Yes, I said it, "Embrace the Suck!"
I was watching the London Olympic ‘s Women’s marathon this morning and thinking of my upcoming Ironman in Quebec. (Yes, I was up at 5am to watch the race and was on my bike trainer so I wouldn’t waste the training time) The announcers were talking about the work these women put in day after day for years that culminates at their shot for Olympic gold. They also talked about the way an Olympic gold could really change many of their lives, especially those from African nations. Although I did find their commentary interesting, the one thing that struck me was the comment that at least 30 of the woman had the athletic talent to win gold, but it was the ability to embrace the suffering inherent in the marathon distance that eventually meant the difference between Olympic champions and also ran.
It reminded me of an article I read in Triathlon magazine by Chris McCormack (for those non-triathletes he is “Macca” and a hugely successful triathlete and pretty neat guy) that had this topic as its theme. “Embrace the suck!” is Macca’s mantra when thinking about long course. He also felt that mind over body and how you controlled your mind during a race meant the difference between successes and also ran or in some cases DNF! (Did Not Finish)
There was one study that had half the athletes doing math problems while doing weight reps and half the athletes concentrating on the weights. Guess which one fatigued earlier? Of course the ones spending mental energy on math and losing focus of the reps. Focus is the key to success!
What does all this mean? My musing this morning comes down to why we do this sport. Whether you are a marathoner or a long course triathlete, you challenge yourself to perform races that most people think are insane. Why? The challenge! The edge! Whether our goal is to finish or a time goal or to win, a satisfying race is accomplished when we come to the edge and come face-to-face with our inner weakness. The edge comes when the risk is compelling enough to make it all count. I find myself asking myself, “Why am I doing this?” about halfway into a long race. How I answer is the difference between success and a less than optimal outcome. Whining is not an option. At that point, I might as well throw in the towel. Perishing on the pavement is also not a good option. Confronting this inner voice and trouncing it makes the race a success.
After finishing my first Ironman, I went back to work the next week with the feeling I could do anything! Not only was my mental attitude better at work, but it was also better at home. I had embraced the suffering and succeeded so nothing was impossible, even the whining of my 13-yr-old! I find in business, the same mantra holds true. If you embrace the suck, meaning put it all on the line knowing it will take work, suffering and an uphill battle; you usually succeed. Why? Same reason, the risk is compelling enough for us to put in 100% effort! We can’t lose when we bring our “A” game!
I have a significant challenge in 2 weeks at Ironman Mont-Tremblant. The course is at altitude and is very hilly! I will conquer the course and finish the race, which is my goal this year. I know I will be asking myself why I am racing and what does it matter to anyone except myself that I finish. My self-talk will tell my inner voice to suck it up and finish no matter how bad I feel, for myself, for my friends and family and for all my patients following their doctor! I inspire them to take on life’s challenges and win! If it were easy, everyone would do it!
Bottom line: Embrace the suck!! In a race and in your life! You embrace the pain and the challenge, then deal with it and succeed!
The top three questions runners ask about custom foot orthotics are:
1. Should they use orthotics in their shoes while running if they don’t have an injury?
2. If they have fatigue in their legs while running or a jacked up gait, they often wonder of orthotics will help?
3. Should they wear orthotics forever after an overuse injury?
The answers are yes, yes and yes!! A new study showed that orthotics have a significant benefit in reducing running injuries as prophylaxis. It makes common sense, that if you have an underlying biomechanical deficit, orthotics give you better alignment so therefore should reduce overall abnormal stressors and subsequently injuries. Now there is a new study that shows just that! Piggy-back that on years of biomechanics research and the answers get much more clear.
This study demonstrated that the subjects who wore orthotics had "a significantly reduced rate of exercise-related lower limb injury across the training period". The authors emphasized that participants were not treated for an injury with orthotics, but were prescribed orthotics to prospectively reduce the risk of injury. In addition, they believe that these "preventative results can be cautiously extrapolated to a recreational running setting and should be considered by sports and exercise medicine professionals."
We generally prescribe foot orthotics to treat specific injuries. This study indicates that orthotics can be a valuable prophylactic tool for injury prevention, supporting orthotic use in at-risk populations (e.g. runners) for medial stress syndrome, iliotibial band syndrome and Achilles tendinopathy.
Considering the results of this study and the results of a previous study on the use of orthotics in runners by Mundermann, it is recommended to use at least a pre-fabricated Powerstep orthotic which incorporate a medial heel skive and rearfoot post, as a cost-effective means of providing prophylaxis with corrections proven effective in runners.
Runners with a previous history of these injuries and/or those that develop symptoms would be good candidates for custom orthoses based on the results of these two studies.
Franklyn-Miller A, Wilson C, Bilzon J, et al. Foot orthoses in the prevention of injury in initial military training: a randomized controlled trial. Am J Sports Med 39(1):30-37, 2011
Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech 18(3):254-262, 2003
Run Happy! And with your orthotics!
Let's talk about how to reach your goals in 2012!
Happy New Year! More in 2012!
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I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?
Let’s talk about ITB syndrome.
The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.
Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.
Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.
Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.
During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.
The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.
The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!
Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.
Ryan Hall said about running a marathon, “It's a long, hard road and it's going to have its bumps; there are going to be times when you fall and times when you don't feel like going on anymore, times when you're just crazy tired but it takes focusing on that one step you're taking. That's what I'm trying to do with the marathon; I don't think about the miles that are coming down the road, I don't think about the mile I'm on right now, I don't think about the miles I've already covered. I think about what I'm doing right now, just being lost in the moment.”
I feel this is even truer about endurance triathlon and Ironman. Focus on the moment and don’t think about the miles and hours to come. Most of the battle in the race is going on in your head!
Fight the negative self-talk. Rememeber your mantras and that it is all about the finish line! Pain is temporary and quitting is forever!
It’s two weeks to Ironman Texas and I can tell you that all my peeps are ready for tapering or already in taper mode! Is there a science to Ironman tapering? Or is it really an art? I combed the internet looking for guidance, called all my veteran friends and coaches, and guess what? No one agrees - as usual. It seems that tapering is as much art as science and there is no one plan that works for everyone.
Here are some tips on Ironman tapering. (And no, doing nothing for two or three weeks before the race and drinking beer is not one of the tips!)
I did read some great advice in an article by the legendary Dave Scott wrote on tapering and then he was instantly contradicted by another, more scientific article, by Alun Woodward. Here are some of their thoughts and my personal commentary (can’t disappoint the fans of my pathetic humor).
Despite clear evidence that a shorter taper is most beneficial for endurance athletes, many Ironman training plans today include a full three-week taper. This is actually due to looking at marathoners and their habitual over training. If you are over-trained, and on the brink of exhaustion, then a three week taper is for you. If you are more like an ultramarathoner and bounce back from your long rides and long runs quickly, your taper may only be a week or so. The hardest part about giving an answer to the question, “How long should I taper before an Ironman”, is that each athlete is so different. Some athletes repeatedly bounce back from 6+ hour rides and 2+ hour runs as if they were nothing (these folks can taper less and i personally hate them), whereas others are sidelined for 2-3 days in a haze as they recover (these folks can taper more and this is much more like me). So the first place I suggest you start is with your own athletic history. How have you recovered from you longer efforts in training? That will give you an idea of how much time you need. (Gues I need a month, oh no! I only have two more weeks….)
Everyone agrees that no matter how long your taper, it should be a fine balance between these 10 components:
Every individual taper is unique. Your age, preparation and personal history of your previous tapers should all play into the final formulation. A balance of rest and active recovery are key, but not too much rest. I recommend that you do something every day and just maintain your schedule. I have gone into a marathon too rested and bonked. I’ve also gone in exhausted and bonked (lots of bonking history) I have learned to listen to my body. Do regular self check every morning and rest as needed. Better to be 15% under-trained than 1% over-trained. Be confident that your body will rejuvenate and respond to resting.
The Gods of Ironman have conflicting stories about tapering, but the truth is in your own history of recovery. If you listen to your body, and are honest about your bonk history; you will know how long of a taper you need. Keep these tips in mind and be ready to rock your next Ironman!
Wow! What a great panel discussion put on by Saucony in Boston last Thursday night. I love going to Boston during marathon week. It's like Marathon Mecca! The whole city seems to buzz with running excitement. Boston will always be my favorite marathon.
I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.
The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours.
After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!
Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.
Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.
Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.
That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come.
Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.
Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.
Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.
A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.
A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.
So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.
A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.
Who shouldn’t try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.
A side note of caution to anyone trying to go “less is more.” When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the “too much, too soon, too fast” syndrome that can sideline even the most cautious of runners.
A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.
Join Dr Crane at the Boston Marathon discussing minimalist shoes and training with an expert panel!
For more info, click here
EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.
The Top 16 FAQ’s About EPAT Therapy for Heel Pain
The most common New Year’s resolution in the United States is to lose weight or improve your fitness. Let’s face it, even for the veteran marathoner or triathlete, the New Year gives us an excuse to refocus or give us just a little kick in the butt we need. We all need a plan to achieve our fitness goals or race success. I woke up on January first and realized it was 21 weeks until Ironman Texas. Wow! That crept up on me! Janet has been blogging for months about the road to Ironman Texas. I’ve been so busy working my butt off and being Mom, it crept up on me. Now it is time to refocus on my fitness goals, so I don’t perish on the streets of Houston on May 21st.
