1. Lack of motivation to change
2. Unrealistic goals 
3. Focusing on goals and not behaviors
4. Change is uncomfortable
5. Excuses, excuses, excuses 
6. Lack of accountability coach
7. Procrastination

So Spring is in the air in the DFW area! Time to dust off your bike and running shoes and head outside. Forego the treadmill or the trainer for fresh air! Yea!

 

So if you are like me, it’s also time for new running shoes. The battered winter pair have had it! How long are running shoes good for? About 500 miles or six months, whichever comes first! Now an aside about the recent craze in minimalist shoes, just because they are “minimal control and cushion” does not mean that they last longer and don’t need to be replaced. In fact, I found my more minimal shoes seem to wear out faster.

 

So you haven’t reached the 500 miles or six month expiration date because you have been lazy the last few months of winter? Please at least decontaminate your shoes! Take a spray anti-fungal (my favorite is Mycomist) or use a shoe sterilizer (like Steri-Shoe) and get rid of the cooties that have been growing in those idle shoes. Don't have something to decontaminate your shoes? Stop by Healthy Steps and they can hook you up! This is especially important for cycling shoes that have been sitting in the closet or garage all winter. Cultures of these kinds of shoes show fungus among us, as well as, staph, strep and nasty pseudomonas bacteria!

 

Also time to take a look at the sock collection. Socks don’t last forever and tend to shrink. If your socks are too small, you can get black toenails and even lose toenails just from the pressure of the socks! If your socks are more than a year old, toss them and uy yourself a spring treat of new socks!

 

And last, but never least, it’s time for girls to take a long look at their jog bra collection. Just like socks, these bra tops need to be replaced about once a year if you expect any supports for “the girls”.

 

Enjoy this first taste of spring coming to Dallas-Fort Worth….who knows, next week it could snow; but my money is on spring is here to stay! Enjoy it before the sultry summer descends upon us!

 

 

  

My patients in my Grapevine, TX office are always asking me: “Why do some runners always seem to be hurt and others can run forever and never sidelined?” Great question!!

 

Amby Burfoot tried to answer that question in an article in Runner’s World in March 2010. He states that George Sheehan, MD, the medical editor of Runner’s World in the 1970’s, felt that one in 100 people were “motor geniuses” and never got hurt. The rest of us were destined to be injury plagued from time to time.

 

Ralph Waldo Emerson stated “that there is a crack in everything God has made,” meaning that nothing is perfect and that can be translated to runners as well!

 

An extensive review of the medical literature by Burfoot reveals a great number of papers on running injuries, but no conclusions. It turns out that running injuries can be caused by being female (funny), being male (more likely), being old, being young, pronating too much, pronating too little, training too much, training too little, having new shoes, having old shoes, and it goes on…..

 

So what can we conclude? Most of us will get hurt at some time during our running career! So what can we do to prevent major, career threatening injuries?

 

 

Best advice I can give: listen to your body, increase slowly and have a plan! If you are one of those oft injury plagued runners, take a look at these tips. Are you following the guideline? If so, take a spin in triathlon! It has saved a lot of weekend warriors…….

 

Thanks to Amby Burfoot and his crew. I have liberally borrowed from their content and just put in my two cents worth. If you want to read his article, “The 10 Laws of Injury Prevention” you can find it in the March 2010 edition of Runner’s World.

It’s one week after the cold, wet rain permeated the White Rock Marathon. Lots of people, including my mother, have asked me if I caught pneumonia from running “The Rock”?

 

So, does running in the rain make you sick? This is one of those questions that seems to be doomed to getting inconclusive answers forever. Especially when it comes to the opinion of Mom!

 

People usually do get sick more when the weather is rainy. That's because they stay indoors more, and indoors is where cold and flu viruses spread because of increased contact between individuals. On a sunny warm day, everybody goes outdoors, where there is (obviously) more space, better ventilation, and less physical contact with large numbers of other individuals.

 

Catching an infectious disease such as the common cold requires direct exposure to the pathogen (virus). Exposure comes in the form of close contact with an infected individual. Going into cold and rainy weather will not make you sick unless you also get colonized by the pathogen while you're out there.

 

There have been reports that cold temperature itself reduces the effectiveness of our immune system, but even that's not sufficient alone - you'd still need exposure to the virus.

 

Bottom Line:

 

 

"Cold and rainy weather causes virus infections to spread more rapidly than usual" - Fact, due to people staying indoors more and getting exposed

 

Prevention:

 

Wash your hands, stay away from people who are sick, and feel free to run and play in the rain, just like we did last Sunday at the White Rock Marathon. Run Happy....and remember to jump in puddles after the 6th mile when your feet are already soaked!

 

 

Do NSAIDs Impair Fracture Healing?

 

There has been a theory that comes from looking at animal studies that NSAIDs like ibuprofen or Naproxen inhibit bone healing and may cause delayed unions or non-unions in fracture patients. Some doctors even go so far to say that you shouldn’t use NSAIDs in postoperative orthopedic case; but what is the truth?

 

A recent article in the Journal of Family Practice by Yates, Shah and Blackwell, showed NO, ALTHOUGH THE EVIDENCE VARIES. Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t appear to impair clinical fracture healing. Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

 

NSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their antiprostaglandin properties delay callus formation and subsequent healing.¹ However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results.

