Dr Marybeth Crane talks about chronic heel pain and the difference between plantar fasciitis (acute) and plantar fasciosis (chronic). Have a listen.....
Rainy weather happens everywhere, even in North Texas. We have all signed up for a race and woken up to a deluge. I actually did an Ironman in Quebec where it rained almost the entire time! Quite the challenge! (an a personal worst time to boot!) Rain happens, so here are some tips to prepare you for running in rainy weather. Personally, as long as it is not freezing cold, I enjoy the flashback to childhood romps in the puddles that can come from a rainy day run outside.
1. Dress in layers but not necessarily waterproof. I find that waterproof jackets actually trap moisture and heat, which can make you overheat in a jiffy. You can get dehydrated in the rain since you don’t notice that you are sweating that much. A water-resistant jacket breathes better. Layer this on top of a moisture wicking technical shirt and you are good to go, as long as it is over 40 degrees! Wear the least you think will keep you warm on a dry day and avoid overdressing. You are going to get wet. More is not better, just heavier!
2. Wear a hat with a brim. It helps to be able to see where you are going and avoid falling.
3. Wear reflective gear. Drivers often has poor visibility and think you are nuts for running in the rain, so they won’t be on the lookout for runners like they are on a nice day. If you don’t have reflective gear, make sure your top layer is light colored.
4. If you are running a race, wear a lawn and leaf trash bag as a fashionable jacket for the start. You can throw it off after the first few miles as you warm up. Please don’t litter! Give it to a spectator or aid station.
5. Wear older running shoes. We all have them in the closet. That pair that has a few too many miles but you haven’t parted with them yet. Pull those out as long as they are not way too worn. If you don’t have an old pair, pick your ugliest. We all have them too!
6. Chafing sucks! Wet weather can lead to chafing so use Body Glide or at least Vaseline on those parts that are prone to chafe or get blisters. This is your toes, heels, underarms, inner thighs, nipples and bra lines.
7. Leave the electronics at home. If you are a music junkie, today is the day to go au natural. Enjoy nature in its fullest and leave the IPod at home.
8. Let loose and enjoy your inner child! Make it fun and even jump in puddles! Life is too short not to enjoy a rainy day like a 6-year-old!
9. Take care of your shoes when you finish. There is nothing worse than a pair of running shoes that shrink. Stuff your shoes with old newspaper and this will draw the moisture away and helps keep their shape. You can put them in the dryer on no heat and that helps too! Spray them with Lysol after they dry to ward off any fungus or mold that may accumulate!
Rainy days can be fun and a time to enjoy a long run! Keep safe and enjoy running in the rain!
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!
Mizuno is looking for a few passionate runner to test drive, and they hope, embrace their shoes. The word "Mezamashii" means brilliant or eye-opening. They want you to have that kind of fantastic run! If you are a passionate runner or triathlete, like most of my readers, then apply to be part of the project. What do you have to lose except maybe an exceptional running experience. (I am need to emphasize the I am not endorsing or being paid by their project, but I like the idea. Test drive and decide for yourself)
To apply to join the project, click here and then click on apply for an invite on the top right of the screen.
This is my first attempt at using animation for patient informational videos. Don't laugh too hard :) Send me topics you would like in this media!
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!
Podiatrists have been prescribing compression socks for years to treat things like chronic edema, lymphedema, varicose veins, and to prevent deep venous thrombosis; but recently they have started showing up on perfectly healthy runners. Yes, sometimes compression socks are used to treat shin splints, but do they make you faster? Can you run longer in compression socks? Many runners and triathletes swear by wearing compression they feel faster and recover better. Do they really work? Is there any scientific evidence that they really work? Or is this just more running lore?
In 2007, one study showed no increase in endurance or speed, but they were shown to stimulate blood flow, helping legs recover faster from a hard run. OK, so they help recovery, but can they make me faster? That early study didn’t think so, but that’s why we kept looking.
Most theories about how compression socks improve running performance focus on the physiological and biomechanical support of the lower legs. It is assumed that compression socks may enhance venous return to the heart through a more efficient calf muscle pump, leading to increased endurance capacity. And there is the notion that because muscles are kept more compact, balance and proprioception are improved and muscle fatigue is minimized. Sounds reasonable, but again, what does the research show?