Maybe you are like me, a race is creeping up on you, or maybe you have just gained a few extra pounds from the holidays, or maybe you are like some of my friends who realized running up their stairs they get out of breath. This is a great time of year to refocus on your fitness goals. We all have obstacles; time, energy, financial, and our own self-defeating voice in our heads! Here are some tips that will help you focus and reach your fitness goals in 2011!
If you follow these few tips, I promise you will reach your fitness goals in 2011! You will thank me! And I will live though Ironman Texas this year! Run happy and towards your goals!
Let’s face it. The alarm goes off at 5:30am and there are many days I don’t want to get up and run or bike. My bed is warm and the air is cold. My pillows are so comfortable and missing one work out won’t matter that much. I’m in great shape! STOP! The negative self talk is waxing away at your motivation and suddenly those fitness goals are sliding away.
It’s not hard to stay motivated during the season. There is always a 5K or sprint triathlon every weekend and they fill your calendar. Your “A” and “B” big races are in red on the schedule and that motivates you to get out of bed and even do two-a-days. But now it’s off season for triathlon, and even the fall marathon season is slipping away. The days are getting shorter and colder; and in some areas the snow has begun to fall. Even in North Texas, the mornings are dark and the winter running gear is coming out of the moth balls. Motivation is hard to come by. I’m tired and cold and my morning run has lost its appeal.
What’s an athlete to do? Well, the winter off-season is a great time to mix it up a little. Training has to change from time to time to be effective. We all get stuck in ruts, so the off-season is a great time to try out some new tools. This is the time to build some strength, allow other muscle groups to become more balances and especially allow for recovery from a hard season. It’s the time to build on the hard work of the season and prepare for even greater success in the future! Motivated yet? Me neither, but I find two great tools do help me shake the winter doldrums and get motivated to work towards the next season: goal setting and visualization.
Everyone yawns now; it’s the goal setting lecture…..Wake up! Most of us have goals in our head, but very few have written concise, realistic, timely goals for the next year. A goal not written down is a mere wish! Teaching yourself to write realistic, yet challenging personal performance-oriented goals will allow you to do the work necessary to achieve those goals, allow you to see improved performance, lead to increased confidence, and ultimately lead to greater success as an athlete.
Goal Setting 101
1. Define what you want to accomplish in 2011. It is important to begin with the end in mind. My goal for 2011 is the finish the Texas Ironman and not perish. Good goal! Time goals or a new distance should be realistic. I once had a patient that told me her goal was to finish a marathon a month in the next year. I asked how many marathons she did last year. None. Not a realistic goal!
2. Know where you are right now. How strong are you? Do you have any nagging injuries?
3. Be honest about what you need to develop. I need to get stringer on the bike. What are your weaknesses? Be objective and painfully honest with yourself. Put your ego aside. This is an important step.
4. Set sub goals and segment them. Perhaps you have a time goal, but you also probably have a weight goal, a nutrition goal and a mental goal.
5. Write performance goal for all the sub categories. Be specific and measurable. Don’t say, “I’m going to stop drinking so much beer,” a better goal is to say, “I’m only going to have one beer a night and only on days that start with S.”
6. Commit yourself completely. A goal should be something that leaves you with a burning desire to reach it! I post my goals on a sticky note on my bathroom mirror so I look at it daily. This motivates me. Have a goal card in your pocket and look at it. Keep a training log and make interim goals. This helps you stay focused.
7. Monitor your progress. Listen to your body and do not become obsessed with your goals. Your body will tell you if you need more rest! Injuries happen when we push ourselves too hard. This does not help us meet our goals.
8. Visualize yourself meeting your ultimate goal. I have watched myself cross the finish line of a full Ironman many times in my head. Close your eyes and visualize the starting line and you are feeling great and in the best shape of your life. Go through the race in your head, feeling confident and relaxed. Watch yourself finish strong and feel the rush of achieving you goal. Practice this weekly and your brain will be mentally prepared for success.
Motivation and drive come from constant focus on the destination and then seeing you move through the process to get there. Having a purpose is important or it is really hard to consistently train during the off season. Take some time and work on your goals. Visualize success, and then get out of bed!
Run Happy! And all winter long.......
I was running around Grapevine Lake this morning at 5:30am and was amazed how many people were out and about. Seems like everyone was going around 20 miles today, so they all started really early. Everyone had a fall marathon on their schedule; some going to Lake Tahoe, some Chicago, some New York. And of course, a lot of people gearing up for the Dallas White Rock Marathon in December.
It is amazing how the marathon bug has bitten so many people! Even Amani Toomer, former New York Giants' wide receiver, is running the New York City Marathon this year for charity. I remember when I planned to run my first marathon in 1999, most people thought I was a little crazy, and the Cowtown Marathon only had less than a thousand people every year. Now, it seems almost everyone is attempting a marathon or two; and the local marathons are busting at the seams with entrants. The Houston Marathon even went to a lottery because it has sold out so quickly the last few years! Wow! So many runners and so many "training theories" for people to hurt themselves with!
Here are a few tips to keep you on the roads and out of my office:
Tip #1: Do not increase your mileage by more than 10% per week. The body grows stronger if it is stressed in small increments, but starts to break down if it is stressed too much. Studies show that increasing your mileage by no more than 10% per week will help you grow stronger without breaking you down. Avoid increasing duration and pace at the same time.
Tip #2: Always follow a hard workout with an easy one. The body’s like a cell phone. If you continue to use it without recharging, it will eventually wear down. By incorporating easy workouts or cross training into your program, you’ll allow your body a chance to rest and repair itself.
Tip#3: Add strength training to your workouts. Strength training is usually absent from most training programs, but cross training with weights is the only component that has been proven to reduce running injuries. Proper strength training can help you overcome muscle imbalances that lead to injury, as well as strengthen connective tissues that help support your joints.
Tip#4: Do regular self-checks. Tune into what your body is telling you. How do your muscles and joints feel? How does your breathing and heart rate feel? Are you straining to keep up your pace? Anything that doesn’t feel the same may be an early sign of overuse. Keep a training log of not only your mileage, but how you feel during and after each workout. Fatigue over a period of a few days is a huge red flag that your body is trying to tell you something.
Tip#5: Respond to pain immediately. If you experience pain during or after a workout, follow the rule of R-I-C-E (rest-ice-compression-elevation). Use an ice massage or cold pack for 10-15 minutes every 4-6 hours to relieve inflammation and swelling. Elevation is also quite helpful in the first 48 hours. Apply a compressive wrap and hang out on the couch for a few hours and rest. After 48-72 hours, if the inflammation has subsided, apply heat to help promote healing.
Tip#6: Do not take pain-relief medication to finish a workout! Non-prescription anti-inflammatory medications can reduce inflammation and pain, but they do not speed healing. Taking anti-inflammatories prior to a workout may decrease your discomfort and allow you to finish a workout, but they also allow you to overstress already damaged tissue. This can prolong the healing process. Pain is a sign you should not ignore!
Tip#7: Choose relative rest over inactivity. Active rest, or easy exercise, is better than inactivity because it stimulates blood flow and promotes healing. If slow running is painless, but picking up the pace is painful, then stick to slow running until you feel better. Or do other activities, like swimming, cycling, or aqua running until you can run pain-free.
Tip#8: Don’t wait too long to seek professional help. If your pain does not respond to a week of R-I-C-E and cutting mileage by at least 50%, see a sportsmedicine specialist. Not only can a professional help you diagnose and treat the condition, but they may also help you determine and biomechanical abnormalities that can lead to recurring injuries.
Tip#9: Try to maintain a positive attitude. You immune system fights injuries with a complex army of nutrients and special cells. But, you immune system doesn’t work alone. Your mind also has a voice in what goes on. Attitudes and feelings are organized in your brain to communicate with your immune system with chemical messengers. A positive attitude can go a along way to help speed healing.
Tip#10: Ease back into your regular training program. Remember, too much, too soon, too fast is what hurt you in the first place. It’s tempting to jump right back in where you left off, but your injured tissue may not be fully recovered. It’s during the first few weeks back that most runners get re-injured. Use the 10% rule to ease back into mileage….
Above all, have fun! Marathon running is a challenge that is mental as well as physical. The miles between 20 and 26.2 take determination, stubborness and probably a tiny bit of inner insanity! Whether you finish in 2 hours or 6+, you are still a marathoner forever after you cross the finish line!
Run Happy! And Injury Free!
How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year.
So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.
Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.
Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.
What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!
So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.
Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!
Run Happy! And Recover Well!
Seriously, I crawl over the finish line and the first thing I want is a beer (or twenty)! I think that beer is a great adjunctive therapy for injury rehabilitation. Think about the benefits of beer:
1. It relaxes you.
9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work
Ice versus heat? This is a common question a lot of athletes, coming into my Grapevine, Texas office, ask. Most understand that ice immediately after injury is very important. The questions usually revolve around when to use heat. There are some basic guidelines that every athlete can use to reduce confusion.
Immediately ice the “fall down, go boom injuries.” Ice works well for reducing redness, swelling and internal bleeding in acute injuries. It also is a great pain reliever. Acute injuries and post surgical pain and swelling usually respond well to 10 to 15 minutes of ice every few hours. This should be done for up to several weeks after an injury or surgery. Ice can be in the form of an ice pack (ice wrapped in a protective towel) or ice massage (massaging with a frozen water bottle or block of ice).
