The Basics of Foam Rolling

You may have heard of foam rolling—you might even own one of the tube-shaped torture devices—but even then, the questions remain: How long should you roll for? What areas? Where do you start? What does a foam roller even do?

Self-myofascial release, otherwise known as self-massage, is a key component of a runner’s well-rounded recovery routine. It tackles tight muscles and works to increase mobility, flexibility and all-around effectiveness during training.

“If you want to run well, you need to do mobility exercises,” says physical therapist Bryan Hill, co-owner and CEO of Rehab United in San  Diego. “Foam rolling is used by many practitioners for that purpose.”

While there are plenty of massage tools avail-able for post-run indulgence—even tennis balls can do the trick!—a good foam roller is tough enough to dig up the right amount of oomph and effective enough that runners are willing to cringe and roll simultaneously, over and over again. (Don’t worry—it’s never as painful the second time!) Hill recommends five key areas to target when working out kinks.

Rules of the Roll
It doesn’t hurt to practice muscle mobility exercises daily, but Hill definitely recommends giving your muscles some extra love after major runs or workouts. Focus on each target area for at least 1 minute (and up to 10 minutes), moving slowly through the motions until you soak up the benefits of sweet release. If you’re a first-timer, pain is still beauty—the more you practice, the less you will cringe in pain as your body adapts to its new form of recovery.

Extra Credit
Need some added release? When you feel a tight spot, pause with your weight resting on that spot until you feel a release. To target pressure on your legs, try flexing your foot and rotating your ankle in circles.



Smooth vs. Bumpy
Foam rollers with extra bumps, such as the Rumble Roller ($45,, offer more intense fascial manipulation—that is, mobilizing the tissue that protects and connects your muscles. The choice between a flatter roller and one with more nubs depends on your desired level of massage—more nubs means more deep-tissue love. If you’re new to rolling out, we recommend starting with a flat roller, such as the Pro-Tec Foam Roller ($25,, until your body adjusts to the added pressure of foam rolling after your run.

Really Get In There

Hip flexors (the muscles between your pelvis and upper thigh) are infamously tight in runners and it can be tricky to dig in with a cylindrical massage tool. Hill recommends grabbing a Mobility-WOD Super Nova ($40, ball to reach the nooks and crannies of a tight flexor.


1. Back

(a) Rest your lower back on the roller with your feet flat on the ground, supporting your upper body with your arms. (b) Slowly move your arms outward, forcing the roller to move up your back, releasing tension along your spine. Return to start position and repeat.

2. Quads

(a) Rest both quads on the roller and sup-port your upper body with your hands on the floor. (b) Using your arms for leverage, move the roller up and down the quads.

3. Calves

(a) Rest both calves on the roller and use your arms and hands to support you. (b) Move your hips forward and backward to move the roller up and down your calves.

4. Hammies

(a) Cross one leg over the other and place the roller under your lower hamstring. (b) Using your arms and hands to support you, move your hips backward and forward to run the roller along your entire hamstring. Continue this motion, then switch legs and repeat.

5. IT Band

On your left side, rest your hip on the roller. Keeping your left forearm and right hand on the ground in front of you, cross your right leg over your left. Using your right foot on the ground for leverage, move the foam roller down your IT band (where the seam of your jeans would be on your outer thigh) to just above the knee. Roll back and forth along this line. Switch sides and repeat.

6. Glutes

Those rear muscles are often a key aggravator of IT band pain—Hill suggests including the glutes as an extension to the IT roll. Rest your left ankle across your right quad and place your left butt cheek on the roller. Using your hands for leverage and leaning to the left as necessary, move the roller back and forth slowly. Switch sides and repeat.




Second Chance

John Mayer had been an avid runner since high school. But at age 45, in 2005, a pain in his knee was getting worse, so he went to see a physician. “This fellow came highly recommended,” says Mayer, of Chicago. After diagnosing a torn anterior cruciate ligament, “he told me there was nothing to do. He was so respected, so convincing, and so definitive that I didn’t even bother to get a second opinion.”