BOTTOM LINE

 

 

 

 

 

 

Crazy Weekend! Wet, Rainy, Cold, Hilly and the most ridiculous course I’ve ever ridden! Let’s be serious. The weather was awful! I had picked a race in the Northeast because I was sick and tired of feeling like I was running on the face of the sun! God has a sense of humor. I was thinking it would be a balmy 65 degrees or so and warm up to 70? No, how about 41 at the start that warms up to 55! Did I mention the rain? Yes, it rained for something like a week before the race so the river was so high we couldn’t swim. 

 

The Delaware River Gap was 7 feet above its banks and had so much debris they were worried one of us would get killed. I get that. Honestly, I was a little miffed until I went down to the river and saw how high and how fast the current was flowing. Then I was glad we weren’t swimming. It was scary looking!

 

So we started with the bike. Hmmm…how do you get 2,000 people on a bike course without killing themselves in a mass start? Time trial start…sorta. They started the pros with 30 second intervals at 7:25am….yes, a little late. The rain and clouds made it a little dark at 7am. Then they started with the age groupers at 3 second intervals…really! So much for no drafting. We were all bunched up on wet roads that were absolutely scary at times. The first half of the bike course was all bunched up and very, very hilly, with a lot of scary turns. Lots of crashing! At one point I was going 34 miles an hour down a hill and watched the guy in front of me wipe out on the turn. At that point I hit the brakes and thought perhaps a slower ride was the better side of valor. The hills were unrelentless. At 50 miles, there was a 5% grade after turning a corner. I did something I have never done since grammar school. After watching one guy fall off the hill with his bike (no time to unclip), I got off and walked the hill! I was embarrassed until I saw about 10 people after me do the same thing! This course was crazy, sick hilly!

 

Into T2 I went with completely screaming quads! I put my running shoes on and took off only to find that my legs were dead! Really dead! I jogged a few miles and they seemed to warm up, but then I hit someone’s version of a joke! Crazy, rolling hills on the run. All kidding aside, they were nothing like the hills on the bike, but we were all bitching and moaning. I saw more people walking than any race I have ever run. I pathetically jogged into the finish. Happy to be done. Freezing! Crazy, cold, rainy weather plus sick course makes for a miserable day. Whatever doesn’t kill you makes you stronger.

 

Perhaps I should venture down to the Longhorn 70.3 in three weeks in Austin and kick some butt, because honestly the Poconos 70.3 kicked my butt! Happy to be alive and smiling! Time was pathetic but I finished. The older you get, the more that matters than the watch!

 

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.

 

 

Are you a member of the Mile High Club? No, not the one that involves airplanes and yoga poses! I’m talking about running at elevations of 5,280 feet and higher.

 

I’m on my way to Colorado to spend a week with my kids at Keystone. Of course, I’m excited to get in some trail runs, but a little worried about the altitude. I called a few of my friends who live in the Mile High State and got some tips on running at altitude that I figured I would share.

 

Running at a higher altitude can make you feel like a slug, and an asthmatic slow one at that. However, if you’re careful, and keep some of the following tips in mind, high altitude running can be very enjoyable and great for racing at lower altitudes!

 

All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

 

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

 

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

 

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

 

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

 

Bottom Line

 

If you are looking for the best way to refuel your body after long, strenuous endurance exercise, a 4:1 combo of carbohydrate and protein seems to be your best choice. While solid foods can work just as well as a sports drink, a drink may be easier to digest make it easier to get the right ratio and meet the 30 minute window. Personally, I’m sticking to beer and will add a peanut butter and jelly sandwich!

 

Good question. Personally, I err on the side of caution. If I’m tired when I wake up in the morning or I feel like I was run over by a truck…..well, that’s a good indication to take a day off. Many runners and triathletes burn the candle from both ends.  The old saying is that it is better to be 15% undertrained than 1% over trained. This is my motto that allows me to take a day off here and there when the fatigue of the mega miles is kicking in. I find that I race way faster when not fatigued! Really!! (Sarcasm)

 

So, do you get adequate rest? How can you gauge your fatigue if you are a sadomasochist training for an Ironman or marathon? The June issue of Runner’s World has a great article on gauging rest. I had to laugh, because you can actually pay someone to tell you to take a day off! Simple solution: Pay me!! Just kidding, let’s look a little closer at guidelines for rest days.

 

On a serious note, there is a service called Restwise, which looks at simple biological markers input by the athlete first thing each morning, calculates a daily recovery score from 1 to 100, then trends it over time. (Rest-wise subscriptions start at $119 for six months; go to restwise.com.) You certainly can pay them, or you can look at 10 biological markers and rate yourself.

1. BODY MASS: You lost weight from yesterday
A two percent drop in weight from one day to the next indicates a body-fluid fluctuation. Most likely, you didn't hydrate enough during or after your last workout. Dehydration negatively impacts both physical and mental performance, and could compromise the quality of your next workout.

2. RESTING HEART RATE: Your resting heart rate is elevated
Take your pulse each morning before you get out of bed to find what's normal for you. An elevated resting heart rate is one sign of stress. It means your nervous system prepared for fight or flight by releasing hormones that sped up your heart to move more oxygen to the muscles and brain. Your body won't know the difference between physical and psychological stress. A hard run and a hard day at work both require extra recovery.

