Last updated: Jul 15, 2009
I seem to be experiencing typical runners knee pain at a very convenient time—in terms of blogging about it, at least. (Not so convenient is the fact that my first triathlon is next Sunday.) Maybe it's just the season for outdoor running and overuse injuries, or maybe its all the headlines about pain relief lately, but everyone seems to be talking about whats safe, what works, and whats best.


Painkillers: Are they safe?
First a federal advisory committee recommended that the government lower the daily recommended dosage of acetaminophen, based on the idea that it is relatively easy to overdose on the drug, and that it's been linked to liver damage. Acetaminophen is in Tylenol, of course, but it's also in plenty of other multipurpose medications.


That information led runners and other athletes—many of us who pop pills often to combat achy joints and muscles—to wonder exactly what we should be taking; after all, acetaminophen is supposed to be safer and gentler on the stomach than other nonsteroidal anti-inflammatories like aspirin. Luckily, my friends at Thats Fit (who have a great triathlon training series going on, by the way) tackled this tough question just when I needed answers.

They interviewed Robert Sallis, MD, the codirector of Sports Medicine Fellowship at Kaiser Permanente Fontana Medical Center, who assured them that Tylenol is still likely the safest choice for most people, and that athletes who take less than 2,000 milligrams a day (about six regular-strength tablets) shouldn't worry. Of course, persistent pain is likely a sign of tissue damage, he added, so it's best to get checked out if you find you're turning to pills on a regular basis.


tylenol-athletes
Muscle-relaxing gels: Do they work?
In related news, another popular remedy for overuse injuries is being called an unproven waste of money in a new report. In fact, the lead researcher has gone as far as to say you "might as well rub your skin with a bit of spit," rather than use over-the-counter creams, heat gels, and other rub-on or spray-on gels containing salicylates.


These products, which include Aspercreme, BenGay, and Icy Hot, proved no better than placebo creams at relieving pain and discomfort when tested in several large, high-quality studies. The review did not cover gels and creams whose main ingredients were capsaicin, or other NSAID medications, and the study authors reported that some of these creams do seem to help relieve pain in some cases.

Some experts still support salicylate creams, and they say that the warming action they offer may be enough to help people feel better. For me, just the smell of BenGay makes me think of the high school locker room and injury recovery—and I believe there might be a bit of a placebo effect in there. But if youre going to spend money on these creams, its important to know exactly what has and has not been proven.

Stretching and strengthening: The best prevention?
The best cure for sports-related pain and injuries, however, is to prevent them in the first place—and the best way to do that is with proper conditioning, including adequate stretching and strengthening. When I finally did get in to see my physical therapist, she basically told me what I already knew: I didnt have a real injury, at least nothing more than slight overuse and general weakness. My knees were bothering me not because Id torn or broken anything, but because the muscles around my knees—mainly my quads and hips—werent strong enough or flexible enough to support all the pavement pounding I've been doing.

So I've been attending physical therapy twice a week, where I work on stretching my calves, quads, hamstrings, and iliotibial bands (with moves like these); do exercises to strengthen those muscles (with resistance bands, balance boards, and ankle weights); and sit for 10 minutes with ice packs on my knees. It's mostly stuff I could do on my own at home, but probably wouldn't have the patience or the motivation to take my time and do it right.

I've also rediscovered my love for another type of stretching and strengthening: yoga. After every long run or bike ride, my stiff muscles remind me of how important it is to really take the time to stretch out and stay limber—and I've recently been experimenting with several different types of yoga classes to keep me that way.

In my next post, I'll discuss more about how athletes of all types, especially runners, bikers, and swimmers, can benefit from and help stay pain-free with yoga.

How do you handle joint or muscle pain when training for a big event? Share your coping strategies here. With just over a week until my big event, I've entered the tapering stage of my training and luckily won't have to worry about overuse for the next few days. Race day, on the other hand, may be a different story!