Mayer was crushed and didn’t lace up for six months. When he tried to run again, the pain came back. Finally a friend suggested he see another doctor, who confirmed the problem but recommended arthroscopic surgery and physical therapy. Mayer’s pain eased, and he’s since run eight marathons.

Not every treatment plan requires a second opinion. But when you’re undergoing rehab—and anxious to run again—it’s important to know when to seek a different perspective.

You’re told that there’s nothing to be done.

Almost all running injuries are treatable. So if a doctor tells you he can do nothing for you, make an appointment with another expert. That diagnosis most likely means “there’s nothing more that that doctor can offer,” says Michael Ross, M.D., medical director of The Rothman Institute Performance Lab in Cherry Hill, New Jersey. And while some conditions, such as severe arthritis in the hip, ankle, or knee, could certainly curtail your career, you’ll want to confirm a diagnosis like that with another physician before you quit running altogether.

You’ve developed a new pain.

Sue Walsh was a month from the Chicago Marathon in 2008 when she developed an IT-band injury and visited a physical therapist. “The IT band got better, but my hip flexor on that same side started to hurt,” says Walsh, 33, from Brooklyn. “I couldn’t get it together for the marathon.”

An appropriate treatment plan should not cause new aches. “A patient who is experiencing increased pain or pain in new locations is likely getting therapy that is overly aggressive for their condition, or was misdiagnosed and should be reassessed,” says Michael Chin, D.P.M., medical director of The Running Institute in Chicago.

Another doctor later diagnosed Walsh with femoroacetabular impingement, a bone deformity of the hip that required surgery. She finally got back to running two years after the initial IT-band issue.

You notice no improvements after two to four weeks.

Most injuries should improve and pain should diminish after four to six sessions of therapy, Dr. Chin says. If they don’t, the rehab plan may be too conservative. David Bakke, 45, of Atlanta, was diagnosed with runner’s knee a week after he started bounding up the steps of the local football stadium. He was told to do some stretching exercises and rest for seven to 10 days. After two weeks, when he’d noticed no improvements, Bakke went to see another doctor who prescribed exercises to strengthen his quadriceps. “In about 10 days, I was finally able to resume my full workout,” says Bakke.

Your injuries keep recurring.

Repeat injuries—or a series of different injuries—suggest you may have an underlying health problem that isn’t being addressed, says Lewis Maharam, M.D., a sports-medicine doctor in New York City and author of the Running Doc’s Guide to Healthy Running. Dr. Maharam says he once treated a woman who had recurring fractures in her hip and feet every three months. “She was biomechanically sound, and her bone density test was normal,” he said. “But we did a blood test, and found she had a parathyroid tumor.”

Your doctor doesn’t ask about your overall health status.

When you go to a doctor complaining of a running injury, it’s easy to focus exclusively on the body part that’s hurt. But a skilled doctor will also ask questions about your health habits and try to gauge your fitness level, says Jim Chesnutt, M.D., medical director of sports medicine at the Oregon Health & Science University in Portland. Runners who aren’t getting enough sleep, for example, may be prone to injuries. A diet deficient in calcium and vitamin D may make you vulnerable to stress fractures. Inexperienced runners may be trying to do too much too soon. If your doctor doesn’t take the rest of your health into account, consider getting a second opinion.

You haven’t been given other ways to stay in shape.

A good rehab plan should include exercises to help you stay fit while you’re on the road to recovery. “Sometimes runners don’t realize they need to take a break and do some cross-training,” Dr. Chesnutt says. For example, a runner in treatment for recurrent ankle sprains should work on strengthening her core and upper body while she isn’t running. Even more important is that the doctor understands your goals. Knowing you’re weeks from a marathon, for example, your doctor may attempt a more aggressive treatment plan. But if you’re months away, you may have the time to rest and heal without additional testing or interventions. If your doctor doesn’t ask you about your fitness goals, consider seeing another doctor who does.