3. SLEEP: You didn't sleep well or enough
A pattern of consistently good sleep will give you a boost of growth hormones, which are great for rebuilding muscle fibers. Several nights in a row of bad sleep will decrease reaction time along with immune, motor, and cognitive functions—not a good combination for a workout.

4. HYDRATION: Your pee is dark yellow
This can be an indicator of dehydration, barring the consumption of vitamins, supplements, or certain foods the evening before. The darker the color, the more you're struggling to retain fluids, because there's not enough to go around. You need H2O to operate (and recover).

 

5. ENERGY LEVEL: You're run down
If your energy level is low, there's something amiss. The key is honesty. Athletes can block out signs of fatigue to push through it, thinking it will make them stronger. It won't always work that way.

6. MOOD STATE: You're cranky
When your body is overwhelmed by training (or other stressors), it produces hormones like cortisol that can cause irritability or anxiety. Stress also halts chemicals like dopamine, a neurotransmitter in the brain that has a big bummer effect on mood when depleted. Crankiness probably means not enough recovery.

7. WELLNESS: You're sick
Any illness, or even a woman's menstrual cycle, will increase your need for energy to refuel your immune system, which is having to work overtime. This means fewer resources available for recovering from training.

8. PAIN: You're sore or nursing an injury
Whether you're sore from overworked muscles or an injury, your body needs more energy to put toward repair, lengthening total recovery time.

9. PERFORMANCE: Your workout went poorly
This is a subjective measure of workout quality, not quantity nor intensity. If you felt great on yesterday's run, you'd evaluate that as good. If you felt sluggish on that same run, you'd count it as poor. Trending workout quality—multiple poors in a row—is one of the easiest ways to identify the need for more recovery.

10. OXYGEN SATURATION: Your oxygen level has dipped
The amount of oxygen in the hemoglobin of the red blood cells can be measured by placing your fingertip in a portable pulse oximeter, a gadget available online for about $40. The higher the percentage, the better: Above 95 percent is the norm at sea level or for an athlete who is fully acclimated to a given altitude. This is a new area in recovery science, requiring more research, but there may be a link between low oxygen saturation and the need for more recovery.

Count Your Red Flags

The restwise algorithm assigns more weight to some markers (e.g., performance) than others (e.g., mood), along with other factors to generate a precise recovery score. But you can get a sense for your ballpark recovery quality by tallying the red flags (left) you average per day in a week.

0-1 GREEN LIGHT
You are clear to train hard.

2-4 CAUTION
You can go ahead with a hard workout if your training plan calls for it, but cut it short if it feels too hard. Better yet, take an easy day, or a day off.

5-6 WARNING
You're entering the danger zone, which could be intentional according to your periodization or peaking protocol. If not, back off.

7-10 DANGER
You require mandatory time off, ranging from a day to a week, depending on the severity of your fatigue and what you've seen over the previous few days and weeks. You may need to visit your doctor.

FEEL Better: Too much rest has its own problems: Your performance stalls. On your recovery days, do something active; go for a leisurely  bike ride or swim (I take my 11 year old out on her bike), walk, or do yoga.

Keep in mind that muscles need 48 hours to recover from a hard workout. Always follow a hard day with an easy one. Watch your red flags and rest accordingly. Your times will show improvement!

 

 

Knee Pain Slowing Your Run to a Crawl? You may have patellofemoral syndrome.

 

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.

 

Hot running is here again this summer. A little too soon for me! It’s 80 degrees at 6:30am, 100 degrees by 1pm; and let’s face it: it’s really hard to get motivated to run!

 

Goals are important during the summer training months. When you look at your calendar and see the races you have penciled in, getting out of bed is a lot easier. Pick a race in the fall and enter! I have already entered the Ironman 70.3 Pocono Mountains in October and the White Rock Marathon in December. The power of the race calendar gets me motivated to get the workouts done on these hot, hot days.

 

I also encourage everyone to try to get their workouts in either early in the morning or inside at the gym in the afternoon. Ozone is so high during the afternoon hours and poor air quality warnings abound this time of year. No reason to stress your upper respiratory system; do it early or do it inside!

 

Just a few tips to keep yourself safe this summer while running in the heat:

 

 

 

 

Over my 30+ years of distance running, I've had many black toenails. In fact, I suffered one at Ironman Texas last weekend! A few of my friends, who also participated, stopped by the office this week for black toenail treatment. The following is my advice in trying to avoid and treating this common problem. 

 

Almost everyone who runs will eventually get a black toenail. Getting your first one is a sign that you are now part of the endurance club. Its kinds like cycling. There are two types of cyclists; those that have fallen and those that will fall. While most runners blame a shoe that is too small, this is often not the main cause. Mine was from the well-meaning volunteers who soaked my running shoes trying to cool off the triathletes with their hose! Squish, squish, squish for 26.2 miles equals blisters and black toenails!

 

If a toe is under pressure from the shoe or a sock that is too tight or too thick, the sustained pressure, step after step, produces an impact or a friction problem between the toenail and the tissue surrounding it. When the tissue gets damaged, fluid accumulates. This is called a subungual hematoma. The red or black color is the result of a few blood capillaries that become broken in the process. The more fluid that accumulates, the more pain. The extra fluid, colored by some blood, accumulates below the toenail. When the pressure gets too great, the existing toenail will be separated from the nail bed.

