride you hit the water bottle, as you are sweating more than usual due to the high humidity. You feel good and push past the aide stations as you sip your water bottle. Your time is good at the Â¾ mark but you notice your hamstrings are tight and there is a pain between your shoulders. You feel bloated and as you transition to the run you notice your water bottles have not been drained. You make another mental note to drink at the first aide station.

As you leave transition and the cheers fade you notice many competitors returning from the first loop of the run are wasted and walking. However, you become distracted when your right hamstring seizes into a painful spasm. “Oh, what’s that?” you say. As you stop to stretch then, BAM!, the left hamstring seizes. You start envisioning your day getting a lot worse as you see your great time quickly slipping away. You limp, rub and stretch your way to the finish line. You have been sabotaged by the heat!

The scene in the medical tent tells the story as IV bags hang next to each cot where exhausted, dejected athletes receive assistance. The medical team explains the typical scenario that played out on the course hoping an educated athlete is the best way to avoid a repeat of what turned out to be a disastrous day for so many. A few were even taken to the hospital suffering severe heat illness.

The doctor explains that exercise in extreme heat puts great stress on numerous physiological systems of the body. It can severely debilitate athletic performance, create bodily damage or illness and in extreme cases, even cause death. However, if an athlete is educated to how the body reacts to heat they can combat this sometimes unpredictable environmental stress intelligently with scientific measures to prevent it from ruining their preparation for a great performance.

He further explains that body temperature rises due to internal and external factors. Internally heat is generated during the metabolism of food sources as eighty percent of all energy from carbohydrates, fats and proteins are eventually transformed to heat. Furthermore, muscular contractions produce heat, as does the mechanical friction of tendons and joints as they move thousands of times during the race. If this heat is not transported to the skin and dissipated to avoid overheating risk of multiple system failure builds quickly.

External factors play a role as well and while it is common knowledge that in warmer weather it is more difficult for the body to dissipate heat than in cooler weather few people realize that in very warm weather the body will gain heat from the environment. Since the skin temperature usually varies between 93°F and 98°F; when the air temperature is greater than 99°F the air actually heats the body more. Direct sunlight increases body temperature further when the body absorbs radiant heat. Humidity magnifies the effect of hot weather by rendering ineffective the very mechanism the body relies on to dissipate heat; i.e., sweating.

The Physiological Response to Heat

Receiving sensory feedback from body receptors both internal and external, the brain senses increased temperatures as a stress to homeostasis. The brain therefore orchestrates a far-reaching bodily response to dissipate heat in an attempt to maintain normal physiological function. This begins with the release of the stress hormones cortisol, epinephrine and norepinephrine, which set off a systematic series of events within the body to offset the heat. In an effort to dissipate heat from the working muscles and the core; blood is shunted by a magnitude of 30-40% from the internal organs to the skin and superficial muscles. However, this is not enough. The heart must increase the volume of blood pumped with each contraction (cardiac output) from 6 liters to 25 liters per minute to get more heat-carrying blood to the skin where it can be cooled. Simultaneously, the brain directs a decrease in kidney production of urine to spare fluids.

The cooling of blood near the skin occurs when millions of sweat glands located just below the surface increase sweat production to moisten the skin. The body is cooled when air moving over the skin evaporates the sweat taking heat with it. In hot, dry conditions sweat evaporation results in 85-90% of all heat dissipation during exercise. In humid conditions however, this efficient mechanism is handicapped as sweat is less likely to evaporate in the moist air. The sweating mechanism continues in vain to cool the body and quickly results in dehydration.

The Physiological Stress of Overheating

The body is very efficient at dissipating heat and under everyday conditions these mechanisms go a long way in preventing overheating. However, these physiological responses can be outpaced with sustained exercise in the heat. Nature apparently relies on the sensibility to stop laboring when one feels overheated. For athletes, soldiers and workers this is sometimes not an option and serious health problems can quickly arise. The circulatory system is taxed when excessive sweating depletes the volume of fluids in the blood and blood is shunted to the periphery. These events lead to a 20% decrease in the circulatory volume in the vascular system. The heart beats faster and harder to deliver the same amounts of nutrients and oxygen to the working muscles.

