Whether you are new to running or have been at it for years, it seems that the same questions always come up year after year.
Should I stretch?
Does ice really help?
Do I need orthotics?
What kinds of shoes are best for me?
When should I foam roll?
Do I really need to do strength exercises?
I hear these questions being asked at local running stores, in my office and in running groups all the time. Today, we are going to set the record straight and get these questions answered once and for all!
Should I stretch?
The research and information out there about stretching can be confusing and, frankly, competing. You may read in one place you need to stretch, and then turn the page and it says not to! No wonder this question keeps coming up.
What we know for sure is that dynamic stretching should take the place of static stretching before you run or race. Static stretching prior to running has been found to impede performance and running economy. It is also correlated with a decrease in power, strength and speed and an increase in the energy cost of running. Dynamic stretching has been found to decrease the incidence of lower extremity injury and increase caloric expenditure. [1-4]
So, I am telling you not to stretch out your calf muscles or your hamstrings ever again right? No. Static stretching has its place, too. Static stretching has been found to improve muscle length and can be very helpful when rehabbing from an injury. If you always stretched and stop stretching, research says you may be setting yourself up for injury – so don’t stop stretching if you are already doing it. Simply modify when you are doing it.
Does ice really help?
On most occasions when people get hurt, they are told to “put ice on it.” Ice packs, cryotherapy and cold-water immersion are cooling techniques commonly used in sports injuries by athletic trainers, physical therapists, chiropractors and coaches. In recent years, cryotherapy has also become a popular way to recovery after difficult workouts or races.
Historically, research concerning the use of ice has been inconsistent at best. In fact, I have heard grumbling and whispers that we don’t need to ice and that heat may actually be better. Many of my patients would prefer to use heat over ice. There is even research out there saying ice is “bad.” However the research that discusses ice damaging muscles and cells is not referring to using ice for running injuries or for 10-15 minute increments. So what should we do?
Exercise is a stress on the body that results in an inflammatory response. Exercise induces microscopic tears in the muscle tissues, which can lead to delayed-onset muscle soreness (DOMS). Structural and biochemical changes occur after an acute or overuse injury. When an injury occurs, there is an immediate inflammatory response at the cellular level, causing inflammation. Inflammation is part of the body’s natural healing process, but sometimes our body overcompensates.
What does applying cold to your body do? It induces vasoconstriction, which is when the blood vessels constrict and the blood flow is decreased. Vasoconstriction causes cell metabolism to slow and thereby reduces inflammation in the body. Cold exposure has been found to positively affect your body at a biochemical level. It can increase the neurotransmitter norepinephrine, which makes you feel good and can assist in the anti-inflammatory process. 
A recent article, “The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis,” addressed the finding that cooling, especially cold water immersion, was found to improve delayed-onset muscle soreness (DOMS) up to 96 hours after exercise and to lower the rate of perceived exertion (RPE).  The article also found that cryotherapy did not have any significant effect on blood lactate levels immediately or even 24 hours later.
So what does this mean for you? Ice baths and cryotherapy following a hard run or race will likely improve your overall muscle soreness and your perceived exertion, and may provide other benefits as well. So go ahead: ice, ice baby….
Do I need orthotics?
Between 35 and 58 percent of runners use orthotics regularly. Orthotics can be found over the counter at many running specialty stores, or they can be custom made.
Orthotics can be very useful in many situations, but not everyone needs them or will benefit from them. In my practice, I sometimes utilize orthotics when someone is recovering from an injury and will benefit from unloading the kinetic chain from the ground up. However, that doesn’t mean the person will need orthotics forever. If a person is put in orthotics to manage overpronation, he or she may easily not need orthotics after spending time strengthening the hips, legs and feet. In some cases, I even recommend orthotics to people who demonstrate a functional weakness and don’t want to take the steps to improve their strength on their own.
I have also been known to take orthotics away from people when the orthotics are not improving their pain or function. I find that some doctors hand out orthotics like candy. It is a pet peeve of mine when patients come into my office having been given orthotics just because they are having pain, not because they need them functionally. If you are given a pair of orthotics and the person giving them to you has never seen you walk or move, be wary. You have to be sure the orthotics feel good in your shoes and you are not leaving with too much support because that can cause issues in the future as well. What you do to your feet can affect your knees, hips, back and more.
If you are told you need orthotics, should you choose custom orthotics or over-the-counter orthotics? It depends. There is no strong research to support the use of custom orthotics vs. off-the-shelf orthotics. [7-9] Custom orthotics are expensive, but when you really need them, they can be worth it. Unfortunately, I have seen many people spend several hundred dollars on orthotics they will never wear. If you get custom orthotics, make sure the person fitting you has a good understanding of movement and is willing to make adjustments to the orthotics after you buy them.
You will be running and walking in the orthotics, so after they are completed, have your physical therapist watch you run in them and see if you need to make any adjustments.
What kind of shoe is best for me?
Whatever kind feels good! The most current research is saying that the best way to pick out a running shoe is to find one that feels good. Nigg et al suggested a completely new paradigm based on this current research. “When selecting a running shoe, an athlete selects a comfortable product using his/her own comfort filter. This automatically reduces the injury risk and may be a possible explanation for the fact that there does not seem to have been a trend in running injury frequencies over time.” 
Footwear does influence the frequency of injury. Comfort is key. Shoes dissipate force, but they do not prevent injury. Research shoes that running shoes don’t prevent injury, but if you are in an uncomfortable shoe or if you have too much stability one you may increase your chances of injury. While they are getting more rare and are not recommended as often, motion control shoes have been found to cause the most injury no matter what type of foot you have. [10-12]
Nigg et al suggests that in the near future, “A ‘good’ running shoe would be a shoe that allows the skeleton to move in the ‘preferred movement path.’ A ‘good’ running shoe would, therefore, demand less muscle activity than a ‘bad’ running shoe."