Who Do You Call?

Reach out to the right help

Primary doctor-> Unless you have an established doctor-patient relationship with a sports-physician specialist, call your primary doctor first, says Michael Ross, M.D., of The Performance Lab, because he or she knows you.

Physical therapist-> While straightforward injuries, such as a mild ankle sprain, can be easily managed by your general practitioner, many running pains are the result of muscular imbalances, overtraining or overuse, or poor running mechanics. A physical therapist can tailor a rehab plan to fit your needs and goals.

Sports specialist-> If you’ve closely followed a rehab plan but aren’t seeing results—or if you have complex running problems—it’s time to seek a doctor who’s done an accredited fellowship in sports medicine, says Lewis Maharam, M.D. These are doctors who’ve been trained in running mechanics and who can spot the underlying problems that are the cause of many injuries. “The doctor should look at how you run and be able to advise you on things like gait and preventive measures,” he says. Find one

Coming back from an injury? Start slowly on a level surface like a treadmill or bike path until your muscle strength and balance are back.

In the past six months, 12% of survey respondents saw a chiropractor; 9% a physical therapist; 5% a sports doc.

The Pros and Cons of Massages for Runners

There is good reason massage therapists are part of an elite runner’s entourage. And why the lines for a postrace massage seemingly extend for miles. A rubdown—even a deep, intense one—feels great. Runners report that massages help lessen muscle tension and improve range of motion, while also making them feel relaxed and rewarded for their hard efforts.

Yet despite massage’s popularity and positive reputation, there’s been little scientific evidence to support why athletes feel so good when they hop off the table. “It can be hard to merge basic science with alternative medicine,” says Justin Crane, Ph.D., a McMaster University researcher who conducted some of the first objective studies on massage in 2012. Practitioners say massage relieves muscle soreness, promotes circulation, flushes toxins and lactic acid from the body, and eases joint strain—claims supported by centuries of anecdotal evidence from China, Sweden, and around the globe. But science hadn’t confirmed just what massage actually achieves—until now. Recent research has sorted out what’s true and what’s not.

First, let’s set the record straight: Science doesn’t support some ingrained beliefs about massage. “It can’t push toxins out of the muscles and into the bloodstream,” says JoEllen Sefton, Ph.D., associate professor of kinesiology at Auburn University, who has practiced massage therapy. “There’s no physiological way that can happen.” Nor does it appear to flush lactic acid from muscles, says Crane, who analyzed muscle samples after subjects cycled to exhaustion and then received a 10-minute massage. “People assumed that because lactic acid feels burny, and massage reduces pain, then it must clear away lactic acid,” he says.

What massage does do is apply moving pressure to muscles and other tissues such as tendons, ligaments, and fascia (which sheaths muscles like a sausage casing). “That energy softens fascia tissue and makes clenched muscles relax,” Sefton says. It also removes adhesions between fascia and muscles (places where the two stick together and restrict muscles’ movement). That’s especially great news for runners, who rely on limber joints and muscles for pain-free peak performance.

Science’s biggest discovery is what massage can do for athletic recovery. Studies published in the Journal of Athletic Training and the British Journal of Sports Medicine found that massage after exercise reduced the intensity of delayed onset muscle soreness (DOMS)—that is, the peg-legged feeling you get two days after your marathon. And other research suggests that it improves immune function and reduces inflammation. Emory University researcher Mark Rapaport, M.D., found that just one massage treatment resulted in an increased number of several types of lymphocytes (white blood cells that play a key role in fighting infection) while also decreasing levels of cortisol (the “stress hormone” linked to chronic inflammation). “More research is needed, but it’s reasonable to think that massage could help runners taxed from exertion,” Rapaport says. It may also help curb chronic diseases. “We know that systemic inflammation is associated with a lot of deleterious effects, such as heart attack and stroke, and that it predisposes people to cancers,” he says.