The cardiac and circulatory stress is further elevated by the loss of electrolytes in the copious amounts of sweat produced in hot weather. Electrolytes are essential to nerve impulses and the resulting muscular contractions that produce movement. Electrolyte depletion and the resulting breakdown in performance begin slowly but degrade quickly if intensity of exercise is not adjusted and electrolyte supplementation and re-hydration is not executed.

Further performance degradation occurs when overheating causes a shift in muscular metabolism from fats (aerobic) to carbohydrates (anaerobic) energy production. Carbohydrate metabolism however produces fatigue associated with lactic acid production. Carbohydrate stores are quickly depleted leading toward total system shutdown called “bonking.”

Prevention of Overheating and Performance Degradation

The prevention of overheating problems during exercise begins in the Base Training Phase of your training (see Triathlon January ’04 issue) where improved fat burning capacity of muscles diminishes the detrimental effects of the unfavorable shift in muscle metabolism from fats to carbohydrates. Early season strength training and skill developing drills improve efficiency of joint stability and movement. Together these athletic attributes prevent unnecessary heat production associated with wasted motion.

Later in the season specific heat acclimation measures will greatly improve your capacity to perform in the heat. (see Heat Acclimation at the end of the article)

Proper Hydration and Supplementation for Prevention of Heat Illness

Staying well hydrated at all times maintains the quality of performance in workouts and competition. 24 – 36 hours prior to the race you should be hydrating and liberally salting foods. Pre-hydration is critical in the prevention of heat related problems. At least two hours before exercise drink 20 ounces of fluid with electrolytes and carbohydrates in a 10% concentration to increase absorption rates. Cold fluids are absorbed quicker than room temperature beverages.

During exercise sweat loss can range from .8 to 1.4 liters per hour and therefore dictates replenish rates of similar volumes. However, the rate that fluids leave the stomach is .8 to 1.2 liters. So, to prevent bloating or the potentially deadly condition of electrolyte imbalance called hyponatremia; hydrate with volumes that do not exceed your absorption rates and always use electrolyte replacement drinks vs. plain water before and during long bouts of exercise.

Catastrophic heat related effects on your performance can best be avoided with knowledge of how heat stresses the body and intelligent scientific training methods that include proper Base Training and disciplined hydration and supplementation practices. Now – go enjoy the day!

A good general guideline would be to consume a sports drink and/or electrolyte supplementation containing 200-500 milligrams of sodium chloride per hour. At the first sign of cramping or performance degradation reduce your pace, drink liberally and supplement with electrolytes or salty foods immediately. You may be able to salvage the day.

Heat Acclimation

Gradual heat acclimation improves your capacity for performing in the heat by creating these adaptive responses with full acclimation occurring with 14 consecutive days of training in the heat.

Increased blood plasma volume by 3-27%

Decreased heart rates by 15-25%

Improved sweat sensitivity and sweat rates by 200%

Decreased electrolyte loss through sweat and urine

Simulated heat training can be achieved by exercising in warm clothes or in a warm room (not a sauna). Intensity must be at least 50% of VO2 max and gradually build up to 90-100 minutes.

Robert Forster, PT is the founder of Forster Physical Therapy and PHASE IV: A Scientific Training & Performance Center, both located in Santa Monica, CA. He has over 35 years of experience treating elite athletes such as Allyson Felix, Jackie Joyner-Kersee, Gail Devers, Florence Griffith Joyner, Pete Sampras, Maria Sherapova & others. He can be reached at 310-656-8600

FOUR REASONS TO TRY SLOW EXERCISE

Source: news.com.au March 4, 2017

Forget about HIIT classes and bootcamp, you don’t need to put yourself through hell to get fit. Here’s why low intensity workouts are better.