 

Really, most of the pressure that results in this "toenail injury" is produced by the regular action of the foot coming forward, thousands of times every mile. Each time your foot swings forward, a little extra blood is pushed into the toe region due to the force of the foot coming forward. If you increase your distance regularly and very gradually, your toes will adjust to each new maximum distance and only complain when you extend farther. In a marathon training program, almost everyone gets at least one black toenail. Running faster too soon and too long will increase the chance of this injury.

 

Hot weather also improves your odds of getting one. When it's warm, your feet swell more than they would on cold days. Because there is more pressure, and more fluid, there are more black nails generated during the summer months. This is especially true when it is humid!

 

How do I prevent black toenails?

 

You'll reduce the chance of a black nail if you ensure that you have enough room in your toe area when you fit your shoes. At least half an inch is needed, when you're standing in the prospective shoes (in the sitting position, the toes aren't all the way forward). If you've had a history of black toenails and summer is approaching (or here), you may want more toe room. When you add more room at the end, ensure that the arch of the shoe matches up with your arch. Also, run in the shoe before you buy it to make sure that the shoe isn’t too big and that your foot doesn't slide forward as you're running, which can aggravate the toe more than a tight toe box.

 

Do all black toenails need to be treated?

 

Leave black toenails alone and allow them to grow out if they are not painful. About 70 percent of the black toe problems are best treated by ignoring them. The damaged part of the nail is gradually pushed out, and the foot slowly returns to normal. If they are painful, red, or swollen; time to see your podiatrist.

 

Can I just stick a needle in it to drain it?

 

Do not attempt bathroom surgery! Many runners will heat up a needle and drain the fluid under their nail. Often this introduces bacteria and now you have a painfully infected toe! Take any sign of infection seriously. If it continues to hurt or the pain increases, this is a bad sign. Toe infections can lead to cellulitis (blood poisoning), gangrene, and worse, especially if you have diabetes. See your podiatrist first, not last!

 

Will I lose my toenail?

 

Yes. It will take a few weeks or months, but as the toenail continues to grow, eventually it shoves out the damaged, blackened toenail. The black toenail is raised off of the toenail bed, and underneath it is often the healthy remainder of your toenail. Your black toenail will gradually loosen from the sides and you will be able to trim it away.

 

When will my toes be pretty again?

 

If pretty toes are important to you, you can paint the black toenail or even the thin new toenail, or the bare skin. You can also stop by Healthy Steps and have a prosthetic nail put on by our licensed medial nail technician. Most people won't notice the difference if you use a darker shade of polish. Full replacement of your toenail takes about 3 to 6 months, and the new toenail will often be a bit wavy, thin in some areas and thicker in others. After 8 to 10 months your toenail should be back to normal (unless you get a side infection of fungus….another topic).

 

Black toenails are part of distance running, but take them seriously or they can stop you in your tracks!

 

 

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!

 

See you all in Houston Texas May 21st!

 

Next article series is on recovery!

 

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. 

Part one talked about why shold you embrace minimalism?

 

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.

 

Six Simple Exercise to Stronger Strides

 

Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.

 

These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down.

 

Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.

 

Watch the video if you need help with the exercises!

 

Join Dr Crane at the Boston Marathon discussing minimalist shoes and training with an expert panel!

For more info, click here

Join an all-star panel of experts (including me!) and coaches as they share their insights and advice on responsibly integrating MINIMALIST RUNNING into training.

Does This Describe You?

 

The genuine marathoner is a rare breed indeed: half athlete and half poet; part rock-bottom pragmatist and part sky-high idealist; completely, even defiantly individual and yet irrevocably joined to a select group almost tribal in its shared rituals and aspirations.

Joel Homer, Marathons: The Ultimate Challenge

 

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

 

1. What Is EPAT?

 

EPAT is an acronym for Extracorporeal Pulse Activation Technology. It is a highly effective non-invasive office based treatment method that accelerates healing of injured tissues.

 

2. How Does EPAT Work?

 

The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

 

3. How is the Treatment Performed?

 

Ultrasound gel is applied over the skin of the treatment area to enhance the transmission of the pressure waves. The pressure waves are applied using a special applicator tip. The tip is moved over the injured tissue using circular motions.

 

4. How Long Does the Treatment Take and How Many Treatments are Required?

 

Treatment sessions take approximately 15 minutes per site and vary slightly depending on the site to be treated. Generally 3 treatment sessions are necessary and are performed on a weekly interval. If you are improving, but not completely better; up to 5 treatments can be performed.

 

5. What Conditions Can Be Treated With EPAT?

 

EPAT can be used to treat many painful soft tissue injuries. Including: plantar fasciitis, Achilles tendonitis, tendon insertional pain, acute and chronic muscle pain, and myofascial trigger points.

 

6. Is EPAT Safe?

 

EPAT is a safe treatment with virtually no side effects. It was originally developed in Europe and is currently used around the world.

 

7. Is EPAT Safe for Pregnant Patients?

 

EPAT is a safe treatment, but has never been tested on pregnant patients. Patients are advised to wait at least 3 months post partum before treatment, as many foot pains subside after weight loss and hormonal equilibrium is reached.