It wasn’t until 2009 that a German study clearly showed that they enhance performance during hard runs. And research done in South Africa and New Zealand both show that knee-highs also improve recovery by boosting blood flow in the extremities. In fact, even compression socks (not your Grandma’s TED hose) have been shown to increase resting arterial circulation by 30% and 40% under physical strain. Many compression sock companies even tout that they have studies that shoe an increase in running efficiency by 5%, which can equate to taking 12 minutes off a four-hour marathon. Crazy? Maybe not? Yet they still aren't for everyone.
One German study conducted on super-fit elite athletes (not most of us in the back of the pack) reported no performance payoffs from compression. According to the study, the socks work better when they're squeezing more performance out of non-elites (you and me).
Lots more studies to come, but if donning some hot pink knee socks will take 12 minutes off my marathon time, bring them on!
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!
Confessions of Myrundoc: Do as I Say, Not as I Do.....
Time to come clean. Yes, I too can fall victim to a running injury. And yes, of course it's a foot related issue. Turns out the old adage is true that doctors are the worst patients, just like plumbers often have leaky pipes at home :) in fact, I think doctors are the worst patients only trumped by pilots. Yes, it's a control issue!
Because I'm the local authority on running injuries I of course started to treat my injury when it was in its mild form....Not! No, I did like most of my patients and ignored it until my foot hurt so bad the day after a race that I could barely out my heel on the ground. Yes, I suffer from the dreaded and incredibly common plantar fasciitis in my left foot. Why? A combination of the perfect storm.
I would like to blame it on the White Rock Marathon, you all remember that glorious day.....45 degrees, pouring rain....but if I'm honest, it started way before that. I ran the DRC Half in November with bronchitis (also a brilliant move) then barely trained the rest of that month as I was getting over my upper respiratory infection. Couple that with an incredibly busy November and December in the office and the OR; you get poor training schedule, exhausted body and depressed immune system. Oh yeah, I also ran the White Rock Half marathon in the pouring rain and had to run the Bold in the Cold Half marathon because my running club was putting it on and the medal was cool.
Long story short, what started as a little tightness at the Phoenix Turkey Trot over Thanksgiving (oh yeah, ran that too, then climbed Camelback Mountain the next day), became a swollen, sore foot by the first weekend in January.
So what do I do? I stopped running. This wasn't really a choice since I could barely put my foot on the ground the day after Bold in the Cold. I started icing, taking Advil and lots of stretching. I looked at my shoes and realized I had five pairs I was working on and all of them were dead. My orthotics were 3 years old and needed replacing. I started wearing nothing but a brand new pair of running shoes to work and clogs on the OR. I even let my partner give me a steroid injection. And I got in the pool and on the elliptical and bike so I didn't gain a million pounds!!
A month went by and I was somewhat better. Maybe 50% but still couldn't run. I was now starting to get annoyed and my staff wanted me to get back to running so I would stop being cranky! Onto EPAT....why have technology if you aren't going to use it? What is EPAT. Yes, I had the EPAT procedure performed the first week in February and yes, it hurts like hell but way worth it. I was about 70% better after the first treatment and 80% after the second. I still did the night splint (incredibly annoying but effective for the first thing in the morning owie), had gotten a brand spanking new pair of custom orthotics and still wearing nothing but running shoes, clogs and a two inch heel when necessary.
I went for my first run in 6 weeks yesterday in Napa Valley, CA. I was in wine country for a conference and my foot was feeling so much better. I did 4 miles of walk run and did pretty well. Tight but not painful! I'm going to have my third EPAT this week and I think that should do it. Maybe I will let the staff video it so you can all join in.
What did I learn? Listen to my own advice. Do as I say, not as I do. If I had started stretching, icing and looked closely at my shoes and orthotics at Thanksgiving; this whole saga probably could have been avoided. Stubbornness and the fact that when I close my eyes I'm 19, did not help me recover.
