Have you ever had an issue with your achilles, hamstring, patella, or IT band? As a runner, you probably just answered, “Yes.” Miriam Salloum, aka The Runner’s Mechanic, shares her tendon injury expertise in this episode, including what causes tendon issues in the legs and feet, how to treat these issues, and most importantly, how you can keep running while gradually getting pain free.
Miriam is a physical therapist who specializes in working with runners at her aptly named business, The Runner’s Mechanic, in Asheville, North Carolina. She hails from Gulfport, Mississippi, earned a BS in Biology at the University of North Carolina at Chapel Hill, followed by a Masters of Physical Therapy at East Carolina University, and then a post-graduate internship at the Mayo Clinic’s prestigious biomechanics and motion analysis lab in Rochester, Minnesota.
Miriam has practiced orthopedic and sports physical therapy for the past 20 years, helping runners in Western North Carolina and elsewhere with foot and ankle rehabilitation, foot orthoses fabrications, taping techniques, spine and lumbopelvic neuromuscular reeducation, spinal manipulation, and the biomechanical analysis of running gait.
Miriam also uses dry needling techniques used for rehabbing the neuromuscular system. In 2015, she studied these techniques under Sue Falsone, head of Athletic and Sport Performance training for the US Soccer’s Men’s National team, as well as effective treatment of chronic tendon disorders in high level athletes and runners. In 2016, she was the physical therapist for the Olympic Training Site under the Center for Excellence for Sports Science in Johnson City, where she worked with Olympic athletes in bobsled and track and field.
Miriam received her certification of orthopedic manual therapy (COMT) for spine and peripheral joint disorders through Maitland-Australian Physiotherapy and is an orthopedic certified specialist (OCS) through the American Physical Therapy Association. She has been a national presenter for North American Seminars for the past 4 years, educating health professionals in the latest treatments of running related injuries. She models her approach to runners’ rehabilitation after the Speed Clinic & Center for Endurance Sports at UVA and Spaulding National Running Center at Harvard, which has allowed her to utilize the most effective techniques for real time gait re-training.
2:15 You are the Runner's Mechanic. What does that mean and how did you come up with the name?
3:45 You provide a wide range of physical therapy services for runners, but today, I would like to talk about just a few specific topics that runners face and what we can do to prevent and treat them. One of the most common issues that comes up with runners is injury to our tendons, most often the Achilles and the hamstrings, but all the other tendons in the legs and feet as well. Can you talk a little bit about what’s going on with this?
6:45 Let’s talk specifically about the achilles first. Is this so common, who is at risk for this, and what do we do about it?
8:30 What do we do to prevent our tendons becoming like brittle elastic bands, or at least push it down the road, specifically with Achilles because I think I hear Achilles injuries most often, and so what would you say you would do if you felt that niggle after, let’s say, a speed workout?
9:56 Can you talk about why hills are a problem for the Achilles?
11:09 Moving up to the hamstring, let’s talk about that. Who’s at risk for that? Is it the same population, or are there any differences you see between people who have hamstring injuries versus Achilles injuries?
12:13 Let’s start talking about treatment. We hear about for the Achilles, some people say do the eccentric drop, some people say the calf raises, some say do one but not the other, so what should we be doing for rehab for that?
16:08 I’ve heard different advice for insertional tendonitis, and I’ve heard different advice for if the problem is a little higher up. Do you use the same protocol for both, or do you treat those differently?
17:26 Are shoes, and orthotics, and things like that helpful? Can you use those long term? Should people with lower-leg problems always wear a kind of a stacked, non-minimalist shoe?
19:18 Once the rubberband (tendon) is overstretched, that’s it, right? There’s no getting back that elasticity, or can the body kind of heal that?
20:19 For the high hamstring, what is the PT for that?
22:24 What about the other tendon issues? We’ve talked about some of the most common ones, but we see runners that have all sorts of issues with tendons, the outside of the leg, the inside of the leg, the top of the foot, all of that. Can you talk a little bit about those and how common those are?
23:34 So basically, whatever tendon it is, there’s a loading protocol and you can still keep running as long as you’re not in too much pain?
24:13 Let’s talk a little bit about the IT band. Some of the issues that I’ve seen, the IT band gets upset when there’s something wrong with your ankles or there’s something wrong with higher up, like in your hips. Can you talk about that and how those are connected?
26:21 If somebody comes in to you and they’ve been suffering for 12 weeks and they’ve been trying some of this PT work on their own, when is that point where more invasive procedures and treatment have to come? What’s the point where maybe you need to have surgery or something like that? How do you know when it’s really, really severe?
29:00 I know tendons take a really long time to heal, and is it something that even if you do everything right, you could just be one of those people that has a cranky hamstring just forever, or is there hope that doing everything right, eventually you will be pain free?
30:14 In this crazy time, I want to ask you, how are telehealth visits going and how do they work if someone wants to schedule an appointment with you?
Questions I ask everyone:
31:42 If you could go back and talk to yourself when you started running, what advice would you give yourself?
32:38 What is the greatest gift running has given you?
33:39 Where can listeners connect with you?
“As we go through our life as runners, there’s always going to be changes in our system, and always ways that we can adapt, and have those addressed, and go on.”
“It was kind of perfect that your demographic was between 35 and 55 years of age. These kinds of tendon issues are usually in this population.”
“Tendons don’t like inactivity.”
“Training errors are probably one of the biggest reasons people can start to kick off some of these tendon problems.”
“In the research currently, even with these tendon-loading programs, if someone’s even doing it perfectly to the T and to the best of their ability, there’s still about a 40% rate of chronic tendon issues.”
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