Runners are Prone to Plantar Fasciitis and Blood Clots

As we get older we are prone to aches pain and injuries. Older for runners could be as early as 40 years old or sooner depending on how hard you run. Below we have good information on how to prevent and/or treat blood clots and plantar fasciitis. Two major factors that can affect a runner at any age.

Article Cause and Effect of Plantar Fasciitis

There are over two million cases of plantar fasciitis treated in America every year. It is one of the most commonly treated symptoms addressed by a podiatrist and is slightly more prevalent in women than men. Most cases are reported from people between the age of 40 and 70. The planta fascia runs from the heel bone to the toes. This is a long ligament and is very strong as it supports the arch and springs the energy created by walking/running from the heel to the toes. Just like a carbon fishing rod it is very strong and will flex from up and down but stretch it length wise and the fibers will tear. When this happens pain and inflammation are felt, usually around the heel and arch area at the bottom of the foot.

 

Symptoms of Plantar Fasciitis:

  • Pain in the morning on the bottom of the foot, near the heel, that will subside after a brief period of walking.
  • Typically the pain develops gradually, but after several weeks, the pain escalates and doesn’t diminish. Most often described as a sharp pain in the heel or arch although some people describe it as a dull pain.
  • Tenderness is felt when pressure is applied to the heel pad or the arch. Most often there is no swelling or bruising.
  • The pain is greater after exercising than during the exercise.

Read the rest of the article here:  https://www.mondaymedical.com/blog/cause-and-effect-of-plantar-fasciitis/

Plantar fasciitis In Runners By Patricia Pande, MClScPT, CSCS, CPed

The literature cites a number of causes of plantar fasciitis in runners, including long plantar arch alterations, rearfoot pronation, and magnitude of plantar loads. Plantar fasciitis in runners can also be associated with fasciosis.

Muscle atrophy. Several studies suggest an association between plantar fasciitis and muscle atrophy, particularly of the intrinsic foot muscles. Chang et al found that forefoot muscle volume, assessed using magnetic resonance imaging (MRI), was significantly lower in the affected limbs of patients with unilateral plantar fasciitis than in the healthy limbs.16 In another MRI study, Cheung et al found that rearfoot intrinsic muscle volume was lower in experienced runners with chronic plantar fasciitis than in healthy runners, while forefoot muscle volume was similar between groups. Kibler et al also found that runners with plantar fasciitis had significantly worse ankle plantar flexion strength than healthy runners; this weakness could be related to muscle atrophy or to reflex inhibition with increased load on the plantar fascia.

Although these studies do not confirm muscle atrophy as the cause of plantar fasciitis or that strengthening exercises will relieve symptoms, research does suggest that intrinsic muscle activation from forefoot contact to toe off may reinforce ligamentous structures. Further studies are needed to evaluate the effectiveness of exercises to improve muscle activity and orthotic interventions to support the foot for generation of muscle power.

Plantar loads. Recently, Ribeiro et al found lower loading rates in runners with acute plantar fasciitis (pain for more than four months) than in chronic cases (diagnosed a mean of 1.5 years earlier, presenting with fascial abnormalities but no acute inflammation or pain). However, loading rates in all runners with plantar fasciitis were higher than in healthy runners. The authors hypothesized that the lower loading rates in the symptomatic runners than in the chronic group were due to a pain-avoidance response, and that higher loading rates in the chronic plantar fasciitis group were due to the loss of a protective mechanism against pain in the degenerated tissue, as well as a reduced ability to attenuate shock.

Similarly, Pohl et al found that maximum instantaneous load rate was significantly higher in female runners with a history of plantar fasciitis than in control runners. Changes in tissue stiffness and fat pad atrophy may contribute to higher loads and may further complicate treatment by reducing lubrication and shock absorption Furthermore, loads related to the running surface may also contribute to plantar fasciitis.

Running pace and volume. There is conflicting information about the impact of running pace and volume on the risk of injuries, including plantar fasciitis. A study by Knobloch et al found that marathon runners have a lower risk of plantar fasciitis than runners of shorter distances, which suggests faster pace may be a risk factor and higher volume may be protective. However, other prospective studies have linked lower extremity injuries, including plantar fasciitis, to higher running volume. Whether due to pace or volume, the resulting stress may overload tissue.