Thank God for technology! The EPAT certainly saved the day for me. I'm sure two months of physical therapy would've had the same result, but time was short and technology available! Bring on the triathlon season! First race St. Pat's Sprint Tri in Keller on March 10th!
Got Heel Pain? Give me a call!
Let's talk about how to reach your goals in 2012!
Happy New Year! More in 2012!
Thanks For Watching....stay tuned for more!
So RunDoc weighs in on the question: "Does Running in the Rain Make You Sick?"
You asked for more video blogging, so here is the newest segment!
Run Happy! And feel free to jump in puddles!!
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.
"Cold and rainy weather causes virus infections to spread more rapidly than usual" - Fact, due to people staying indoors more and getting exposed
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.
The majority of physicians agree and recommend using NSAIDs temporarily along with other measures—such as rest, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free.
For more info on this retrospective study, click here.
Sarcopenia, The Age-Related Loss of Muscle Mass is Preventable and Reversible!
So why is it so hard to keep muscle mass when we age? Turns out it is caused by sarcopenia. Really! I'm not making up the term. Sarcopenia is the progressive loss of muscle mass that results from the normal aging process. It has been felt, in the past, that the loss of one to two percent of your muscle mass each year after the age of 40 is inevitable.
Turns out there are lots of things we can do about sarcopenia. One of them is to stop trying to look like a cachectic Holocaust victim and actually build some upper body muscles!! Runners tend to feel like if they bulk up at all in their upper body that it will slow them down. Research actually has refuted this claim over and over, but it is still one of those long-standing running myths. Strength training actually helps preserve muscles and strengthen bones which often improves your running economy and hence makes you more efficient, reducing the amount of energy to run at a certain pace. Win-Win!
Many factors go into the onset of sarcopenia. Chronic disease and environmental factors can accelerate loss of muscle mass, but these are not really controllable. Factors under our control that affect the progression of sarcopenia are motor unit restructuring, protein deficiency, and changes in hormone concentrations. These combine to produce the age related loss of muscle coordination and mass.
Really, it is all about proteins. There are two kinds of proteins; non-essential (those your body can synthesize) and essential proteins (proteins we need to get from foods). Your body seeks a balance between protein production (synthesis) and usage (metabolism) for energy and cell structure.
We don't usually lose our ability to metabolize proteins with age, but we do lose our ability to synthesize them. This is where hormone balance comes into play. Things like Insulin-like growth hormone (IGF-1), testosterone and growth hormone. As our bodies age, our hormone concentrations decline. This is why aging baseball players love growth hormone, they think it stops sarcopenia! (Hgh declines after age 40 but there is not good research that proves supplementation will actually help!) What's more, it appears that as we age, we actually require more protein but continue with a similar diet hence we are out of balance.
The hormone decline and protein deficiency one-two punch is largely responsible for sarcopenia, but when you add the most vital aspect - motor unit restructuring - they combine to form a cocktail that results in the physical manifestation of aging.
Motor unit restructuring is the product of the inevitable death of neuron cells. Fast twitch neurons (those responsible for precise or quick movements) die off first. When the cell reaches its predetermined life span, it dies. When a motor neuron dies, the muscle fibers that are under its command can deteriorate or atrophy. To prevent atrophy, when a fast twitch neuron dies, a slow twitch neuron nearby attaches itself to the now abandoned muscle fibers, innervating and keeping them alive. This change is known as motor unit restructuring. This is why we become slower and less coordinated as we age.
So how can we thwart this process? Move! Often! Sitting on the couch and leading a sedentary lifestyle is a good way to ensure sarcopenia with age. The best way to cure or at lest slow down the onset of muscle mass loss is resistance training. We recommend our patients participate in daily exercise, but often this is not enough. It will help your cardiovascular system, but resistance training with weights is the only way to reverse muscle mass loss. Couple this with increases protein intake to have the building blocks to redevelop muscles.
So, you want to be able to beat the young pups when you are in your 50's and 60's? Talk to your doctor about any health issues like diabetes or hypertension. Change your diet to higher protein and less carbohydrates. Forgo the pasta dinners and add lean protein! Resistance training with light weights and high repetitions at least 45 minutes, three times a week. Make it a habit you will take into your senior years!