HIGH Intensity Interval Training (HIIT) is all the rage these days, but is it really any better than traditional cardio? While it may churn through body fat at a faster rate, research also shows it’s less enjoyable, with poor adherence rates for those trying to lose weight. The best exercise is the one you do consistently and stick to long-term. Enter Lower Intensity Steady State cardio, or LISS for short. This is basically the opposite of HIIT and is defined as exercise that elevates your heart rate to 40 — 50% of your estimated max (calculated by 220 — age), or exercise at a level where you can talk and sing comfortably. Belting out your favourite tunes while you exercise is definitely a bonus, but there are many circumstances where LISS is actually better for you. Here are four reasons why you should opt for a lower intensity workout:

YOU’RE JUST STARTING OUT

If you’re new to fitness, it’s important to gradually build up your exercise regimen to let your body adjust. Going too hard too soon can increase your risk of injury, such as stress fractures, muscle strains, inflamed tendons, and plantar fasciitis. Bypass the bootcamps for now and focus on building a base of fitness instead by accumulating at least 30 minutes of cardio a day such as brisk walking, cycling, or swimming and doing plenty of stretches after to stay injury free.

YOU DON’T ENJOY HIGH INTENSITY TRAINING

It’s a complete myth that you need to run or get your heart rate ridiculously high to reap the benefits of exercise. According to a study in the Journal of Sports Science Medicine, moderate intensity steady state cardio, like brisk walking, provides the same heart health benefits as HIIT, but is much more enjoyable. Some easy ways to make exercise more fun is to buddy up with a friend or partner, listen to your favourite music, or head outside for a walk in nature. Finding joy in movement will ensure you keep up the habit throughout your lifetime, which is the ultimate goal.

YOUR BODY AND BRAIN ARE STRESSED

Stress can come in many different forms, but two of the most common are mental stress from work, and physical stress from lots of intense exercise. Both of these lead to chronically high levels of a hormone called cortisol, which can lead to increases in blood pressure, weight gain around your waist, and a suppressed immune system. The good news is that you aren’t powerless against stress, and engaging in some mind-body forms of exercise like pilates, Tai Chi, or yoga, will boost your mood, health, and energy levels while lowering cortisol.

YOU WANT TO TAKE IT EASY ON YOUR JOINTS

Let’s face it pounding the pavement with long runs or lots of box jumps in Crossfit aren’t exactly kind to knees, ankles, or hips. That’s why it’s important to include lower impact exercise into your weekly routine. One or two active rest days where you go for a light swim, or walk will give your body sufficient time to recover between high intensity sessions. It’s during this time that your muscles, bones, ligaments and tendons repair so you’re fitter and stronger next time you hit the gym. While LISS is kinder to your body long term, that doesn’t mean you can’t enjoy HIIT training from time to time. Just be sure to listen to your body, and switch to lower impact options if you start to feel exhausted instead of energized from your workout routine.

7 Ways to Put Spring into Your Health

The University Of Tennessee

With the change of season comes the impulse to clean and replace the old with the new. But spring doesn’t just have to be about cleaning and reorganizing – it’s also a great way to start healthy new habits and break the old. Here are a few tips to get a head start in your spring health!

Start an Exercise Routine – The weather is warm and the days are longer which makes it a perfect combination to get active outside. The American Heart Association recommends that individuals do moderate exercise for at least 150 minutes per week, or 75 minutes per week of vigorous exercise.

Revamp Your Diet with Fresh Fruits and Vegetables – Take advantage of the variety of vegetables available during spring. A healthy diet includes adding vegetables and fruit every day. Vegetables like broccoli, green beans, leafy greens, zucchini, cauliflower, cabbage, carrots, and tomatoes are low in calories and high in fiber, vitamins, and minerals. Try to eat about 3 to 5 servings every day. Fruit is also a good source of fiber, vitamins, and minerals. You should try to eat about 2 to 3 servings of fruit each day. It goes without being said that its OK to indulge in the occasional ice cream cone. Although, frozen yogurt would be a healthier alternative.

Drink More Water – As the heat kicks into high gear it is harder to stay hydrated and more important to drink more water. Drink plenty of water before going outside and have plenty on-hand to stay hydrated. If you aren’t a fan of water, try one of our recipes for Cucumber Water—it makes a great party beverage for those hot days!

Cut Out the Night Cap – If one of your habits is having a drink before bed, or having a few at dinner, you may want to reconsider your next glass of Merlot. Alcohol not only causes dehydration, but is also associated with sleep disorders, high blood pressure and certain types of cancer. It is recommended that women limit themselves to one drink per day, and men up to two alcoholic beverages each day.