 

8. Is EPAT FDA Approved?

 

Yes, the machine is FDA cleared for usage.

 

9. What are the Expected Results?

 

Most people will experience pain relief after 3 treatments. Some patients report immediate pain relief after the first treatment, but maximum relief can take up to four weeks after the last treatment to begin. Over 80% of patients treated report to be pain free or have significant pain reduction.

 

10. Are There Any Special Aftercare Instructions?

 

All patients receiving EPAT therapy should be off all anti-inflammatory medication for a minimum of 2 weeks prior to the procedure and 4 weeks after. This includes common over the counter medication such as, ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin. Your doctor will provide you with detailed after care instructions.

 

11. What are the Possible Side-Effects or Complications?

 

EPAT is a non-invasive treatment and has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. On rare occasion, the skin may become bruised or red after the treatment.

 

12. Who Should not Have EPAT?

 

EPAT should not be used in people who have deep venous thrombosis or malignancy. It is also best to avoid the procedure if you are taking blood thinners.

 

13. Why Consider EPAT?

 

EPAT has a proven success rate equal to or better than traditional treatment methods (including surgery) without the risks or lengthy recovery time. It is performed in your physician's office without the need for anesthesia.

 

14. Does My Insurance Pay For EPAT?

 

No, unfortunately insurance companies do not pay for EPAT, though the cost of EPAT can often be reimbursed from a qualified health savings account. Non-covered services and/or procedures without billable terminology are paid to the office by the patient at the time of service; a claim will not be submitted to the insurance, though our office can provide receipts for reimbursement accounts to consider.

 

15. How Much Does it Cost?

 

EPAT is an affordable alternative to invasive surgery, lengthy physical therapy and other costly treatments. The first 3 treatments are bundled at a cost of $500 for the procedure, but you are still responsible for any co-pays or costs associated with the initial and/or any follow up office visit. If a 4th or 5th treatments are deemed necessary, these cost $100 per treatment.

 

16. How Can I Get More Information About EPAT?

 

The physicians at FAANT all have experience in providing EPAT treatment and are the best people to speak with if you have additional questions regarding the procedure. Call or contact our office for a consultation.

 

There is also much more extensive information available at www.curamedix.com

 

Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).

 

I wonder how many of them were runners? I watched from my window this morning as one of my crazy neighbors fell running on the sidewalk in front of my house. The snow had not even stopped coming down yet! Crazy! Even I ran on the treadmill this morning, and most of my peeps will tell you: I Hate Treadmill Running! Better the treadmill than the emergency room!

 

Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.

Safety Tips

It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:

Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping. Trail running shoes are better than your regular road shoes.

 

Run or walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run quickly. Run in high alert!

 

Run or walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying anything that may cause you to become off balance. This even means leaving your precious water bottle at home.

 

Run or walk "small." Practice your "Chi" running and throw your center of gravity forward. Avoid an erect, marching posture. Look to see ahead of where you step.

 

When you step on icy areas, take short, shuffling steps, curl your toes under and run or walk as flatfooted as possible.

 

Run where the path has been cleared. Even in your own yard, remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Don't be stupid like my neighbor and try to run while snow is still flying!

Falling Safely

Even when you practice safe running and walking habits, slipping on ice is sometimes unavoidable. It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.

 

When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.

 

People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If it is not a choice to hit the treadmill, practice caution while running in the snow and ice. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn’t mean it is not broken.

 

Run Happy and Be Careful! Don't Be a Statistic!

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!

 

 

 

This Thanksgiving weekend I sit back and reflect on how thankful I am for all the blessings I have in my life. I have a wonderful family with three healthy and happy girls. My oldest two even did their first triathlon this fall with me. I am blessed with healthy and happy 70+ year old parents who support me and my girls in all our crazy endeavors. I have siblings, who think I’m nuts, but would cross the globe to help me. I have amazing and creative friends who have circled the wagons every time I needed them. I am blessed to be loved by a caring, thoughtful and selfless man who treats me like a princess. I have an unbelievably rewarding and fulfilling career in a profession that not only supports my family, but fulfills my need to be needed and useful in other people’s lives. And I enjoy the ability to run, jump and play (as well as swim and bike) with all my friends and the rest of the crazy marathon running, triathlon trying community. I am truly blessed and remember that daily.

 

Why is that peace so elusive to so many? I think Blake Mycoskie, the founder of TOM’s shoes and one of my personal heroes, hit the nail on the head in his Thanksgiving blog post, “This Thanksgiving, try to really stop. Sit still. Hold a loved one's hand, and simply be thankful. No matter what your situation, positive or negative, sad or joyful, take the opportunity to truly experience this moment. The stillness. The mystery of this life. For this, and no other reason, I'm thankful.” If you are not familiar with TOM’s shoes, take a look at their website. He gives a pair of shoes away to a needy child every time they sell a pair of shoes. They have given out more than a million pairs of shoes already! Changing lives one pair at a time. Not bad for a 30-something guy from Arlington, Texas!

 

Happiness and peace of mind does not need to be elusive. Enjoy a still moment. Revel in the people and places around you. No matter what is going on in the circus that is your life, we all have something to be thankful for; even if it is just breathing another day. And for all the runners and triathlete’s who follow my blog, we should all be thankful for the ability to enjoy our sports activities.