You will thank me when you are still running in your 70's!
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.
Love the Shout out in the Dallas Morning News!
Thanks to the shout out from my friend and running peep Spareribs LaMothe in the Dallas Morning News Running Blog this morning. He made a few great points about injury management in his blog. The two best were to seek professional help early in the injury course. The faster you obtain a correct diagnosis, the sooner you will get better! The second point was to find a doctor who runs! As a sports medicine podiatrist who endulges in border-line crazy endurance sports, I speak your language and have a network of other doctors and therapists that are all on the same page!
If your doctor thinks that "LSD" is still a drug and not an acronym for "Long Slow Distance", maybe you need another doctor for your running injury!
Thanks again Spareribs! See you around Lake Grapevine!
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!
Bottom line: Take it slow and easy and enjoy your runs!
I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)
I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!
A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!
The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
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!
Ok, I have been joking all week with my triathlon peeps that beer is the best recovery drink! But seriously, I think there are two questions that need to be answered:
So, here are some simple answers to what is actually two very complex questions! Remember that individuals all differ and our sweat ratios also differ. A great way to determine how much fluid you need after a race or long run or ride is to weigh yourself before and after exercise and replace fluid losses by drinking 20-24 fl oz water for every 1 lb lost.
What should you drink and/or eat? Yes, I like beer after a race but science shows that you should consume a 4:1 car/protein ratio. (I hear all those fans of chocolate milk cheering).
Research has shown that eating 0.3-0.6 grams of carbohydrate for each pound of body weight within two hours of endurance exercise is essential to building adequate glycogen stores for continued training. Waiting longer than two hours to eat results in 50 percent less glycogen stored in the muscle. The reason for this is that carbohydrate consumption stimulates insulin production, which aids the production of muscle glycogen. However, the effect of carbohydrate on glycogen storage reaches a plateau.
Research also shows that combining protein with carbohydrate within thirty minutes of exercise nearly doubles the insulin response, which results in more stored glycogen. The optimal carbohydrate to protein ratio for this effect is 4:1 (four grams of carbohydrate for every one gram of protein). Eating more protein than that, however, has a negative impact because it slows rehydration and glycogen replenishment.
One study found that athletes who refueled with carbohydrate and protein had 100 percent greater muscle glycogen stores than those who only ate carbohydrate. Insulin was also highest in those who consumed a carbohydrate and protein drink.
Consuming protein has other important uses after exercise. Protein provides the amino acids necessary to rebuild muscle tissue that is damaged during intense, prolonged exercise. It can also increase the absorption of water from the intestines and improve muscle hydration. The amino acids in protein can also stimulate the immune system, making you more resistant to colds and other infections.
Good replenishment food?
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!
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:
Get motivated and get out there, but run safely in the heat so we can all enjoy the fall race season!
Today, June 1, 2011, is National Running Day! You may run alone, but on National Running Day, we celebrate together! On this day, runners everywhere share their passion for a lifestyle that is one of the best, and simplest, ways to stay fit—and so much more. You can head out solo to clear your mind, gab with your regular running peeps, or turn an unsuspecting friend into a running fiend. This day is for us!
Spread the word....tell us why you love to run!
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!
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.
Watch the video to help you perform these exercises correctly
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!
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.
Join Dr Crane at the Boston Marathon discussing minimalist shoes and training with an expert panel!
For more info, click here
Come join me in Boston on April 14th at 6pm
Saucony presents "Step into Minimalism"
Click here for more info!
Run stronger and happier!
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
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.
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!
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!
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!
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!
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!
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!
Discipline is necessary
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!
Hey, it's May. You know what that means? It's national running month!
Wow, what a great month to get started with your new running program! We all know that there is a new running boom and running is one of the fastest growing sports in the United States next to my second favorite, Triathlon! The bottom line is that running gives you the best fitness that you possibly can get from a simple exercise that costs almost nothing! So think about it. Let's walk down to the local running store and get yourself a new pair of running shoes! Let's get back on track today just because national running month! It's a great excuse to get started.