Ice can also be helpful in reducing swelling in a chronic injury like runner’s knee or plantar fasciitis. Icing immediately after activity can prevent further inflammation of an already annoyed area and help in recovery.
So where does heat come in? Heat can be used in several different ways. Contrast baths with ice/heat/ice can be helpful in chronic injuries. Especially those joints or tendons that still have just a little inflammation or edema. Heat should never be used alone in these cases. Moist heat is best for chronic stiffness and old injuries with scar tissue. It can also help in the rehabilitation process. For example, when plantar fasciitis becomes plantar fasciosis after four to six months (which is a chronic degeneration of the plantar fascia), deep heat therapy with ultrasound or moist heat packs can help increase range of motion of the area and increase the effectiveness of physical therapy. Heat actually temporarily increases inflammation in an area, but this is often helpful in kick starting the healing process. Heat can also be used to calm muscle spasms and relax a tight muscle.
Heat causes an increase in circulation to an area, so it should never be used in acute injuries or chronic injuries with a lot of swelling. It can actually make an injury worse if there is still a little internal bleeding going on. A great way to heat a joint or tendon is to use a reusable heating pack or an electric heating pad for about 20 minutes before stretching, massage or other therapy. Heating an old injury before exercise can also be helpful in warming up the area to ready it for increased activity.
The simple rule of thumb is that ice is used for acute, swollen injuries and heat is used for stiff, chronic injuries. This subject is debated continuously, but I hope this discussion clears up the mystery of ice versus heat!
I declared myself heat tolerant this weekend in my recent Twitter. I did a 3 hour bike ride in 99 plus heat at 5pm in the Texas heat and could still spit when I was done! That’s a success in my book! It definitely took 2 full weeks of suffering in the heat and a good hydration plan to finally feel like my body had made the transition to feeling relatively comfortable in the soaring Texas summer heat.
Dehydration, heat stroke and hyponatremia are your biggest worries while training in the summertime. Whether you are in Texas or Rhode Island, when the temperature soars over 90 degrees, heat illness can seriously hamper your endurance training. Most of us have an “A” race on the calendar in the fall and require a lot of base training in the summer. No way around those long runs and even longer bike rides in the heat. The average triathlete can sweat up to one liter of fluid an hour while training and sweat contains about 3 grams of salt per liter. How can we conquer the heat? Preparation and constant hydration! Diligence is the key! Always stay one step ahead of the hydration curve. Remember that heat illness really can kill you and hyponatremia has taken out more than one healthy marathon runner and triathlete!
Here are some simple tips that will help you train safely in the heat:
Heat-illness is real! Be smart while training this summer! Follow these tips, heat acclimatize over a period of several weeks and be diligent about your hydration plan while training in the heat. Let’s get to those fall races stronger and without any heat-related training drama! See you on the run! Run Happy!
There was a good Q & A in Running Times talking to Deena Kastor about her foot fracture at the Olympics. I think it's funny that she broke the same bone I did last year. Her discussion about the need for rest and recharging sounded like an echo. I think it is so important for us to realize we need rest after an "A" race or marathon. Also, as women, we need to understand the relationship between Vitamin D and the uptake of calcium. To read more about Deena's injury click here for the complete article. For more on metatarsal fracture in runners, click here.
Run Happy! Rest easy....and more than anything else...run forever my friends!
To purchase a copy of Dr Crane's new book "If Your Running Feet Could Talk" click here.
I recently received this email from a runner in Virginia asking a good question on running with arthritis:
“I have been running since I was 13yrs old and I am 42 now. Friday I was diagnosed with osteoarthritis after 6 weeks of no running but cross training on the elliptical. The doctor thought it was tendonitis but after not getting better he decided a MRI would be appropriate. The MRI confirmed it was osteoarthritis. I am starting physical therapy on Monday 3x a week.
My question: Is it possible for a runner who has osteoarthritis to be able to run again. I feel like my world has been rocked and shaken. Running is HEAVEN for me and nothing compares. It is my total stress reliever and if I do nothing else in a day if I've run my day is totally complete. I am the mother of 3 great kids and I guess I should be thankful I can do the cross training now because I get cranky when I don't get to do something. I just feel like this means my running career is over. My mileage before getting injured was about 25 a week.
Please let me know your thoughts. I have searched the internet for help on other runners who are going through what I am and have osteoarthritis of the foot with no luck so far. Thank you so much for taking my comment. I'm praying for a miracle. I know it's not life threatening but it's my mental state I'm concerned about.”
Let me start my answer with a story. I have a runner in his late 30’s as a patient who had the unfortunate luck to be blown up in the Desert Storm conflict while he was serving in the Marines. He has severe arthritis in both feet from his injuries. He has had at least 5 foot surgeries including a fusion of his subtalar joint in one foot. He ran the 2008 Marine Corps Marathon in less than 41/2 hours. If he can run a marathon on feet that are that bad, I am confident that you can get back to some kind of running.
The name of the game is accommodation. You will need a great pair of orthotics made by a podiatrist that knows what they are doing and specializes in biomechanics. They can fabricate a device that will transfer the stress from the arthritic area to a strong, healthier part of your foot. That coupled with physical therapy, core strengthening exercises and a good pair of running shoes will get you back on the road! For more information on living with arthritis click here!
Run Happy! And pain free!
Race day jitters can completely derail your race before it has even started. Don’t let the negativity ruin all your hard work and preparation! Relax! Follow these tips and remember to banish the negative, and stay positive throughout the race! Try to have fun! Whether this is your first marathon or your 100th triathlon, remember to celebrate your training and have a great race!
Run Happy! And anxiety free!
I’m just getting over a spring sinus infections. Again! I’ve always considered myself a middle-of-the road, moderate intensity runner. I run two marathons a year and dabble in triathlon in the spring and summer. Nothing crazy. Yet, every spring I seem to be susceptible to the dreaded runny nose syndromes. I’ve always chalked the whole thing up to Texas allergens, but is that it? Or does my running make me more susceptible to the common cold? Interesting question posed to me by an ENT colleague. She pointed out that many marathoners experience significant increase in upper respiratory infections in the post-race months.
Let’s look at the research. A recent survey of 30 different studies of runners and decreased immune function that may lead to increased upper respiratory infections revealed little agreement from the experts. Yes, they all agree that moderate activity may enhance immune function, but they describe this as brisk walking for 30 to 45 minutes a day. What runner does that little activity? Most studies also agreed that high-intensity exercise temporarily impairs the immune competence. Hence the increased incidence of upper respiratory infections in marathon runner and especially ultra-marathon runners.
Athletes, when compared with their couch potato colleagues, experience higher rate of upper respiratory infections especially in the few weeks after intense training and races. In non-athletes, increasing physical activity is associated with a decreased risk of upper respiratory infections.
This so-called open window of altered immunity is temporary, lasting from three to 72 hours after an intense, prolonged event. Nevertheless, it presents an ideal opportunity to viruses and other invading pathogens, especially those that enter the body through the respiratory system.
Sounds bad, so what can we do to increase our immunity and avoid the runny-nose syndromes?
Several vitamins and minerals, including vitamins A, E, and C, and the minerals zinc and iron, are essential for normal immune function. Vitamins C and E, in particular, are also powerful antioxidants. It has long been known that long-distance running and other endurance events can increase the levels of free radicals—molecules that oxidize and cause damage to cells, including immune cells. The body produces its own antioxidants to counter free radicals and oxidative stress.
Many runners, operating under the theory that more of a good thing is better, take vitamin and mineral supplements. And while moderate amounts may very well be beneficial for the active individual, there is little evidence to support taking megadoses, with the possible exception of vitamin C. Some studies found that taking vitamin C (about 600 milligrams/day) for three weeks before an ultramarathon reduced postrace cold symptoms. Other researchers have found that vitamin C supplementation made no difference. Sounds like a multivitamin with extra vitamin C can’t hurt, but may not be our savior!
Should you run when you’re sick?
If you have a cold, most doctors recommend waiting a day or so after your cold symptoms disappear to resume intensive exercise. Mild to moderate exercise (such as walking) when you have a cold is fine. If your illness is more serious—fever, fatigue, muscle aches—you should wait two to four weeks before resuming your training regimen. Like any of us do that!
Just as intense, extended physical stress can depress certain immune responses, so too can chronic psychological stress and inadequate sleep. So during periods of intense training and before long races, the take-home message is this: keep other life stresses to a minimum if possible. Get enough sleep, avoid rapid weight loss, and eat a healthy diet. Sounds like a no-brainer!
Bottom line: marathon runners are more susceptible to upper respiratory infections. Getting more sleep, decreasing your overall stress and taking a multivitamin with extra vitamin C may help.