Check In for a Check Up – You may have chalked up some symptoms and illnesses to the winter blues, but now that it is spring, its time to get back to the doctor for a head-to-toe check up! A periodic well-exam for all ages is not just about good medical care, but it also gives you the opportunity to learn more about beneficial health habits, counseling and community support services as well as an overall view of the best ways to take care of yourself and your family for a lifetime. Your doctor will let you know how often they need to test for high blood pressure, diabetes, other diseases, and cancer screenings.

Protect Your Skin – Its going to get hot, the sun is shining, and your skin needs protection. Not only do men and women need to regularly moisturize their skin, but also protect it from the harsh rays of the sun. If you’re outside, make sure to use a sunscreen with SPF 15 or higher that protects against UVA and UVB rays. It doesn’t hurt to throw on a pair of sunglasses and hat as well!

Renew Relationships – It’s time to get out of the house and visit with your friends and family. Research has shown that good, strong relationships benefit your overall health and happiness. Spend the day with people you love, and schedule regular outings to enjoy the great spring weather.

RESOURCE: https://www.utmedicalcenter.org/healthy-tips/94/7-ways-to-put-spring-into-your-health/

EXERCISE ALTERS OUR MICROBIOME

Exercise Alters Our Microbiome. Is That One Reason It’s So Good for Us?

From: Phys Ed

By GRETCHEN REYNOLDS JAN. 3, 2018

Exercise may change the composition and activity of the trillions of microbes in our guts in ways that could improve our health and metabolisms over time, a new study finds.

The results provide novel insights into how exercise can affect even those portions of our bodies that seem uninvolved in workouts, perhaps providing another nudge to stick with our exercise resolutions this year.

I think we all have heard by now that each of us contains a pulsating little universe of bacteria within our guts. This microbiome includes countless different species of microbes in varying proportions that interact, compete and busily release various substances that are implicated in weight control, inflammation, immune responses and many other aspects of health throughout our bodies.

In broad terms, our microbiomes tend to be relatively stable, most studies show. But our microbiomes can change as our lifestyles do. Diet clearly affects the makeup of a person’s microbiome, as do illness, certain drugs, how much we weigh and other factors.

Exercise also has been associated with variations in the microbiome. Past studies have shown that endurance athletes tend to have a somewhat different collection of microbes within their intestines than sedentary people do, especially if the athletes are lean and the sedentary people are not.

But those studies have been associational and could not show whether exercise actually altered microbes or how any microbial changes might later affect health.

So for the new study, which was published in November in Medicine & Science in Sports & Exercise, scientists from the University of Illinois at Urbana-Champaign decided to track the guts of people who undertook an unfamiliar exercise routine.

The study was designed, in fact, as a follow-up to an earlier, interesting animal study by the same scientists. In that work, the researchers had allowed some lab mice to run and others to sit around for most of their adult lives. Gut material from the mice was then transplanted into animals that had been bred to be germ-free, so that their guts would easily incorporate these new tribes of bacteria. After the animals’ microbiomes were established, the scientists exposed the mice to a substance that can cause tissue irritation and inflammation in the colon.

The scientists found that the animals with gut bugs from the runners were better able to resist and heal tissue damage and tamp down inflammation than those whose microbes had come from sedentary mice.

Now the scientists wished to see if exercise would likewise affect the functioning of microbes in people.

They began by recruiting 32 men and women who did not exercise. About half were obese and the rest of normal weight.

The scientists took blood and fecal samples and tested everyone’s aerobic fitness. Then they had the men and women begin supervised workouts, during which their efforts increased over time from about 30 minutes of easy walking or cycling to about an hour of vigorous jogging or pedaling three times per week.

The volunteers were asked not to change their normal diets.

After six weeks, the scientists collected more samples and retested everyone, and then asked the volunteers to stop exercising altogether.

Six weeks later, the tests were once again repeated.

The subsequent analysis showed that the volunteers’ gut bugs had changed throughout the experiment, with some increasing in numbers and others declining. The researchers also found changes in the operations of many microbes’ genes. Some of those genes were working harder now, while others had grown silent.

Most of these changes were not shared from one person to the next. Everyone’s gut responded uniquely to exercise.

