Each time you land in your running stride, forces are being propelled from the ground into your body, moving from the muscles into the bones. The way the force is received and which muscle receives it helps your brain decide which bones to move and joints to bend. In the process, one structure is responsible for the transmission of force from the muscle to the bone: .听

Because it鈥檚 subjected to high force loads, and with poor blood supply, a tendon can easily become worn-down, leading to . In runners this most often shows up in the lower limb tendons: patellar, Achilles, hamstring, peroneal, and anterior tibialis tendons.听

The prevalence of tendon-related injuries and the performance costs associated with them is not lost on researchers and clinicians. Working together, they are seeing similarities in treatment protocols for tendon issues. Moreover, statistically supported studies have offered a new way to look at treating, rehabilitating, and preventing tendinopathies.

Progressive Loading

These studies have concluded the most effective treatment method to get runners back to running quickly and effectively is . Tendon specialized researcher says that for all tendon issues, a plan with progressive load, respecting pain, has been shown to be effective. This treatment involves loading the tendon via weight or amount of impact in a progressively increasing manner, i.e., increasing weight or increasing sets. For example, doing seated calf raises where load is increased by number of repetitions or by adding weighted barbells.听

In the context of running, progressive load means scaling back intensity and volume, then gradually increasing them as the tendon tolerates it. For example, a runner doing 60 miles per week who presents tendinopathy symptoms would be encouraged to reduce their mileage to a level where pain is minimal during running (i.e., 30 miles per week), and to eliminate any high intensity efforts like fartleks or tempo runs.

Rest Not Required

Previous treatment methods involving rest are no longer suggested, as the long-term outcomes are not successful. While pain may initially dissipate after rest, it returns with time back in the activity as the tendon has not been properly rehabilitated.听

鈥淭raining for sport comes from doing sport,鈥� says Malliaras. And being inactive is not going to allow a structure to regain functionally active capacity. This is good news for runners because most treatment providers, aware of the research, will be in favor of allowing you to continue running while simply altering the load (i.e. distance, time and intensity).听

A critical caveat of this treatment method however, is to recognize that it must be individualized. The load level to start, the load level to progress, and the advancement to energy-storage exercises are unique for every person and their tendons. If this is not properly outlined and monitored, the tendon could potentially regress instead of progress.

is a runner-specialized physiotherapist and puts a lot of time and thought into crafting individualized rehabilitation plans for runners presenting with tendinopathies. He explains how he diagnoses based on symptoms: 鈥淚f a runner can point to the location of their pain with one finger and it is over the site of a tendon, this greatly influences the likelihood of a tendinopathy.鈥�

The progressive load treatment methodology should begin as soon as possible, Sharpe explains, starting with 鈥渁 level that is tolerated and slowly building up.鈥� The starting point will be individualized, ranging from low level calf raises to simply decreasing mileage. If there is no irritation to the tendon during the exercise or in the 24 hours post-exercise, that鈥檚 a good indication the loading capacity is suitable.听

For runners, tendinopathy will sometimes be painful at the beginning of a run, then settle down and hurt less as the run continues. The following day, however, the pain is likely to show up if the tendon has been overloaded. Runners should take note of this as an indicator of tendon stress.

Choose The Right Doctor听

As the patient, it is important to advocate for yourself and seek out a healthcare professional who knows the importance of continuing to run and progress load for treatment, and who is also adept at crafting appropriate loading volumes.听

However, it is imperative to also recognize that this science is still evolving. While the understanding has progressed, there remain several areas with lacking research. Tom Goom, a physiotherapist, researcher, and owner of the popular resource site says, 鈥淭here are a lot of theoretical papers, narrative reviews, biomechanical studies etc., but very few testing treatments.鈥� What actually works with runners and how can the results in a lab be transitioned to a practical application?