 

Always answer the question, “Why do you run?” with the answer, “Because I am blessed that I can!”

 

Happy Thanksgiving to all! Run happy! 

Whew! What a weekend! The Dallas Athletes put on a great Halloween party at the Monster Triathlon in Keller, Texas this fine Sunday morning. After severe weather yesterday afternoon, the weather had cleared up to be perfect for racing. The start was in the beautiful Keller natatorium where the water is always a balmy 81 degrees. A lovely hilly ride (hills for Texas) through Bear Creek and finished with a run through the nature trails. What more could you ask for? (Maybe next year we could start at 9am instead of 7? Ha ha)

 

This year, I have been running long course triathlon and concentrating on the 70.3 distance, so frankly I was in no shape to race a fast sprint. I decided to have fun with the day and put on my costume. I was the “Tri-fairy” because it turns out they don’t make a Tinkerbelle costume in my size. I borrowed wings, a crown, and a magic wand from Sasha, my 4-year-old, and got a black tutu from Target. Add to that some ribbon on my hot pink bike and my costume was ready!

 

Tom was the race starter in his Burger King costume and we were officially under way. It’s amazing how triathletes really do come in all shapes and sizes! The youngest one I saw was 10 and the oldest at 78. Tall, thin and muscular all the way to looking like a small Sumo wrestler. It’s great to see so many people (almost 700) celebrating fitness and pushing the envelope.

 

The race is a favorite among the local tri-heads, but it also tends to draw a lot of first timers. My office administrator, Lori, was a newbie this morning. Not only did she push herself hard and do fantastic, but she finished in a virtual tie with me! I see many more triathlons in her future!

 

As for my race, I had a nice swim and was only run over by three guys. Got my costume on and went for a nice bike ride with 700 of my closest friends. Lots of comments when you are biking in a tutu with a crown affixed to your helmet and pink wings on your back!

 

Off the bike and on to the run! Tom announced as I went by the finish line that “This is Dr Crane, she treats feet and halitosis”. Very funny Tom! I only treat halitosis if your foot is in your mouth!!

 

Lori passed me on the run as I was jogging along giving lots of fairy dust to other runners with my magic wand. I sped up as she past me and finished just a few steps behind her! A good time was had by all! 

 

Now it’s time to get busy and build some base for the winter s we can tackle the Inaugural Texas Ironman in May 2011. Tune back for updates from Janet and I on the road to Ironman Texas! 

 

Run Happy! 

Wow! What an afternoon. My two oldest girls are doing their first triathlon tomorrow in Keller, Texas. We spend hours this afternoon running around, picking up their packets,  getting new bike helmets (can’t bike with our skate board or horse back riding helmets according to the rules!), and finding appropriate gear. Luckily my 10 and 12-year-old can fit in my triathlon unitards (good thing I’m a midget ha ha). We even had to find swim caps.

 

Whew! Gear is all together and ready to go at 6am tomorrow morning. I’m excited. My first tri was at the age of 40! I’m glad my kids can get a taste of the sport I’ve come to love. The race is called the “Monster Kids Triathlon” and looks to be a lot of fun! They have competitors as young as 4 and as old as 13. Picture little kids on tricycles up to early teenagers. What a mix!

 

The adult sprint triathlon is Sunday, so we get to get up before dawn both days this weekend! I think I’m more excited then the girls, but my 12-year-old was telling everyone in school she was doing a tri and they were all impressed! Wish them luck! Will update with results and even pics!

I just hope they both have fun and maybe even want to do it again!

 

Run Happy! (and Bike and Swim if you please!)

 

Like many people in Southlake, Texas this afternoon, I was reading the new edition of Southlake Style magazine that came in the mail today. After the usual local nonsense, I came across an article by Harold Wilson of Multisport Coaching Systems about weight loss exercise programs for truly obese people. He talked about the fact that most articles spend so much time talking about the overwhelming numbers associated with obesity and of course the associated health risks, but almost never spend much time on how an obese person can actually lose the obese tag.

 

Harold spent some time talking about the people in the news that have successfully lost the weight (Think “The Biggest Loser” or Jared of Subway…heck, he is even going to try to run the New York City Marathon next month!).

 

The meat of the article discussed the keys to successful weight loss: strategy + execution = success! Wow! Isn’t that the key to just about everything? But wait, maybe Harold is on to something. I have runners that get so caught up in planning their training program that they have little energy left to execute it. Same goes for weight loss programs. Many people spend all their available energy in the planning, so they never get around to executing it!

 

So, I will reiterate to you Harold’s tips for weight loss and you will see that they hold truth in all exercise programs!

 

1. Save most of your energy or effort level for execution

2.  Choose workouts that are smart and simple

3.  Build your day around your workout and plan ahead

4. Educate yourself on the science of nutrition

5. Remember these absolute truths: 

 

Discipline is necessary

 

Like many things in life, profoundly simple, yet simply profound! Thanks Harold!

 

PS. Since I shared with you Harold’s article, if you find yourself needing more advice you can find him at www.getfitgetfast.com or at the Southlake Larry North Fitness.

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!