Structural variables. Thickening of the plantar fascia has been associated with plantar fasciitis, and may arise from a combination of bending, compression, and shearing forces from muscle weakness or from degenerative thickening. Wearing et al found that thicker fascial structures were associated with a lower arch in patients with plantar fasciitis but not in healthy controls; it is still not clear whether this finding suggests that having a low arch causes the disability or results from gait adaptation.

Root’s theory that foot type contributes to plantar fasciitis remains controversial. The fact that the spectrum of foot types does not form a bell-shaped curve complicates the argument, as does the prevalence of subject-specific kinematic variations. Additionally, the connection between foot structure and plantar fasciitis is unclear.  Some researchers found a lower arch index with increased range of dorsiflexion in female runners with plantar fasciitis than in their healthy counterparts, but others suggest this relationship is not easily defined due to the foot’s adaptability to prevent injury. Nielsen et al found no increased risk of running-related injury in novice runners with moderately pronated feet. Additional well-controlled randomized prospective studies of homogenous running groups are critical to furthering our understanding of these factors.

Biomechanics. Kinematics and kinetics during walking in individuals with plantar fasciitis differ from healthy volunteers, and clinicians should consider the possibility that these or related differences may extend to running. The coupling mechanisms between the hindfoot, tibia, and arch during running are well-documented, but the relationship between segments of the foot is not clearly understood. Still, it is important for clinicians to be aware that treatments or interventions focused on a single aspect of the foot can also affect other aspects of the kinetic chain.

Clinical applications

The American Physical Therapy Association’s clinical practice guidelines for treatment of plantar fasciitis combine stretching, activity limitation, iontophoresis, night splints, and prefabricated or custom inserts. The American College of Foot and Ankle Surgeons recommends initial treatment with ice, stretching, ergonomics, off-the-shelf arch supports, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, with progression to custom foot orthoses and physical therapy if little or no improvement after six months.

Inserts must be able to absorb ground reaction forces, particularly in runners. Prefabricated and customized EVA (ethylene vinyl acetate) orthotic devices were associated with similar levels of pain relief in patients with noncomplicated plantar fasciitis after eight weeks. Interestingly, another study found reduction of plantar pressures at the heel associated with two types of EVA sham orthoses (flat and contoured) were similar to those associated with custom foot orthoses—a finding the authors attributed to the attenuating and pressure-redistributing properties of EVA. The findings of Pfefffer et al also support the use of less rigid orthotic devices in this patient population; felt and silicone or rubber were more likely to be associated with symptom relief than more rigid devices.

The use of orthoses to control or supplement motions has been the traditional mainstay of treating runners and nonrunners with plantar fasciitis. Research has demonstrated that orthotic devices are associated with kinetic and kinematic effects in healthy runners. One study showed a decrease in forefoot to rearfoot coupling angles with the use of foot orthoses, and another showed a change in rearfoot eversion angle and eversion velocity in female distance runners.Mündermann et al found that molded foot orthoses and molded and posted foot orthoses both reduced vertical loading rates and ankle inversion moments in healthy runners. However, researchers have not yet determined whether similar biomechanical effects can be expected in runners with plantar fasciitis, or to what extent those changes might affect patient symptoms.

Recent studies in which workload or strain causes pain in connective and muscular tissue support interventions to reduce kinetic effects on such tissue. Nigg’s Preferred Movement Pathway theory stresses force reduction and advocates self-selection based on comfort; however, this and other similar theories need vigorous scientific inquiry.

Conclusions and recommendations

Clinicians should advocate for the cost-effective, judicious use of foot orthoses for runners with plantar fasciitis, in accordance with the present body of knowledge, which suggests such devices should:

  • be comfortable
  • provide shock absorption
  • not increase torque at other lower extremity joints
  • fit well in the shoe without hindering use of the toe flexors and intrinsic muscles
  • be semicustomizable for patient comfort; and
  • address any compensatory adaptations.

Future studies should continue to assess the kinematic causes and effects of plantar fasciitis in the running population, along with factors that predict positive response to treatment.

Patricia Pande, MClScPT, CSCS, CPed, is a physical therapist, pedorthist, strength and conditioning specialist, and founder of FootCentric.  Read the whole article here: http://lermagazine.com/article/plantar-fasciitis-clinical-considerations-in-runners

Let’s Talk about Blood Clots

Below you will read how runners, especially those who are traveling to an event are prone to blood clots.