A wise woman always says that the hardest part of a marathon is the first three steps out of bed in the morning, so let's get out there and get running.
If you are using your on and off foot pain as a good excuse to stay on the couch, click here and order my free book on foot and ankle woes. Yes, I said FREE!
If you need more advice to get started, click below and watch my video from a recent visit to Luke's Locker in Colleyville, Texas!
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!
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.
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.
I read a quote today that really outlines how I feel about running's goal in my life so I figured I would share:
"The secret shared by women runners: running is not just physical exercise but a spiritual, mental, and emotional journey. " Taken from Runner's Gazette
Running has always been my stress relief, my Prozac, and my outlet. A time that is all mine with an audience of God and nature.....and a few peeps from time to time. I hate the treadmill because I don't get my daily dose of nature, critters, and fresh air. Thank God it's spring!
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
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!
Many of our patients, much like their estimated 75 million obese neighbors, are stuck in a never-ending, life-threatening cycle: Obesity aggravates the pain in their feet; sore feet make it almost impossible to exercise for weight loss; and without exercise, their weight continues to increase which puts them at risk for worsening of diabetes, heart disease, high blood pressure, stroke and other life threatening diseases.
It’s the New Year and more than 50% of New Year’s resolutions have something to do with weight loss. This includes a resolution to exercise on a regular basis. Do not let foot pain thwart your resolution to exercise! The best way to break the pain cycle is to seek help from your podiatrist. Often simply placing you in the correct shoes with arch supports or custom foot orthotics will decrease your foot pain and fast track your resolution to exercise.
Many of our patients have not exercised in years, so they have many questions on how to get started. Before starting any program, it is important to discuss exercise with your doctor to see if you have any restrictions due to heart disease, diabetes, or arthritis. Get a physical! It’s a great way to start off the year. After your physical, visit your podiatrist to discuss your foot and ankle aches and pains.
There is no perfect exercise program for anyone, but if you are more than 20 pounds overweight, I recommend you start with a walking program that also has a strength and flexibility component worked in. What does that mean? Start with walking, not running, and add stretching and a little weight training to balance your program. If you need help with program specifics, consult a personal trainer or physical therapist.
Walking really is the easiest and least expensive exercise program that can be done indoors or outdoors; and this can progress to a running program as you lose weight and get healthier.
Did you know that inactivity is the second leading preventable cause of death in the United States, second only to tobacco use?
Need more motivation? Here are six great reasons other than the obvious physical fitness improvements to start a walking program:
1. Walking prevents type 2 diabetes. The Diabetes Prevention Program showed that walking 150 minutes per week and losing just 7% of your body weight (12-15 pounds) can reduce your risk of diabetes by 58%.
2. Walking strengthens your heart. In one study, mortality rates among men who walked less than one mile per day were nearly twice that among those who walked more than two miles per day. Women in one study who walked three hours or more per week reduced their risk of a heart attack or other coronary event by 35% compared with women who did not walk.
3. Walking is good for your brain. In a study on walking and cognitive function, researchers found that women who walked the equivalent of an easy pace at least 1.5 hours per week had significantly better cognitive function and less cognitive decline than women who walked less than 40 minutes per week. Think about that!
4. Walking is good for your bones. Research shows that postmenopausal women who walk approximately one mile each day have higher whole-body bone density than women who walk shorter distances, and walking is also effective in slowing the rate of bone loss from the legs.
5. Walking helps alleviate symptoms of depression. Walking for 30 minutes, three to five times per week for 12 weeks reduced symptoms of depression as measured with a standard depression questionnaire by 47%.
6. Walking reduces the risk of breast and colon cancer. Women who performed the equivalent of one hour and 15 minutes to two and a half hours per week of brisk walking had an 18% decreased risk of breast cancer compared with inactive women. Many studies have shown that exercise can prevent colon cancer and even if an individual person develops colon cancer, the benefits of exercise appear to continue both by increasing quality of life and reducing mortality.
I don’t know if we’ve convinced you yet, but a walking program is a great way to start the New Yea