A is one of the first of its kind to look at exercise therapy in treating tendinopathies of the lower limb, but experts agree that more work needs to be done on narrowing down specific exercise programs which are most effective.听

There is currently no set of guidelines or recommendations for practitioners around exercise treatment other than the importance of progressive loading. Meaning that a runner may get a different exercise program from different therapists.听

鈥淣ot all of these are going to be equally as effective,鈥� explains Malliaras. This is why he and his team have completed data collection on exercise programs for the Achilles tendon. They are testing four different types of loading protocols with the goal of finding conclusive evidence on the one that works best.听

Beware of Quick Fixes

Steroidal injections are another type of treatment that is often misused or misunderstood. Keen to get back to running quickly, runners can be misled into thinking they are an effective treatment, as they do often provide relief in the short-term鈥揺specially on lower limb injuries.听

As a long-term, sustainable option however, the research shows they are not the solution. Malliaras explains that the pain will initially be mitigated, making the injection seem successful, but it will return after the athlete has been running for a period of time.听

Multiple steroid injections may have negative long-term consequences. 鈥淎 quick steroid fix is never a good option,鈥� says Malliaras.听 It is better to have a combination of steroid and exercise, or simply an effective exercise-loading protocol. While the latter may take longer, it will also provide lasting results that will allow runners to return to running completely, not temporarily.

Malliaras warns that runners also need to be mindful of the use of imaging. The research has shown that is not indicative of pain level, time required for recovery, or the correct treatment protocol. The best indicators are pain and function.

The Culprit: Too Much, Too Soon

Despite the areas of research that await to be covered, there is a sound understanding of the cause of tendinopathies: injury occurs when the load capacity is exceeded. This means that while a clear recovery exercise protocol may still be alluding researchers, we do know how to keep tendon injuries at bay so as to continue running.听

It comes down to load management, avoiding short-term passive treatments, and reducing the risk of overloading the tendon. 鈥淏eing methodical with your training and running at an intensity high enough to allow adaptation without overloading it towards a reactive state is the key to success,鈥� says Sharpe. He also notes the importance of working with an experienced professional to help in combining a runner-specific designed strength and conditioning routine, with an individualized running program.听

Perhaps most importantly when it comes to tendinopathy is accurate education to ensure practitioners and runners alike are all on the same page: 鈥淲e need to help people understand tendon pain and recognize that the tendon can strengthen when loaded in the right way, similar to how muscles get stronger in the gym,鈥� says Goom.

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Recent research has shown that many runners can 听and by adopting a slightly faster cadence than they typically fall into.

Other studies, however, have shown that cadence is , part of one’s natural stride, or preferred movement pattern. This self-selected stride is the 鈥攁nd any .

A new study may explain the reason for this anomaly, and a hope for those looking to retrain their gait. This听 out of East Carolina University looked at brain activity during gait retraining using EEG brain imaging. The study examined the cognitive changes following an increase in step rate over a period of time.

If you鈥檝e put in the work yourself to try to alter your stride, you may have already have noted the amount of effort and concentration it requires and how much harder it feels. More than that, you may have found yourself thinking, 鈥淲ill this ever become habitual for me, or will I always have to think about it this much?鈥�

The researchers were asking the same question. 鈥淲e have always wondered if runners actually 鈥榣earn鈥� a new running pattern in a gait retraining study or if they have to think about it in order to maintain it,鈥� said Richard Willy, professor in the School of Physical Therapy and Rehabilitation Science at the University of Montana and one of the researchers on the cognitive demands study.

8 Sessions of Mentally-Taxing Focus

For the study procedure, participants had to methodically practice this altered running pattern for eight sessions, during which the EEG showed a large increase in brain activity in the prefrontal cortex. After the eight sessions, however, brain activation levels returned to the same level of activity as they were at baseline prior to the retraining program鈥攖he new gait had become a learned pattern.

鈥淐hanging a runner’s gait is initially quite mentally taxing and requires a lot of focus,鈥� says Willy. Fail to stick with the work, and you may not get results, or at least not results that are easily maintained over time without undue mental processing.

Runners need to consider this mental cost and required commitment before considering a gait change. Furthermore, trying to change your stride without also changing the mechanics at the root of 听 usually leads to a less-efficient gait and can potentially end in injury.

To that end, this is not a casual decision or one that can prove valuable鈥攐r is advisable鈥攆or everyone. But there are some definitive instances when gait retraining may be in order.