 

2. It is a great pain reliever.

3. It makes the end of a race much more enjoyable.

4. It can precipitate post-race amnesia making you want to do another one.

5. It tastes much better than Gatorade.

6. I think I even read a study that showed beer helps flush out all that lactic acid!

7. It promotes social activity after a race when you feel like you just got run over by a truck

8. It’s a great carbohydrate replacement recovery drink.

9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work 

 

All right, all funny aside, how about the ice versus heat question?

 

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!

 

Run Happy!

Spring is finally here! That means more and more older runners and athletes are flocking to my Grapevine, Texas, office complaining of a multitude of aches and pains. 'Tis the season to overtrain and suffer from the dreaded tendonitis. What is this mysterious 'itis? Why does it effect aging athlete's more than the younger ones? Why does one person have multiple bouts of recurrent tendonitis all over their body and another does not? These are all great questions!

 

Let's start with the basics. A tendon connects your muscles to the bones. It is a flexible but really tough band of fibrous tissue. A muscle contracts to move one of your joints and transmits a force on the tendon to cause the movement. Tendons, when functioning normally, glide very smoothly when the muscle contracts. When they are irritated, they cause pain and even creaking when they glide. This is tendonitis or in easier terms, inflammation of the tendon.

 

Tendonitis can occur in any tendon, but in your foot and ankle the most common tendons effected are the ones that stabilize you foot when you run, jump and play with the other kids. These are the Achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendons. Less likely to be irritated are the multitude of smaller flexor and extensor tendons in your feet.

 

Tendonitis is more common in your aging athletes between 40 and 60. This is because the lovely aging process causes our tendons to become less elastic and therefore less forgiving. A stress that would've been easily absorbed in our 20-year-old tendons causes tendonitis and even rupture in our 40+-year-old tendons.

 

Tendonitis is usually due to repetitive stress with an underlying biomechanical abnormality or anatomical deviation. This is why it is important to treat the tendonitis and the underlying cause before return to sport. If not, recurrence rates are high!

 

What does tendonitis feel like? Pain and swelling in the tendons usually first thing in the morning or at the beginning of an activity. The pain and stiffness often "warms up" in the early stages, but can become constant if you ignore the early symptoms. Sharp stabbing pains can occur but these are usually a sign that your tendon is so stressed it may actually tear!

 

How is it diagnosed? Usually your doctor will perform a physical exam and then rule out a bone problem or fracture with an x-ray. Sometimes an MRI is needed to rule out a small or partial tendon tear.

 

Treatment for tendonitis begins with relative rest. Take the stress off the inflamed tendon by doing alternative exercise like cycling or swimming. Sometimes complete rest is needed. Ice, anti-inflammatory medicines, bracing, physical therapy and even a cortisone injection may be needed. Functional foot orthotics are often quite helpful in chronic tendonitis because they stabilize the abnormal movements and help treat the underlying biomechanics of your feet.

 

Remember that after having a bout of tendonitis, slowly return to activity and try to avoid the overuse that caused the tendonitis in the first place! Too much, too soon, too fast syndrome is often the culprit in tendonitis!

 

Run Happy!

 

This morning I spoke at the DFW Sports Medicine Symposium in Arlington, TX. What a great crowd! Over 300 physical therapists, athletic trainers and sports medicine physicians from all over Texas gathered to discuss advances in the medicine of sports.

 

 I spoke on running injuries and more specifically the need for a complete biomechanical exam to not only diagnoses, but to guide your treatment plans. This way the runner can return to running in much better shape than they walked into your office. I feel it is a missing link in a lot of offices due to the time involved. Dynamic gait analysis can actually help the clinician diagnose the root cause of an injury instead of just treating the symptoms. This will decrease the chance of a repetitive injury.

 

 I also talked about the current barefoot running phenomenon and the fact that the average runner will most likely not benefit from barefoot running due to poor biomechanics and muscle imbalances. There is much more of a chance that they will actually hurt themselves. Those runners with fairly good biomechanics and patience can benefit from some barefoot running in a controlled environment. Lots and lots of questions still exist and more biomechanics research needs to be done in this arena.

 

The need for functional foot orthotics was also discussed. No! Every runner does not need orthotics, but almost 80% need some kind of biomechanical help. Most can be accommodated with shoes, stretching and strengthening programs. You would be amazed how much impact a core strengthening program can have on your running biomechanics. Recurrent, nagging injuries often require orthotic control to alleviate recalcitrant pain.

 

The last thing I discussed was the need for a gradual return to sport so there will be no more of the too much, too soon, too fast phenomenon that plagues so many runners!

 

A great question and answer session followed. I gave away a few copies of my book, If Your Running Feet Could Talk. I think we all learned something this morning. A good time was had by all and all the athletes in the Dallas-Fort Worth area and all over the State of Texas will benefit!

Sounds like a funny question, but what is the right answer? Is there a universal unwritten rule? Should you always wave so that other runners will see you as friendly? Or should you only wave at people you know so that a stranger won't think you are a potential stalker?

 

In Texas, it is typical to wave and even say hello to every runner you pass on your runs. Heck, I wave at runners, walkers, people's dogs, and even a few passing motorists who yell out the window. I figure they are either saying "Hi!", because they know me or they are admiring my sweaty derrière. Either way, a wave is indicated. I also talk nonstop while I run, so people either love to run with me or find me incredibly annoying. I was even told to shut up by another runner while running a marathon. Guess they were having a bad day. I know my incessant chatter can be distracting, but what about the wave?