Crane’s research, published in Science Translational Medicine, found less inflammation in massaged limbs—and 30 percent more of a gene that helps muscle cells build mitochondria (the “engines” that turn a cell’s food into energy and facilitate its repair). “What we saw suggests that massage could let runners tolerate more training, and harder training, because it would improve their recovery and speed up their ability to go hard two days later,” he says.

Studies on rabbits confirm Crane’s prediction. At Ohio State University, Thomas Best, M.D., Ph.D., put a device on exercised animals that simulates massage and records the applied pressure. “We’ve shown a 50 to 60 percent recovery in muscle function compared with no massage,” he says.

The new evidence is so convincing that even the researchers have made massage a regular part of their routines: Crane, Rapaport, and Best have all become devotees as a result of their findings, and they recommend that runners follow suit. Regular massage can boost recovery and be a valuable training tool to help you run your best. “Muscle stiffness can throw off your gait, which leads to problems over time,” Sefton says. “And by getting a sense for how your body should feel when everything is in balance, you’re more likely to notice small issues before they turn into chronic problems.” Even beginning runners can benefit from massage, because alleviating the soreness that comes with starting a new sport makes people more likely to stick with it.
Can’t afford weekly treatments? Self-massage with foam rollers and other tools like tennis balls can be beneficial in between visits. They can also help runners prep for workouts, since they loosen muscles. “Just don’t overdo the pressure,” says Sefton, who notes that even a person’s body weight on a foam roller sometimes applies too much force (and causes muscles to tighten in defense). “Bodywork just before a race or hard workout should be light,” says massage therapist Anna Gammal, who worked with athletes at the 2012 Olympics. “We don’t want muscles to feel sore or overworked.”

After a race or grueling workout, a therapist may go deeper in order to help with recovery—or not. It all depends on the individual, Gammal says. “Through talking with the athlete and using touch, a therapist will determine the state of the muscle and if it’s best to use light strokes or deep-tissue techniques to treat an athlete in a safe and productive way.”

The Owner’s Manual For The Female Runner

Whoever said that you can’t get too much of a good thing must not have been a runner—especially not a female runner.

Sure, running helps you beat stress, lose weight, look fantastic, meet great friends, gain more confidence, stay mentally sharp, live longer, and generally feel like a goddess. But go too far and running can make you moody, and even make you hurt.

To help make sure you never cross that line, use this guide. It tells you everything you need to know to run healthfully and sensibly for a lifetime.

Your Hips
Due to our wider hips, we women can develop more than our share of below-the-belt aches, including bursitis, an inflammation in the bursa sacs that surround and cushion your hip joint. “Think of bursitis as a kind of blister,” says Nicholas DiNubile, M.D., an orthopedic physician in Havertown, Pa., and consultant to the Philadelphia Ballet. “If the joint isn’t aligned, you’ll have rubbing. And if you run enough miles, that rubbing will create real irritation.”

To prevent bursitis, wear the right shoes for your foot type, avoid running on sloped surfaces, and be sure to increase your mileage gradually (no more than 10 percent per week). If you’re experiencing hip pain now, do stretching and strengthening exercises that target your hips and thighs, and cut down on your mileage, says Dr. DiNubile. If you ignore hip pain, you could end up with other problems, such as knee injuries or even stress fractures.

Your Knees
Just one joint down from the hip is the knee-the second victim of our wider-hips problem. Many women suffer knee pain from patellofemoral syndrome, in which the underside of the kneecap rubs against the bottom of the thighbone, causing irritation, inflammation, and pain, says Richard T. Braver, D.P.M., a sports podiatrist in Englewood, N.J. This syndrome is especially common in women because our hip-to-ankle line often isn’t perfectly straight, creating either knock-knees (when the legs curve in at the knee), or bowlegs (when the legs curve out).

To prevent and relieve knee pain, do exercises to strengthen your quadriceps, and make sure you’re running in the correct shoes, Dr. Braver says. In particular, look for shoes with good medial support, which will keep your feet and ankles from rolling in too much. You also should cut back on your mileage, at least until the pain goes away.