By Amanda Zaleski, MSc; and Beth Taylor, PhD                                                          There are several published case studies of athletes who have experienced deep vein thrombosis (DVT), pulmonary embolism (PE), or both following athletic competition or physical activity. Tao and Davenport, for example, reported on a female triathlete who was diagnosed with DVT and PE after competing in a half Ironman triathlon. After competing in the triathlon she traveled five hours by car the following morning. She subsequently experienced symptoms of left lower extremity swelling and pain, accompanied thereafter by dyspnea and lightheadedness on exertion. There are also several published cases of DVT and PE occurring after marathon running. Mackie and Webster described two male marathon runners who developed DVT and PE approximately one week after running a marathon; in both cases, DVT was misdiagnosed initially (either as a muscle strain or Baker cyst).

The myriad benefits obtained from regular sustained exercise are undeniable. However, such case reports indicate that, in at least a small fraction of otherwise healthy avid exercisers, there may be an augmented risk of DVT following endurance exercise.

Car, bus, train, or air travel by an athlete who has recently engaged in endurance exercise may shift the hemostatic balance, increasing the risk of venous complication.

Research has established that strenuous endurance exercise, such as marathon running, activates the coagulatory system (clot formation) by immediately increasing markers of coagulation such as thrombin-antithrombin complex (TAT), prothrombin fragment 1 and 2, and D-dimer. In response, the fibrinolytic (clot breakdown) system (eg, tissue plasminogen activator [t-PA] antigen and activity) activate in coordination with the coagulatory system following exercise, such that changes in coagulation are paralleled by an activation of fibrinolysis to preserve hemostatic balance. In other words, in healthy athletes, postexercise clot formation is approximately equal to clot breakdown. This phenomenon, by which both markers of coagulation and fibrinolysis are increased in the bloodstream, is termed “hemostatic activation.”

While exercise-induced hemostatic activation is not detrimental for most individuals, factors incident to marathon running may disproportionately activate the coagulatory system, increasing the risk for venous thromboembolism (VTE) and contributing to reports of DVT, PE, or both—all of which have been reported after prolonged strenuous endurance events in otherwise healthy athletes. Given that marathon participation has increased 40% over the past decade, with 550,637 finishers in 2014, this has implications for the increasing numbers of athletes who compete in endurance events.

Risk factors for VTE

Benefits of regular sustained aerobic exercise are indisputable. Paradoxically, endurance training and competition expose athletes to factors that may increase their risk for VTE. Virchow’s triad is composed of three factors—venous stasis, endothelial cell injury, and hypercoagulability—that augment blood clot risk. Endurance athletes are exposed to a combination of these factors; they experience repetitive microtrauma, endothelial damage, and dehydration during competition, followed by periods of inactivity, immobility, and stasis while traveling to and from athletic events or recovering from the event.

The superimposition of car, bus, train, or air travel on an athlete who has recently engaged in endurance exercise, for example, may shift the hemostatic balance in athletes postcompetition, thereby increasing the risk of VTE in certain individuals. The MEGA trial reported that any travel by car, bus, train, or plane longer than four hours increases risk of DVT twofold, and, indeed, there are several published case reports and substantial anecdotal evidence on the Internet detailing athletic individuals who have experienced VTE after the combination of competition and travel. To the best of our knowledge, however, we are the first group to examine the effect of prolonged exercise and air travel on thrombotic risk factors.

We examined 41 time-qualified runners participating in the 2010 Boston Marathon who either flew more than four hours (travel group) or drove less than two hours (control group) to the race. We obtained blood samples to assess coagulation (TAT, D-dimer, P-selectin, and microparticles) and fibrinolysis (t-PA) the day before the marathon, immediately after the event, and the day after the marathon following the flight home.

Baseline TAT, t-PA, D-dimer, P-selectin, and microparticle levels were not different between travelers and controls. Immediately following the marathon, all markers of coagulation and fibrinolysis were significantly higher than baseline, indicating that hemostatic activation had occurred. However, among individuals who flew more than four hours, the increase in coagulation factor TAT from baseline to after the race in the travel group was nearly double the increase seen in the controls (5 ± 4 to 12.9 ± 15.6 mg/L vs 4 ± 1.2 to 6.1 ± 1.2 mg/L; p = .02).

Similarly, exercise-induced increases in D-dimer, a clinical biomarker of DVT, were also significantly greater immediately after the marathon in the travel group of athletes than in controls (142 ± 83 to 387 ± 196 ng/mL vs 85 ± 26 to 233 ± 95 ng/mL; p = .02). In fact, six of the runners in the travel group (vs no local controls) had D-dimer values that exceeded the clinical threshold for preliminary diagnosis of DVT (> 500 ng/mL).