Cowtown Marathon kicked my butt! I'll admit it. I have again been humbled. It happens to all of us from time to time. I thought I was in good enough shape even though I had been lazy in my training lately. Too many things to do, not enough time. I was taught again to respect the distance. Yesterday's Cowtown Marathon in Fort Worth, TX was typical of the marathons I have run in the last two years: Freezing (25 degree wind chill factor), 30 mph wind in your face half the time, and added killer, rolling hills to the mix. I have not had good race karma. I thought White Rock Marathon in December was bad, but this was much worse and very hilly. For the record, I HATE COWTOWN! The last time I had run this race was in 1999. My peeps talked me into running it again because the Austin Marathon weekend timing didn't fit the schedule and this was closer to home. Never again....But truly it was not all the race's fault. It was poorly organized with random water stops and almost no spectators, but that's not why I had a bad day. I've been traveling too much, hadn't run enough (only one 20) and was mentally and physically tired. My absolutely wonderful running peep, Dr Steve Buksh, ran the whole way with me and should get a huge reward for not killing me when I started whining then ultimately crying (yes, that bad of a day). My hamstrings went into a seizure at about mile 16 from all the hills and we walked a good 2 or 3 miles. By 23 miles, I could barely run and looked like an epileptic. Definately not my day...but the lesson learned is to respect the distance. No matter how many times you have run 26.2 miles, it is still a formidable task and not for the weak or unprepared. The marathon humbled me yesterday and I learned my lesson....always respect the distance.
Now we can talk about delayed onset muscle soreness tomorrow when I can barely walk :)
Run Happy ....and respect the marathon or she will beat you into submission!
Inspiration From Newbies!
This morning I got to spend a few minutes with a new group of hopeful marathon runners who had joined the local Team-in-Training Program raising money to fight Leukemia and Lymphoma. It was 35 degrees and I had to drag my 2 year old with me because of life's bad timing :) I was not in the greatest of moods when I got there, to say the least.
My bad mood cloud almost instantaneously lifted and my mood changes 180 degrees! What amazed me is that you could almost palpate the hope and joy in this group. A cold Saturday morning at 7am and they are laughing, joking and supporting each other in this endevour. These types of moments always reinforce the realization that it is the journey, the miles on the pavement, the friends and peeps we run who support us, laugh and cry with us, that make marathoning such an uplifting pursuit....a growth experience for all...not the race itself, but the journey to get there.
I applaud everyone who got up this morning, laced their running shoes and headed out the door to run with their peeps.....
Happy Valentine's Day! Here's to the love of the run.......
Is carbo loading all about eating more pasta?
Is there a magic formula?
If you are an endurance athlete who is fearful of hitting the wall,listen up: proper fueling before a marathon, triathlon, century bike ride, or other competitive endurance events can make the difference between agony and ecstasy!
If you plan to compete for longer than 90 minutes, you want to maximize the amount of glycogen stored in your muscles, because poorly fueled muscles are associated with needless fatigue. The more glycogen, the more endurance (potentially).
Read the entire article by Nancy Clark, a leader in sports nutrition.
Run Happy! And Bold in the Cold!
There is always one in every crowd that answers, “Run slower.” Ha Ha!!
DOMS is a regular visitor in most distance runners’ lives. This does not have to be debilitating, but prevention is your best defense against this nagging pain. We have discussed some of the treatment options and suggested methods for prevention.
Above all, remember that certain muscle pain or soreness can be a sign of injury. If your muscle soreness does not get better within a week consult your doctor.
Run Happy! And try to avoid muscle soreness!!
Tim just completed the White Rock Marathon in Dallas this weekend. Weather was warm and extremely windy, but he was feeling good and managing to keep his pace through the half way mark. The race was going perfect and pacing was exactly as planned all the way until about mile 18. As he passed the 18 mile marker, he started feeling small cramps in his calves. He tried to slow down a bit to make them go away, but by mile 19 they hit so hard if felt like a ball bearing digging into his calf muscle and the pain literally brought him to the ground in the middle of an intersection. (Much to the traffic cop’s surprise) He had to stop, stretch and hobble along until they stopped. He had to walk for awhile, until they went away and then slowly started to run the last few miles. The cramps did not disappear and he had to stop again and stretch once or twice every mile. So much for his time goal!!
Question is, why do cramps happen and how can you prevent them? They have never occurred during his extensive training, so why in the middle of a race?
Muscle cramping usually occurs due to a depletion of "The Big 4": sodium, potassium, magnesium, and calcium. Also, if an athlete is dehydrated, even slightly, going into a race, muscle cramps can be common (no matter how spot-on race day hydration is). Cramping can occur due to the depletion of one or a combination of these four minerals. One area that I would first examine is your everyday fueling. I realize that conventional thinking says that if an athlete cramps up during a race, then it must have been something nutritionally that went awry during the race. This may be the case, but actually the answer usually lies in one’s everyday nutrition and hydration.
The first thing I would suggest is to monitor your hydration levels before and after training (especially long training days). This can easily be done with a body fat scale that also measures body water percentage. Take this reading each night before bed for 7 days straight so you can determine an average body water percentage; then, after training sessions, re-measure your water percentage. You will probably notice a reduction in your water percentage, as this is normal. Your goal now is to refuel and rehydrate in order to get this water percentage back to its ‘normal’ level. Another easy way to monitor your hydration level is to pay close attention to your urine color. The goal is to keep your urine color in a range from clear to a very light yellow. If one’s urine color is a darker yellow, this can be a sign of dehydration (be aware, that if you take a multiple vitamin, the B-vitamins will turn your urine color yellow, and this is normal; not a sign of dehydration). Following a long training run or race…get your urine clear and keep it clear throughout the day, as this will ensure proper hydration.
In regards to the Big 4, try to consume a fluid replacement drink that contains all four of these minerals, and be sure to consume this fluid replacement drink during training and racing. Also, be sure to use your “sodium capsule” of choice during training, and not just on race day (you may already be doing this). If you find yourself avoiding sodium in your daily nutrition, try to lightly salt your foods with sea salt. Also, drinking vegetable juice is a great source of sodium and potassium (be sure to check with your physician that there are no blood pressure issues that would contraindicate the use of additional sodium).
So, in summary, my advice to Tim would make everyday hydration and fueling your focus as this will get you to the start line in a state of optimal hydration. This should help avert any nasty cramps in your next race!
Run Happy! And cramp free!
Today was the White Rock Marathon in Dallas. This is an annual event that I usually participate in with many of my patients and peeps. Wonderful event with a full marathon, a half-marathon, and a 5-person-relay. This year had record participation of 17,000 people with almost 7,000 runners in the full marathon. Unfortunately, today it was 68 at the start and warmed up to about 75. Did I happen to mention the 30 mile an hour head wind that was in our face for at least 14 miles of the marathon.
This should be the tale of two half-marathons. Most of us were doing great at the half. I personally hit the 13.1 mile marker exactly as predicted in my pre-race planning at 1:52 which would have brought me in at 3:45 with the negative split I was planning. I've always said that a marathon is a fast 10K with a 20 mile warm-up, so I always try to bust it in with a negative split. Unfortunately, the weather was not cooperating! I turned the corner at 14 miles to go on the lake access road and was hit by gale force winds. Being small of stature, I was blown all over the place! I felt like a small kite for at least 10 miles.
At 16 miles, my day was done! I was putting forth the effort for an 8 minute mile and crawling at somewhere between 10 and 11 minute miles. My goal was shot, but my wonderful brother (who on the spur of the moment last night thought he would pace me in the marathon - crazy!) would not let me quit (I really wanted to because the wind was positively evil!)so we persevered on against the wind.
My friend Mike Horton was a sight from God that jumped in at 19 miles and ran us through the worst of the hills (Thanks Mike!) We did some walking, then decided it would be faster to finish if we were running.
My awesome BFF office administrator Lori Cerami jumped in at 23 (at this point my brother jumped out since this was the most he had run in 2 years) and yelled at me to get my butt moving....she stayed with me giving me gummy bears and Accelerade until the 25 miles marker. At that point I figured I was almost done so I ran a quality 1.2 miles to the finish.
My assistant Penny, associate Dr Mollye Karp and pedorthist Janet were at the finish, but had already drank all the beer :) So salty pretzels and some Starbucks were my reward, but I loved seeing them with signs cheering me on.
Only one of my peeps was even close to her goal today, so it was basically a PW (personal worst) for almost all of us, but I think my finishing time of 4:13:45 deserves an astericks next to it for the weather.
To put it in perspective, only 3,878 people finished out of almost 7,000 and I was 1,339 overall, the 329th woman, and 58th master woman (yes, I am that old). Not what I had hoped for, but the course humbled all today due to the crazy conditions. The winner finished in 2:22 in comparison to the 2006 winner who ran 2:12; so I think we can all comfortably subtract 20 minutes from our time for conditions. :)
We survived to run again.....and should rejoice that we can....
An excerpt from the upcoming "If Your Running Feet Could Talk" coming in January 2009! From myrundoc.com
Appendix I: Every runner needs a little humor!
I hope after reading this book you feel like part of our running communities. It never ceases to amaze me how I can travel to another part of the country or the world and instantly make new friends with other runners. We share the same experiences, goals and crazy traits across age, sex, and abilities. Runners are a world community. So I have included this list that has traveled the internet and has been edited many times by many groups. Here is our version:
Many people have been asking for exerpts from the upcoming book so here is a chapter that reminds our friends and families what we need for Christmas...make your shopping lists.
Run Happy...and don't forget the essentials!
Congrats to all the runners...over 5000! Wow! What a huge race for Dallas and a beautiful morning. It was 55 or so at the start and warmed up to 76 at the finish. HOT!!! and Hilly!! Lots of great times were run (I unfortunately was not one of them) and the post-race parties in the tents were fun! Nice showing from the Lake Grapevine Runners and Walkers as well as the Dallas Athletes (most of which did a tri last weekend).