 

To complicate the musing in my head, I also wonder about cyclists? Do you wave to everyone on a bike? After plunging head first into the triathlon world a few years ago and riding hundreds of miles, I still don't know the answer to the waving question when it comes to cyclists. The first few months I was learning how to cycle without falling down; a wave would've caused me to crash. I didn't even think about it! Now, I often wave or at least nod at the passing cyclists. You never know who is a friend or not with the helmets on.

 

Geography may also have something to do with it. I have come to realize, after running quite a bit while traveling, that the automatic wave is not the norm in other cities. I even started to think it was just a Texas thing, but remembered my childhood running in Rhode Island where everyone waved. Then again, everyone knew everyone else in my small town. Maybe it's a suburbia thing. In fact, while running in Chicago, people looked at me quite strange when I waved. No one actually returned my hello and I have to admit I was not feeling very welcome by the time I finished. My experience was similar in Pittsburgh. Not a lot of waving going on. I expected the same in New York, but was surprised when I received quite a few waves and even a passing grunt while running. Who knew New York runners may be friendlier than Chicago and Pittsburgh?

 

So, I embarked on a mission to answer the waving question. To wave or not to wave? After a very unscientific poll of over a hundred runners across the country, it turns out there are no hard and fast rules. There are however some loose guidelines:
1. It is always better to wave than not to wave unless you are running in a city. Wavers may be confused with muggers.
2. Wavers tend to be out for a recreational run, not a hard tempo run or speed workout.
3. There are more wavers in the South than in the North.
4. Woman wave more than men. In fact, one man felt a wave may be interpreted as a pick up line.
5. Non-wavers are often wearing an IPod and never even realize they are possibly considered rude and unfriendly.
6. Most cyclists have actually never even thought about waving, but feel a simple nod is recognition enough.

So, I guess there is no universal rule about waving, but I am going to continue to wave to ever and all runners to try to foster a community feeling while I run, but as for cycling; I think I will stick to the nod.

 

Run Happy!

Vigorous Physical Activity Modestly More Protective Than Moderate Activity !

 

New study shows that we are not crazy! Running is better than walking!

 

For complete study click here

The last few week, lots of patients have been coming into my office in Grapevine, TX saying, “My shins are killing me after running". This is a common complaint of new runners or runners increasing their mileage or intensity.  It has been estimated that "shin splints" account for approximately 15% of all running injuries and may account for up to 60% of leg pain in runners. Many terms have been used to describe exercise-induced leg pain, including shin splints, medial stress syndrome, tibial stress syndrome, recurrent exercise-induced ischemia, and chronic exertional compartment syndrome. "Shin splints" has been commonly used as an all-encompassing term for many disorders causing lower-leg pain so that’s how I’ll refer to it during this discussion.

 

So what is a “shin splint”? Shin splints are pain in the lower leg usually caused by a variety of overuse or chronic stress related fatigue syndromes. The root cause of most shin splints is chronic biomechanical imbalances of the lower leg and feet. What does that mean? Bad feet, muscle imbalance, bad shoes, or improper training. In Caitlin’s case, she was running too much, too soon, too fast like many new runners and needed better stretching and arch supports.

 

What can a “shin splint” represent? The underlying pathology of a shin splint can be a fatigue injury of almost ever tissue seen in the lower leg. This can include:

Wow! That’s a lot of things that can cause shin splints!

 

While every shin splint injury has its own specific biomechanical causes, most are rooted in tight calf muscles and relative weakness in the front leg muscles. What's going on is that your tight calves are pulling up on your heel, which in turn pulls the front of your foot down. This puts strain on the muscles in the front of your leg, which unfortunately are not strong enough to resist the pulling. This causes a big pain in the leg! This is very, very common in runners, since running tends to exercise the calf muscles more than those in the front. But fear not, a little rest and a lot of stretching and strengthening will fix you up and possibly make you a better runner, too.

 

How do we treat them? Early on in the syndrome, shin splints are treated with ice, relative rest (slow down and get off the hills and uneven surfaces), anti-inflammatory like ibuprofen, stretching, and arch supports. Take a good look at your shoes. These often need to be replaced or upgraded to a better pair for your foot type. (More discussion on that topic in a future article).

 

After we address your shoes and overpronation or underpronation (your foot rolling in or out excessively when you run), then we move on to the muscle imbalances in your lower leg. Your calf muscles are too strong and tight, while your front leg muscles (anterior compartment) are too weak. This is easy to remedy but won’t happen overnight. Stretching your calf muscles with a simple wall stretch for your Achilles tendon many times a day( how many?) will help. Strengthening the front of your leg can be done by actually putting a small weight (or an athletic sock full of sand) on your foot and lifting it towards your shin. Hold that for a count of ten then relax. Repeat twenty five times. You will be amazed how tired those muscles are!

 

If your pain persists after two weeks of these simple solutions or is at any time pinpoint or severe in nature, call you podiatrist or sports medicine physician. Stress fractures can creep up on the overzealous new runner and can take 8 to 10 weeks of no running to heal!

Shin splints are common in today's active population. It is important to keep in mind that shin splints, like most running injuries, are basically an overuse injury. Listen to your body and back off when you begin to feel pain.

 

These are just a few tips to get you on the road to recovery! Run Happy!