Most notable, however, was that marathon-induced increases in the fibrinolytic factor t-PA did not differ between control and travelers, indicating a hemostatic shift toward a more procoagulatory state in athletes who flew to Boston and ran the marathon. Moreover, the increase in the TAT response was greatest in the oldest runners (p < .01), and older subjects also had greater P-selectin values (a marker of inflammation) than younger subjects, indicating that age appears to moderate the coagulatory response to endurance exercise in combination with cross-country air travel.

These data provided the first evidence that the combination of marathon running and air travel disrupts the hemostatic balance and favors a coagulatory response, which appears to be exacerbated with increasing age. Other factors specific to endurance athletes that could additionally exacerbate VTE risk include oral contraceptive use, presence/family history of a clotting disorder, sex, injury, bradycardia, atrial fibrillation, or previous history of VTE.

Compression socks during a marathon

Researchers obtained venous blood samples from marathon runners the day before the event, immediately after the event, and 24 hours later.

The Evidence-Based Clinical Practice Guidelines from the American College of Chest Physicians suggests the use of properly fitted compression socks to mitigate blood clot risk in high-risk populations. The use of compression socks, or mechanical prophylaxis, to maintain hemostatic balance has been studied with participants at rest and has been shown to be effective in reducing VTE in some clinical populations (eg, patients with a previous history of DVT or recent surgery),26 but contraindicated in others (eg, patients with arterial insufficiency).27

Awareness of VTE in endurance athletes has grown significantly in the past few years, and, consequently, running associations and events are increasingly urging athletes to wear compression socks during flight and competition to diminish DVT risk.2 Although these informal (albeit common-sense) recommendations are grounded in evidence derived from clinical populations, the efficacy of compression socks to attenuate marathon-induced hemostatic activation has been tested only recently.

Our group recently examined the safety and efficacy of compression socks worn during a marathon on hemostatic activation immediately following the 2013 Hartford Marathon in Connecticut. We randomly assigned runners (n = 20) to a compression sock group or a control group at the initial screening. The runners reported to the marathon exposition the day before the event. We obtained venous blood to measure coagulatory factors (TAT, D-dimer), a fibrinolytic factor (t-PA), and hematocrit (Figure 1). We also obtained blood immediately after completion of the marathon in the main medical tent approximately 100 m from the finish line and within 24 hours of the race finish.

Runners in the sock group (n = 10) were compression sock naïve; they received their socks (19-25 mm Hg at the ankle) at the marathon expo and were instructed to wear them to the race start and throughout the duration of the marathon . Runners in the control group (n = 10) were instructed to wear their typical athletic socks, but refrain from compression sock use during training, the marathon, and on the day after the marathon.

Plasma concentrations of D-dimer, TAT, and t-PA did not differ between groups at baseline. Consistent with findings from previous studies, we observed parallel increases in markers of coagulation and fibrinolysis immediately following strenuous exercise, specifically, exercise-induced increases in D-dimer, TAT, and t-PA. Of note, these parallel increases of coagulation and fibrinolysis did not differ between recreational Hartford marathoners and elite Boston marathoners who trained more and performed faster, reinforcing the negligible impact of differences in training history and race time on exercise-induced hemostatic activation. Average t-PA across all three time points was lower in the compression sock group than the control group (p = .04).  Similarly, average TAT across all three time points was lower in compression sock group compared with the control group, with a trend toward statistical significance (p = .07); however, plasma D-dimer did not differ between the groups across all three time points (all p > .2).

Because runners were not wearing compression socks at baseline, and there were no differences in hemostatic markers at baseline between groups, the findings related to t-PA and TAT suggest a significant effect of wearing compression socks on immediate and 24-hour post marathon hemostatic markers—specifically that overall hemostatic activation following a marathon was lower with compression socks than with typical athletic socks. Most importantly, compression socks did not appear to adversely influence markers of hemostasis during a marathon and thus they appear safe for overall use in runners.

Given that prolonged travel (greater than four hours) activates the coagulatory system, and many marathoners travel long distances to an event, the use of compression socks as a preventive measure should be considered, assuming they are tolerable and properly fitted.However, the efficacy of compression socks still remains to be tested in combination with travel, as the athletes in this study traveled local, short distances to and from the marathon.

We caution that there is a need for larger studies, as well as studies of hemostatic alterations following a marathon in combination with other risk factors (eg, oral contraceptive use, prolonged travel, and genetic predisposition for VTE). We maintain a DVT registry of athletes who have had a history of VTE after competition to better identify individual risk factors that may contribute to this phenomenon.