My peeps all ran well with Tim Jacobs leading the way with a 1:35, Heather Wallace blasted by me at 8 miles and finished in 1:45, I personally bonked at 8 miles, but held on to a 1:48 (but at least it was a minute faster than last year and 19th out of 329 in my age group...not a terrible showing) and Steve Buksh rounded out the crew with a 1:50. Special guest appearance by an old friend, Dan Banse at 1:51. Dan and I suffered from the same disease....going out too fast and having unrealistic expectations!
This was a good building block for the marathon next month...watch out White Rock here we all come! And hopefully will be smarter from our bonk today!
A very smart person once said that a goal not written down is just a mere wish. I passionately believe this is true and have proven the power behind written goals in many aspects of my personal and professional life. In fact, this year I was planning on running the Sacramento Marathon, but fell in a pothole and broke my foot just a few months before the race! The fact that my foot was broken did not deter me from trying to reach my goal (Yes, I am that stubborn). I cross-trained; swimming and biking for hours, trying to keep my cardio fitness intact, just so I could indeed run this planned marathon. It was the week before the race when my husband interjected just a little common sense (please don’t tell him I said he was right) and he asked me why I was so hell bent on running Sacramento? There were so many other races on the schedule and I had only recovered from my stress fracture 3 weeks prior and done a long run of only 16 miles. I really did not have any good reasons to tell him except for the fact that I had written it down as a goal almost 6 months prior and I was determined to reach that goal. Common sense intervened (maybe I’m not that stubborn after all) and instead I did my first triathlon, all that biking and swimming was good tri training, then I picked a marathon 2 months later that I could run after adequate training. Goals are a powerful thing. Running goals can take on a life of their own and guide our training.
I challenge all of you to do a goal writing exercise to determine where running fits in your life. Think about lifetime goals; perhaps qualifying for Boston or just to finish an entire marathon; then break down your goals into smaller segments. Try to ascertain how you will reach that lifetime goal by achieving smaller goals; write down your 5 year goals, your 3 year goals, your 1 year goals, and finally your immediate goals. It is hard to run a marathon without starting a running program, perhaps training for your first 5K can be your quarterly goal, then a 10 or 15K for 1 year goal, then build up to the marathon or a faster marathon from their. Again, looking at lifetime goals by themselves is often overwhelming; but broken down into smaller increments become very doable!
Look at your goals then start a reasonable plan to meet them! Not only are you more likely to meet your goals if you write them down, but you are also less likely to get injured if you follow a plan.
Run Happy! And reach For Your Goals!
What is patellofemoral pain?
Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.
The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.
What can I do to help my knee mend and relieve the pain ?
Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.
Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.
Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.
Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.
Will I ever be able to run again?
Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”.
Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.
Run Happy! And free of knee pain!
There are general rules for injury prevention that must be followed to avoid loss of training due to injury. Consistency and gradual incremental increases in overall athletic stressors are the key to any successful training program.
Causes of injury
Probably the main cause in distance running is the volume of training, especially if there is insufficient rest between sessions. This is the classic “too much, too soon, too fast” syndrome. Research has indicated that there is no link between speed and injury in distance runners, unless of course an appropriate warm-up routine has not been followed. Don't overdo it! The amount of training you actually carry out plays a key role in determining your real injury risk. Studies have shown, for example, that your best direct injury predictor may be the amount of training you completed last month. For example if May is a heavy training period, watch out in June! This relationship may seem strange at first, but it simply reflects the fact that vigorous training produces tired muscles which may not be able to stand up to further training stresses. Fatigued muscles also do a poor job of protecting their associated connective tissues, increasing the risk of damage to bones, cartilage, tendons, and ligaments.
Many injuries occur due to weak muscles or muscle imbalance. Assessment of muscle strength and balance and regular sports massage can be an integral part of a sports injury preventative strategy.
Resistance strength training can make muscles less susceptible to damage. This can be achieved in the gym or at home in your living room with a few dumbbells and a core ball.
It is important that any exercises are specific to your sport. In distance runners, adding hill training to your strength program can be a valuable tool for injury avoidance if carried out properly. Core stability exercises are an extremely useful tool in preventing muscle imbalance, especially in woman.
Remember that to achieve your running goals, you need months and years of successful running free of injury and illness. Pay attention to your body and all of these tips to ensure that you’ll continue to pound the pavement injury free for years to come!
At Mile 24 Vinnie asked what my goal was for this race. I already knew that his goal was just to casually finish. After all, this was just a long training run for him. I told him that 4:32 was my PR, but I wanted to come in under 4:30. He looked at his watch and commented that I was going beat that goal by quite a bit. I said it was looking that way, but until I crossed the finish line I wouldn’t say that. Noting he was a 3:20 marathoner I told him that I didn’t want to slow him down and he was more than welcome to move on without me. He immediately said no. He wanted to watch me get a PR and encourage me along the way if I started to falter. I realize that running is often considered a solo sport, but sometimes you’ll find success with a team. Vinnie was my team. He was the reason I didn’t need my iPod to motivate me. As we continued along mile 24 I told him that I would like to reach mile 25 under four hours, another one of my smaller goals. He looked at his watch and then me. "That won’t be a problem." We reached mile 25 a few minutes under four hours, a bridge greeting us just on the horizon that made me inwardly groan because of its incline, but Vinnie and I again took it without slowing down.
Now we were less than a mile from crossing the finish line and my stomach was starting to feel funny. Maybe it is nerves or too much adrenaline or just my psyche, but whenever I get near the finish line of a marathon my stomach always begins to feel a little queasy, making my legs not feel as strong. This time, though, I had Vinnie pacing me. We ran by two ladies within .2 mile of each other telling us that the finish line was just around the corner. After the second one Vinnie joked, "That’s what the last lady said."
We crossed mile 26 and there was the finish line just ahead. Vinnie looked at me and said congratulations and offered his hand. I shook it hardily, a handshake that said "Thank you" better than I could then verbalize. In a moment that is etched in my mind we came upon a runner at mile 26.1, without a word we both pivoted, Vinnie to the right and me to the left, passed him and crossed the finish line. The time was 4:07:18. Later I would discover that my chip time was 4:06:12. I had beaten my PR by over 25 minutes.
Vinnie came over and again congratulated me. I then let him in on another reason I had trained so hard for this run, a reason I hadn’t told anyone directly. It was written on the back of my pacer tag. "I RUN IN MEMORY OF SUE KATE WEBB." She was my grandmother, one of the greatest women I have ever known and will ever know. She had passed away in March of Breast Cancer. When I crossed the finish line I had pointed Heaven-ward and thanked God and then thanked my grandmother. I began to choke up when I told Vinnie, but held it together. He wished me well and we shook hands one more time.
Suddenly I heard my name being called and there was George, waiting outside the finisher’s coral. He "high-fived" me and said, "I was expecting you around 4:30! What is this all about?" He made me feel like a "Rock Star", telling me how awesome my time was. I was humbled by this considering he had just run the marathon in a time of 2:52:33 (a 6:35/Mile pace). I thanked him for waiting around to see me finish and he smiled and said it was worth it.
Shortly thereafter Tom crossed at a mark of 4:11:03, a Boston Qualifier (again) at 66 years of age. I congratulated him. I waited around a few more minutes for Gordy to lead the rest of 4:15 crew across the finish line which he readily did at 4:13:59. I walked over and thanked him for helping me to achieve my goal. He is a great guy and the best pacer I’ve ever had the privilege to meet.
I spent a while longer meandering around the finish line, wanting to verify that my time was legit and not my imagination. I took the shuttle back to my hotel where my brother, Owen Kelly, and Trisha had already texted me to ask how I had done. I made calls to my wife and kids, mom, dad, friends, coaches, and runners to tell them how I did. I was ecstatic. Carolyn Bolsinger called me and simply asked, "How did you do?" She had jokingly (or maybe not) told me that if I didn’t break the 4:30 barrier she wouldn’t talk to me until next year. I told her that I didn’t break the 4:30 barrier; I broke the 4:15 barrier. She was very happy for me. I guess we’ll still be talking for the remainder of the year.
That night I had a pizza at a local establishment known as "Cranky Pat’s", but I was anything but "cranky". I was so happy, so thrilled. I still feel that way. At times like this I feel sad for those who have never experienced the thrill of finishing a marathon, that feeling of accomplishment. This is also when I remember why I run, why I enjoy it after all these years. Yes, there are times when I’d rather not train, when I’d rather not wake up so early to get in my run. But marathoning is not meant to be easy, and that is what makes it fun.
I think that's a great story! Run Happy!
I had trained harder for this marathon than I had for any other. Taking a page from the book of Julie Brauer I had followed the Luke’s Locker schedule almost verbatim. I promised myself that I was going to break the 4:30 marathon barrier, but I was also running for a much more personal reason. One that I had kept to myself. One that I would write on the back of my pacer tag.
Saturday morning rolled around and I boarded a plane to Chicago O’Hare. From there I flew to Green Bay, Wisconsin. The drive from Green Bay to the Fox Cities area was around 30-minutes, enough time for me to get acquainted with Wisconsin and get nervous thinking about the race. The packet pick-up was very efficient and the people running the Expo were very nice. That is one of the reasons I so enjoy "smaller" marathons: the people are so sincere and personable. That afternoon I met with the leader of the Pace Group with which I would be running. His name was Gordy McDaniel. He’d paced every Green Bay Marathon, lived in the Fox Cities area and had paced the Fox Cities Marathon several times, and was an Ironman Triathelete. I felt I was in really good company.