But there were some similarities, the researchers found. In particular, they noted widespread increases in certain microbes that can help to produce substances called short-chain fatty acids. These fatty acids are believed to aid in reducing inflammation in the gut and the rest of the body. They also work to fight insulin resistance, a precursor to diabetes, and otherwise bolster our metabolisms.

Most of the volunteers had larger concentrations of these short-chain fatty acids in their intestines after exercise, along with the microbes that produce them.

These increases were greatest, though, among the volunteers who had begun the experiment lean compared to those who were obese, the scientists found.

And perhaps not surprisingly, almost all of the changes in people’s guts dissipated after six weeks of not exercising. By and large, their microbiomes reverted to what they had been at the study’s start.

Still, the study’s overall results suggest that even a few weeks of exercise can alter the makeup and function of people’s microbiomes, says Jeffrey Woods, a professor of kinesiology and community health at the University of Illinois who conducted the study, along with his doctoral student Jacob Allen (now a postdoctoral researcher at Ohio State University) and others.

In theory, Dr. Woods continues, these changes could contribute to some of the broader health benefits of exercise, such as its ability to reduce inflammation throughout the body.

“But more studies need to be done to prove this,” he says.

He also hopes that future research can explain why the obese volunteers showed smaller gains in their fatty-acid producing microbes than the leaner men and women. Additional study could also help to determine whether and how people’s microbiomes might continue to change if they exercise for longer than six weeks — a goal that all of us, of course, have resolved to do in the coming year, right?

A version of this article appears in print on January 9, 2018, on Page D4 of the New York edition with the headline: Gut Bacteria Need Exercise, Too. Order Reprints

The Biggest Loser Study

How the Biggest Loser permanently ruins participants’ metabolism

Posted June 30, 2016 by Peter Janiszewski, Ph.D. in News, nutrition, Obesity Research, Peer Reviewed Research, Physical Activity

The Biggest Loser has received a healthy dose of backlash from the medical community over recent years; all of it well deserved.

If you haven’t seen the show (I admit I’ve only seen an episode or two), essentially a number of individuals with morbid obesity sign up to go through a grueling program of starvation combined with insane volumes of exercise in the hopes of winning some cash for losing a bunch of weight. They get pushed abused by their ‘trainers’ all week, only to endure the humiliation of being weighed in front of millions of viewers. At the end of the 30 week period, contestants often lose astounding amounts of body weight; WAY beyond what any respectable health authority would ever recommend.

This all makes for a very popular reality TV show.

But what happens to these contestants after they are done with the show and the drill-sergeant trainers aren’t there to scream at them to exercise for hours while subsisting on grapefruit?

A recent study published in the journal Obesity (read the whole article for free) sought to evaluate exactly this question by checking in with 14 Biggest Loser participants some 6 years after they appeared on the show.

First thing to note is that on average these participants lost an astounding 58.3 ± 24.9 kg during the 30 week competition.

As the human body is really good at maintaining equilibrium (and keeping you alive), it does something interesting but unfortunate when significant weight loss occurs: it reduces the number of calories it burns. In effect, it becomes more efficient with energy in order to prevent what physiologically is happening: starvation. This process is called metabolic adaptation.

So how much can such a tremendous weight loss impact one’s daily metabolic rate?

At the end of the competition, the participants’ resting metabolic rate (energy you burn while doing nothing) decreased by 610 ± 483 kcal/day.

Such a change would most definitely make subsequent weight loss more challenging despite the same commitment to starvation and exercise.

Not surprisingly, 6 years after appearing on television, 13 of 14 participants regained some, all, or in excess of the weight they had lost during the show; 5 participants were at their original weight or higher.

But had their metabolism also gone back to normal along with their body weight?

Unfortunately, no. In fact, 6 years later they were still burning approximately 700kcals less per day that when then started on the show. This means that just to maintain their weight, they have to expend an extra 700 kcals or reduce their consumption by 700 kcals over what they were doing before. Their energy expenditure was approximately 500 kcal lower than you’d normally expect for a person with these demographics and measurements.

This suggests that while the weight loss achieved with the Biggest Loser is most certainly not permanent, the damage done to the underlying physiology of energy homeostasis is.

This doesn’t even address the fact that such drastic lifestyle changes are completely unsustainable.