Performance, recovery and VTE risk

Runners in the sock group were given compression socks and instructed to wear them throughout the duration of the marathon.

Athletes wear compression socks for a variety of reasons beyond reduction of blood clot risk, and thus their influence on noncoagulatory outcomes deserves further mention. Compression socks are increasingly popular with athletes due to perceived enhancement of exercise performance and recovery. To date, the research regarding the efficacy of compression socks to enhance performance, aid in recovery, or both has been equivocal. This is partially due to the difficulty of conducting placebo-controlled trials and the use of subjective qualitative reporting as primary outcome measures. Studies that have measured objective physiological markers of muscle damage (ie, creatine kinase, a marker of muscle damage, and lactate, a metabolic byproduct) have been limited and inconclusive, perhaps because the studies are vastly heterogeneous in terms of a) the type of compression garment used (eg, whole body, sleeves, knee-high compression) and b) the modality of exercise being tested (eg, resistance or aerobic).

Hypothetical mechanisms underlying performance and recovery benefits of compression socks differ depending on their timing of use (ie, during or after exercise), but are similar in that all theorize that the mechanism of action targets components of Virchow’s triad.

Compression socks worn during exercise are thought to reduce microtrauma and enhance venous return by applying an external circumferential pressure gradient that reduces swelling space, improves blood flow, and in turn improves performance.

Compression socks worn during recovery are thought to accelerate metabolic waste clearance, attenuate edema and swelling, and improve oxygen delivery to muscle.

A recent meta-analysis incorporating 12 studies found a favorable effect of compression socks for enhancing recovery from muscle damage, based on creatine kinase and reduced severity of delayed onset muscle soreness. However, of the studies included in the meta-analysis, not one sought to examine the influence of compression socks in response to a sustained aerobic event (eg, marathon or triathlon), making the interpretation of the findings difficult to apply to endurance athletes.

A separate systematic review concluded the available literature does not fully support or refute the use of compression socks for improving performance or recovery. For example, three studies found no difference in running performance while wearing compression socks,while one demonstrated improvements in running speed and performance.

To the best of the authors’ knowledge, there are only two randomized controlled trials that examine performance and recovery in marathon runners.4 One found compression socks worn for 48 hours after a marathon were associated with a 5.9% improvement in functional recovery (ie, time to exhaustion on a treadmill two weeks after a marathon). The other reported that compression socks worn during a marathon did not result in better race performance or lower markers of exercise-induced muscle damage, as assessed via serum myoglobin and creatine kinase concentrations before and after the event.

Conclusion

In conclusion, with the exception of one study, the data do not appear to reveal any adverse consequences of compression socks, and in some cases suggest socks may result in psychological advantages that translate into performance gains. Assuming that socks are properly sized, marathoners can consider compression socks a sports garment that has preliminary evidence to support its use for preserving hemostatic balance during exercise and hastening recovery from exercise, but not for enhancing performance.

Runners should be aware of manufacturer specifications and proper sizing techniques. Although a minimum threshold of pressure applied at the ankle is not yet clearly defined in the literature, compression socks should be graduated (ie, lower pressure at the ankle gradually increasing to higher pressure at the knee). Lastly, socks should be sized according to calf circumference, not shoe size, to avoid excessive pressure at the calf and to potentially increase the risk-benefit ratio. By following these specifications, athletes may be reassured that compression socks likely do not harm athletic performance and recovery, which is critically important given the time and effort associated with training and performance.

Amanda L. Zaleski, MS, is an exercise physiologist in the Department of Preventive Cardiology in the Henry Low Heart Center at Hartford Hospital in Connecticut and a doctoral student in the Department of Kinesiology at the University of Connecticut in Storrs. Beth A. Taylor, PhD, is the director of exercise physiology research in the Department of Preventive Cardiology in the Henry Low Heart Center at Hartford Hospital and an associate professor in the Department of Kinesiology at the University of Connecticut. Her interest in blood clot risk arose from the experience of her older sister, who experienced a DVT and PE after running a half marathon and flying home to Seattle, WA, from Hartford, CT.

Disclosure: Amanda Zaleski has received funding from the CT Space Grant Consortium Graduate Fellowship, Hartford Hospital, and the American College of Sports Medicine NASA Space Physiology Grants for her ongoing research to examine risk factors associated with VTE in active individuals. In addition, she discloses product sponsorship from 2XU Compression Socks.