After picking up some "Olive Garden" pasta (and some chocolate chip cookies from a local grocery store called "Woodman’s") I proceeded back to my hotel, the Holiday Inn in downtown Neenah, just a half-mile from the finish line. All week I had been receiving calls and emails from my Luke’s Team and Luke’s coaches wishing me well. Now I was receiving the same from family and co-workers. My wife had hidden a card in my duffel bag that I didn’t find until late afternoon so I set it on my desk, encouragement from her and my kids to further inspire me. Then the phone rang and it was no other than Julie Brauer, the woman whose training regiment I had followed for the duration of the season. She was calling to make sure I was "ready" and that all the "last minute" questions that sometimes plague us runners had been chased away. We talked around twenty minutes and I felt better. Then the phone rang again and it was Trisha Cavender (with Stacy Geigenmiller in the background) calling to wish me well. We had a very short, but funny, conversation and I hung up feeling that I had all the support in the world behind me. The last call of the night was to my wife. She wished me luck and then I put the phone away for the evening.
I think that is loneliest part of being a runner, the time between when you go to bed and when you start the race. That is when you try to sleep and wrestle with any and all insecurities that still might be plaguing you. You feel cut off from everyone because, after all, only you can run that race. As I lay in bed I recounted, out-loud, as I had done for several nights now, my race strategy. Start out with the 4:15 Pace Group. First Gel between miles 7 and 8. At Mile 14 pick up the pace if you feel okay. Second Gel between miles 14 and 15. Put your iPod on at mile 18 and pick up the pace. Third and final Gel between miles 20 and 21. If you start to feel sick, ignore it. You can be sick after you cross the finish line. Don’t leave anything on "the table". Somewhere around 10:30 I fell asleep.
However, nervousness does not lend itself to a good night’s sleep so I proceeded to wake up almost every hour, making sure I hadn’t overslept (despite the fact that I had set the alarm for 5:15 AM and had arranged for a wake-up call at 5:30 AM). Around 3:30 AM I woke up to find that the alarm clock had come unplugged. I plugged it back in, reset the time, reset the alarm, and then arranged for a second wake-up call (that is one alarm and two wake up calls). I woke up on my own at 5:00 AM and turned the alarm off and cancelled the wake-up calls. I prayed, showered, dressed, reviewed my plan and left for the shuttle. Leaving the hotel I was greeted by a crisp 54-degree Wisconsin morning.
The shuttle ride to the starting point was around 15-minutes long. Upon arrival I proceeded to the "Bag and Tag" where I had arranged to meet with George Bene, our very own Bobbie Mulholland’s brother. He is an elite runner who happened to be up in Green Bay on business and decided he’d go ahead and run the Fox Cities Marathon. I had a vague idea of what he looked like as I’d seen him in a picture with Bobbie from the Disney Half-Marathon (one of the best marathon pictures I’d ever seen by the way). Aside from that all I knew is that he was full of energy. He arrived on the scene as advertised, very outgoing and friendly. It was almost as if we’d known each other our whole lives. He asked me what my goal was today and I told him that I’d told everyone at Luke’s it was sub-4:30, but my primary goal was 4:15 or better. George’s goal? He said he’d just see how he felt. He wished me the best of luck and then I proceeded off to the restroom before finding the 4:15 pacing group. I remember how three days before I had been talking with Brent Wolfe and telling him how I wished I was at the starting line. He had said I would be there before I knew it. Well, I was there. Brent had been right.
The race began with The Call’s "Let the Day Begin" ringing through the Appleton, Wisconsin area. The sky was mostly overcast and the temperatures had not seemingly changed, a slight breeze lending a chill to the air on occasion. Everyone seemed to being doing well at the start with jokes of "the first .2 miles are always the toughest" and similar comments being heard. From the onset I was impressed with the crowd support. The Fox Cities area is made up of several small cities such as Appleton, Menasha, Neenah (which is pronounced Nee-nuh, but being a Texan I kept pronouncing it Nee-Nah like Hee-Haw) and Kimberly. Everywhere you went people were out there to greet you, sometimes in droves sometimes just a family or two, but they were there. Most runners had their names imprinted on their bibs so if the crowds could see the name they would call it out as you ran by them. Cheerleaders from the area schools were out in force, doing cheers for you as you went by, creating "tunnels" to run through, or doing the wave for individual runners. It was so encouraging that you couldn’t help but unconsciously speed up as you ran past. It was an exhilarating atmosphere from beginning to end. However, I think the first point where I felt that the race would be different was around mile 3 when another runner named Chris and I stopped for a restroom break. There was a line so after (patiently) navigating that, we had to speed up for almost a mile to catch our crew, averaging a sub-eight minute mile for the duration and I didn’t feel tired. I felt ecstatic.
Gordy was an excellent pacer. He’d run the Fox Cities area for several years and knew every curve, divot and pot hole and directed us accordingly. Another gentleman in our crew was Tom Jensen, a 66-year old runner who was a veteran of 50 or so marathons. I also met Vincent Uzzardo, or "Vinnie" as he introduced himself, a runner from Chicago who was running his first of three marathons in nine weeks. He had run a PR of 3:20, but was using this race as his final long distance run for Chicago. His reasoning? "What’s 6.2 more miles?" You have to love the attitude of marathoners!
We soon came across a girl limping along the course and my "Luke’s Coach" instinct took over. She had a 4:30 pace sign on her back, but it was obvious she had taken off on her own and (maybe) gone slightly faster than she should have. I asked her if she was okay and it turned out her knees were really bothering her. I had some ibuprofen so I offered it to her which she gratefully accepted. Again, I sprinted back to catch up with the group and still felt great. Chris joking said that I should now be referred to as the "Road Doc".
As we moved along Gordy, Tom, Vinnie and I were heading the 4:15 crew with the others behind us. At mile 9 we reached Riverside Park and it was Gordy’s turn for a quick restroom break and I was (somehow) "elected" to be the pacer until Gordy’s return. For a minute I was back at Luke’s and it was Saturday morning. Margaret McKinnon and I were leading the Yellow Crew out on a long run. Gordy quickly caught back up and I was released from "point". The weather was still cooperating and the miles felt great.
We reached our first hill at Mile 11 and Vinnie and I trudged up it. Gordy caught up with us and told us that we were going too fast and needed to slow down just a little. I’d never been told I was too fast with any pace group; that was another sign that maybe this race would be different from the others. But we still had 15 more miles to traverse and things could change quickly.
We crossed the halfway point and I told Gordy I was thinking, per my plan, about pulling away at Mile 14. He said it was my call, but he suggested that I wait until mile 20 and then take off. I decided that it might be wise to listen to a course veteran so I held off and continued with the group. Besides, I really enjoyed the company. The clouds were starting to clear away so I donned my University of Texas bandana (i.e. "do-rag") and a cheerleader encouraging the runners yelled out, "Go, bandana guy!". My second nickname of the day.
We reached Mile 18 at just under 3-hours, a small goal that I had established for this race. Gordy said that Vinnie, Tom and I should plan on speeding up at mile 20. We said okay, but didn’t want to just leave Gordy behind, especially since he had so expertly navigated the course for us. It seems though he had a subtle way to make sure we complied. As we approached Mile 20 he told us he was dropping back to check on the rest of our crew that was starting to dwindle. Telling us to "maintain our pace" and that he’d "be back later", he dropped back and we proceeded onward. It wasn’t until mile 22 that Vinnie noted Gordy hadn’t returned. "I think that was his way of getting us to speed up", Vinnie offered. From miles 20-23 we did sub nine minute paces and sometimes, sub-eight. Around mile 23 Tom said he was going to slow it down a little. He was trying to qualify for Boston, 4:15 at his age, and he didn’t want to do anything that might cause him to falter. So now it was Vinnie and I.
To be continued......
Running Injuries are not Inevitable Part Two! Dr Crane advises new marathon runners on how to avoid common mistakes. Take a look!
How many peolpe realize that Shalane Flanagan won the bronze medal in the 10,000m this weekend? The first time in forever that a woman distance runner from the US won a medal! I was hopeful that this was the beginning of a resurgence of the US woman at the longer distances, but alas the pre-race US favorite Deena Kastor DNF the marathom due to a foot injury; she broke her foot around the 5K mark (come on over, we'll see what we can do to fix it!), Magda Lewy also DNF and the top American, Blake Russell, finished 27th in 2:33.13 (still an awesome I could never even think of even attempting to run time). This Olympics made me nostalgic for 1984 and Joan Benoit.....guess we just have to continue to build our grass-roots kids distance programs in this country and look to the future.....Congrats to Shalane....We are proud of you....
Runn Happy! And Deena....Get better soon!
The jury is still out when it comes to stretching in the running community. I have been running for almost 30 years with multiple coaches on numerous competitive levels, all of them told us to stretch daily to get faster and avoid injury. Yet many incredibly competitive runners never stretch and never seem to get injured. Is there any proof that this common recommendation is actually valid? What do the studies say about stretching? Does it really prevent injury? Will it make me faster? Again, the experts really don’t agree on much! In most arguments between stretchers and non-stretchers, it inevitably comes down to "stretching helps prevent injuries" and "stretching is a leading cause of injuries in runners".