Not To Be Undertaken Lightly

is an assistant professor of Southeastern Louisiana University in the Department of Kinesiology and Health Studies, where he has taught a running and biomechanics course. As a runner and running coach himself, Green knows that not all athletes can benefit from gait retraining. Once a hard-lined believer in minimalist shoes for all runners, he has since seen the research and athlete experience to validate that there is 鈥渁 time and a place for gait changing.鈥�

To help determine this, his first priority to address is to find out the athlete鈥檚 injury history and performance goals. He notes that in his experience as a certified athletic trainer, people suffering from chronic injuries or those who have hit a performance plateau and have not had success from other means of improvement can stand to benefit from gait retraining the most.

Willy agrees that gait retraining presents an opportunity to improve long-term performance because it allows athletes to improve energy efficiency. For whatever reason鈥攅xperts speculate on a combination of sedentary lifestyles, compromised mechanics, shoes, neuromuscular inexperience鈥攎any runners, especially those who are new to the sport, run with a cadence that is slightly less than optimal for energy efficiency.

Getting to this level of optimization however, requires not only consistency, but also strategy and a methodology behind the process. Green employs a specific change process protocol with his athletes: the Part-Part-Whole teaching method. After careful evaluation he breaks their stride down into parts and has the athlete focus on changing one specific part鈥�, for example鈥攁t a time. As they confidently grasp each part, another is added, eventually putting it all together to create the whole: a retrained gait and improved performance.

The cognitive contribution to this process can鈥檛 be overlooked. If a runner has to think about a pattern constantly, it makes it more likely that he or she will give up because of the mental demand, or falter away from the pattern when getting fatigued during running. Furthermore, mental fatigue can lead to running burnout and the eventual dislike towards the sport they once loved.

Preventing this, and maintaining athlete longevity is a huge factor behind why Green only tackles one part at a time and pays specific attention to how the athlete听feels while running with the new pattern. Adhering strictly to what coaches or conventional wisdom says is supposed听to be altered, or how stride is supposed to look from a coach鈥檚 perspective is not relevant if the athlete does not feel comfortable and in control of the changes he or she is undertaking. By making changes one part at a time, Green is able to monitor this more effectively and address any problems along the way.

The good news: Given a period of intense, focused work as demonstrated from Willy鈥檚 study, and appropriate coaching techniques like those Green refers to, after the pattern is learned, it will become mentally efficient and habitual. And, perhaps more importantly, the new study shows that, if you want or need to make a change to your gait, and are willing to put in the focused work, you can see lasting results.

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Should I breathe through my nose or mouth while running? If you鈥檝e never asked this question, you probably don鈥檛 have to. In general, breathing comes as natural as, well, breathing. You do what you have to do to keep up with demand.

People have, however, researched the question. A 听from the International Journal of Kinesiology and Sports Science looked at oral versus nasal breathing during moderate to high intensity aerobic exercise, and concluded that oral breathing was more effective, particularly at higher intensities. Oxygen uptake during nasal breathing was approximately 10% lower than mouth breathing.

That said, there are times and reasons you may want to close your mouth. Ultra great Scott Jurek, in his 2012 book, said he trained himself to breath through his nose on easy runs because it 鈥渓owers one’s heart rate and helps brain activity.” Experts say there are no studies proving physiological advantages of nose breathing, but Jurek鈥檚 descriptions of teaching himself to relax into nose breathing hints at the mindful focus it can create.

听do show that nose breathing is effective in “conditioning” the air we breath. These suggest that you may want to stick to nose breathing when the air is dirty, dry, or, extremely cold. The nasal passages help clean, humidify and warm inhaled air before it hits the lungs.

Coach James McKirdy, of , suggests another reason to think about nose breathing. He differentiates between using nose breathing for getting in oxygen and using it as a tool for gauging pace and effort. 鈥淲e tell [runners], that on an easy run, if they can鈥檛 breathe through their nose for 10鈥�15 seconds, chances are they aren鈥檛 running easy,鈥� he says.

For different levels of intensity, McKirdy encourages his runners to use nose breathing as a marker, but 鈥渙nly in spurts, and never for extended periods of time.鈥� In the end it comes back to the simple fact that the mouth听can move more oxygen, and going too long without enough oxygen during a run is not on any list of 鈥渂est ways to run faster.鈥�

If you are out for an easy recovery run, nose breathing may be a way to relax, gauge your pace and make sure you are not overdoing it. If you are rounding the track doing 400m intervals, gunning for a PR in your half marathon, or bounding down the finishing chute for that BQ, open your mouth and nose and take in all the air that you can!

