Ask the Doctor
By Dr. Chad Carlson
Q: I’ve been recently diagnosed with diabetes, but my doctor said exercise can mess up my medication. I don’t want to give up running. Do I need to?
LW from West Des Moines
A: Running is perfectly safe in a newly diagnosed diabetic without other organ system problems. There are multiple studies now showing the benefits of regular exercise on blood sugar control in type II diabetics. This lowering of blood sugar values occurs because of the tendency of exercise to optimize the action of insulin, which is the hormone that helps your body regulate glucose. This lowering of blood sugars occurs both immediately after an exercise session and over time in response to regular bouts of exercise. This latter effect requires exercise sessions of at least three times per week.
Keep in mind that as a diabetic your risks for cardiovascular disease, including heart attack and stroke, are increased. Exercise reduces those risks in addition to its benefits on blood sugar control. So by all means, keep running, observe your body’s response to the exercise and learn to be the agent of your own control. Good luck!
Q: I registered for the Boston Marathon, then discovered that I was pregnant. I’ll be five months pregnant at Boston in late April, and my running has been going well, slow, but well. How do you feel about running while pregnant?
LN from Waukee
A: There is evidence that women can maintain their training regimen and optimize cardiovascular fitness for the duration of their pregnancy with risks that are low. Exercise has been shown to reduce the risk of fetal distress at birth. Regarding exercise and heat risk, recommendations are that core temperatures stay within 3 degrees (F) of resting temperature and no higher than 102 degrees F. There are studies looking at pregnant women who were in training prior to their pregnancy which show that these women are well-protected from hyperthermia during low to moderate exercise intensities. All told, running a marathon while pregnant, though certainly not common, can be considered in women who are already well-trained, who can limit their race intensity to appropriate levels by setting their own pace (and avoiding the urge to race) and who have the maturity level and self-awareness to know when to stop if necessary.
Q: I developed Plantar Faciitis in November. I’ve taken time off running, I stretch, ice occasionally, wear supportive shoes and it still continues to bother me. Any ideas? Can I continue to run and still have it get better?
DM from Des Moines
A: Plantar fasciitis is a common problem in runners. The plantar fascia, which is a band of tissue running from the heel to the toes, normally provides support to the arch and “spring” to a runner’s step. Over time, small tears develop in the fascial origin at the heel, which leads to scar tissue formation and thickening of the fascia. Efforts at treatment ideally should try to reverse the scar tissue response and restore normal mechanics to the legs.
Treatment of plantar fasciitis involves stretching and ice as you have indicated, as well as occasional use of custom orthotics or night splints. Physician evaluation of patients with this problem should go beyond an evaluation of the heel and look at biomechanical contributors that led to the problem in the first place. This allows a home exercise program to be tailored to the patient, increasing the likelihood of treatment success.
Non-operative treatment options that have been shown to be effective include high-energy shockwave therapy and platelet-rich plasma injections. Cortisone injections are another commonly-used option in our office. Finally, another approach that has been shown to be effective is ASTYM – a treatment approach whereby the plantar fascia is mechanically-stimulated from the skin surface, irritating the tissue in a controlled manner – done in conjunction with flexibility and stability training. It’s certainly not a panacea, but when it works, it works very well. All of our staff therapists are ASTYM-certified, and athletes can continue to run during much of their treatment cycle.
Dr. Chad Carlson is available to discuss any of the above options in more detail. He can be reached by calling Stadia Sports Medicine: 515-221-1102.
