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Just call her 'The Runner's Mechanic'
Karen Chávez, firstname.lastname@example.org, February 11, 2015
ASHEVILLE – Like the horse whisperer working with injured steeds, Miriam Nelson can root out the causes of hurt and pain in her specialty species — the Asheville runner.
As that breed is gearing up for the big races such as the 40-mile Mount Mitchell Challenge this month and the Asheville Marathon at Biltmore in March, and the countless 5Ks, more are scratching at Nelson's door. And with a Yoda-like wisdom, a soothing touch, a calming voice and a prickly needle or two, Nelson can get most any kind of running-damaged goods up and galloping again.
Just call her "The Runner's Mechanic." Nelson, a physical therapist, gave her newly opened business the name, she said, since she often looks at runners like cars.
Some are Oldsmobiles, some are zippy little Mazda Miatas, while some are top-heavy Hummers or energy efficient Honda Fits. But just like a car, a runner needs the right fuel, the right finessing and the occasional tune-up and alignment to make it go, make it hum, make it run efficiently, and give it a long life with lots of mileage.
Having been a sports and athlete-oriented physical therapist for more than 15 years, catering to the area's legions of outdoors athletes while working at Southeast Sports Medicine and other clinics, Nelson, 39, had always worked one-on-one with athletes, mainly runners, in a more functional approach. That side business was growing so quickly, the mom of two young children decided she couldn't do both, and stepped out on her own.
The Runner's Mechanic officially launched the first week of the year in a shop on Hendersonville Road in South Asheville, conveniently located between two loves of local runners — Foot Rx Running and Dunkin' Donuts.
Nelson said the abundance of Asheville runners, the access to so many types of running terrain, running shops and running clubs, makes this the perfect place for her business and her skills.
"I was an athlete growing up, mostly playing basketball," said Nelson, who grew up on the Gulf Coast of Mississippi. "Running for me was a way to gain speed and endurance for other sports. Then in graduate school, I started running for relaxation, and then when I moved here, found I could run outdoors."
She developed a specialty in foot bio-mechanics and orthotics. That eventually evolved into analyzing gait as a whole for walking and running, and led Nelson to her specialty with runners.
Jackie Lalor, 50, a nurse at Carolina Day School, has been running longer and longer distances since she turned 40, everything from half to full marathons, to the 18-mile Shut-In Ridge Trail Race on the Blue Ridge Parkway. "I just started having issues with pain in the high hamstrings, and a friend told me to come to Miriam," Lalor said.
Nelson used video of Lalor running on a treadmill in the warm, cozy studio setting, as well as outside, to analyze Lalor's gait pattern. Nelson found that when Lalor began upping her mileage and running intensity, she was overloading certain muscles, and has been working with her to "re-educate her muscles and gait pattern."
This is done partly with dry needling, a technique Nelson uses with needles that "look like acupuncture needles, but is nothing like acupuncture," also known as intramuscular manual therapy. The needles are pushed into a tense muscle or knot, known as a trigger point and release it. She also uses techniques such as Kinesio taping, individualized exercises and strength and balance training.
"The thing I really love about working with people is making sure the alignment is correct," Nelson said. "The idea is similar to working with cars, symmetry and alignment. The basic fundamentals of running health is to distribute the forces equally, right to left, as people land. When that symmetry is disrupted, it creates a timing issue, so that the limb movements are no longer reciprocal."
Nelson said she works with all ages, from high school cross-country runners to seniors running for fitness, to women wanting to get back into shape after pregnancy, and across all levels, from ultra-marathoners to those aiming at a personal best in a local 5K. "No matter the reason someone comes to see me, whether it's injury prevention, symptom, non-symptom, long or short distance, the same concepts apply — regaining the strength and mobility and timing throughout the gait cycle. It all has the same outcome — injury reduction, better performance and better efficiency."