The motion of running, repeated over many years, strengthens and shortens several posterior muscles. The most affected are the calves, the hamstrings and the lower back muscles. These muscles play a primary role in lifting the feet and moving the runner forward. Exercise physiologists blame shortened muscles for a reduced range of motion, decreased athletic performance and increased risk of injury. To add insult to injury, the aging process contributes to further loss of joint and muscle flexibility.
The majority of runners and coaches believe stretching improves performance and reduces the risk of injury. In the meantime, experts disagree on the benefits and dangers of stretching. While many experts credit stretching with numerous benefits, improper stretching remains the second leading cause of running injuries! So, if we believe in stretching; what is the most effective method?
First and Foremost; the warm up and cool down should never be optional in your running routine. Cold muscles are at the highest risk for injury; by warming up and increasing the temperature of your muscles they will be more flexible and have an increased speed of motion. Warming up can loosen your muscles and soft tissue as much as 20 percent. The cool down allows blood to continue flowing through your muscles, working its way more slowly from a high level of exertion to its normal resting condition. Build stretching into your regular schedule, both before and after your daily run; after warm up and as part of your cool down. Take the time, it’s worth it!
Bottom line: Most experts agree that stretching reduces muscle soreness after running and results in better athletic performance. Gentle stretching after a race or intense workout can also promote healing and lactic acid removal from the muscles. Stretching is most effective when performed several times each week; a minimum of one stretching session per week is sufficient to maintain flexibility. Most coaches and runners believe in stretching before and after every workout. The experts never agree on much, but the majority seems to feel that stretching is beneficial to runners if done properly. So follow the precautions outlines and always warm up prior to stretching. Your body will thank you and who knows, you may even get a little faster!
Run Happy! And warm up and stretch before!
Can you believe it! Mother of sextuplets runs a marathon one year later! What a super woman! What am I complaining of? If she can do it, so can you.....
Full story with video
For more pregnancy related tips from the trenches (yes, I survived three kids and still run today! )
Run Happy! And long......
1. you roll your eyes when people say, "You run twenty six miles...at once? In one day?"
2. you won't wait the 30 seconds for whooever it is using the portapotty in a race to finish, you just squat and pee next to it!.
3. you come up with weird answers to questions like "why do you run so much?"
4. all your socks are either stained or torn.
5. you can spit while running.
6. you finish the race looking like you wrestled a bear and you don't care.
7. if you schedule dates around races.
8. you spend more on training clothes than work clothes.
9. you have running withdrawal if you don't run everyday.
10. you wake up every morning in pain, and like it!
11. Gatorade is your drug of choice.
12. your Saturdays for the past 10 years were ruined for sleeping in.
13. you enjoy running hills.
14. your favorite food group is carbohydrates.
15. you are always hungry.
16. your house, car and gym bag smells like Biofreeze.
17.. you think sprinting is for wussies.
18. you don't know what an "off-season" means.
19. you have shin splints, and embrace them!
20. you find yourself saying, "it's not really a hill..."
21. your feet are comparable to rawhide.
22. there's nothing like intervals to start the week off fresh!!
23. watching the New York Marathon on T.V. made you get up and go for a run.
24. you can say "I like to run" in four languages.
25. your calves are bigger than your biceps.
26. you're toe nails are falling off.
27. you wear skimpier clothes than Madonna.
28. You run through puddles instead of around them.
29. You know at least 3 different ways to tie a shoelace.
30. You can blow nose with your index finger. (Snot rocket scientist)
31. You know exactly what a difference .14 miles can make
32. Water is everywhere
33. Your running peeps are like family
34. you have more inside jokes than a stand up comedian does.
35. you have almost or have gotten hit by a car.
36. you can add up miles and meters in your head, any other math you need a calculator.
37. You go through cases of water/gatorade in a week
38. You insist on running without a shirt when kids with three times your body fat content want you to put one on.
39. You know what sweat taste like
40. You've become a professional at popping blisters
41. You have some cool looking tan lines
42. You were asked to be an extra for Schindler's List
43. Your running peeps know more about you than your husband
44. you measure distance in time
45. you tell how old your shoes are by how many miles are on them
46. LSD is not a narcotic
47. you can run 6 miles while singing the entire way
48. The phrase "moisture-wicking material" is a regular part of your vocabulary, because...
49. You have suffered through one too many cases of "runner's nipple."
50.. You've been able to squirt blood by pushing on your toenails.
Run Happy....and laughing all the way...more to come!
Anne was running the White Rock marathon in Dallas in 2007. It was a cold, wet day, and by mile 18, she had a “cramp” in her hamstring and into her butt. It continued to get worse and worse as it got colder and colder. First she described that her fourth toe went numb, then the entire bottom of her foot. By the time she got to mile 24, she relates being freezing, wet, miserable, and could not feel her left foot or calf! Quit? Never! It’s not even in her vocabulary….Although her running friends that were doing their best to drag her to the finish kept encouraging her, Anne was convinced she had somehow severed her sciatic nerve with the muscle spasm in her butt! What was going on? Piriformis syndrome!
Anne had just experienced a very rude introduction to her piriformis muscle. This muscle arises from the sacrum, passes through the sciatic notch (an opening in the pelvic bone) and attaches to a bony prominence on the side of the thigh bone (greater trochanter). The piriformis muscle acts in outward rotation of the hip. The sciatic nerve exits the spinal cord and passes through the notch in front of the piriformis (in some people the nerve actually passes right through the muscle).
What went wrong that day around White Rock Lake? Anne irritated her piriformis muscle by getting tired (because her pre-race training had been, when she was being honest with herself, less than adequate), which caused her to overpronate, and then she coupled that with running on uneven surfaces and progressively colder temperatures which caused Anne to tighten all of her muscles shivering anyway! As the piriformis became inflamed, it swelled and compressed the sciatic nerve, which caused her foot to become progressively numb.
Most piriformis injuries are caused by overuse or by forced rotation of the hip caused by running on uneven surfaces. You can also irritate your piriformis by falling on your butt and having a direct blow! Pain can usually be elicited early in piriformis syndrome with direct palpation or stretching of the muscle. Anne describes pain enough to jump off the massage table pain when her piriformis was palpated for a month after the marathon!
Why me? Look at your training schedule and you may see an answer. Anne did! Worn out orthotics and not enough miles coupled with an unusually cold day! Other factors come into play like tight hip adductor muscles and excessive pronation. If your adductors are tight, the piriformis has to work harder to abduct the hip before it can help in outward rotation. Also, when your foot excessively pronates (or rolls in) when pushing off, your whole leg rotates inward and the piriformis acts to externally rotate your hip and has to work overtime every time you push off.
Can I keep running with piriformis syndrome? Yes and No. In the early stages, you can run; if you continuously stretch before and after, as well as making sure you warm up the piriformis before running. Decrease your mileage at least 30-50%, slow down and avoid hills and speed work as well as uneven surfaces. If you are finding that the muscle pain is causing you to alter your gait, slow down and start therapy before you end up with another injury. Think of it this way, as the piriformis tightens, the pelvis is actually pulled upward which gives you a functional leg length discrepancy. This can cause major biomechanical injuries to your other foot and leg! In other words, piriformis tightness in the left hip can cause arch or knee pain in the right leg!
What else could it be? The best answer to piriformis syndrome is to get a true diagnosis from a sports medicine physician. Lumbar spine injuries like a herniated disc or degenerative arthritis as well as a pelvic stress fracture can mimic piriformis syndrome. A complete physical exam should highlight the culprit muscle and x-rays or even an MRI may be needed to rule out other possible causes.
Piriformis syndrome is treated with physical therapy, pelvic manipulation, tons of stretching, anti-inflammatories, functional orthotics or shoe inserts to align your gait, deep tissue massage and manipulation, and even the dreaded cortisone shot to the butt in some cases. Very few people need surgical release of the muscle for complete relief of symptoms.
After Anne experienced piriformis syndrome, I bet she will never joke about a pain in the butt again! Be smart! Maintain your core strengthening routine, wear your orhtoics if you pronate excessively, stretch your hip adductors, and strengthen your abductors to ward off the dreaded piriformis syndrome!
Run Happy! And hopefully without a pain in the butt!
Is it a foregone conclusion, that if you run for years, you will have arthritis? Many of my patients are concerned that the aches and pains that are inevitable from distance running are actually harbingers for the future aches and pains of arthritis. This fear is even strong enough to get older runners to quit and start a lower impact exercise regimen like swimming and cycling. Is this a reasonable fear? Yes and No! Running by itself does not cause arthritis; improper biomechanics coupled with the rigors of running can cause arthritis.
Consider the stress of running on the joints for a minute. The foot hits the ground and the bones and joints experience force up to six times the runner’s body weight at impact. The joints are being asked to move and glide efficiently and smoothly while enduring this stress. In the event of a misstep or stumble, the joints need to continue to be stable to maintain their perfect alignment.
Osteoarthritis, a.k.a. “wear and tear arthritis”, is what runner’s dread. This is degeneration of the articular cartilage which absorbs shock, distributes stress and allows the joints to glide smoothly. The ability to run pain free depends on the health and integrity of this cartilage as we age. In osteoarthritis, the surface of the cartilage becomes roughened, fissured and even starts to shred into small fragments. These fragments “float” around the joint and cause more damage. The bone tries to protect itself by producing small bony prominences called osteophytes which actually in the end make the joint damage and pain worse.