Your Shins
Pain along the front or inside edge of the shinbone, known generically asshinsplints, is another problem for women. We tend to have looser ligaments in our knees and ankles, which means we’re more likely to overpronate. That places extra strain on all the muscles in our lower legs, including those in the shin area.

If your shins are sore, shift to non-impact workouts until the pain disappears, and add stretching and strengthening exercises to your routine. You also should check your shoes for adequate arch support and appropriate stiffness, says Dr. Braver. “Lots of women come to see me with shin pain, and it turns out they’re running in shoes that are way too stiff.”

A runner who overpronates might buy a rigid shoe hoping to keep her ankles from turning, he explains, but many motion-control shoes are simply too stiff for a woman’s less-muscular foot to bend. “If you hear a slapping noise every time your foot hits the ground, your shoes are too stiff,” he notes.

Trying to run through pain is a big mistake, especially if the pain is worst at the beginning of your run. By continuing to overload your muscles, you could cause a stress fracture, a tiny crack in the bone due to repeated strain. In the case of shinsplints, the crack forms after your already-tight muscle is gradually pulled away from the bone, taking its connective tissue with it. If you have a stress fracture you’ll have to give up running (and any other impact activities, including power walking) for several weeks or longer.

Your Feet

If you’re experiencing pain anywhere in your legs or hips, the cause of the problem may be your feet-or more specifically, your shoes. Women typically have narrower heels than men, and many women buy shoes that are too small in order to keep their heels from slipping, says Dr. Braver. Because we tend to pronate more, we also need shoes with the right mix of stability and support.

Shoes that don’t meet those requirements can cause pain in any of the joints of your body, including those in your feet. The wrong shoes can contribute to a condition called plantar fasciitis, an inflammation of the fibrous tissue that runs along the bottom of your feet. It often produces a stabbing sensation in the bottom of the heel or arch.

The best shoes for your feet will feel snug enough to prevent sliding, but loose enough to allow your feet to flex properly.

Most specialty running stores can give you advice about the best shoes for you. To figure out your foot type, do the wet test: Step out of the shower onto a piece of paper, and trace the outline of your footprint. Then take it to the store with you, along with an old pair of running shoes. These items will help the salesperson determine the shape of your arch and the way your foot typically moves when you run. If the best off-the-shelf shoes don’t cure your problems, try some drugstore inserts, or see a podiatrist for custom-made orthotics.

Your Breasts

You have to love your sports bra, because it gives you the support you need during running. But you probably curse it, too, if it digs into your skin after a few miles, or worse, leaves you chafed with little wounds that torment you once you hit the shower.

Newer fabrics are less likely to rub, but many women still suffer “bra burn” from every model they try. A properly fitting bra should be snug but not suffocating, with no loose spots that might bunch up. The bra should reduce bouncing to almost none. (To test a bra, jump up and down in the dressing room). If you’re still getting rubbed, apply a bit of petroleum jelly or other lubricant to trouble spots before your runs. If you’re doing long runs, bring along a trial-sized tube in your waist pack for touch-ups along the way.

Your Lungs

Asthma and its cousin, exercise-induced asthma (EIA), are more common in women than men-and more common among athletes than the general public. Asthma involves two factors: chronic inflammation of the airways, and a hyper-responsiveness to various triggers.

Some common triggers for asthma and EIA include: cold air, hormones (many women are more prone to attacks right before or during their periods); and physical and emotional stress. “Stress definitely affects the smooth muscle in your airways,” says Cathy Fieseler, M.D., an ultramarathoner and sports-medicine practitioner at the Cleveland Clinic Foundation. In fact, stress can create a condition called vocal-chord disorder, which produces asthma-like episodes but is actually a physiological response to anxiety.

Dehydration can also contribute to an attack, so drink 8 ounces of fluid every 15 to 20 minutes while exercising. And clear your diet of possible asthma triggers, such as wheat gluten (found in any food containing white or whole-wheat flour), dairy products, soybeans, and nuts. If your symptoms persist, see your doctor.