More Reading On Compression Socks And Do They Really Work? By Kelly Dunleavy O’Mara

“There is no doubt that many runners trust compression garments,” said Ajmol Ali, a PhD in the Sports and Exercise Science Department of Massey University. Ali has conducted a number of studies on the garments with mixed results.

For decades, medical-grade graduated compression socks have been used to combat deep vein thrombosis, or the formation of blood clots. By increasing the circulation and blood flow, research has found the socks to be effective for bed-ridden and inactive patients.

RELATED: Did Meb’s socks help him PR?

Research on the effectiveness of compression garments in athletic pursuits, though, has been hit or miss.

“Very little evidence exists (ie. two to three studies out of 15-plus) from a sport and exercise perspective that compression garments improve performance when worn during exercise,” said Rob Duffield, a professor at the School of Movement Studies at Charles Sturt University.

One study found that when 21 male runners did two step tests – one with compression socks and one without – they were able to go slightly longer wearing the compressions before exhaustion. There have also been some small increases seen in anaerobic threshold, particularly in cycling, and in jumping performance. The theory is that the tights prevent oscillation of the muscles sideways and promote muscle efficiency.

But, Ali noted that many of the studies that have found increases in performance did not use a placebo or control, making it nearly impossible to tell if the increases were really from the compression or from the athlete’s perception of the compression.

And, countless other studies have found no differences in running times, VO2 max, oxygen consumption or heart rates between athletes wearing the socks and those who weren’t.

“Most of the research shows that there are no performance benefits,” said sports physiology professor Elmarie Terblanche, from Stellenbosch University in South Africa.

Terblanche, however, said that most studies are done in the lab. She recently conducted the first real-world study, following athletes running the Two Oceans ultra-race in South Africa. What she found was that the athletes who raced in compression socks, versus those in regular knee-high socks or those without either, had significantly less muscle damage and were able to recover more quickly, with some even ready to train again three days later. Those wearing the socks also ran on average 12 minutes faster.

“Considering that they ran one of the most difficult ultras in South Africa, this was significant,” she said.

Terblanche recommends that athletes wear the socks for long sessions and for the 24 hours following. While she acknowledges her study can’t be considered conclusive, because there’s always a chance for a placebo effect in the real world scenario, the recovery findings are in line with other research.

Multiple studies, including one done by Ali, have found decreases in muscle soreness and perceived fatigue. Some possible increases in blood flow and lymph removal during the recovery period have also been found – though other studies found that wearing the socks after workouts had no greater recovery effect than taking an ice bath.

It was the recovery benefits that won over Chris Solinksy, the former American 10,000m record-holder, who wore compression socks when he became the first American to break 27:00 two seasons ago.

“I found I was able to come off the workouts much, much quicker,” said Solinksy. He wears the socks during hard workouts and races, and finds he recovers faster. He also originally thought he raced faster in them, but that proved not to necessarily be true.

Solinksy isn’t too worried, though, about how exactly it works or what the science says. He knows he likes it.

“I’m kind of a simplistic barebones type of runner,” said Solinksy.

RELATED: What’s up with Solinsky’s socks?

For athletes to get the full benefit, the compression needs to be graduated (tighter at the ankle and decreasing to the hip), fit the individual, and have 22 – 32 mmHg of pressure. There haven’t been any differences found in brands. And, Terblanche said she hopes to study next how compression garments hold up with use.

To a degree, if there’s no harm done – as long as it’s not too tight or irritating or causes blisters – then it hardly matters whether the benefits are in the athlete’s head or not.

“If athletes like wearing them, and feel that the garments are helping their performance and/or recovery (whether it is a true effect or simply a placebo effect), then I don’t see any harm in recommending them,” said Ali.

About The Author:

Kelly Dunleavy O’Mara is a journalist/reporter and former professional triathlete. She lives in the San Francisco Bay Area and writes for a number of magazines, newspapers, and websites. You can read more about her at www.sunnyrunning.com.

I think it is safe to say that if you are a serious runner who is over 40, custom Orthotics and Compression Stockings are a good investment. Both of them won’t cost as much as a good Driver for Golf. Personally I can state that I wear custom orthotics and run, mostly on a treadmill, I do have less foot and knee pain. I don’t travel to compete but I will start wearing compression socks on any long drive or flight. I feel that this will be a safe practice to start. After reading these articles, how do you feel about foot orthotics and compression stockings?

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