Any kind of sports participation can increase the incidence of osteoarthritis due to increased twisting forces, high impact, muscle weakness or over-development and joint instability which causes abnormal peak pressures and greater stress in certain areas of cartilage which can lead to osteoarthritis. Nevertheless, for normal joints , there is no scientific evidence that simply the action of running, even over a long period of time, causes permanent joint damage or even a predisposition for osteoarthritis.
What is the risk of osteoarthritis in runners? Many studies of long-term runners show no increased incidence of osteoarthritis in these competitive runners. Some studies did show more evidence of osteophytes, but no correlation with joint pain or instability. Confusing the issue for many runners are the numerous incidents of misdiagnosis of repetitive stress injuries like patella-femoral syndrome as arthritis. This is reversible and caused by abnormal tracking of the kneecap, which is treated with physical therapy and orthotics.
Joints are in fact strengthened by activity and damaged by inactivity. Studies have shown that the articular cartilage actually thins and becomes more fragile with inactivity, therefore increasing the risk of arthritis. Joints adapt to the stress of exercise and become stronger and more able to endure the long term stress of running. Remember the doctor saying to increase slowly? This is why. Ligaments and muscles, which support the joints, are strengthened and reinforced by the stresses of the running activity, improving joint mechanics, if the joints are properly aligned.
Here is the truth about foot biomechanics. Proper biomechanics during the strengthening process is essential for joint health. Improper biomechanics can increase the stress on the joints in an abnormal fashion and actually increase the incidence of osteoarthritis and hasten joint damage.
Bottom line? Running does not increase the incidence of osteoarthritis unless the lower extremity biomechanics are faulty. In fact, almost 75% of Americans over the age of 65 experience some symptoms of osteoarthritis. This is not increased in runners. In fact, running may actually help with the symptoms of osteoarthritis.
The benefits associated with long distance running profoundly overshadow the risk of osteoarthritis. In runners, orthotic devices to correct their biomechanics early in their training may actually decrease the stress associated with increased osteoarthritis. If you have joint symptoms, see a sports medicine podiatrist today and have your gait realigned. Your joints will thank you. Remember, your feet are meant to carry you for a lifetime. Don’t let the fear of osteoarthritis rob you of the joy of a lifetime of distance running!
This is a great article looking at the qualification standards for Boston and people who are trying to cheat the system, but actually are cheating themselves of the experience of making it to running "Mecca". I can't imagine what would motivate someone to buy a bib number when they can run for charity if they can't physically qualify. My husband doesn't understand and really thought it was no big deal because he's not a runner, but I have multipe friends and myself personally who it took many marathons to qualify. Making it there on my own merit was an extremely personal goal and acheivement, so cheating to get in personally offends me to my core!
Full article in NY Times "Cheating Starts Before the Race Does" by Gina Kolata
Welcome to Mecca! should be the sign the runners see when they get off the bus in Hopkinton. I ran the Boston marathon in 2002 and was lucky enough to run with my younger brother. He's waaaaay faster than I am, but we both qualified in 2001; so he decided he would come back a few thousand peolpe to where I started and run with me. (He ran 3:01 to qualify and I ran 3:40) What a day! Everyone (most everyone) has to qualify to get into the race, so the start is seeded by your time. The first 15 miles is like taking a training run with 25,000 of your closest friends. These peolpe from all over the world get it! They understand why you run and why it was so important that at least once in your life you ran Boston! Every year at this time, I get whistful and start to think about what that day felt like...it was amazing! The crowd was unbelievable and we had great weather. The weekend before the marathon was filled with running friends and an unbelievable expo! It seemed like for just one weekend the entire city of Boston was full of runners. My best memory of that day was my brother Rob turned around backwards at the top of Heartbreak Hill asking me, "Can you run a little faster? My knees are starting to hurt from running so slow!" We finished in a pedestrian 3:52, but as you round the corner to the finish, the crowd was so loud, you would think we were winning! Good Luck to all my peeps that are running from Texas! My training partner Heather qualified this year, so now I've been challenged to run a qualifying time in the fall so we can go together...good thing this old lady now only has to run a 3:50!!!! Run Happy!
Boston Marathon 2008 results
Starts and ends at the Cotton Bowl. Should have great weather!
You have got to check out this story! A 101 year old man decides he wants to run a marathon. He decides to start with a half-marathon which takes him 5 hours because he stops for a beer.
What an inspiration (just kidding), but hey...the guy is still running at 101 years old! Maybe he knows something we don't. PS. He smokes too....check it out...It's at least good for a chuckle!
I met with the Team in Training group in Grapevine at 7 am and had a great discussion about shoes, socks, and sun screen! They are on their fourth week, so many are still running in tennis shoes with cotton socks! I reminded the group that running shoes only last 400-500 miles (or six months, whichever comes first!) and that if they are training for anything longer than a 10K, they should have two pairs that they alternate. We also discussed the need for moisture wicking socks and sunscreen even in the morning in Texas….don’t want to be the health nut that dies from a melanoma at age 35! I directed all of them to the “Top 10 Stupid List” on the website and wished them all well in their running plans as well as their fundraising. It’s great to spend time with new marathoners and I only hope a few listened so they won’t repeat the mistakes of the past. Some things are only learned in the school of blood, sweat and tears!
I then ran 6 miles with my peeps (who decided to run way to fast this morning) around Grapevine Lake. It was inspiring to see all the Lake Grapevine Runners and Walkers out cleaning up the trails. If I didn’t have such a busy day planned, I would have been right there with them. It’s amazing how much trash accumulates on the trails!
At 9am, it was off to Luke’s Locker in Colleyville to meet with their newby runner’s group. They had lots of questions about biomechanics and how your feet can cause your hips and knees to hurt. We discussed OTC inserts versus custom orthotics and had a lot of great questions. The morning concluded with a three hour foot screening and shoe clinic inside Luke’s. I think I saw about 30 people and definitely helped quite a few with their shoe choices.
It always amazes me when young girls and boys just want to try on Nike shoes…what an advertising machine! I personally wear Brooks and think that there are so many shoe choices that you shouldn’t limit yourself to one brand….see the Shoe List for details on shoe choices and foot types….that’s a discussion for another day.
Most people get hurt running too much, too soon, too fast. The marathon is just that….a marathon. The training should be done over a 4-6 month period. Put in the time, put in the mileage, and be smart so you will get to the finish line (and be able to walk the next day). Marathon running is like everything else worth doing in life, nothing comes easy and nothing comes free! You have to put in the time and sweat or you will feel the effects of your under-training at the famous “wall” between 18 and 22 miles. I’ve been there, and it’s not pretty….at Chicago in 2004 I thought I was going to perish on the street at 24 miles due to lack of training the last few weeks before the marathon (and a stomach bug the week before)…that was the most painful 4:07 I ever ran….
So what is good training? What program should you follow? Take my advice, if you have never run a marathon before and your goal is to finish your first; join a training group. It’s amazing how much easier those long runs are when you have a group of like-minded (usually completely insane) people to run the distance with. Several national groups are available in most cities and in my personal experience, the Galloway walk-run program and Team-in-Training from the Leukemia/Lymphoma Society seem to be the two best at getting novice runners to the finish line. Local running stores often have good support groups as well. In the DFW area, both Luke’s Locker and Run-On have good training programs. The worst thing you can do is download a program from the internet and try to follow it without any support group. Most people don’t have that much will-power and tend to either quit or get hurt following a half-hazard schedule. Individual training is fine for those of us who have been running marathons for years, but I even like getting my group together and finding a common goal. It’s like group therapy….when you’ve been to hell and back with a group of people, that bond is amazing…I’m closer with my running peeps than most of my family.
Having trouble getting started? Buy a book on marathoning or one that is particularly inspiring. My personal favorite is Jeff Galloway’s Marathon. He gives good advice for the novice runner and helps you to have realistic expectations of your projected finishing time. My most valuable tip on getting started is to find a goal. Pick a race that is 6 months or so in the future. Enter! Write a goal time down on a business card and then write intermediate goals for local 5K’s, a 15K and a half-marathon along the way. Put this card is your pocket or purse and carry it with you everywhere. Look at it daily! Put a sticky note on your bathroom mirror asking “Did you run today?” And keep a detailed log of your running. Either on the computer or handwritten, nothing is more motivating than not wanting to fill in a zero!
So now you’ve started…the first few miles are under your belt and you no longer feel like you are going to throw up after running just a few miles. You have your program, your log started and goal card in your pocket. And two pair of shoes…oh yeah…we forgot to talk about shoes (see Shoe Advice from Dr Crane). Now you are ready…oh yeah, what about stretching (see Stretching 101 from Dr Crane). Truly, you must be ready to go now….oh yeah, my foot is starting to hurt me when I first get up in the morning (see Injury 101 from Dr Crane). I guess there is more to this running thing than just getting out of bed in the morning and lacing on the shoes….but they do say that the hardest part of a marathon training program is the first few steps out of bed or off the couch! Good Luck and Happy Marathoning….need more tips, peruse the website (my favorite is “The top ten things people do to hurt themselves” or send me an email…..and remember, don’t try anything new on race day…same food, same socks, and shoes with at least 50-75 miles on them….
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