Peter

Reference:

Fothergill et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. 2016 Obesity

LATERAL KNEE PAIN AND THE ILLIOTIBIAL BAND

By CEO Robert Forster, PT Author: Healthy Running Step by Step, The Complete WaterPower Workout Book

Pain on the outside of the knee is one of the most common complaints from marathoners we see as they build up the mileage in training.

The usual culprit is excessive friction between the thick band of fascia on the outside of the thigh called the Illiotibial band, and the bump at the end of the thighbone (femur).

In most cases, the pain is in one knee and not the other. This begs the question: why would only one knee hurt if both legs ran the same mileage? The answer, as in all one sided “asymmetric” marathon overuse injuries, a mechanical deviation in the pelvis on the injured or non injured side of the body.

Most often, the cause of IT band syndrome is a pelvic misalignment, causing a functional leg length discrepancy. When the pelvis is unbalanced, the joints of the “short” or “long” leg will make adjustments to compensate in an attempt to level the pelvis.

Typically, the foot on the long leg side will over-pronate as a strategy to flatten the arch and functionally shorten that leg while the foot on the short side will typically supinate in an attempt to hold that arch up and functionally elongate that leg. Either of these subtle but significant compensations will cause aberrant forces to bear down on the vulnerable tissues on the outside of your knee.

An effective rehabilitation program must not only treat the painful area, but also address the cause of injury by exposing and correcting the mechanical imbalance at the pelvis.

Anatomy and Function

The Illiotibial Band is a thick band of fascia that extends from the pelvis down along the outside of the thigh to attach below the knee on the outside of the lower leg bone called the tibia. The IT Band functions to stabilize the thighbone and knee during the weight bearing “stance” phase of the running or walking gait; and helps guide the lower leg as it swings forward through the air in the swing phase.

Just before foot strike, the illiotibial band slides over a bony prominence on the outside of the knee called the Lateral Epicondyle. This irritates a structure called a bursa (a fluid filled sac much like an internal blister that is supposed to be there) which is designed to prevent friction between the bony prominence and the illiotibial band.

Pain Presentation

Illiotibial Band problems may also present at the top end of this broad band of fascia running along the outside of the thigh. Either at the top, where it originates on the outside of the pelvis; or much more commonly, at the lower end at the site of the bursa on the outside of the knee. This lower IT Band pain tends to appear suddenly on a run and it often becomes so severe you have to limp or stop the workout and walk home.

While it does not represent a high degree of damage to the bursa or the IT band, it can be one of the most painful conditions runners suffer and it will stop you in your tracks.

If you ignore the pain and continue to run, the pain will progress to daily activities including stairs, squatting and pivoting. At the top of the IT Band, where it attaches to the outside of the pelvis bone; the pain can come on more gradually and is typically much less intense, but can be equally as persistent. Pain in either the top or the bottom should never be ignored because they can be very stubborn and difficult to resolve if you run through the pain for any period of time.

The pain typically limits your workouts rather quickly before it can cause significant damage to the bursa or the illiotibial pain. However, if pain causes you to limp or alter your gait in an effort to limit the pain, you are likely to cause excessive stress on other structures and cause additional, potentially more damaging injuries.

Rehabilitation

Alleviating marathon-training injuries requires the right treatment to the right structures. The first step in any sports rehabilitation program is to first get an accurate diagnosis. Most often, lateral knee pain in marathoners is an IT Band syndrome, but it is critical to rule out a meniscus cartilage tear and tendon injury before settling on a diagnosis.

The primary approach to all IT Band syndromes is to address the inflammation and pain at the injury site while simultaneously working to limit the amount of pronation in the foot when you run. Ultimately, this involves correcting leg length inequality with stretching and strengthening exercises. This takes some time but improving running gait mechanics can immediately start to reduce the pain.

Summary

Lateral knee pain needs to be evaluated immediately to rule out problems in the joint itself. Local icing and PT treatment at the painful site will help, but ultimately we need to address the leg length discrepancy for total resolution of the problem. We will teach you stretching and strengthen exercises to correct your alignment and work with you to improve your running mechanics.

Call Forster Physical Therapy for your free evaluation: 310-656-8600

Remember, California law allows you to go directly to Forster PT without first seeing a doctor for a referral.

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