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Recovery options for the runner are continually growing. The ever-expanding body of research on recovery needs as well as the rapid advancement in can be overwhelming. We dug into the details to give you the need to know on three options in this new age in recovery.

Infrared Sauna

Rather than heating by steam as in traditional saunas, infrared saunas use lamps that release electromagnetic radiation into the air. This radiation is absorbed by the skin and the heating occurs from the inside: the radiation increases the vibration of the water molecules under your skin, raising their temperature due to the increased energy present, and heating you up.

Benefits:

鈥� Relaxation and rest, as heat promotes muscle tension release

鈥� Improved circulation and blood flow

鈥� Cleansing of the pores and skin purification

鈥� Detoxification by release of small amounts of toxins through sweat

Science

The act of sweating is a calorically driven process that is part of the body’s听. When the body sweats, it requires an increase in circulation and blood flow. This increased blood flow is key in getting muscles the oxygen and nutrients they need to facilitate recovery, as well as to flush out lactate. This combination of circulatory related benefits, as well as toxin release and helping calm the mind, all come together to make infrared saunas a valuable .

Cryotherapy

The next level of ice baths, Cryotherapy involves standing in a room for four to five minutes that is set at a temperature between -100 and -140 degrees Celsius. The idea is that if applying ice to areas of inflammation or jumping in an ice bath after a hard work out is helpful, immersing the whole body in extreme icy conditions will work better and quicker. High-level athletes like Dathan Ritzenhein, Galen Rupp and Jordan Hasay have been reported using the method.

Benefits

Websites and individuals who promote or offer cryotherapy recommend it for anybody who is seeking to improve their overall health and recovery. They claim it is particular useful to:

鈥� Speed recovery from athletic activities, such as running or cycling

鈥� Reduce in overall body inflammation

鈥� Reduce or eliminate muscle discomfort and fatigue

鈥� Improve immunity to help eliminate illness, such as a cold

鈥� Reduce the effects of chronic inflammatory conditions such as rheumatoid arthritis

鈥� Improve physical and mental performance

Science

The FDA has not cleared or approved Whole Body Cryotherapy devices for treatment of any medical condition and . Due to their relatively new presence on the market, the research is not yet available to indicate conclusively that they are or are not beneficial. One concluded they could be assistive in rehabilitating adhesive capsulitis of the shoulder, but until additional research is available, researchers and sports professionals indicate other, more accessible methods of cold therapy 鈥攕uch as ice packs and ice baths鈥攁re also effective in reducing inflammation and pain.

Float Tanks

If you鈥檝e taken Epsom salt baths in your tub, you can think of floatation therapy as the business class version of your economy class DIY bath-time. Flotation therapy involves lying in a 鈥減od鈥� of warm water in a pitch-black room. The tub is filled with over 1000 pounds of Epsom salts, creating a water and salt balance that lets you float. Your body lies there feeling suspended and weightless, allowing you to fully relax into the water, take all the strain off of your muscles and be completely at rest.

Benefits

鈥� Encourages a meditative state for your body, helping with mental relaxation and mindset

鈥� Allows your muscles to rest and relax

鈥� Reduced sensory input, further encouraging relaxation

Science

Right now most of the science supports that the unique combination of environmental factors in a flotation tank allow the body and mind to actually rest and relax. The salt makes the water feel warmer and smoother; the darkness and quiet reduces stimulation; the ability for weightlessness allows the muscles to relax. This (Restricted Environmental Stimulation Technique) has a significant impact on blood lactate and perceived pain compared with passive recovery, and in its efforts to facilitate rest and relaxation may indeed be a valuable method of recovery.

Recovery is different for everyone, and there may never be the science behind every method of recovery to know whether it is the right one for you. What experts do say, however, is that the point of recovery is to relax, rest and let your body rebuild. Whatever works for you to help you do that, that is the answer鈥攏ew age or back to basics.

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