Your GI Tract

Though any runner can suffer from heartburn, diarrhea, and stomachaches, women are particularly prone. That’s because more often than men, women tend to develop irritable bowel syndrome-a condition that can include alternating episodes of diarrhea, constipation, and abdominal pain-as well as lactose intolerance, the inability to digest dairy products.

If you experience chronic GI problems, monitor the foods you eat to see if you can determine a pattern. Common culprits include dairy products, caffeinated beverages, chocolate, fried foods, and acidic fruits and vegetables such as tomatoes and oranges.

Also, for most runners, a big meal before a big workout won’t sit well. “What you can eat, and how long you have to wait after eating it, vary enormously from person to person,” says Dr. Fieseler. “I’ve seen people in ultras who can wolf down a cheeseburger while they’re running, but most people need at least an hour between eating and exercise.” In some female runners, the hormonal swings associated with the menstrual cycle and pregnancy can exacerbate indigestion, meaning you’ll need to be even more careful of what and when you eat.

“Generally speaking, the greater the intensity of your workout, the less blood will reach your digestive tract, and the more digestive troubles you might have,” Dr. Fieseler explains. “And exertion definitely loosens your esophagus, the gatekeeper for everything you’ve just eaten, which makes you more vulnerable to heartburn.” Unless your workout is no more grueling than a stroll around the block, you’re better off allowing your body to process a meal before you ask it to go aerobic. If you’re starving, grab an easy-to-digest energy bar or a carbohydrate drink.

Your Reproductive Organs

Missing a period (or two) is fairly common among women, especially those at the beginning of their reproductive years. But stress, and particularly the stress that comes from overtraining and/or undereating, can trigger a potentially dangerous suspension of menstruation called amenorrhea. Women who go for 3 to 4 months without menstruating risk a range of health problems, all related to the lack of circulating estrogen in their bodies. For example, amenorrhea leads to osteoporosis in older women, but it also weakens bones in young women, leaving them susceptible to stress fractures.

Simply exercising regularly doesn’t put you at risk, says Dr. Fieseler. But eating too little and running too much definitely will. If your periods are erratic, take a good look at your training plan, and make sure you’re eating and resting enough. If you’ve gone more than 3 or 4 months without a period, talk with your doctor.

Your Bladder

Urinary-stress incontinence-the condition in which an adult leaks urine while sneezing, laughing, or running-strikes more than 10 million adult women in the United States. In fact, about half of all women will experience it at some point in their lives. It’s most common in women who have had children and/or have passed menopause, but many young, childless women have it, too.

To prevent incontinence, Dr. Fieseler recommends eliminating diuretics (especially coffee) from your diet. If you’ve had children, ask your doctor about a pessary, a small, doughnut-shaped device that will give your bladder extra support. (You also can insert a tampon before you run, suggests Dr. Fieseler.)

And try Kegel exercises, in which you contract the muscles you use to stop the flow of urine. “Try to hold each contraction for 10 seconds or so. You can practice at every traffic light,” Dr. Fieseler suggests. If all else fails, chart a few pit stops into your running routes. “Don’t cut back on fluids before your run to avoid urinating,” she warns. “Dehydration is a much bigger problem than a little leaked urine.” Dehydration can actually lead to a bladder infection, which will increase your urgency even more.

Listening Device

Experts tell us that the best way to keep ourselves in optimal health is to pay attention to our own bodies. “Your body will tell you exactly what to do if you listen to it,” says Cathy Fieseler, M.D. To become better acquainted with your body, track the following six factors in your training log:

1. Your menstrual cycle (assign each date in your log a number corresponding to the day in your cycle, starting with 1 on the first day of your period)

2. Your mood (before and after your run)

3. Your weight

4. Your daily diet (including when and how much you eat)

5. The time of day and weather conditions of your run

6. Any discomforts you feel while running (digestive distress, headache, wheezing, etc.)