Nelson, who has degrees from UNC Chapel Hill and East Carolina University, said she had always wanted to go into medicine. She opted for physical therapy to be able to spend more time with people. "I find that physical therapists tend to treat people more holistically," she said. "Being a physical therapist, you have a more tools, more things to offer people, like soft tissue release and therapeutic taping, dry needling, bio-mechanical gait analysis. You can spend more time, look at someone as a whole and do more problem solving."
Nelson is constantly improving her own game, attending clinics on the latest research in running at the University of Virginia SPEED Clinic, lecturing nationally on the treatment of running injuries, and has even invented a device to be worn in shoes to address problems related to sources of plantar fasciitis and arch pain. Working with local designers and Western Carolina University's Small Business and Technology Development Center, Nelson is in the process of trademarking the device.
"The end goal is all the same — the mobility and stability to run. It's using the basic properties of physics — the way someone lands on a leg, their structure, mobility, and strength. Everybody has a different genetic bag."
Lifestyle not conducive
Nelson said that so many runners get injured because of incorrect running form, and because of a long-honed lifestyle that has made humans ill prepared for such physical exertion. After the book "Born to Run" was published in 2009, documenting how humans were actually born to be running creatures, a widespread movement toward "barefoot," or minimalist running took hold. The creature-esque "five-fingered," skin-tight running shoes were ubiquitous. But Nelson said runners were starting to be injured in different ways and are now moving away from those types of shoes.
"I do think minimal shoes are a step in the right direction, but specific to the culture in the United States, most individuals are not conditioned for the demands (minimal shoes) make on tendons. We didn't grow up running or doing hard physical labor, as our ancestors used to, on natural terrain," she said. "In our culture, even the most physically fit people don't do a lot of heavy lifting, carrying and running from place to place."
Minimalist or barefoot shoes load the Achilles tendon much more, which she said some people can adapt to, but some cannot. What is becoming more common in running footwear now are shoes with a low "ramp differential" — the difference between the height of the heel and the height of the forefoot. Minimizing that differential is beneficial for most people. "This community is a big driver for me," she said. "Running is so highly accessible here and so social and so connected to the natural environment. As a species, we're drawn to running."
Paige Burton, 45, a fourth-grade teacher, had been running for seven years for exercise but recently began developing IT (iliotibial) band pain whenever she ran over 10 miles. She stopped running for a couple of months to let it heal, tried using compression tights, tried different shoes, but the pain always returned, so she went to Nelson. "My gait was off. I crossed over every time I ran. That's why I was having pain," Burton said.
Burton said the video analysis showed she was using her IT band (a muscle that runs along the outer thigh) instead of her glute (backside) muscles. Four separate sessions added up to about $400, which is not covered by insurance, Burton said. She said Nelson did dry needling and other exercises and after a few sessions she was able to run more than 10 miles without pain.
"It was pretty unbelievable. I'm happy to be running pain-free," Burton said. "Running is my sanity, my inspiration, my peace. If I can run comfortably for $400, it's way worth it."
Often, Nelson can give a runner the tools to run more balanced, which will reduce tendency toward injury and keep them from needing to return.
"The thing that makes what I do important is I look at people's individual structure. Ninety-nine percent of people's hip flexors are too tight. People's glutes cannot fire efficiently, and that leads to a whole host of problems," Nelson said. "That can be a game changer."
Javan Lapp, 27, an Asheville attorney and competitive runner, started going to see Nelson about a year ago. A college runner at UNC Charlotte, Lapp began doing longer distances and more hills when he moved to Western North Carolina and developed hamstring tightness, sometimes to the point he had to stop mid-run and walk back to his car.
"The main difference between Miriam and PTs at bigger practices is she does video analysis, she spends a lot of time talking to you about your entire running history," said Lapp, who races with the Asheville Running Collective. "She gets much more in depth. She's really into running and understands the sport and takes the time." Lapp said he had dry needling performed for the first time by Nelson and found it to be extremely helpful in getting up and running after an injury.
"If you get injured, you can just take time off, but Miriam helps you find the inefficiencies or stride problems you have that are causing the pain in the first place," he said. "She helps you find those imbalances and finds the root of the problem. It's helped me break out of that injury cycle."